I am no expert on mental health crisis intervention. I have only seven personal experiences to base my opinions on. Nonetheless, it is not a stretch to say that there are some major flaws in the system that should be addressed. I know I am not alone in such an assessment and hope that we can share our ideas for how to make it better.

In trying to better understand all of the points of view, I have spent a lot of time discussing it with all sides of the debate. I gained some great insight from those who identify themselves as part of the anti-psychiatry movement. I could be wrong, but it seems that much of the hostility that they have comes from bad experiences when in crisis. I have a unique perspective on such experiences because I was once hired to stay with someone during his lockdown in a psych facility. I saw first hand how bad it can be while I had the clarity to know what was going on.

74 Comments to
How Do We Treat A Mental Health Crisis?

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  1. Hi ecoli,
    Anyone who would pooh pooh something that you found that works is not interested in making things better. It sounds like you found a wonderful person to help and perhaps we should all consider the possibility that we can find more solutions by looking outside of the system that is not working so well. If someone was to turn to you for help they would be very lucky to have found someone who really cares.

    I know your experiences were horrible and inexcusable, but you became a better person from having been through them. Thank you for sharing your insights.

    Hi Colette,
    As you know, I have been looking for an excuse to visit Australia for a while now. Maybe we can make it sooner and visit some of these ‘Official Visitors.’ It sounds like a program that needs to spread around the world.

  2. Hi Tom

    Ha ha ha. You can google ‘Council of Official Visitors Western Australia’ in the meantime.

    Colette

  3. I was really glad when my husband was placed on a 5150 hold, because he clearly needed to be in the hospital and he wouldn’t have stayed there if it hadn’t been for the hold. However, I wish the hospital had allowed me to stay with him, rather than limiting visiting hours to 90 minutes a night.

    When I had appendicitis, my husband stayed with me 24 hours a day. When he was hospitalized, he was extremely disoriented and confused, and the fact that he had such limited contact with me didn’t help at all.

    During a crisis, you want the people you love to be nearby. I don’t know why mental hospitals take such a restrictive approach to visitors.

  4. Hi Heather,
    Great point. It makes no sense at all the way they treat us different from other health crisis situations.

    Although, with some of the families I have seen maybe it is a good thing…

    Perhaps the right system is for us to define it. If I am in crisis and I feel like having someone with me it should be my choice, not the choice of the clinic or the family member who pushed me into the crisis in the first place if that is the case.

  5. Tom, thank you for your kind words. Although I certainly am not glad to have been through these experiences, it did help me to realize that I and other people deserve better than this. I have met some incredible people along the way who have reached out to me and been that light in the darkness when I needed it, I hope that I can do the same.

    What I like about your blog is that you remind people that we are not diseases, we are individuals and as such there is no one size fits all answer here. I think the U.S. could stand to learn a lot from other places that seem to be able to provide treatment in a humane manner, like New Zealand, etc. We have to do better.

  6. Hi Ecoli,
    Thank you also for your kind words about what I am trying to do. I do have one issue though – what do you mean “Like New Zealand, etc.?” I thought we had The Best Health Care In The World™ – which is a major part of the problem since we refuse to see that other’s actually do it better. We being the US, not we as in those of us commenting here.

  7. In my experience, family and friends just turn their backs and hope i’ve forgotten their numbers.

  8. Hi Leo,
    It is great to hear from you. I hope you are doing well. You are so right that people abandon us when we need them the most. I have done it myself when I didn’t know what to do, so we need to forgive them if we can, but perhaps find others that we can count on.

    I have been thinking a lot today about what Heather said. I remembered the time my wife called the police on me for being depressed. She was the last person I wanted to see for several days. It was a rough time, but our relationship became much deeper after working it out and coming to an agreement that she would never do it again without first consulting with my doctor.

    If we want to prove Bipolar In Order is an advantage we need to be the ones who repair the damage instead of hoping they will. They are doing the best they can and if they really love us are not doing it to harm us. Those friends we need to renew. Thank you so much Heather for inspiring me to ponder what you said all day.

  9. Tom, truthfully, I don’t know that New Zealand is any better. I haven’t exactly been a psych patient there. It would be interesting to hear from patients there to see if what I read is accurate.

  10. Dear Tom,

    I am convinced this is an easy issue to solve.
    Common citizens who do not understand the difference in various mental illnesses ask the government and police to protect them from danger and assume violent individuals are violent due to a mental illness as portrayed in so many books and movies. Until we educate the public to understand that having a mental illness and violence are not natural partners then I believe we will see little success in trying to make things change even if 5150 becomes 5149 or 5148…..The good thing about the term 5150 is that everyone involved knows there is a person suffering with a mental illness and they are being discreet in relaying that message to medical personnel. Changing the names ( clients or patients to consumers) or numbers from 5150 to 5149 only distracts from the real issues.
    Having a Voice and to Educate, to end the Stigma associated with having a mental illness is the answer.
    I think our society as a whole has little time for individuals before, during and after a crisis. We should have more drop-in treatment programs at clinics, churches and hospitals where we can receive help without appointments.Find solace before problems arise and get aftercare interventions when things go wrong. Having to schedule a mental health crisis intervention is like tying your sneakers with your feet, it’s impossible, yet you feel like it’s so close you might actually make it. Many times individuals seek help just before a crisis and don’t get help because they get turned away. I think healthy (well) client visit appointment with your doctor is always a good idea, but vital when you have a mental illness and or are taking new medications. I wish we could get more insurance paid well visit appointments periodically. Doctors should get to know individuals so they have baseline information on who that person is and how they look and feel when they are well. Many times I can visually see when someone is not doing well if I know them personally.
    We must have good solutions to every situation and let the public know that having a mental illness is not problematic so that jail is no longer the only alternative. Having a mental illness is like having cancer it can be cured, resolved or go into remission if we get the proper treatment.

