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“Rules” At Mental Hospital March 5, 2015

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, Uncategorized.
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Fairfax HospitalNAMI (National Alliance on Mental Illness) has a few signature programs for people living with a mental illness. One such program is a series of 10 classes called Peer to Peer. The classes are designed to help people with a mental illness understand their illness better and build a fulfilling and satisfying life. All classes and programs are free, and are led by volunteers. The Peer to Peer class is led by two people who are successfully living with a mental illness. NAMI Snohomish County is holding their first ever Peer to Peer class, and last night was Class 9.
In that class, we discussed a stay in the mental hospital, which most people in the room were familiar with, including me. The focus was on the “rules” of the stay. Some are known, and some are not.
One of the biggest “rules” was how long the stay was going to be. Although there are guidelines, there are no hard and fast “rules”. During my hospital stay, I was told by several patients who had been in the revolving door of the hospital that their average stay was 2 weeks. But no one in authority gave me any indication of how long I would be there. When I point blank asked my psychiatrist daily, he was cagey about this point. He wouldn’t even give me a ballpark number. I was held, against my will, in a mental hospital and no one would tell me when I could leave- or even what I had to do in order to be released.
In the days before I was involuntarily committed, I was supposed to be helping my best friend, Becky, move from her home in Washington to Minnesota. But as the day of her move got closer, my psychotic episode worsened. I was supposed to help her drive back to Minnesota the day I was hospitalized. In retrospect, the added stress of her move was the straw that broke the camel’s back.
But the nature of my psychotic break was such that I suppressed the memory of helping her move.
Unfortunately for me, about all my psychiatrist had to go one was this one thread of information. My husband told the people at the hospital emergency room that I was supposed to be helping my friend move, so that’s what went on my chart. My psychiatrist read the chart, and, absent much else, laser focused on that one fact and built a treatment plan around it.
Day after day, my psychiatrist tracked me down and asked me the same question: Who was I supposed to be helping move?
I was bewildered by this question. I had no memory of anyone I knew moving, much less helping anyone move.
After a few weeks of this, I figured out that the answer to the question was my passport out of the place. But I couldn’t figure out the answer, much as I tried. My mind was blank.
Eventually, I came to believe that my husband and sister were having an affair (not true), and that they were keeping me locked up so they could continue. I even told my theory to my psychiatrist, who didn’t seem convinced.
After every one of our “sessions” where he asked me the question, I asked him when I was going to be released. He told me he didn’t know, but that I would be there awhile longer.
I realize now that my psychiatrist was using my ability to remember that event as some kind of “wellness” gauge. In his defense, he had very few tools at his disposal. All he knew was what was written on my chart.
As it turns out, my hospitalization was a good thing, but I didn’t see it that way until months later, when I was in recovery. My civil rights were violated, and no one explained why. There is no written documentation that I was ever told I was being held because I was a danger to myself or others. And although you aren’t supposed to hold someone involuntarily because they don’t remember who they were supposed to be helping to move, that is in fact what happened to me. Oh yeah: and I wore gold clothes.
Apparently my psychiatrist picked up on the fact that I favored gold colored clothes. When I figured this out based on some comments he made, I switched to blue and turquoise colors, and he noticed. But it wasn’t enough to get me released.
Even the day before I was released, my psychiatrist told me I would be there awhile longer after he asked me the question I had no answer for. I didn’t believe my court-appointed attorney when she told me I would be released the next day, because my psychiatrist told me something different that morning. I didn’t know who to believe, so I chose to believe my psychiatrist because I thought he had the most power. As it turns out, he didn’t.
Although I understand the difficulties of treating someone in my condition, I feel my case was mismanaged.

6 Year Anniversary of Involuntary Commitment June 23, 2014

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Today is the 6 year anniversary of the day I was released from Fairfax Hospital after spending over 3 weeks involuntarily committed there. A lot has changed.

