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The Law and Involuntary Commitment January 2, 2012

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

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

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

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

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

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

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

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

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

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

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Involuntary Commitment in Washington State November 1, 2011

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

Patient Rights

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

Basis for Involuntary Commitment

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

Initial Detention

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

14 Day Hearing

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

90 Day Hearing

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

180 Day Hearing

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

Less Restrictive Alternatives

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

This article was written by Carolyn Annette Elsey.

My Experience…

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

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

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

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

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

Trapped in Involuntary Commitment May 11, 2011

Posted by Crazy Mermaid in Involuntary Committment.
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Trapped!

As I stood outside, I glanced around the small courtyard, taking in my surroundings. A fifteen foot high chain link fence topped with two layers of razor barbed wire surrounded the south and east sides of the compound. The building itself served as a fence on the south side. A six foot high wrought iron fence with a small (locked) gate served as a sentry for the west side of the courtyard. The whole effect made an impermeable barrier from the outside world, discouraging anyone from trying to run away from the mental hospital.

Hours before, I had just learned that I had been involuntarily committed to a mental hospital.  As I came to realize the enormity of that fact, a sense of claustrophobia engulfed me.  I realized that I had been imprisoned, and there wasn’t a reason why.  I had been pulled out of society and stuck in a jail in some god-forsaken place, unable to even learn what city I was in.

They didn’t and wouldn’t call it jail, but that is in effect what involuntary commitment really is.  If you can’t leave when you want to, then you’re in jail.  If they won’t tell you when (or if) you’re ever going to be released, then you’re in jail.

Some people would argue that being locked up on a psych ward is no different than being on a job that you hate. I argue that in the case of the job, although you might feel trapped, you are in fact free to quit if you want to.  You can walk out of your “jail” any time you feel like it. The consequences might be such that you can’t afford to leave, but in fact you are free to walk away at any time and no one can or will stop you.

I, on the other hand, wasn’t being paid to be there.  In fact, unbeknownst to me at the time, I was being charged between $2,500 and $3,500 a day to be there.

I have never been one to stay in situations where I felt trapped for very long.  If someone tried to hold me down, I would kick and scream and bite until they finally decided that I wasn’t worth the effort.

In the case of hospitalization, no amount of trying would free me from my captors.

The daily grind of captivity lasted almost three weeks, and the worst part was that no one could tell me when (or if) I would be released.  It was up to my psychiatrist, and he wasn’t willing to let me out until I could comply with a set of criteria that I was not allowed to know about. For obvious reasons, they guarded that criteria from me because they knew that if I found out what that criteria was, I would do my best to trick them into thinking that I had complied in order to get out of “jail”. The object of their game was to get me to fulfill that criteria without a hint from them of what that criteria was.  I tried and tried to figure out what that criteria was, but in the end I wasn’t successful.  Eventually, as I would later learn, I was released ($60,000 later) when my insurance benefits came to an end.

There is no sweeter feeling than being released from a prison.   After 48 years of taking freedom for granted, that three weeks made me realize just how easy it is to get your freedom snatched from you, as you stand helplessly by. I never want to experience that jailed feeling again.

Reluctant Gertie: Unwanted Medication February 3, 2011

Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital, mental illness.
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“NO!”

“You have to.”

“I won’t!” said Gertie, a 350 lb white woman dressed in a hospital gown, squeezed into a chair next to a blood pressure machine at the nurse’s station.

“Please, Gertie. We’ve been through this already.”

“You have no right…”

“We have every right, Gertie,” said Marjorie, the nurse handing out medication. “We’ve already been through this. Don’t you remember what happened before when you refused to take your medication?” She shook the cup of pills at Gertie. “Go ahead and take these.”

“But I don’t like the way they make me feel.”

“I’m sorry, but the doctor said you need to take these.” She rattled the cup again. “Please.”

Gertie shook her head.

“Then I have no choice.  We’ll have to give your medication to you intra-muscularly, Gertie. Just like we did before.”

Gertie continued to shake her head. “No.”

“Shall I get the other nurses?” asked a red-headed nurse in a pink tunic.

Nurse Marjorie nodded her head. “I really don’t want to do it this way, Gertie, but you’re giving me no choice.”

“Please don’t do this, Nurse,” begged Gertie.

“I’m sorry, Gertie, but I have no choice in the matter. You know that.”

“Our Father Who Art In Heaven. Please deliver me from having to take these pills,” Gertie prayed.“Please Nurse. Please. Don’t,” begged Gertie.

