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“Boarding” the Mentally Ill January 25, 2014

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital.
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An article Thursday January 23, 2014 about boarding at Evergreen Hospital in Kirkland, WA, gave me hope for the future of treatment of mental illness in hospital emergency rooms. .  http://seattletimes.com/html/localnews/2022721653_boardingupdatexml.html. I had my own horrific boarding experience with this hospital in May of 2008.

Boarding is the practice of “storing” someone in a mental illness crisis at the hospital while waiting for someone with a mental health background to do a diagnosis and  find treatment for the person in crisis. At the time, Evergreen had no one on staff to do the assessment, and it sounds like nothing has changed in the past 5 years.  This lack of staff caused major headache and expense to everyone involved.

When I went to the emergency room at Evergreen, not one person with a psychiatric background, except for the Designated Mental Health Professional (a King County employee) interviewed me during my crisis.  All the hospital personnel did was lock me in a white room by myself for hours.  They kept me locked up alone until the on-call DMHP arrived, which was approximately 7 hours after I got there.

After hours of isolation with no explanation about what was going on, I became more agitated, as anyone in my circumstances, mentally ill or not, would be.  Locked in a room, isolated, with no explanation about what was going on, my delusions and hallucinations got progressively worse. I started to believe they were irradiating me, with the intent of killing me. That was, in my mind, the explanation of why they didn’t feed me during my day-long stay.

After hours of contemplation, I finally thought of a plan to get out.  I got them to allow me to use the restroom, then broke away into the emergency waiting room yelling “fire” in an attempt at escape.  This effort failed miserably.

I understood my rights, and I knew they had no legal basis whatsoever at that point to hold me.  I refused to sign the paperwork that would have checked me into the hospital, and I knew they couldn’t legally check me in.  And yet they locked me in a room.  What was I supposed to do?

At that point, I had done nothing dangerous.  My only “crime” was thinking I was a mermaid, which was not a violent thought at all.  People don’t associate mermaids with aggression, and I didn’t give the hospital staff any reason to consider me dangerous.  Even taking my clothes off in the emergency room didn’t pose a threat to anyone.  It was a sign of poor judgment- nothing more.

It was only after I had been locked in that room for several hours, with no explanation about what was going on, that I decided to throw the furniture at the wall in a misguided attempt to gain my freedom.  Had I been given any kind of explanation by the staff, any communication by them, about what was going on, I probably wouldn’t have thrown the furniture at the wall.

At the point I threw the furniture at the wall, I was declared a danger, which was my ticket to involuntary commitment.  I could likely have avoided involuntary commitment had I been seen by a psychiatrist at the emergency room.  I would at least have had a chance.

Hopefully, with the changes Evergreen is being forced by the Federal Government to make, they will have a psychiatrist on staff to interview people in the middle of a psychotic episode, and treat them more humanely.

After the DMHP declared that I was to be involuntarily committed, which was about 6 pm, the hunt for a mental hospital bed was on.  In the meantime, I was kept locked in that white room, with no contact with the outside world, and with no explanation about what was happening.  They should have at least made an attempt to tell me the plan.

At about midnight, three people walked into my locked room with a red four point restraint board and directed me to “hop on”.  There were straps erupting from all directions on that board, and I knew instinctively that they were going to strap me down once my head hit the board.  So I refused to jump aboard.  Upon my refusal, two security guards came at me, one grabbing me by the throat and slamming my head down on the board. He choked me so hard that he cut off my air supply.  I screamed.  The other security guard buckled me into the restraint board.  After he finished, a nurse came at me with a syringe and plunged it into my thigh.

I woke up the following morning in a room with a bed bolted to the middle of the room, and no other furniture.  I had no idea where I was or what had happened.  As it turns out, I had been involuntarily committed to Fairfax Hospital in Kirkland.  Even when I found out where I was, I knew nothing about the hospital or the process of involuntary commitment.

With proper treatment from the emergency room, I believe this whole scenario could have been avoided.  I’m happy to see things might change for the next person having a psychotic break.

