Just curious and hoping someone can help

[ngc_7331]

So, I was leery of posting this at all but I know we have a few medical type people on here so maybe someone can give me some clarification. Last weekend, I had a major depressive episode (I'm bipolar) and ended up in a crisis unit for a few days. I've been lucky so far in my life to have avoided this up until now. I'm not sure exactly what I was expecting from it but it wasn't this. I thought there would be some kind of maybe group therapy or something, but all I did was sit around and watch tv and play spades (the card game of the held against their will the world over it seems). We did pretty much nothing else the entire time I was in. Oh and eat and take naps. It was a mixed ward, whatever, guys don't bother me but we were also all thrown in together, depression cases, paranoid schizophrenics and people detoxing and waiting to get into rehab. Is this normal for a crisis unit?

[Teskeria]

I don't have a lot of experience, but my younger daughter is bipolar, and when she was placed into a crisis center, they did a couple sessions of group with them daily. She was 14 at the time, and the floor she was on had an age range of about 14-20 so it may be different with teenagers.

[Amina516]

The crisis center here focuses on getting you over the hump, or past the time you may be harmful to yourself. They do 1:1 once a day and a group meeting twice a day, but the rest of the time it sounds exactly how you outlined. Theyre not equipped for intensive therapy, or more than having someone lead you in drawing a picture or plan an intrument for relaxation. For help I suggest you see a a counselor on an ongoing basis. They should have hopefully told you that when you left your crisis center. Crisis centers are good for keeping you safe short term, however, the longterm therapy is something thats needed on an outpatient basis, usually at a different place. Good luck. I hope you find what you need.

[dalesys]

When I was in the psych hospital (15 days), weekends were mostly stabilization, with most therapy during the week.

Jeez, has it been 21 years already?

[Sapphire Silk]

The other thing crisis centers may do is start you on meds to stablilze your moods. OR

In some cases they may let all meds clear from the system to restart med therapy fresh.

But basically, the point is to stabilize you and hopefully get you hooked up with outpatient therapy.

Hope you are feeling better!

[HappyFun Ball]

This is very normal for a crisis center (Having had to visit one many times myself).. Mine was different because they wanted to keep you doped up on sedating psych meds and then lock you out of your room. In mine you saw your own psych doctor, or if you did not have one they would appoint one to you, they'd start you on all kinds of expensive meds and when they started to work, they'd discharge you with a script for the meds and would expect you to stay on them even if you can't afford them..

Sorry, my last visit was a bad experience, they had to change up the crisis ward due to so many homeless people and freeloaders being there, the last time I was there, I was not allowed any actual clothes, just hospital gowns, was not allowed to use dining utensils, all the food was stuff you could use your hands to eat. No TV, except for a couple of hours a day and no groups and just plain nothing to do.. If you weren't crazy when you went it you were certainly crazy when you left.

[Little Retail Rabbit]

I'm wondering if any of you are fans of/have heard of musician Emilie Autumn, because she describes similar negative experiences in her novel The Asylum for Wayward Victorian Girls. Happyfunball's sentiments certainly seem to echo hers- EA recalls being given a spoon to eat spaghetti with...and she was the "crazy" one:rolleyes:.

She went in because she was suffering bi-polar disorder (and probably several other problems), had attempted suicide and her doctor could not repeat her prescription unless she went in voluntarily. Her stay stretched out longer than it should have done and most of the time, the nurses were more concerned in trying to get her to admit she had an eating disorder (which she doesn't). After she left, she was diagnosed with PTSD.

To be honest fearing I'd end up in a similar circumstance and turning out worse than I was to begin with was the reason why I put off approaching my doctor for so long.

[wagegoth]

Here in California, doctors can give you electroshock treatment if they deem it necessary, no permissions from patient or family required. This is why I won't go into a ward, even though there have been a couple of times I probably should have.

[ngc_7331]

.. If you weren't crazy when you went it you were certainly crazy when you left.

Yes, this. Since I went in voluntarily (well kinda but that's a whole other ball of wax), I didn't have to stay the mandatory 3 days even though I know they wanted me to. Basically, how are you gonna get better if you sign yourself out? Well, sitting around here staring at the tv or the walls ain't gonna help me either and if it did, I'd rather stare at my own walls, kthnx.

But they did get me a rather quick appointment to see a therapist and whatnot, a lot quicker probably than had I stayed completely outpatient. Hasn't stopped them from implying that I should readmit myself though. I just casually ignore that part of the conversation.

[trailerparkmedic]

Here in California, doctors can give you electroshock treatment if they deem it necessary, no permissions from patient or family required.

It takes a LOT to get to that point.