By this time, three other nurses had arrived

“Please God, save me from these evil nurses and their injection,” prayed Gertie as the nurses positioned themselves strategically around her.

As Nurse Marjorie prepared the syringe, I caught sight of a long needle.

“Please Gertie, don’t make me do this,” she begged.

“PLEASE GOD!  DON’T LET THEM!” screamed Gertie.

All at once, the nurses grabbed Gertie, holding her down as Nurse Marjorie plunged the needle deep into Gertie’s thigh.

“NOOOOO!” screamed Gertie. “THEY’RE KILLING ME!”

The injection complete,  the nurses released their grip on Gertie.

“There. All done, Gertie,” said Nurse Marjorie, her voice shaking slightly as she fastened a band-aid on the injection site.

By this time, the entire ward was shaken up, having watched this gruesome display.

“I think it’s time for a special Smoke Break,” said Nurse Marjorie. “Everyone outside!”

(Excerpt from my book, I Thought I Was A Mermaid)

How Long Does it Take to Become Psychotic January 8, 2011

Posted by Crazy Mermaid in Delusions, Disability Claim, ESP, mental illness.
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Back when I was working as a Project Manager in downtown Seattle, my employer- let’s call them M Construction- paid for a long and short term disability policy as part of my compensation package.

As the stress on that job escalated to impossible levels due to the fact that I had no support staff (no matter how hard I tried to get it), I began to believe that I had ESP, and that I could communicate with my flesh-and-blood bosses via that ESP. As my mental illness rapidly progressed, I became more enmeshed in my delusional world, communicating with my bosses via ESP several times a day.  They knew, I believed, the untenable position I was in.

As the pressure on my job escalated to impossible levels, we (my ESP bosses and I)  hatched a plan.  They directed me to in effect hold my job hostage. I was supposed to tell the flesh-and-blood boss that I had a job offer with a competitor- someone whom the company had recently lost a lot of employees to. The result was supposed to be leverage to get the staff I needed in order to perform my job. At the direction of my ESP bosses, I made that threat to my flesh-and-blood bosses. But instead of getting the staff I needed, the flesh-and-blood bosses wished me well and held an exit interview.

During my exit interview, as I sat in a Starbucks with my flesh-and-blood boss across the table from me, my flesh-and-blood boss wrung his hands, asking me why I didn’t say something sooner. I tried to argue that point, saying that I would stay if I was given the staff I needed. The flesh-and-blood boss said it was too late, while the ESP boss told me this discussion was part of the ultimate plan to get me that staff.  At the end of the interview, I was officially out of a job. But my imaginary ESP boss told me to sit back and wait for things to happen.

After a few days of waiting around for their phone call to return to work, my ESP boss told me to give him a call, which I did. My flesh-and-blood boss tried to argue with me, telling me that I had quit. I explained that I was only doing what he told me to do. Confusedly, he ended the phone call, telling me once again that I had quit. During this conversation with my flesh-and-blood boss, that same man (in the form of ESP) told me this conversation  was all part of the plan, and that the offer to return to work was imminent but that he couldn’t say so over the phone. “Just relax” was my direction.

As the weeks leading up to my ultimate involuntary commitment wore on, I continued to maintain regular phone contact with my flesh-and-blood bosses, truly believing that my return to M Construction was imminent, despite his continued assurances that my job had been filled.  When my husband asked me how my job hunt was coming along, I explained that there had been a mistake and that I would be returning to M Construction soon.  I didn’t even bother to apply for unemployment, because I knew my return to work was imminent.

Within three weeks of holding my job hostage, I was involuntarily committed to a mental hospital. During the three weeks at the hospital and the subsequent months in recovery, the furthest thing from my mind was the insurance policy. But as I began to mentally re-enter the real world, my husband reminded me of that policy and asked me to check on it.  Digging around the house, I located the policy. Sure enough, I was covered!

I called M Construction’s Human Resources department to start the claim process, only to be informed that I had quit before entering the hospital. Policy null and void.  Submitting the claim anyway, I wasn’t surprised when Prudential’s denial letter arrived, saying the same thing: I had quit before I became crazy.

Upon further consideration, I realized that what I really had was an on-the-job injury, just like I was hit on the head with a 2X4.  But the 2X4 in my case was the stress that caused me to go psychotic.

