At the mental hospital, I got to know  five people who ended up there because they tried to commit suicide. That isn’t really a big surprise, since suicide “failures” (people who were unsuccessful in their suicide attempt)  usually end up at the psych ward of mental hospitals. I was shocked at how many people in the mental hospital made no secret of their desire to kill themselves.

In fact,the mental hospital went to extreme lengths to avoid having suicide on their premise. There are no glass makeup bottles allowed. No hair dryers (because of their long cords), no eating utensils except for a plastic combination fork and spoon (spork), no shoestrings, and obviously no razors.  Although t is inconvenient for those of us who aren’t suicide risks to go without those things, it is worth it if someone is prevented from taking their own life.

As I said in previous articles, depression is by and large a brain chemistry issue. In fact, research suggests that there may be a relationship between suicidal behavior and decreased levels the neurotransmitter serotonin in the brain.  While antidepressants, including the class of serotonin reuptake inhibitors (drugs that keep serotonin around longer) often successfully treat depression, researchers are currently investigating whether these medications can also reduce suicidal behavior.

Genetic factors likely contribute to the risk for suicidal behavior. It’s one of the many psychiatric disturbances associated, at least in part, with genetic causation. Major psychiatric illnesses such as major depression, schizophrenia, bipolar disorder, certain personality disorders, and substance abuse (including alcoholism), which run in families, increase the risk of suicide behavior.  This doesn’t mean that suicide is inevitable. It just means that a vulnerability to suicidal behavior may exist and should be monitored if a psychiatric disorder is diagnosed.

Interestingly, when a suicidal adolescent or young adult is exposed to suicidal behavior in others (including friends and famous people), the risk for suicide goes up in that adolescent or young adult.

Eventually, hopefully in the  near future, brain scans will routinely screen for depression. That’s important because over 90 percent of people who commit suicide have depression. That will move depression and other mental illnesses from a “mental” disorder to a physical disorder that can be detected by way of a scientific test, which should help reduce the stigma associated with mental illness and result in more people getting the help they need so they don’t want to commit suicide.

How big a problem is suicide? Over 30,000 Americans take their own lives each year, making suicide the 11th most common form of death in the U.S.  Though exact numbers on attempted suicide are difficult to calculate, it is estimated that there are somewhere between eight and twenty five attempts made for every “successful” suicide.

Men complete suicide four times more often than females, though more women than men report suicide attempts. The most common method of suicide completion for both sexes is by firearms, with white males comprising seventy three percent of all suicide deaths and eighty percent of all firearms deaths. Suicide is the third leading cause of death among 15-to-24-year-olds, and white males 85 years old and older comprise the highest rate of completion (more than six times the national rate).

Those statistics are why my Least Restrictive Treatment plan, required before I could be released from the hospital, required me to get rid of all of my guns before I was allowed out of there.

If someone threatens suicide or starts giving away his/her possessions, please take them seriously and intervene. You will save their life.

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.

Major depression, or clinical depression is a serious medical illness affecting 15 million American adults, in a given year. About 8% of the population is clinically depressed at any given time, and 16% will have a bout of clinical depression in their lifetime.

Major depressive disorder is a disabling condition that adversely affects a person’s family, work or school life, sleeping and eating habits, and general health. In the United States, around 3.4% of people with major depression commit suicide  and up to 90% of people who committed suicide had depression or another mood disorder.

Unlike normal emotional experiences of sadness, loss or passing mood states, major depression is persistent and significantly interferes with an individual’s thoughts, behavior, mood, activity and physical health. Clinical depression differs from short-term depression in several major ways.  It impacts the ability to function, affecting everything from sleep cycles to weight loss or gain to not enjoying the present.

In some cases, for example if the person is genetically predisposed to clinical depression or suffers from post traumatic stress disorder, short-term depression becomes clinical depression.  While the best way to prevent clinical depression is to minimize or eliminate short-term depression, doing this doesn’t preclude the possibility of it.

I have had one bout of clinical depression. It was when I was on massive doses of Haldol when my psychiatrist tried to stop me from having horrible visions. At the time, I couldn’t get out of my head pictures of gore and even murder and the voices in my head were exceptionally loud.  When I called Dr. K’s emergency number and told him what was going on, he prescribed 5 mg of Haldol twice a day.  To give you an idea of how much Haldol he gave me, the normal dose is .5 mg once a day.  But the alternative was going back to the mental hospital, which I had only left a week  before.  So I agreed to this treatment.