Psych Ward Male Night Nurses January 22, 2014

Posted by Crazy Mermaid in Mental Hospital, Mental Illness and Medication.
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The Psych Ward was in reality a maximum security prison. Nobody left of their own accord.  Every 20 minutes, the nursing staff made their rounds to track down every patient. Whether we were in the shower, asleep or whatever, they always knew where we were.  As we slept, the night nurse came into our dark bedroom with a flashlight and shined it on our face and chest to make sure we were still breathing. If we were in the bathroom, they stood outside the bathroom door calling our name.  If we didn’t open the door to tell them we were there, they assumed that we were either trying to hide,  trying to kill ourselves, or already dead.  So they opened the door and hunted us down. There was no such thing as patient privacy.

A 10 foot barbed wire fence (with razor wire at the very top) surrounded the entire building, including the tiny courtyard attached to the building.  We weren’t allowed outside except for supervised group smoke breaks inside that tiny little courtyard. There was no such thing as structured exercise- or even unstructured exercise. If it happened at all, it happened at 8 pm, provided we could talk a staff member into walking us down the hall and out the steel double doors to a gym. Most days, the nursing staff was too short-staffed for that, but occasionally we got the chance to actually stretch our limbs out and break a sweat.

The hospital was always short-staffed, and the hardest shifts to fill were the night shifts. Nobody wanted to be a nurse on a psych ward at night. Most nights the only people they could get to handle the night shift were male nurses.  So usually there were two male nurses on the night shift overseeing about 25 patients. Sometimes only one male nurse was on the night shift.  Night nurses had unlimited and unsupervised access to all of those drugged up people (everyone was given sleeping meds) lying in their dark bedrooms .  Were there cameras?  In a few rooms.  But not all.

Night nurses were  required to walk into those dark bedrooms and shine a flashlight on the patient’s  face and chest every 20 minutes to make sure we were still alive, so they had every right to be in a patient’s dark bedroom alone. Under those circumstances, it would be child’s play for an unscrupulous  person to take advantage of a patient lying alone in her dark bedroom- a patient who was so full of sedatives  that she  wouldn’t wake up under almost any circumstance.  Even a patient sharing the bedroom with another patient could be a target, since both were heavily medicated. Added to that was the fact that the general reputation of a psychotic patient was that they were unreliable and their memories untrustworthy, and the psych ward was a virtual hunting ground for an unethical night nurse.

The morning following a night with one male night nurse on staff, I  thought I might have been violated by a male nurse. But I couldn’t make my mind up.   Was it my imagination?   I just didn’t know. I admitted to myself that I had been heavily sedated. Even then, I was in a fog. Was it real? Or wasn’t it?

Realizing that I had to let the people in charge know about my suspicions, I complained to the head nurse on duty.   I explained to her what I thought happened and that I couldn’t be sure, since I was sedated during the night. But certain things pointed in that direction.

Although she brushed off my complaint,  I watched as she returned to the nursing station.  A look of shock flash across her face as she read my chart. She immediately sought out the male night nurse on duty, and I overheard her berating him. The head nurse was obviously shaken up by what happened, but nothing further was communicated with me.  I was, after all, just a psychotic mental patient, obviously delusional and unreliable.

New Mental Hospital Beds Coming October 24, 2013

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, mental illness.
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Finally, things are looking up here in Washington State.  Currently, we are 50th out of 50 in terms of mental hospital beds per capita for the State. Two new mental hospitals are scheduled to be online within the next few years.  A 68 bed facility at Fairfax Hospital, where I was involuntarily committed, broke ground in May of this year.  A 75 bed mental hospital, complete with a 25 bed facility for children, is seeking approval for a location in Smokey Point near Marysville in Snohomish County. Currently, Swedish Hospital in Edmonds, with 23 beds, is the only mental hospital facility in the 733,000 person county.  And it doesn’t handle children.

Bringing these two hospitals online should help reduce or end the practice of “boarding”.  “Boarding” is the act of keeping people housed in regular hospitals while waiting for a bed in a mental hospital to open up.  This is common in King and Snohomish County because there are too few beds. In King County right now, two thirds of all detentions for involuntary commitment end up being “boarded”- sometimes for days, while waiting for a hospital bed to be freed up.