For any treatment, you need to give consent. Even if you are involuntarily admitted to a psychiatric hospital, you cannot be treated against your consent unless a lot of legal hoops are jumped through, and it has been proved that you are a danger to yourself or others without treatment. For example, Jared Loughner (the guy accused of shooting the Congresswoman in Arizona) is being medicated against his will, but only after a judge ordered it. In Texas, it's handled on a county level, with slightly different standards in each county, but it generally boils down to proving a danger to self or others. I saw people in my psych clinicals who were involuntarily admitted and refused to take medication and were eventually released because the standards for involuntary medication weren't met.

The crisis center sounds lame in some respects (no group, even on a weekend) but typical in others (lots of diagnoses thrown together). From what I've seen in my area, psych hospitals are used to stabilize patients and get them connected to at least a few resources and then the patients leave to continue work on an outpatient basis.

[Seshat]

Sadly, there still are some 'mental hospitals' or asylums or whatever you want to call them that are little more than warehouses for the inconveniently sick. :(

I'm not saying whether this was one. I have no clue. I wasn't there. But they still exist.

[wagegoth]

It takes a LOT to get to that point.

For any treatment, you need to give consent.

I read the patients rights and legal code, and you do not have to give consent once you have been admitted. If the doctor decides it's necessary, that's it.

[Sapphire Silk]

I read the patients rights and legal code, and you do not have to give consent once you have been admitted. If the doctor decides it's necessary, that's it.

I would love to look over the legal code; do you have a link you could provide? I'm not saying I don't believe you, I am saying I find the idea very startling. It's like saying you can operate on someone simply because you signed a consent to be admitted to the hospital.

Usually, you sign a consent for treatment when you are admitted to ANY hospital. However, invasive or extreme treatments require additional consent forms: surgery, blood transfusions, invasive diagnostic procedures like biopsies, and so on. ECT has always been on that list, and given how liberal California is I'm surprised to hear it might not be there. I certainly never heard this while I lived there. So I'd like to get additional information, if you could steer me to some.

[Andara Bledin]

I checked around, and those who are admitted, voluntarily or involuntarily, to a mental facility retain the right to refuse ECT and a number of other things, as well.

It's all part of The Lanterman-Petris-Short Act which is part of the California Welfare and Institutions Code (http://www.leginfo.ca.gov/cgi-bin/calawquery?codesection=wic&codebody=&hits=20) ss 5000-5579. The relevant section is 5325-5337 (http://www.leginfo.ca.gov/cgi-bin/displaycode?section=wic&group=05001-06000&file=5325-5337).

This is actually some very good info for any who might consider themselves as candidates for mental treatment in the state of California.

^-.-^

[Eisa]

If I remember correctly from my Clinical Psych and the Law class, even someone in a mental hospital can deny medication or treatment--for the doctor to do so anyway, it involves a hearing to prove that it is necessary and that the patient is incompetent to make the decision. Or something like that.

If you had zero therapy at all of any kind, I would call that unusual! Otherwise, it can be a mixed bag.

[ngc_7331]

Yup, no therapy at all. It might have been, like someone suggested, because I was in there over a weekend and was released fairly quickly. They did get me set up to see a therapist as an outpatient so I am getting something now. The whole thing seems a little surreal now in retrospect but is absolutely something I hope to never have to do again.

[wagegoth]

I checked around, and those who are admitted, voluntarily or involuntarily, to a mental facility retain the right to refuse ECT and a number of other things, as well.

It's all part of The Lanterman-Petris-Short Act which is part of the California Welfare and Institutions Code (http://www.leginfo.ca.gov/cgi-bin/calawquery?codesection=wic&codebody=&hits=20) ss 5000-5579. The relevant section is 5325-5337 (http://www.leginfo.ca.gov/cgi-bin/displaycode?section=wic&group=05001-06000&file=5325-5337).

This is actually some very good info for any who might consider themselves as candidates for mental treatment in the state of California.

^-.-^

The operative section reads as follows:

"5326. The professional person in charge of the facility or his or
her designee may, for good cause, deny a person any of the rights
under Section 5325, except under subdivisions (g) and (h) and the
rights under subdivision (f) may be denied only under the conditions
specified in Section 5326.7. To ensure that these rights are denied
only for good cause, the Director of Mental Health shall adopt
regulations specifying the conditions under which they may be denied.
Denial of a person's rights shall in all cases be entered into the
person's treatment record."