After about 5 days, the feeling of clinical depression came over me, but I didn’t recognize it. At first, I couldn’t get out of bed. Then I sat around and cried.  I had no reason to cry, even crying on my 25^th wedding anniversary while we sat outside at a lovely restaurant in the middle of a beautiful summer day.  After a few days of continuous crying, my thoughts turned to suicide.  I so badly wanted to take a loaded handgun and blow my brains out that I would have done it in a heartbeat had I had the guns in the house. Incidentally, one of the requirements of my release from the mental hospital was that I had to get rid of all of my guns.  As a hunter, I had two shotguns and a rifle in the house before they made me get rid of them. Now I know why.

Anyway, when I became suicidal, my sister and husband insisted that I call Dr. K to tell him what was going on.  The only thing I could think of was that I didn’t want to “bother” him so I didn’t want to call him. Finally, after they threatened to call him if I didn’t , I called him. He immediately reduced the Haldol. Funnily enough,  I was willing to commit suicide but I wasn’t willing to disturb my doctor. Go figure.

Having suffered a major episode of clinical depression, I am empathetic towards those experiencing it . I wouldn’t wish it on my closest enemy.  It wrecks your quality of life and the quality of life of those surrounding you.

I can’t get the statistics out of my head. For example,  ninety percent of people who “successfully” commit suicide are depressed.  I am more convinced than ever, given my experience, that clinical depression is actually a case of a chemical imbalance of the brain and is nothing to be embarrassed or shameful about.  Detecting it earlier gives the person a better chance of being able to control it, both by medication and psychotherapy.  I don’t know why the psychotherapy works, but I suspect it affects brain chemistry in the same manner that medication does.

In my blog, my articles are tied to search engines. They pop up when certain key phrases are written in a search engine. The saddest and scariest search engine terms I have repeatedly seen in my blog are “how to commit suicide without people knowing what it is”. Fortunately, my blog entryis more of a “prevention” article, citing all of the ramifications of the act, rather than be a “how to do it”.  But even having that term come up on my search engine term at all is sad and scary.

Keeping holiday depression away is the best way to avoid clinical depression. But if you find yourself clinically depressed, it is critical to seek immediate medical help.  A psychiatrist is preferable to a general practitioner because he is more experienced in mental disorders.  It’s like going to a gynecologist rather than a general practitioner for a pap smear.  The more cases he has handled, the better your treatment will be.  Just remember: You don’t need to have your quality of life affected by this mental illness.

The National Alliance on Mental Illness is a grass-roots organization that sprang out of the accusation by the medical profession that schizophrenia was simply the result of poor parenting.  Specifically, the mothers of schizophrenics were called “schizophrenogenic  mothers”.   Eventually, after years of being blamed for their child’s illness, the women banded together to fight the accusation that they had caused their child’s schizophrenia.  That first organization eventually branched out to include all people with mental illnesses and their loved ones and friends.  The organization eventually changed its name to National Alliance on Mental Illness, called NAMI for short.

NAMI has chapters in all States, and has several different Affiliates in each State. They can be reached at www.nami.org

NAMI has several “signature” programs that they offer in all 50 States, including NAMI Basics, NAMI Family to Family classes, In Our Own Voice, and several support groups.  Some of the groups are geared towards people with friends or loved ones who have a mental illness.  Others are geared towards people suffering from mental illness.  Because the needs of the loved ones diverges greatly from  the needs of those suffering from mental illness,  the two groups are kept apart.

I have been involved in a program called In Our Own Voice (IOOV for short) for several years.  This program is free, and it brings people who have a mental illness in contact with groups that want to learn about mental illness.  The program is structured into five parts, and includes a DVD that interacts with the presenters as well as a question and answer session at the conclusion of the class   There are two presenters, both of whom have been diagnosed with a mental illness.  I of course am one part of the team. My partner is a practicing chiropractor.  We are a good match, since we both have had psychotic episodes.  Coincidentally, we both purchased very expensive cars while psychotic.  I have been told that we are both fascinating people to listen to during our presentation.