I had my own experience with “boarding” when I was involuntarily committed five years ago.  During my psychotic break with reality, I thought I was a mermaid named Pangaea.  Life was good in the bubble universe I was in.  My friends included Bill and Melinda Gates, Oprah Winfrey, and the Dalai Lama among others.  Bill and Melinda provided me with all the money I needed (in my fantasy world), and everyone hung on my every word, telling me how gorgeous I was.  And I had ESP. This went on for months.

Then things turned nasty.  Zombies showed up, with the intent of capturing me.  It was at that point that I remembered something I learned in grade school:  when your environment isn’t safe, head to a police station or hospital.  So I convinced my husband to drive me to a hospital by telling him I was hearing voices.  Except I didn’t mean it in the traditional way, but I knew he wouldn’t understand that I had ESP.  Feeling my reality dissolving around me, I wanted my husband to take me to the nearest trauma center, Harborview Medical Center in Seattle, but my husband chose Evergreen Hospital in Kirkland instead.

Once we arrived, my friends told me via ESP that the hospital was a trap, and I changed my mind about wanting to be there.  But I had made an error in judgment by telling my unsuspecting husband that I was hearing voices in an attempt to get him to take me to the hospital.  With that confession on his mind, he wasn’t about to let me return home.

Once I displayed my fins to people in the waiting room (I could feel the flap of skin between my toes, since as a mermaid I had fins) and took off my clothes in the emergency room, they locked me in a room for hours as they waited for an overworked County Designated Mental Health Professional to examine me to determine whether to involuntarily commit me.  That was in the late afternoon.  After her examination, she determined that I should be committed (but I didn’t know that).  That’s where the “boarding” came in. She finished her evaluation at around 4 pm, deciding to commit me.  But where? At that point, she started looking for a bed at a mental hospital.  But there weren’t many choices, and they were all full.

Not knowing what was going on, I sat in that locked room, for hours.  Finally, around midnight, they showed up with a four point restraint board and expected me to jump on and get buckled in.  I refused, so they grabbed me by the throat and pinned me down and buckled me in, then came at me with a syringe and plunged it into my thigh. I passed out, coming to in a mental hospital.

With new hospital beds on the way, and with some money (thanks to a new tax that goes towards funding for mental illness) to get training for emergency room personnel, the experience I had should become a dim memory.  At least that’s what I hope.

Obsessive Compulsive Disorder (OCD) February 15, 2013

Posted by Crazy Mermaid in Anxiety, Mental Hospital.
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Obsessive–compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry; by repetitive behaviors aimed at reducing the associated anxiety; or by a combination of such obsessions and compulsions. Symptoms of the disorder include excessive washing or cleaning; repeated checking; extreme hoarding; preoccupation with sexual, violent or religious thoughts; relationship-related obsessions; aversion to particular numbers; and nervous rituals, such as opening and closing a door a certain number of times before entering or leaving a room. These symptoms can be alienating and time-consuming, and often cause severe emotional and financial distress. The acts of those who have OCD may appear paranoid and potentially psychotic. However, OCD sufferers generally recognize their obsessions and compulsions as irrational, and may become further distressed by this realization.

Obsessive–compulsive disorder affects children and adolescents as well as adults. Roughly one third to one half of adults with OCD report a childhood onset of the disorder, suggesting the continuum of anxiety disorders across the life span. The phrase obsessive–compulsive has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is excessively meticulous, perfectionistic, absorbed, or otherwise fixated.

Despite the irrational behaviour, OCD is sometimes associated with above-average intelligence. Its sufferers commonly share personality traits such as high attention to detail, avoidance of risk, careful planning, exaggerated sense of responsibility and a tendency to take time in making decisions.

OCD occurs in two to five percent of the population, and is the fourth most common psychiatric diagnosis. The majority of OCD patients who have not experienced symptom relief may have not received adequate trials of appropriate medication and/or behavioral therapy. The remainder  typically do not respond because of poor treatment compliance, unrecognized cognitive impairment, co-occuring psychiatric illness or poor understanding of treatment. Adequate treatment for OCD often requires that medication trials be longer than those for other psychiatric illnesses. Additionally, behavioral interventions are time- and labor-intensive, frequently requiring close supervision and support.