Fairfax Hospital
Before I was committed, I had only vaguely heard about mental illness. I knew one person who claimed to have bipolar disorder, but I had no idea what that phrase even meant. The guy with that diagnosis was emotionally unstable, and made poor decisions in his work life and especially his personal life. I attributed his poor decisions to a lack of moral character rather than to any mental illness he might have been suffering from.
As a large portion of society does, I classified depression as something other than a mental illness. My mother and sister both suffered from depression, and it seemed like a lack of moral fiber rather than something they had no control over. I considered them weak because they took medication to ally some of the symptoms.
When I woke up in the hospital, I had no idea where I was. I had never heard of Fairfax and never in a million years would I have guessed such a place could exist a mere 5 miles from where I used to live. Mental illness was invisible to me.
Like many other people, I only heard about schizophrenia as it relates to someone’s bizarre and dangerous behavior in the news, never having knowingly met someone suffering from that illness. I thought all of those people should be locked away somewhere in an insane asylum where they couldn’t harm anyone.
As a productive, innovative, and intelligent member of the working world, I was used to calling the shots, in both my personal and professional life. I had money to spend however I saw fit. That all changed once I was released from the confines of the mental hospital.
While hospitalized, I wanted my family to tell everyone where I was. I was so psychotic I didn’t fully realize the ramifications of my incarceration on the social fabric that was our life. Only weeks later, after the medication started to take effect, did I have to come face to face with the stigma of having a mental illness. In fact, I thought it was all a giant mistake. I couldn’t possibly have a mental illness. I was too intelligent and too stable to have such a weakness.
With time came the realization that I do indeed have a mental illness. It’s not my fault. It’s not my family’s fault. And there are things I can do to mitigate its effect on my personal life, although there is no hope at this point of mitigating its effect on my now non-existent professional life.
I have come to terms with my new existence. Although I don’t suffer from depression, I have come to accept that depression is a chemical imbalance of the brain, just like bipolar disorder and schizophrenia. I even learned there is such a thing as schizoaffective disorder, which is now my latest diagnosis.
My world is much smaller now, but I’m relatively happy in my new existence.

My Civil Right to Own A Gun May 31, 2014

Posted by Crazy Mermaid in Involuntary Committment, mental illness.
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With the latest killing spree in California, there is renewed discussion of keeping guns out of the hands of the mentally ill.
I am a hunter, but one of the things I had to give up in order to be released from the mental hospital was the right to bear arms. I’m not sure how, but the State managed to take away my right under the constitution. If I try to purchase a gun, I am supposed to be prevented from doing so. I haven’t tried to buy a gun to see if they really stop me, but I can tell you that I legally purchased a handgun prior to my involuntary commitment, and no one has tried to take it away from me. I don’t know whether they would stop me from getting a hunting license. I am tempted to try, but haven’t done so.
Yesterday was the 6th anniversary of the day I got involuntarily committed to a mental hospital for throwing some furniture at a wall in a hospital emergency room and taking off my clothes there as well. It is also the 6th anniversary of the day my civil rights were violated when I lost my ability to own a gun. Although I am no longer involuntarily committed to a mental hospital, my civil rights continue to be violated. Despite the fact that I was never arrested, I am being denied my right to own a gun. Simply being involuntarily committed by the State of Washington resulted in my loss of the right to bear arms, which is supposed to be a constitutional right.
According to my attorney in the mental hospital, once I’ve been out of the mental hospital and stable for about 7 years (her number), I can go before a judge and request my constitutional right to own a gun be restored to me. I plan to go before a judge to make that request next year.
Can the government eliminate a civil right because I threw some furniture at a wall in an emergency room? Was being diagnosed with a mental illness reason enough to take away my civil rights?
Politicians will tell you the right of society to live in a safe environment trumps my civil right. Is having a mental illness a good enough reason for the government to take away my civil rights? Apparently so.
I realize there will be some anti-gun people out there who don’t believe anyone has a right to bear arms under any circumstances, so I discount those people because they don’t believe anyone should have that civil right. I am more interested in the people who believe everyone (except the mentally ill) should be able to own as many weapons as they want, with no restrictions. They want to give everyone carte blanch to own anything- unless you happen to have a mental illness. They even want to reach a little further and “catch” those people who appear to be unstable, and take away their right to own a gun too.
Civil rights are, by definition, supposed to be universal. Everyone is supposed to have the right to speak their mind without fear of incarceration. And everyone is supposed to be able to own a gun. And yet some conservatives, who are overwhelmingly for the 2nd Amendment, are probably the first people who don’t think I should be able to own a firearm because of what I might do with it. Do the reasons for violation of civil rights matter? They say they do.
I have been told that guns are dangerous for people with a mental illness. They say people with a mental illness are more likely to use a gun on themselves or others. People with a mental illness, they say, are too unstable to own a gun.
In fact, with the latest round of murders in California, there is the usual talk of not allowing people with a mental illness access to guns. But the problem is that, once again, the guy they want to prevent from having a gun is the guy without a diagnosis. And if you take away the right of people with a mental illness to own a gun, nobody will want to get diagnosed. Besides, how do we find those people? By the way they act? Is it going to become easy to get someone diagnosed against their will with a mental illness?
What is the solution to the problem of preservation of civil rights and making sure society stays safe? Is there a balance?
The solution lies in making it socially acceptable to seek a mental health diagnosis, and in making it easier to get people help. The parents of the kid who went on the latest killing spree tried to get him help, but they failed. The system failed them. So now people think the answer is to keep people who they suspect as being unstable from being able to exercise their constitutional right to own a gun. But is it legal to prevent someone from owning a gun because of what they might do with it? I say no. It is a slippery slope, and we need to be careful. Pistol

