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Least Restrictive Treatment March 28, 2010

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, mental illness.
Tags: , , ,

On a beautiful summer day in 2008, the evening before what turned out to be the discharge date from my involuntary commitment to a mental hospital, my court-appointed attorney, Devin, came to the hospital to see me. 

At that point, I had been at the hospital for 3 weeks, with no idea of how long I would be staying.  During my entire stay, my psychiatrist, Dr. S, continually refused my request to be released. In fact only hours before, he made it clear that I wasn’t yet ready to be released and continued his refusal to give me a date or even a time frame on when I could expect to be released. So when my attorney arrived to “spring” me the following day (on June 18), I didn’t know who to believe. Pragmatically, I chose to believe him over her, but gladly cooperated with her in case she was right.

Opening her briefcase, Devin took out a stack of paperwork and laid it on the table in front of me.  The second she told me that the paperwork was going to get me discharged from the hospital, she had my undivided attention.

She noted that although I was being released under a 90 day “Less Restrictive Treatment” plan (LRT), I was in fact still a mental patient.The only difference was that I could be treated at home instead of at the mental hospital.  In order to remain out of the hospital, I had to meet certain conditions.  Should I fail to meet those conditions, she made it very clear that I would return to the mental hospital (involuntarily, of course).

The first conditiotn of the LRT was that I had to have my first visit with a psychiatrist and therapist set up and arranged before I could leave.  Obviously, hat meant that I had to have a psychiatrist.  My hope of the discharge momentarily left me, since I had neither the way nor means to locate a psychiatrist and set up an appointment. Thankfully, Michelle, my caseworker at the hospital, had located one and set up that first appointment for me.  On the LRT form, my new psychiatrist’s name and the date of my first appointment had been neatly printed on the form, arranged for me without my involvement in the decision-making process.

According to the paperwork, my first appointment with my therapist was for 1 pm the following day (June 18) and my first appointment with my new psychiatrist, Dr. K.,  was for 1 pm June 19.

The second condition was that I must take all of my medications as prescribed, including the medications prescribed by my attending psychiatrist at the mental hospital, and to comply with any lab tests for medication monitoring if required.  This meant that they had the right to draw blood from me whenever they deemed fit, which was particularly useful in the case of lithium, since checking my lithium levels would also be checking to verify that I was indeed taking my lithium.

The third condition under the LRT was that I had to refrain from the use of alcohol and unprescribed drugs and comply with random urinalysis if requested.  In other words, no drinking.

Although I am not what you would call a big drinker, I am (or was) a social drinker.  It’s not the “full glass” situation that I miss. There is always the option of having that glass of sparkling cider or diet coke or water. I miss not being able to participate in those occasions by having that glass of wine or beer with everyone else. I also miss the taste of beer and wine.

I know many people who choose not to drink.  Some don’t like the taste of alcohol or choose not to drink because they don’t like the effect of alcohol on their bodies. Others had problems with alcohol and so choose to give it up. But I don’t fit into any of those categories. I didn’t choose not to drink.  It’s a choice that was made for me. And no matter what anyone says, it’s different when you didn’t choose not to drink.

The fourth condition of the LRT was that I couldn’t harm myself, others, or the property of others.  No repeat acts of the Evergreen Hospital scenario, in other words, where I threw a stool against the wall repeatedly trying to break a small window in a door.

Other than to remind the patient how he/she got involuntarily committed in the first place,this condition seems pointless, since the law already allows the State to commit anyone who presents a danger to himself or others or who damages the property of others.  It seems redundant to state following the letter of the law already on the books as a condition of the LRT.  Unlike the other conditions, which are new and specific, this condition is nebulous and general and to me seems unnecessary.  Nevertheless, it was a condition of the LRT.

The final condition of the LRT was that I couldn’t possess any firearms.

Explaining to I Devin that I was a hunter, I protested that I had some guns. She told me that I would have to make arrangements to get rid of those guns or risk not being allowed to leave. Furthermore, she said that people who have been mental patients are legally barred from possessing firearms. This was a permanent thing rather than a 90 day thing, on other words.  As I continued to grouse about the unfairness of it all,  she said that eventually, say a few years from then, I could petition the courts to allow me to get my guns back and return to hunting, but for now I had to give that up. Although I didn’t know it at the time, my dad had already removed my guns from my house before I signed the LRT form.

The purpose of this condition was to prevent my death by suicide.  With bipolar disorder, especially when the patient is in the depressed stage, large numbers of us attempt suicide.  And one of the more popular ways to commit suicide is to shoot ourselves with guns.  Therefore, the purpose of removing guns from the grasp of a mentally ill patient is to prevent that patient from committing suicide.

But that didn’t make giving up my guns and hunting any easier.  Although I hadn’t been hunting for several years, I wanted the ability to decide for myself whether or not to hunt or shoot clay pigeons or target practice with my 30-06 rifle.  That had been taken away from me as a condition of my release from the mental hospital.

Although I wasn’t exactly thrilled with any of the conditions of my Least Restrictive Treatment, I have continued to abide by those conditions even beyond that 90 day period of time.  While life is significantly more boring in my new world, at least I don’t risk a return to the mental hospital.



1. Astrid - April 4, 2010

We got something like that here, too, only it’s called a provisional order, in that you will get a court order to be involuntarily committed unless you abide by the provisions set forth in your treatment plan. This order can be obtained for people inside and outside of mental hospitals. People can also be provisionally discharged from the mental hospital, but I don’t think that requires a new court order.

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