"5326.7. Subject to the provisions of subdivision (f) of Section
5325, convulsive treatment may be administered to an involuntary
patient, including anyone under guardianship or conservatorship, only
if:
(a) The attending or treatment physician enters adequate
documentation in the patient's treatment record of the reasons for
the procedure, that all reasonable treatment modalities have been
carefully considered, and that the treatment is definitely indicated
and is the least drastic alternative available for this patient at
this time. Such statement in the treatment record shall be signed by
the attending and treatment physician or physicians.
(b) A review of the patient's treatment record is conducted by a
committee of two physicians, at least one of whom shall have
personally examined the patient. One physician shall be appointed by
the facility and one shall be appointed by the local mental health
director. Both shall be either board-certified or board-eligible
psychiatrists or board-certified or board-eligible neurologists. This
review committee must unanimously agree with the treatment physician'
s determinations pursuant to subdivision (a). Such agreement shall be
documented in the patient's treatment record and signed by both
physicians.
(c) A responsible relative of the person's choosing and the person'
s guardian or conservator, if there is one, have been given the oral
explanation by the attending physician as required by Section 5326.
2. Should the person desire not to inform a relative or should such
chosen relative be unavailable, this requirement is dispensed with.
(d) The patient gives written informed consent as defined in
Section 5326.5 to the convulsive treatment. Such consent shall be for
a specified maximum number of treatments over a specified maximum
period of time not to exceed 30 days, and shall be revocable at any
time before or between treatments. Such withdrawal of consent may be
either oral or written and shall be given effect immediately.
Additional treatments in number or time, not to exceed 30 days, shall
require a renewed written informed consent.
(e) The patient's attorney, or if none, a public defender
appointed by the court, agrees as to the patient's capacity or
incapacity to give written informed consent and that the patient who
has capacity has given written informed consent.
(f) If either the attending physician or the attorney believes
that the patient does not have the capacity to give a written
informed consent, then a petition shall be filed in superior court to
determine the patient's capacity to give written informed consent.
The court shall hold an evidentiary hearing after giving appropriate
notice to the patient, and within three judicial days after the
petition is filed. At such hearing the patient shall be present and
represented by legal counsel. If the court deems the above-mentioned
attorney to have a conflict of interest, such attorney shall not
represent the patient in this proceeding.
(g) If the court determines that the patient does not have the
capacity to give written informed consent, then treatment may be
performed upon gaining the written informed consent as defined in
Sections 5326.2 and 5326.5 from the responsible relative or the
guardian or the conservator of the patient.
(h) At any time during the course of treatment of a person who has
been deemed incompetent, that person shall have the right to claim
regained competency. Should he do so, the person's competency must be
reevaluated according to subdivisions (e), (f), and (g)."

So, yes, there is some review, but I operate on the principle that you cannot count on the justice system (and I work in it).

[Sapphire Silk]

So, yes, there is some review, but I operate on the principle that you cannot count on the justice system (and I work in it).

Understandable. However, the conditions for involuntary ECT are pretty stringent. A physician who failed to follow them and provide the adequate documentation is a) open to a malpractice lawsuit, b) open to disciplinary action by the Medical Board which could include revocation of his license, and c) open him up to a criminal charge of battery.

[wagegoth]

Understandable. However, the conditions for involuntary ECT are pretty stringent. A physician who failed to follow them and provide the adequate documentation is a) open to a malpractice lawsuit, b) open to disciplinary action by the Medical Board which could include revocation of his license, and c) open him up to a criminal charge of battery.

That's assuming the patient is able, after the treatment, to file a complaint, follow it through, and that the medical board will actually do something about the complaint, instead of protecting the physician. Here, a doctor has to kill multiple patients before they'll actually do anything about him. 80% of malpractice claims that go to trial (don't settle or are dismissed) are decided in favor of the doctor.

[Sapphire Silk]

That's assuming the patient is able, after the treatment, to file a complaint, follow it through, and that the medical board will actually do something about the complaint, instead of protecting the physician. Here, a doctor has to kill multiple patients before they'll actually do anything about him. 80% of malpractice claims that go to trial (don't settle or are dismissed) are decided in favor of the doctor.

That's true nation wide. I won't pretend that the system is perfect because I know its not. However, I don't think a physician would force ECT on an unwilling patient without considerable evidence that it was necessary. Not saying such a thing couldn't happen. Don't believe it happens routinely.

I do some legal nurse consulting on the side. I've seen some pretty egregious malpractice, true. But most of the cases have been either a case of someone who a) massively fucked up and was trying to hide it (ie, not malicious, just stupid) or b) not malpractice at all, but a massive misunderstanding on the part of the patient OR a patient unhappy about an unavoidable bad outcome looking for someone to blame or c) a minor fuckup that exploded into a major problem because of a rare side effect or complication.