“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.

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.

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”

Mental Illness and Smoking November 16, 2012

Posted by Crazy Mermaid in Anxiety, Involuntary Committment, Smoking and Mental Illness.
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Not a smoker myself, I had the luxury of watching the etiquette of cigarette smoking unveiled right before my very eyes as I roamed the small courtyard at our 15 minute cigarette breaks during my three week stay at  the mental hospital.

Without the luxury of time afforded their rich brethren with their ready-made cigarettes like Camel and Virginia Slims, the homeless patients- who comprised more than half the mental hospital population- managed to use their ingenuity and creativity to make cigarette rolling into an art form, combining speed and efficiency.  It was fascinating to watch a patient impress his rolling technique with his own personality. Some rollers – mostly men- fancied thick, squatty joint-looking rolls. Others- mostly women- preferred thinner, more ladylike cigarettes. Each cigarette had its own distinct look. It was amazing how much variety could be squeezed out of the same ingredients. Who knew that tobacco and rolling paper could be formed into so many individual shapes while still retaining their purpose?

As a nonsmoker, I was initially offended by this dichotomy: serving cancer sticks to the ill seemed morally bankrupt. Later on, I came to understand the stabilizing influence of tobacco. Its anti-anxiety effect became crystal clear to me as I watched the nicotine-deprived mentally ill patients visibly calm down after the administration of a cigarette or two.  Forcing a psychotic patient to suddenly stop smoking was not good medicine, I came to realize. Besides, if the nicotine was looked upon as an anti-anxiety drug, then its administration to a suicidal patient became an action similar to administration of morphine to a cancer patient. Side effects, in other words, are relative.

Watching the daily calming influence of nicotine became a siren call for me to take up smoking, much to my husband’s chagrin.  His daily visits, usually during smoke breaks, were spent watching me learn to roll cigarettes, and then having to listen to my explanation of why I was going to start smoking. To his credit, he neither discouraged nor encouraged me, sensing that any direction whatsoever to a psychotic mentally ill person- especially his wife- would be useless and even counter-productive.

My announcement to the nursing staff of my intention to start smoking was met with less than enthusiasm. The nursing staff, viewing my intentions as simply another manifestation of my mental illness, did everything they could think of to discourage me from lighting up. But the reality was that the same tobacco and rolling paper the homeless used was also available to anyone who wanted to start smoking. Even me.