Anyway, our favorite presentation is the one we do in front of a Family to Family class.  The free  Family to Family classes educate family and friends of people with mental illnesses about their illnesses. Generally speaking, these people are seeking to understand what is happening to their friend or loved one and how best to help them.  It’s our favorite class to give our presentation to because the audience is so thankful that we’re there.  I’ve been told many times that our stories inspire hope that one day their loved one can improve enough to live a better life.

In my portion of the presentation, I talk about what led to my psychotic episode and what it’s like to be in a psychotic episode.  The audience is allowed to ask questions, and we are supposed to make sure that we don’t answer any questions that we think are uncomfortable.  Keeping in mind that one of my “go-to” symptoms when I get under stress is hearing voices, I am asked often whether I’m hearing voices during that presentation.  Since I am uncomfortable admitting it, I deny that I’m hearing voices, which tends to surprise the participants.  I don’t know whether they believe me, but it is a form of self-protection .

I encourage anyone interested to call their local NAMI office and request an IOOV presentation. You’ll be glad you did.

Learning to control that anxiety, as it builds up higher and higher with each passing day as the medications take effect, is how patients spend their time. At the mental hospital, we take classes on it, we do exercises on it, we learn various coping methods for it.  And in the end, we even take medication for it.  But the medication is never enough, and we are limited in the amount that we can take. So we have to learn how to handle the anxiety ourselves, to the best of our ability.

Although some people live with anxiety their whole lives, in general anxiety is not on most people’s radar. They have absolutely no concept about what anxiety is and how debilitating it can be. It’s difficult to put into words what anxiety feels like, but I’ll try:  Stand up straight, legs slightly apart. Now, tighten every muscle in your body. Ball up your fists. Clench your jaw. Next, try sitting down. Can you do it? Probably not for long. Imagine feeling like this all of the time, 24/7. You can’t relax, no matter how hard you try.

If you sit down, the muscles in your legs are still tight. The muscles in your entire body remain tight.  You can bend your limbs  in the right direction, but those muscles don’t relax- ever. Your whole body, though not rigid, can’t relax. You clench your teeth. It’s exhausting.  When the anxiety gets unbearable, you feel like you’re crawling right out of your skin.

One of the most common outlets for handling anxiety in a mental hospital is to pace the halls.  Those of us with severe cases would walk up and down the halls, over and over again, trying to work out some of that anxiety.  We couldn’t stop walking for very long, because the anxiety would come back in full force if we stopped walking.  And so we continued to walk the hallways, over and over again.  We walked miles every day, one foot in front of the other, up and down those carpeted hallways.

Everything that we did there was structured to teach us how to cope with that anxiety. Group therapy sessions discussed and sometimes actually showed us how to handle stress and anxiety. There were physical steps we could take with our bodies- everything from squeezing the flap of skin between our thumb and index finger to massaging our finger of choice to controlled breathing. Then there were steps we could take that weren’t direct acts upon our bodies. We could blow bubbles, color in coloring books or on blank white sheets of paper, watercolor, or do jigsaw puzzles. There was also aromatherapy. Lavendar was the favorite. But walking the halls was the single most valuable outlet for handling anxiety.

Unfortunately, the building’s psych ward wasn’t built with our anxiety side effect in mind.  The hallways were about 10 feet wide and about 50 feet long. So only a few of us could fit comfortably at a time.  Sometimes it got a little crowded with all the people pacing.  But when you’re that anxiety-riddled, pacing is your only option and crowded hallways are the least of your worries.

I seriously considered taking up smoking at the hospital because I heard from some of the other patients that it would help me with my anxiety. My mental hospital was the only one in the State to allow smoking, even going so far as to supply the tobacco and rolling paper for the homeless people who had no money to buy cigarettes.

Anyway, once I became convinced that smoking would help my anxiety, I actively tried to take up smoking, but my nurse/guard did everything she could to discourage me.  In the end, because she made it almost impossible for me to start smoking, I didn’t take it up.  I’m eternally grateful to her.

Before my breakdown, I went to sleep the minute my head hit the pillow. But with all the medication I was taking, sleep just wouldn’t come. The anxiety was just too powerful. Sleeping pills were discouraged long-term because they’re so addictive. So access to them was very restricted.