Located in Belmont, MA, the OCD Institute at McLean Hospital is a national and regional center dedicated to the advancement of clinical care, teaching and research of obsessive compulsive disorders. The program provides partial hospital and intensive residential care for individuals age 16 and older who suffer from severe or treatment resistant OCD. It offers an innovative combination of somatic, behavioral and milieu treatments not found in other programs. It takes Medicare and Medicaid among other insurance plans, and comes highly recommended by a friend who completed the 8 week program in September 2012.

(Reprinted from Wikipedia and The McLean Institute)

Mental Health and Competency Restoration in Washington January 29, 2013

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital.
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Imagine having a mental health crisis and finding yourself in a county jail, with little or no mental health treatment, isolated with no direct human contact, in a cell with no toilet or furniture for 23-24 hours a day, wearing only a smock, as days become weeks, then months, all while the symptoms of your mental illness get worse.

According to a report, released today by Disability Rights Washington (DRW), this is a recurring problem in local jails across Washington State.  Over the last few years, people with mental illness, intellectual disabilities, and traumatic brain injuries have had to wait for several weeks or even months to get an evaluation to see whether or not they are competent to stand trial. If they are found incompetent to stand trial, they often wait additional weeks or months to get services at the state hospital where there is mental health treatment designed to restore competency to stand trial. While they wait in jail, they are held with little or no mental or behavioral health treatment, often under severe punitive conditions for disability-related behavior. This includes being held in isolation, where their mental health often deteriorates.

Individuals may be held for low-level infractions, like trespassing or vagrancy, often because mental health services were unavailable.  “It is unacceptable that people end up in jail facing criminal charges simply because they cannot obtain the mental health services they need in the community.  We are turning these individuals into prisoners when they should be patients,” said Emily Cooper, attorney with DRW.

“Jail is the worst possible place for people struggling with serious mental illness.  As a society, we need to stop the pattern of unnecessary incarceration of people with mental illness,” said Gordon Bopp, President of the Washington Chapter of the National Alliance on Mental Illness (NAMI).  “They are not criminals. Nobody chooses to have a mental illness, and therefore nobody should be jailed for having one. Instead, they should be offered treatment,” Bopp said.

Along with sheriffs, mental health providers, judges, prosecutors, defense attorneys, and disability advocates, DRW has worked on this issue through multiple legislative sessions. Last year, the Legislature adopted an aspirational, seven-day performance target for the completion of competency evaluations and state hospital admission for restoration services.  The Joint Legislative Audit Review Committee confirmed in a report issued last month that the state hospitals are failing to meet this target, and the time people spend in jail awaiting evaluation and treatment is growing.

“The longer a person with a mental health crisis spends in jail, the more devastating and long-lasting the consequence,” said David Lord, DRW Director of Public Policy.  “Eliminating the excessive time these individuals spend in deplorable jail conditions must be one of the highest priorities of the legislature,” Lord said.

From January 25, 2013 report from Disability Rights Washington “Lost and Forgotten: Conditions of Confinement While Waiting for Competency Evaluation and Restoration”

Insulin Shock Therapy December 3, 2012

Posted by Crazy Mermaid in Medication, Mental Hospital, Schizophrenia.
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In a desperate attempt to find a cure for mental illness in the early part of the last century, barbaric treatments were invented. Insulin shock therapy was one such treatment.

In insulin shock therapy, a patient was put into an insulin coma six days a week for months on end in an attempt to “cure” schizophrenia by “resetting” the brain. Occasionally that seventh day was filled with electro-shock therapy. Sometimes this “treatment” went on for years.

Insulin shock therapy was started by psychiatrist Manfred Sakel in 1927 when he began to use low (sub-coma) doses of insulin to treat drug addicts and psychopaths in Berlin. Interpreting his results as successful, he got the idea of “resetting” the brains of schizophrenics using the same therapy. News of his work spread, and this treatment was picked up by mental hospitals worldwide.