There was no doubt that I had become sick. My involuntary commitment was physical evidence of that. But one burning question remained:  How long before my hospitalization was I psychotic/sick?  Was it before I “quit” my job, or afterward?  How long does it take a person to become psychotic? More than three weeks or less than three weeks?

I hired an attorney to find out.

A Case for Involuntary Commitment January 1, 2011

Posted by Crazy Mermaid in Involuntary Committment, Medication, Mental Hospital, mental illness.
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As part of my psychotic experience, I believed that I had ESP (extra sensory perception). I thought I had famous people as part of my entourage, hanging on every brilliant “word” coming out of my “mouth”. At first, these conversations took place entirely inside my head, without me uttering a single word.  However, towards the end of my psychotic experience, my need to talk out loud to them became very strong. Too strong to ignore.

Thanking God for Bluetooth technology, I decided that talking out loud to my friends would be mistaken by everyone who witnessed it as simply conversing on the cell phone, as long as I had my “ear bud” in my ear. So I began wearing my “ear bud” everywhere except to bed.

In this section from my memoir (called I Thought I Was A Mermaid), I had just driven to Walmart (really) to go shopping with my (imaginary) friends.

(Note to blog readers: As far as the people with me go, they were a mixed bag. Although I had never met the real Claudia, she was in fact a real person whom I had heard about and wanted to meet.  Mike was actually based on my (real) boss at Mortenson, where I was a project manager on a $55 million ice hockey rink under construction.  Bill Gates needs no introduction, except to say that although I had never met him in real life, my circle of friends (really) included someone who had (really) worked with he and Melinda Gates, his wife, at Microsoft back in the day.

Rolling into the colossal Walmart parking lot, I turned off the key.

Me: Here we are, everyone!

Claudia: I can’t believe how nice the cars are. I thought they’d be all dumpy and old and stuff. But they’re not too bad. Even a Lexus or two.(Note to blog readers: the people I conversed with could see through my eyes, so they saw exactly what I saw).

Bill Gates: I’ve never been to a Walmart before. But I know someone who has. And she’s dying to meet you. Oprah Winfrey, meet Kathy. Kathy, meet Oprah. I was shocked, to put it mildly.

Me: I never expected to meet you in a million years, Ms. Winfrey.

Oprah: Call me Oprah, Kathy.  And it’s very nice to meet you.

Me: It’s nice to meet you also.

Oprah: I’ve been hearing a lot about you, Kathy.  Bill and Melinda Gates are friends of mine. When I heard they knew you, I begged them for an introduction. And it’s so funny that I’d meet you here in a Walmart parking lot. I grew up with Walmart.

***

During my three week involuntary hospitalization (at Fairfax Mental Hospital), I continued to believe that I had ESP. The day I was released from Fairfax, I met my new psychiatrist for the very first time. After my meeting with him, I believed that I talked with him via ESP during my car ride home.

My point is that it took over a month for the medication, initially forced on me during my hospitalization, to finally kick in enough that I no longer believed I had ESP. Without involuntary commitment and its accompanying medication, I would still believe I had ESP and I would still be talking out loud to my imaginary friends. At first I fought tooth and nail, but in the end, involuntary commitment saved my family and I from a terrible fate.

Driving and Mental Illness November 22, 2010

Posted by Crazy Mermaid in Medication, Mental Hospital, mental illness.
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When I first began driving, I was a teenage girl living in Kihei, Maui, Hawaii. My dad was Project Manager for a mid-sized construction company named Red-Samm/General, a joint venture between two fairly large construction companies.  He was in charge of putting together a seven mile long sewer line through downtown Kihei.  In fact, I tell my friends that if they’re staying in Kihei and flush the toilet, they can thank my dad.

In those days, my dad came home from an extremely stressful job and started  “driving school for Kathy”. Things were different in those days.  There was no Driver’s Ed on Maui.

After working late, he drank a few beers and then threw me the car keys, saying “Let’s go”.  I climbed behind the wheel of a manual four wheel drive Jeep pickup truck, and he climbed in the passenger seat. As I learned where the gas and more to the point brakes were on that manual transmission, he sat in the passenger seat, holding on for dear life.  Anyone who has ever sat in that passenger seat can tell you it’s no picnic.  Around the Island we drove (it’s a 50 mile trip around the whole thing), driving on two lane roads out in the country lanes.

As I got older, I learned to drive other vehicles, eventually even owning a few of my own. Like my father, I taught my two boys how to drive (with the help of Driver’s Ed).  I became comfortable (and so did they) in my role as Driver Instructor.