When I was released from the hospital in the care of my psychiatrist, he started right in trying to treat my anxiety so that I could sleep.  He pointed out that lack of sleep would put me back in a manic stage and I would have to return to the hospital.  Understandably, I became extremely anxious about trying to get enough sleep. So anxious that it affected my ability to sleep. I would lay awake until 2 am, knowing that if I didn’t get to sleep I would get manic. The anxiety was so bad that I would lay in bed trying to get to sleep, my teeth clenched so tightly that my jaws hurt. So we (my psychiatrist and I) worked on finding a way to get me to sleep and keep me asleep.

Over a period spanning many months, “we” went through many different drugs looking for one that worked.  I would buy one (expensive) drug, take it for a few weeks and abandon it when it didn’t work. Then I would buy another (expensive) drug and take it for a few weeks, abandoning it because it didn’t work. On and on it went, racking up hundreds of dollars for drugs that didn’t work. Finally, we found Seroquel. It’s an anti-psychotic that also acts as an anti-anxiety drug for me, and I can take up to 400 mg of it if I have to.  Although I take just 200 mg of it at night, just knowing that I can take up to 400 mg makes getting to sleep much easier.

Fortunately for me, I didn’t become addicted to sleeping pills or start smoking.  I’m learning other ways to handle my anxiety.

If you had to guess which medical condition was the worst, which one would you pick?

Most people’s thoughts would go immediately to the most widely publicized: the disease advertised as the most painful and deadliest of all diseases. Cancer.  With pancreatic cancer, the victim suffers prolonged agony, relieved only by colossal injections of pain medication, until finally he expires, leaving his cancer-ridden body once and for all.  The worst possible disease, some would say.

Many would choose Alzheimer’s disease as the worst disease.  Your mind slowly loses memory, forgetting things and people and places. Eventually, your heart “forgets” to beat, and you pass on, leaving a wake of pain and suffering by your loved ones.  Because you generally become less aware of your surroundings as time goes by, and because the deterioration happens over years or even decades, the pain and suffering are felt more by your family and friends than you.

Some would say that Lou Gherig’s Disease, also known as ALS, is the worst. Like Alzheimer’s, your body slowly forgets to function, but unlike Alzheimer’s, your mind works perfectly.  The result is a little like waking up in the middle of a surgery, and being unable to communicate to the staff that you are awake. Your body is paralyzed, but your brain is wide awake. Thankfully (or not), death is generally relatively quickly.

Others would say that a stroke is the worst, for reasons similar to ALS. Your mind is generally awake, but your body is unable to communicate that awareness to the world at large. Thinking that your brain has turned to mush because you undergo the humility of wearing diapers and eating baby food,  your family may treat you like you’re a piece of furniture, or as if you’re an infant. Unable to communicate your complete awareness to them, you suffer for years or even decades in silence.

As the worst possible disease, mental illness isn’t even on most people’s radar. But consider, for a moment, the facts.

One of the problems is that unlike cancer, mental illness has a lousy public relations campaign. It doesn’t have a public personality attached to it- at least nobody positive. There’s no Lou Gherig or Lance Armstrong or Stephen Hawking to bring a sense of empathy to the masses. Unlike breast cancer, hundreds of millions of dollars aren’t spent on events to publicize mental illness- events like the Susan G. Komen Walk for the Cure – where the color pink has come to symbolize breast cancer in everything from headbands to hand mixers. Unlike Lance Armstrong’s Livestrong cancer campaign, where yellow bracelets signify triumph over cancer, there is no little plastic bracelet color for mental illness awareness. In fact, because of its enormous stigma, you would be hard-pressed to find victims and family members willing to take the spotlight for mental illness.

Everyone recognizes that the term “cancer” is a blanket term for a multitude of illnesses all sharing the same basic characteristic: improper cell division. Unlike cancer, the general public doesn’t perceive mental illness as a blanket name for illnesses caused by improper brain chemistry. Both are breakdowns of normal bodily functions, yet cancer doesn’t have the reputation of being a character flaw or a sign of moral bankruptcy that mental illness does.

Patients with cancer are not embarrassed to tell their friends and family their diagnosis. They aren’t afraid of being thought less of as a person for that diagnosis, that somehow they fell short. But with mental illness, the stigma is so great that the fear of rejection and isolation is a legitimate concern.  You just don’t tell anyone.