After being injected by insulin, patients experienced various symptoms including flushing, pallor, perspiration, salivation, drowsiness, or restlessness before falling into a coma. Each coma lasted for up to an hour and was terminated by intravenous glucose. Seizures sometimes occurred before or during the coma, and these were viewed as positive events.  Only the healthiest patients were chosen for the treatment, since it was so hard on their bodies. Broken bones were common.

For years, this “therapy” was performed on the mentally ill, including John Forbes Nash, the brilliant mathematician whose life story is told in A Beautiful Mind by Sylvia Nasar. The book goes into a little detail about his treatment.

Insulin shock therapy started to fall in disfavor when Harold Bourne, a British psychiatrist, published a paper entitled “the insulin myth” in Lancet in 1953, in which he debunked the therapy.  Then, in 1957, Lancet published the results of an experiment whereby insulin shock treatment was shown to be an ineffective treatment for schizophrenia.  Over the years, it slowly began to fall into disfavor, and is now thought of as barbaric.

It is relatively easy to see why insulin shock therapy was quickly adopted by the mental health community.  Up to that point, there was no other treatment available. Anything that had a remote possibility of working was greeted with open arms, and the “science” behind the treatment made perfect sense. “Resetting” the brain would result in curing the illness, they reasoned.

Eventually, science caught up with insulin shock therapy, and the medical community was forced to abandon this treatment, but not before much pain and suffering occurred.

In the future, it will be interesting to see which of our current therapies are viewed as barbaric as insulin shock therapy and lobotomies are viewed today.

Here We Go Again: Reducing Mental Hospital Beds August 19, 2012

Posted by Crazy Mermaid in Delusions, Mental Hospital, mental illness, Schizophrenia, Uncategorized.
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Here we go again: more psychiatric hospital beds are disappearing in Washington State.  How do I know?  Not from anything in the news.  It’s because I got a phone call from a 75 year old woman whose 54 year old schizophrenic son is being released from Western State Hospital.  She called because she was desperate to find housing and help for her son before he is released, which will be soon.  She explained that she is an old lady and can barely care for herself, much less her son, who has been at Western for many years.

At Western, he has case managers and people who make sure he takes his medication as well as  living support.  He never learned how to shop or care for himself because his symptoms were so severe that they required him to be permanently hospitalized.  I’m guessing that  even with proper medication, he isn’t symptom-free or he would have been released years ago.  Even with proper medication, delusions and hearing voices is fairly common in hard-to-treat cases like his. Once out of that protective environment of the hospital, she is concerned that when he stops taking his medication, his symptoms will increase and he will become unmanageable. She is looking for housing for him that will also provide help in adjusting to life on the outside.  And she doesn’t have much time.

This situation is tragic.  They’re taking a man who has spent most of his life in an institution getting the help and support he needs in order to function, and throwing him outside to fend for himself.  Had there been any adjustment support for him, she wouldn’t be so desperate.  Programs like those he needs are overfull.  He won’t be able to get into those programs for years because they’re at or over capacity right now.  And with the State releasing more people like this man, more people will fall through the cracks.  The State hasn’t funded stop-gap programs for people like him.  There simply isn’t anywhere he can go.  Who knows what will ultimately happen to this man?

Although I understand the need to balance the State budget, balancing it on the backs of the more vulnerable population is unconscionable.

Contrary to popular opinion, 99.9 percent of people housed in institutions like this aren’t dangerous when released.  So we shouldn’t be afraid of him. In fact, statistically they are the ones who are more likely to be assaulted  and victimized  because they’re not equipped to survive outside their institution.  Turning a man out who has been taken care of most of his life will not make his quality of life improve.  In fact, the type of living situation that he was in had allowed him to have his “home base” at the hospital, able to freely come and go at will.  The point of the hospitalization was to keep him taking his medication allowing him to live with and manage his schizophrenic symptoms.  If he is left to his own devices at this late stage of his life, he will likely discontinue taking his medication, which will mean the symptoms of his illness, barely contained anyway, will return in a big way. I’m not saying he will be a danger to others.  I’m just saying that hearing voices and other negative symptoms will likely return in a big way without proper medication and supervision.  Clearly, his case must be particularly difficult because had he had an “easy” case, he would have been released years ago. He’s there because that’s where he needs to be.