During my career as both an owner of a mid-sized commercial general contracting firm and project manager of commercial buildings, I learned to operate heavy construction equipment, including (bull) dozers, backhoes, dump trucks, and skidders (used for logging operations).  My dad, also a project engineer but for sitework subcontractors until we went into business together, taught me how to operate all of these and more.

If there was any driving to do, I did it. I never let anyone drive if I could help it.

All that changed when I entered Fairfax Mental Hospital.

The initial dose of Lithium (900 mg) knocked me on my ass. I had major coordination problems, including doing what my husband calls the “lithium shuffle” up and down the locked down hallways of the psychiatric ward – where those of us who were involuntarily committed were housed.  I lost my sense of coordination, developed the typical side effects of massive doses of lithium, and lost my desire to drive anywhere.

As the Lithium gave way to Geodon and subsequently ,when Geodon failed to work, Risperdol, I continued to be uncomfortable driving.  In fact, when I got behind the wheel of the car on those rare occasions when I absolutely had to, I had trouble telling how far I was from the car in front of me. I couldn’t tell where the end of the car began.  I had trouble finding the gas and more importantly the brakes.  When I had to go to the local hospital where my gynecologist’s office is, I hit the gas instead of the break when I parked the car. It scared me so badly that I refused to drive myself anywhere for quite some time.

The Risperdol made things better as far as my coordination went, but still I avoided driving at all costs unless I absolutely had to. I felt much safer with someone else being behind the wheel.  I had neither the focus nor physical coordination to drive and I knew it.

Recently, with the switch from Risperdol to Geodon, I finally, two and a half years after my hospitalization, began to feel that I could actually be comfortable driving.  Yesterday, I am proud to say, I volunteered to drive my husband and I to the local Home Depot.  It was the first time in 2 ½ years that he had been in the passenger seat with me.

Everyone around me has been very patient with me, giving me the emotional support I needed to get to this stage.  But I am learning the joys of driving again, albeit slowly and cautiously.  It feels good.

$58,752 for 18 Days of Involuntary Committment to Mental Hospital August 14, 2010

Posted by Crazy Mermaid in Escalating Healthcare Costs, Health Insurance and Mental Illness, Involuntary Committment, Mental Hospital, mental illness.
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$58,752. Take a good look at this number.  It’s the cost for 18 days of room and board (no additional services like medication and Dr. visits are included) at Fairfax, a private mental hospital in Kirkland, Washington.*, where I was involuntarily committed back in May 2008 to mid June 2008.  That breaks down to $3,900.20 per day for the first 10 days and $2,468.75 for the final 8 days.

At Eastern State Hospital  (WA), a comparative public facility, the average cost per day for a stay there is $524 per day.  My stay there (room and board ONLY) would have cost $9,432. At Western State Hospital  in Lakewood, Washington, also a public facility, the average cost per day is $438.  My cost for 18 days of room and board there would have been $7,884.   Fairfax, a private hospital, charged over six times as much for the identical service.  What’s wrong with this picture?

It gets even better. At these rates, if 25 patients pay $3,900 a day, Fairfax grosses $97,000 a day.  If the beds stay full for a year, Fairfax grosses $35 MILLION dollars.

My family and, by extension, I, had no say in whether I would be involuntarily committed, much less the location or cost of my commitment. The State of Washington made the determination that I would be involuntarily committed.  Because it was an emergency situation, forced on me, my family had no opportunity to explore the various facilities and then do a cost comparison.  Even if we had known the cost, we had no choice. Fairfax was the only mental health hospital in the State with a bed. The State of Washington was forcing me to be involuntarily committed (against my will).  I had to go somewhere, and Fairfax was the only place with a bed. That’s why I went there.  Fairfax had me over a barrel, with no other options.  They took advantage of the situation to make their stockholders a little richer.

Lest you think I was at Club Med, let me rid you of that misconception. The food was cafeteria-style, brought to us on trays stacked in a three foot high mobile metal tray rack.  Built in the 1960’s, the building has not undergone any visible major or minor remodeling since its inception.  As it is a private hospital, the public information disclosure required by the State hospitals is not required of it. My stay there was not in some kind of padded room.  It was in a plain old regular dorm room, similar to one you’d find at an old college.  Granted, the doors to the outside were locked 24/7, but the facility itself was run-down. Unlike Western and Eastern State Hospitals, there is no website data from Fairfax citing its daily cost.  It’s a private facility.