Because their loved one’s illness isn’t associated with moral bankruptcy and character flaws, friends and relatives of cancer victims don’t have the same incentives to keep anyone from knowing their loved one has cancer. Protecting themselves from the unspoken charge of moral bankruptcy by association isn’t a top concern of the families of cancer patients.

Other diseases, like cancer or ALS or a stroke, don’t cause its victims to commit heinous crimes.  You don’t see a breast cancer victim as the lead-in story on the nightly news because she murdered a bunch of school children. You don’t hear about a stroke victim trying to assassinate the President. A lung cancer victim doesn’t jump off a bridge to get away from the voices in his head. And yet the connection between these types of actions and mental illness, if the news media even bothers to make one, is voyeuristic rather than sympathetic.

No legitimate insurance company would dare decline to authorize or pay  for mainstream treatment of a cancer victim, but most insurance companies have little or no such coverage for mainstream treatment of mental illness, reasoning that it isn’t, after all, a real physical illness. If they do cover it, it’s under a separate policy from “physical” health, called “Behavioral Mental Health”.  We don’t see major insurance companies splitting off cancer from a list of diseases, calling it “Cell Divisional Health”, severely restricting its access, and farming out its administration to an entirely separate company.

When it comes time for hospitalization, there isn’t a question of whether a cancer victim or stroke victim even needs to go to a hospital. If they’re seriously ill, a cancer patient doesn’t have to be at death’s door before he’s admitted to the hospital. But a mentally ill victim has to either be about to hurt or kill himself or others (as determined by a third party) or needs to have tried (and failed) to kill himself before a mental hospital will consider admitting him.

If they’re hemorrhaging, but not near death, a cancer patient isn’t turned away for lack of space. Cancer patients don’t have to wait until there’s room for them at a hospital. Unlike hospital space for the mentally ill, hospital space for cancer victims hasn’t decreased over the past 20 years.

Alzheimer’s patients aren’t routinely discharged from hospitals onto the streets, left to fend for themselves. Cancer patients aren’t routinely discharged before they are stabilized. And yet the mentally ill are routinely discharged out onto the streets all of the time. Who do you think the homeless people are?

The cancer patient doesn’t have to give up his civil rights in order to be treated. He can leave the hospital whenever he wants to. But in order for a mentally ill patient to be treated, he has to give up his civil rights. Mental patients are locked in, physically unable to leave the hospital until someone else- the attending psychiatrist- says they can go- however long that takes.

Once in a hospital, a cancer patient has the option to discontinue medication at any time. Again, a cancer patient doesn’t have to give up his civil rights in order to be treated.  Mentally ill patients, on the other hand, must leave their civil rights at the door when they enter a mental hospital. Whether they want to or not, they are forced to continue medication while they are hospitalized.

Comparing the physical pain of the cancer or the effects of cancer treatment with the effects of mental illness is in some ways like comparing apples to oranges.  Whereas the cancer victim fights for her life, the severely depressed victim fights to kill herself.  Is the physical pain of cancer worse than the emotional pain of continually hearing voices in your head nonstop? Is radiation sickness worse than lithium side effects?  Is prostate cancer preferable to schizophrenia?

I’m not trying in any way to minimize the pain and suffering that these diseases engender. My point is that each of these diseases -all of them- including mental illness-engenders tremendous pain and suffering. None of them- including mental illness- is any less severe than any other.

I

For too long, mental illness has been a quiet disease. Quietly terrible, but still quiet.  This is a disease- or a family of diseases- on par with cancer and ALS and strokes, and yet there is a huge vacuum out there. Nobody even thinks about mental illness as a true physical disease. It’s not even on the radar. This needs to change. We need to raise people’s consciousness about mental illness, and give it the parity it deserves.  We’ll know we’ve done our job when “mental illness” takes its rightful place on the list of Terrible Diseases in the public consciousness.

(reprinted from earlier blog entry)

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.

Norman Bates in Psycho, a 1960 horror movie, was inspired by Wisconsin serial killer Ed Gein.  The insane Leatherface from Texas Chainsaw Massacre, a 1974 horror movie, and Buffalo Bill in Silence of the Lambs were both inspired by the same serial killer, a man whose “guilty but insane” conviction landed him in a mental  hospital.  In The Shining, Jack Nicholson gave a good impersonation of a psychotic man.  Dr. Jekyl was clearly insane when he became Mr. Hyde in the 1931 classic Dr. Jekyl and Mr. Hyde.   Then there’s the classic: Halloween, about a young insane murderer who escapes from his Sanitarium (mental hospital) after being locked up for 15 years- ever since he was 6. Over and over the mentally ill are exploited for the benefit of the media.  In fact, out of the top 50 best horror movies of all time, over half involve mental illness. Mental illness is, after all, scary.