His institutionalization is very different from involuntary commitment, so his release shouldn’t scare anyone from the standpoint of him being a threat.  Far from it.  He is allowed to come and go at will, but his base is always at Western State Hospital.  He goes on outings and to visit his parents, but he never stays there for any length of time.  He always has to return to Western so they can give him the care he needs.  He hasn’t gone grocery shopping or done the dishes or any number of things we are all used to doing in order to survive.  If left to his own devices without any education in performing these relatively easy tasks, he will risk his well-being to the point of being dangerous.  Just turning him loose out into the world will be a hardship.  His 75 year old mother won’t be much help, and because of his symptoms he can’t live with her- especially once he’s off his medication.

They say the mark of a civilization isn’t how they treat their rich.  It’s how they treat their poor and vulnerable population.  And from the way this gentleman is about to be treated, it’s clear that we’re not exactly the best civilization in the world.

http://www.dshs.wa.gov/mhsystems/wsh.shtml

Lobotomies and Rosemary Kennedy March 7, 2012

Posted by Crazy Mermaid in Mental Hospital, mental illness.
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During World War II, the military became increasingly more interested in treatment of mental illness, given the high number of war-related new cases it was seeing.  Coinciding with that new interest was the development of new mental illness therapies including lobotomies, where part of a patient’s brain was cut away in an attempt to cut out their mental illness- much as we cut cancer away from a body now. But instead of removing a cancerous growth from a brain, they removed part of the patient’s brain. Between 1936 and 1960, about 50,000 lobotomies were performed on mental patients in the United States alone, with devastating results.

The ugly spotlight of reality was finally shined brightly on lobotomies when the sister of a President of the United States got one, with disastrous results. Rosemary Kennedy, the sister of President John F. Kennedy, received a lobotomy in 1941, when she was 23 years old. At the time, her father was told by her doctors that a cutting edge procedure would help her DEPRESSION (Note: Many media reports incorrectly say she was treated for retardation, but in reality she was treated for depression). At the time of her operation, only 65 previous lobotomies had been performed. Dr. Watts, who performed the surgery while Dr. Freeman supervised/observed, described the procedure on Rosemary as follows:

We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch.” The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. “We put an instrument inside,” he said. As Dr. Watts cut, Dr. Freeman put questions to Rosemary. For example, he asked her to recite the Lord’s Prayer or sing “God Bless America” or count backwards. … “We made an estimate on how far to cut based on how she responded.” … When she began to become incoherent, they stopped.

Instead of producing the hoped-for result, however, the lobotomy reduced Rosemary to an infantile mentality. She had to wear diapers because she was incontinent. She could do nothing except sit in a chair and stare blankly at walls. Her verbal skills were reduced to unintelligible babble. The procedure left her completely incapacitated, and her family was devastated and filled with guilt.

Although Dr. Watts’ license to practice medicine was revoked after he performed over 3,000 of those operations, it wasn’t because of the horrendous nature of the operation.  It was because of the death of one of his patients.  After the procedure destroyed many lives, it finally became viewed as the destructive tool that it was. It is no longer in use.

The Law and Involuntary Commitment January 2, 2012

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, mental illness.
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You’d think that once a bill gets passed by the House and Senate and signed by the Governor, there would be no question whether the bill goes into effect.  But that’s not true.

Back on March 17, 2010, I posted a blog entry about the passage of House Bill 3076. I was excited because it would no longer required Designated Mental Health Professionals to disregard evidence given by friends and family members of people with severe mental illness in their decision of whether to involuntarily commit a person with severe mental illness.  Prior to this law, the Designated Mental Health Professional could not take into account testimony by friends and family members regarding the mental state of their friend or loved one.

Senate House Bill 3076 was a major victory for people with severe mental illness because it enabled them to get much-needed help by enabling their friends or loved ones to give evidence to the Mental Health Professional doing the assessment of the person with severe mental illness to determine whether that person should be involuntarily committed.