Oh yeah: one more thing.  Fairfax is owned by Psychiatric Solutions Inc. (PSI). Please join me in congratulating PSI for making Fortune Magazine’s list of Top 100 Fastest-Growing Companies:

FRANKLIN, Tenn., Aug 18, 2009 (BUSINESS WIRE) — For the fourth consecutive year, Psychiatric Solutions, Inc. (”PSI”) (NASDAQ: PSYS) has made Fortune magazine’s list of the Top 100 Fastest-Growing Companies. It is the only Tennessee company to make this year’s list, as it was in 2008 and 2006. https://www.psysolutions.com/facilities/news/fortune-magazine.html

PSI, which is the largest operator of psychiatric inpatient facilities in the country, ranked No. 98 on the list released by the magazine in August 2009, which considers factors such as revenue and earnings per share (EPS) growth rates. Last year, PSI ranked No. 64. In 2007 and 2006, it ranked No. 49 and No. 34, respectively.

How can they get away with this? Simple: There is more demand than supply for short-term mental health care facilities. Solution: build more short-term care facilities.  I think that everyone would agree that $35 Million builds quite a few new facilities.

* Taken from Fairfax’s invoices to my insurance company.

Mental Illness and The Law: How We Got Where We Are June 29, 2010

Posted by Crazy Mermaid in History, Insanity, Involuntary Committment, Mental Hospital, mental illness, Mental Illness and Medication, Psychotic.
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2 comments

If you want to change things, first you need to understand how they got the way they are.  In the case of mental illness law, politicians and lawyers had the best of intentions, but as with other ventures, the devil was in the details.  The unintended consequences of their actions continue to remain the source of frustration and even danger.

In his 1946 article “Bedlam 1946: Most Mental Hospitals Are A Shame and A Disgrace” http://www.mnddc.org/parallels2/prologue/6a-bedlam/bedlam-life1946.pdf in Life Magazine, Albert Maisel made the case that mental hospitals were terrible institutions.  The final paragraph of his article summarized his point succinctly: “Given the facts…the people of any state will rally… to put an end to concentration camps that masquerade as ( mental) hospitals and to make cure rather than incarceration the goal of their mental institutions.”

While the sentiment is perfectly understandable given the horrific conditions he found when he investigated the state of mental hospitals throughout the United States shortly after the close of World War Two, he threw out the baby with the bath water when he declared, in effect, that nobody should have to be institutionalized.  The wildly popular Life Magazine gave Maisel a platform from which to launch his idea of closing all mental hospitals, also called deinstitutionalizing the mentally ill.

Helping this idea along was the development of the first generation of antipsychotic drugs in the 1950’s. Used to treat schizophrenia and other psychoses as well as acute mania, agitation and other conditions, their discovery allowed many mentally ill people once hospitalized to return to their families, hopefully with their illness under control and able to function as productive members of society in many cases.  In many cases this was true, but not in all.

The advent of these new antipsychotics lent fuel to the fire of the deinstitutionalization movement, and, combined with the publicity of the atrocities perpetuated in the mental hospitals, served to throw the doors to the mental institutions wide open in the mid-1950’s.

From the mid-1950’s to the mid-1960’s, a small percentage of the eventually deinstitutionalized were released. But from that point forward, the trickle became a flood, culminating in the release of the majority of the mentally ill by the mid-1980’s. And as the mentally ill were released from the hospitals, rather than wait to see whether whether the experiment was going to work, those hospitals were closed down forever, shrinking from a high of around 550,000 beds in the mid-1950’s to around 40,000 today. As this experiment failed,the homeless and prison populations of every major city and State ballooned.

In the meantime, California was the first state to pass the Lanterman-Petris-Short Act in 1967, giving the mentally ill the legal right to avoid treatment for their mental illness, regardless of how damaging that mental illness became. Unless the person was in imminent (immediate) danger of severely harming or killing themselves or someone else, they had the right to be left alone, free to wander the streets, homeless and victimized, eating out of dumpsters, lost in their own world. Other States followed their example, with the former Governor of California, Ronald Reagan, leading the charge on a national level as he ascended the highest office in the land, the Presidency.

The mistakes the do-gooders made in this two-pronged approach of first deinstitutionalizing and then arming the mentally ill with the right to refuse treatment were twofold.  Their first mistake was  in perceiving all hospitalization to be bad hospitalization. Secondly they assumed that anyone who has a mental illness has the presence of mind to know when to seek treatment for that illness.