Unfortunately for those of us who are mentally ill, the media makes no distinction between delusional people in the middle of a psychotic episode,  insane murderers, schizophrenics, and what I like to call garden-variety mentally ill people (bipolar, depressed, OCD, etc). We’re all, in their collective minds, the same as Ed Gein, the Wisconsin serial killer who inspired both Psycho and Texas Chainsaw Massacre. There’s nothing scarier, after all, than a mentally ill person.  Especially a psychotic one.   It’s no wonder that nobody wants to be identified as mentally ill. Who, after all, wants to be Ed Gein?

One in four adults experiences a mental disorder in any given year. One in 17 adults lives with serious mental illness such as schizophrenia, major depression or bipolar disorder.

MIAW is especially important this year as severe budget cuts threaten mental health services in many communities around the country. People who do not receive treatment end up in hospitals, shelters, in jail or dead.

Learn more about mental illness and support, education and advocacy to improve the lives of individuals affected by serious mental illnesses at www.nami.org. Please join the public dialogue during MIAW.

Mental illness is a medical illness. No one is immune. About 60 million Americans experience mental health problems in any given year. One in 17 lives with the most serious illnesses.

Treatment works, but it can take 10 years, between the onset of symptoms and getting help. Half of cases begin by age 14, but less than half of children or adults get help when they need it. People with serious mental illness live 25 years less than other people.

Fight for community mental health care. Watch PBS’s new program Minds on the Edge: Facing Mental Illness: www.mindsontheedge.com. If nothing else, rent DVDs of the movies Canvas and The Soloist and discuss them with family and friends. Let’s learn and watch out for each other.

(From NAMI’s “Letter to the Editor” marketing package)

Although the National Institute for Mental Health considers ADHD to be a mental illness, few parents would put it in the same category as schizophrenia or bipolar disorder- what they perceive to be “real” mental illnesses. But that’s where it belongs.

I know that when my elementary aged child received the diagnosis of ADHD a number of years ago, I didn’t put that illness in the same category as a mental illness, and neither did my son’s doctor. That thought was the furthest from my mind. Had I identified ADD as a mental illness, things would have been different.

I wouldn’t have been so forthcoming about his illness, since the shame and stigma of a mental illness would automatically follow my son’s new identity as a mentally ill child.   I would have vehemently disagreed with anyone who tried to tell me that my child’s brain chemistry problem shared many of the same characteristics as schizophrenia and bipolar disorder.  Hell, I hadn’t even heard of bipolar disorder back then, and schizophrenia to me was a scary, violent disease that people needed to be locked up for.  That was my perception of reality back then.

I have since met parents whose children have been diagnosed with schizophrenia, and I realize the fallacy of my previous assumptions.  And then there’s the new reality that bipolar disorder is in fact diagnosable in children, contrary to what people perceived even ten years ago.  In fact, scientists are now learning that many cases of  bipolar disorder have been misdiagnosed as ADHD.

Things are not so black and white any more.  There’s a lot of gray in the world of mental illnesses.

According to the National Institute for Mental Health, somewhere between 3% to 8% of children suffer from ADHD.  About 1% of the population suffers from schizophrenia. Bipolar disorder occurs in about 4% of the population.  And about 8% of people suffer from major depression in any given year.

That’s a lot of people with mental illnesses.

Splitting hairs, separating depression and ADHD from “real” mental illnesses, has done no favors to those suffering from all mental illnesses.  Were the umbrella reflective of real statistics, there would be much more money and energy available for studying more mental illnesses. It is difficult to sweep 20% of all people into the “mentally ill” category and not change people’s perception of mental illness. Let’s expand our minds to include mental illnesses like ADHD and depression in the category of “real” mental illnesses.  It would make the world a much better place.

Note: Sarah sent an interesting article regarding the over-prescription of ADHD medication at  http://www.psychiatrictimes.com/adhd