“Chapter 280, Laws of 2010 (Second Substitute House Bill 3076) expanded in two ways the factors that Designated Mental Health Professionals and the courts may consider when determining whether to commit a person to involuntary treatment. First, the 2010 law provides that a Designated Mental Health Professional must consider all reasonably available evidence from credible witnesses when determining whether to detain a person. Credible witnesses are defined as family, landlords, neighbors, and others with significant contact and history of involvement with the person. Second, the 2010 law additionally provides that, in determining whether to detain and commit, Designated Mental Health Professionals and the courts may consider symptoms and behavior that, standing alone would not justify commitment, but that show a marked deterioration in the person’s condition and are closely associated with symptoms and behavior that led to past involuntary psychiatric hospitalization or violent acts. The 2010 law set January 1, 2012 as the effective date for both of these changes”

At the time the bill was passed, I assumed that it would become effective immediately.  In fact, I assumed this whole time that it was in effect. That assumption was obviously wrong.  Had I read the bill more closely, I would have known that the law wouldn’t become effective until January 1, 2011.

I made another assumption as well.  I assumed that, once the law came into effect, it would not and could not be revoked.  That, too, was an assumption that was wrong.

In fact, another bill, Senate Bill 5987, gutted House Bill 3076.  I was shocked at this turn of events.

Basically, the summary of Senate Bill 5987 changed the effective date of the 2010 statuary changes from January 1, 2012 to January 1, 2015.

The reason for the change, said the Staff Summary of Public Testimony, is that there isn’t sufficient treatment capacity to meet current involuntary needs, let alone increased demand. Already, said the new bill, between 25 to 50 percent of all persons involuntarily committed in King County are “boarded” in facilities that are not certified to accept such patients. The legislation, it said, needs to be passed in the special session before the January 1, 2012 effective date of the original legislation. Department of Social and Health Services supports to purpose of the 2010 legislation, but lacks the resources to implement it.

Although it is frustrating that the law is now delayed another three years, the reason it was delayed makes perfect sense.  It’s yet another victim of our funding crisis.

Involuntary Commitment in Washington State November 1, 2011

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, mental illness.
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Washington State Mental Health System: Involuntary Commitment

Patient Rights

At all times in the legal process, patients have the right to agree to entry of a court order detaining them in a facility. Involuntary commitment should not be confused with competency to handle financial and legal affairs. Patients have the right to refuse psychiatric medication 24 hours prior to any court hearing. Patients have the right to have: an attorney to represent them (a public defender if unable to afford private counsel), witnesses to testify for them, to cross-examine witnesses against them, and to present documentary evidence. Patients have the right to testify or to remain silent. The Rules of Evidence apply to these hearings. Patients have the right to view and copy all petitions and reports in the court file as well to have adequate time to prepare for the hearing. Hearings are not closed but the patient has the right to object to the presence of others not involved with the case. The court decides if the hearing should be closed.

Basis for Involuntary Commitment

A person can be detained on any of three grounds: likelihood of serious harm to others; likelihood of serious harm to self; or most commonly, grave disability. Grave disability is defined as a condition in which a person, as a result of a mental disorder (a) is in danger of serious physical harm resulting from a failure to provide for his or her essential human needs of health or safety, or (b) manifests severe deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or volitional control over his or her actions and is not receiving such care as is essential for his or her health or safety.

Initial Detention

A person can be detained by a Designated Mental Health Professional for up to 72 hours without a court order. The 72 hours does not include weekends or legal holidays. When being interviewed by the DMHP, the patient has the right to speak to an attorney and the right not to participate in the DMHP’s evaluation. The legal standard for the initial detention is probable cause.

14 Day Hearing

If the patient is not ready for release within the 72 hours, a petition for involuntary treatment is filed seeking detention for up to 14 days (calendar days). If the patient elects to have a contested hearing, then a judicial officer decides the outcome. There is no right to a jury trial. The petitioner cannot request detention for any other period of time (i.e., 9 days or 13 days). Once the court order is entered, the petitioners can release the patient before 14 days is completed if the patient is ready for release. The legal standard is preponderance of the evidence.