Treating mental illness like any other illness, disregarding the fact that one of the symptoms of the illness can be a failure to realize they are ill, and denigrating all mental hospitals as evil are poor choices for which we have all paid dearly, in the form of the fallout from our endless supply of suicides, the incarcerated mentally ill population, the homeless population, and mentally ill people who attack and assault others.

Until we realize that mental hospitals can also be used for good, and that mentally ill people can’t always help themselves, nothing will change.

(Note:  Part of my research for this article was done with the help of Dr. E. Fuller Torrey’s book The Insanity Offense. (2008).

Anosognosia Symptom: Lack of Insight into Mental Illness June 22, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Involuntary Committment, mental illness, Schizophrenia.
Tags: , , , ,
4 comments

It’s a crying shame that I had never even heard of the term ansognosia until I read Dr. E. Fuller Torrey’s latest book, The Insanity Offense (2008), since it’s such an integral part of understanding how the symptoms of mental illness interfere with a person’s ability to get help.

The term anosognosia is derived from the Greek words “nosos” which means disease and the word “gnosis” which means knowledge. The “an” prefix notates the negative.  A person who suffers from anosognosia is unaware of the existence of their mental illness.

This lack of insight into their illness, associated with damage to the right hemisphere of the cerebral cortex or the frontal lobe,  is a problem of major proportions because it’s the main reason why people with certain mental illnesses such as schizophrenia and bipolar disorder refuse to take their medications.   They aren’t trying to be a pain in the ass: they truly believe that they’re not ill.  And if they’re not ill, there’s no reason to take medication. Period. End of Story.

If a patient can be made to take their medication, a large percentage of them will improve their awareness of their mental illness and thus continue taking their medication on their own.  But under the current laws, forcing a patient to take necessary medication is illegal, in a large part because the law refuses to take into account anosognosia in making decisions regarding who should be forced to take medication and who should not.

It’s not easy to convey to the average person what it means to be unaware that you have an illness. How can someone who is sick not know it, especially when their symptoms are so obvious to others? Because it’s not like any other illness. It’s the brain, rather than other parts of the body, that is the problem.

In the case of the paranoid schizophrenic, there is another layer of difficulty to add to the equation. The paranoid schizophrenic lives in a world where the universe is out to get him.  So he views any attempt to get him help as simply another attempt at persecution.  He distrusts anyone who tries to get him help. It’s a magnification of anosognosia.

Unfortunately, treatment of a patient whose symptoms include anosognosia is impossible, since treatment for an illness requires admission that there is in fact an illness and cooperation by the patient in treatment of that illness. The law of the land is written around the concept that a person is capable of deciding whether or not he is ill, and therefore whether or not treatment for that illness is appropriate. The law, in other words, has never heard of the symptom called anosognosia, which makes it impossible for the patient to believe that he is mentally ill, and therefore makes it impossible for him to believe that he needs treatment. The result of this failure of the law to consider this singular symptom is that the patient goes about his business believing that he is not ill, living in his own world. How is this a problem?

Instead of being able to treat those people whose symptoms include anosognosia, families of people with mental illness live in fear of their  loved ones, aware they’re living with a ticking time bomb. They know it’s only a matter of time before their loved one hurts or kills someone, but they’re unable to prevent the atrocity from happening because the law ties their hands.

Prisons are full of people with anosognosia who commit crimes- sometimes horrendous crimes. Had they been forced to seek treatment for their mental illness, they might have lived full and productive lives. Instead, they fill our prisons, unmedicated, costing taxpayers tens of thousands of dollars a year. Or they murder police officers or random people before being apprehended and found to be not guilty by reason of insanity, then locked up in mental hospitals.

The streets of every major city in the United States are full of people with anosognosia who refuse to believe they have a mental illness. Instead of being forced to get treatment, they wander the streets, victims of crime, living off the streets, eating out of dumpsters, and living a horrible life simply because they cannot believe they are in need of medical help.

We have to change our laws, taking into consideration this terrible symptom.  We have to make it easier to involuntarily commit those with this symptom, thus improving the quality of life of those with anosognosia and making the world a much safer place for all of us.

(Note: Research for this article was done with the help of articles by the following: Dr. Kevin Thompson, PhD http://www.mentalmeds.org/articles/anosognosia.html ; Treatment Advocacy Center http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=27&Itemid=56; Pages 112 and 113 of Dr. E. Fuller Torrey’s new book, The Insanity Offense (2008) among other sources)