My anxiety, from the medications as well as the illness, was enormous. Unbearable, even. It was so awful that I would do anything, try anything, to alleviate as much anxiety as I could.  The prospect of dying of lung cancer paled compared to the anxiety of desperately wanting to crawl out of my skin. If smoking would relieve even a small portion of that horrible anxiety, I reasoned, then the price was more than worth it.

While not outrightly engaging in any sort of discriminatory behavior, the nursing staff nevertheless managed to communicate their dislike of smoking, stopping short of suggesting to the smokers that it might be a good time to quit. They realized the very strong stabilizing effect of tobacco on their charges’ psyche. But while they didn’t actively engage in trying to get people to stop smoking, Hell was going to freeze over before they were going to allow a non-smoking patient to take up smoking.

Their first line of defense was to try to reason with me.  Didn’t I realize that the reason the drug (tobacco) calmed people down was because it was a “fix” from the habit of smoking? That it really didn’t alleviate anxiety like the anti-anxiety pills did?

But I wasn’t buying any of their bullshit. They were lying to me.  I was convinced the drug really was like an extra dose of the anti-anxiety pills. Besides, the doctors limited the number of those pills we could take, but not the number of cigarettes we could smoke. It was, I believed, like getting an extra dose of Klonopin.  Besides, all my new friends smoked.

In the end, I couldn’t make my mind up whether to start before I was discharged from the hospital. Once out of the smoking environment, I totally forgot about my desire to take up smoking. Besides, the tools- the tobacco, paper, and rolling machine- were no longer at my fingertips.

M medication is stabilized and I no longer have that incredible surge of anxiety through my system…most of the time.  Although I am glad that I never took the habit up, I no longer pass judgment on the smokers of the world.

Murder, Ian Stawicki, and House Bill 3076 June 21, 2012

Posted by Crazy Mermaid in Committment Hearing, Involuntary Committment.
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June 21, 2012

Editor, The Seattle Times

Some people blame the City of Seattle for the recent murder of five unsuspecting people by Ian Stawicki.  I blame the taxpayers of Washington and the government.

The problem, in a nutshell, is with the mental health system, which was brought on by the State’s refusal to fund a bill that would have had Stawicki involuntarily committed.  At the point he was diagnosed as mentally ill (because of the involuntary commitment), he would have been denied the ability to purchase guns as well as been started on a medical treatment for his disorder.  Since he was never diagnosed as mentally ill (because House Bill 3076 was never funded), he was not prohibited from possessing a firearm.  But because of a lack of funding (and a lack of mental hospital beds), Ian was allowed to roam free, wreaking his havoc among the people in Seattle.

Currently, as the law reads, a person can be involuntarily committed only when a third party, the Designated Mental Health Professional, does an independent assessment of a person who is thought to be an imminent danger to himself or others.  This changed with House Bill 3076.  In that bill, the DMHP could rely on testimony from friends or family members of those who clearly have a mental illness.  As it stands now, input cannot be given by family members or friends of a suspected mentally ill person.  But House Bill 3076 changes all of that.  With the new bill, however, come costs.  The big problem with passing and funding House Bill 3076 is that there aren’t enough hospital beds to take those people who would have been involuntarily committed because of testimony of friends and/or loved ones.  So the State acknowledges the need for such a place, but declines to do anything about it.

So when there is a lot of handwringing and rhetoric about the state of the mental health laws, I have little or no sympathy for those doing their handwringing.  NAMI (National Alliance on Mental Illness, a grassroots organization for those suffering from mental illness and their friends and loved ones) has testified before Congress at the need for such facilities.  But we are always told it is too expensive to fund.  This is what happens when needs are ignored.  There will be more Ians because of this situation.

Until Congress and the State of Washington take steps to build hospital beds for those people like Ian to go get help, there will be more cases of mental illness-sparked murders.  So if we are truly concerned about people like Ian, who clearly have an undiagnosed and untreated mental illness, and his victims, nothing will change.

People on the radio and tv have wrung their hands about people like Ian getting access to firearms.  But until House Bill 3076 is funded, there will be no diagnosis of mental illness, and there will be continued access to guns by those with no business owning one.

The Law and Involuntary Commitment January 2, 2012

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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

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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.