90 Day Hearing

If the patient requires treatment beyond 14 days, then a petition seeking detention for up to 90 days (calendar days) is filed. The petitioner cannot file for another 14 days nor for any other number of days. It has to be up to 90 days. The patient has a right to a jury trial (using a jury of 6 or 12 persons) or to have a bench trial as in the 14 day hearing. Jury trials may take up to 20 business days to occur. The patient also has the right to seek a second opinion regarding their mental status as well as the use of a professional such as a social worker to seek less restrictive placement for the patient. There may be a preliminary hearing for the court to formally advise the patient of his/her rights as well as to allow the attorneys and the court to deal with scheduling issues for contested cases. Once the 90 day order is entered, the petitioners can release the patient early if the patient is ready for release. The legal standard is clear, cogent convincing evidence.

180 Day Hearing

If the patient requires treatment beyond 90 days, then a petition for 180 days (calendar days) is filed. The petitioners cannot ask for another 90 days. It has to be 180 days. As with the 90 day hearing, the patient has the right to a jury trial, a second opinion and a preliminary hearing. The legal standard is clear, cogent and convincing evidence. The petitioners can release the patient early if the patient is ready for release.

Less Restrictive Alternatives

At any point the petitioners can ask that the patient be on a Less Restrictive Alternative (LRA), court-ordered treatment outside of the facility. Conditions the patient must comply with include living at a specific address, maintaining compliance with treatment, taking medications as prescribed, refraining from threats or acts of harm to self, others or property, as well as maintaining one’s own health and safety in the community. Possession of firearms is prohibited. Failure to comply with any of the LRA conditions results in being returned to the facility for a revocation hearing. The rights in Step 1 apply to revocation hearings. If the LRA is revoked, the patient is detained at the facility for the remainder of the commitment period (e.g., revoked 30 days into a 90 day LRA = 60 days at the facility). The patient may later be re-released on a new LRA. LRAs can be extended in 180 day increments (they start with 90 or 180 days).

This article was written by Carolyn Annette Elsey.

My Experience…

My experience was very different from the way this article is laid out. The Designated Mental Health Professional that handled my case interviewed me in a local hospital to determine whether I should be put on a 72 hour hold.  I entered the local hospital at around 10:00 a.m., and the DMHP finally interviewed me at around 5:30 p.m. She determined that I should be involuntarily committed, and the search was on to find a mental hospital that would take me. It took until midnight for a bed to open up.  At that point, I was strapped to a board (a four point restraint system) and loaded into an ambulance for my trip to the  mental hospital.

Around 48 hours after I arrived a the mental hospital, the mental hospital  presented me with a public defender who was supposed to represent me before a judge to determine whether I was going to be committed for 14 days.  Unfortunately for me, that representative took ill the day of my hearing, and I was represented by a different public defender who didn’t know my case.  In order to transport five of us to the court, we were loaded onto a van with windows tinted so dark that we couldn’t see out. The interior was outfitted to transport prisoners. We had no idea where we were going, and no one told us anything. When we got there, contrary to what this article says, I was not allowed to say anything to the judge in my defense at my hearing. I sat there in disbelief as the hearing happened right in front of my eyes as if I were a piece of furniture.

As a practical matter, when I was involuntarily committed, I wasn’t  privy to the laws, so I didn’t know that my rights had been violated.  Besides, who would I, a “crazy mental patient”, complain to?

Close to the end of my 14 day hold, the hospital wasn’t ready to release me, so the original public defender (who had fallen ill before my first hearing) again represented me at my second hearing. But she convinced me not to attend the second hearing.  As I hadn’t been involved in the first hearing, I assumed the next hearing would be a duplicate of the first (with no opportunity to speak), so I went along with her recommendation and stayed away.

I was released a week later, which meant I spent 21 days in the mental hospital at a cost of almost $60,000. But it was a conditional release, called Least Restrictive Treatment (LRT) instead of the Less Restrictive Alternative it was called in this article. They pointed out to me that I was still in treatment, and that if I didn’t follow the LRT, I would be re-committed to the mental hospital.

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