  11. Hi Brenda,
    I love the way you point out issues and possible solutions along with them. It is important that we see the issues of course, but without solutions they will not change.

  12. Dear Tom,
    I read all the comment in reaction to your article about dealing with crisis. I still remember how scared I was being 17 committed to a state hospital in 1965. i had no idea what was going on. The people on the locked wards scared me. It would have been nice if someone treated me humanely and walked me through that experience. They gave me one set of shock treatment and then insulin shock. I had no say over anything. They pumped me up with Thorazine. I was in a manic state, depressed and paranoid.
    It took another seven years in and out of hospitals before I was corrected diagnosed and medicated. I hated myself every time I was in a psych ward or hospital. I spent a total of two years in such places between 1965 and 1972. I wrote about my struggle with bipolar disorder on my web site.
    Then things started to turn around. I learned how to hold down a full time job and saw a private psychiatrist for over ten years.
    In 1972, i was put on lithium which helped put a brake on my episodes. Back then manic-depression was a diagnosis not used that often. Today I believed it is over used.
    There were certain vital things I learnt from the private doctor. I learned about the cyclical nature of my illness and to keep a close eye on my sleep patterns and what to do if my sleep started getting compressed. The ant-psychotic I was on was raised then for the duration of my episode, the brought down to maintenance doasge.
    I never ever forgot his immediate responce to a question I asked him, “Do I have a right to lead a normal existence, get married, maybe have children?” I felt cursed. He said right away, “You have as much right as any one else.” I felt like he saved my life with that response.
    In 1987 I married, had two children right away. In 2003 I divorced. She “pushed’ me off my anti-psychotic med and I had a bad breakdown.
    I have used too much space already in this comment. I did remarry and this time it was a better fit.
    To make some quick comments regrading your article. I do not call hotlines. I still have episodes. I do not usually share my paraoia with anyone. I have difficulties in crowded areas. I over the years have developed a natural network. I do not trust all professionals. They are too quick to hospitalize you.

    I know who is trustworthy. I go to a very well run community mental health center. I know what meds works for me, what to expect, what a therapeutic level and how quickly meds works.
    I value my individual freedoms highly. I take whatever measures I need to take to stay out the hospital. I may be on disability now but it does not mean I do not reach out to others. I do. I am a survivor but I thrive.

  13. I’ve been thinking about this topic. I think part of the problem is that many mental health professionals have decided that the reason patients end up in crisis is because we lack insight into our illness and stop our meds. So, therefore, they see no problem with responding in a forceful manner because we’re nuts and our opinions don’t mean anything.

    I don’t know that we’re going to get anywhere if patients’ opinions aren’t respected. My parents were taught that if patients stop meds it’s because they lack insight due to their disease. That was the end of the story. Nevermind, that many patients stop drugs because they cannot afford all the copays for these cocktails they’re put on, or they cannot get in with the psychiatrist for a month or more, or the psychiatrist doesn’t take insurance, or the side effects are intolerable, or when they call about the side effects the psychiatrist doesn’t bother to call back, etc.

    So, the system is sort of set up to wait until patients are in crisis to get help. How many patients who work full time and are functional can just take off all the time during business hours to sit in a psychiatrist’s office? I can’t. I have to work, so if I need to see a psychiatrist well then I’m going to have to wait until I’ve lost my job and can come as needed during business hours. Of course, then I wouldn’t be able to afford the psychiatrist so I would be on a waiting list for charity care and on and on.

    So, while it’s convenient to blame patients’ mental health crises on their lack of insight, it’s missing the real problems. If people won’t acknowledge the root of the problem, then it’s not a surprise that there’s such an issue with developing solutions.

    I really believe that if people had access to quality care where they were treated with dignity and respect, many if not most patients would continue with treatment. People don’t appreciate being treated disrespectfully and having their thoughts/opinions disregarded. In addition, many of us don’t have the ability to pay mental health professionals out of pocket. Blaming anosognosia, as so often happens, is a cop out.

  14. cool

  15. I’d like to see a room that is comfortable, a bit of soft color on the walls,pperhaps a mural a recliner, a bed, and a chair for the person who has been taught to know when to say nothing and listen, without judgement, offering water and healthy food. Also taught how to talk in a soothing none insolent way, but reasuraly, that this is only temporary. Many times my crisises were precided by several days of not eating, or sleeping becouse I just didn’t have the time.

  16. I love that idea! First the staff members would actually be open-minded and understanding and would really care and hear what you say. They would be amazing and open-minded enough to know (like my psychotic; astral reality while in-body experience) that it’s not all inaccurate. Some psychic things really do happen and others could be more thought formy since it’s, to me, being mentally at the astral level only being in-body instead of out-of-body which I’m used to being off and on. It’s still astral but the rules of the dream reality are delusions on the physical plane like hallucinations being thought forms. The staff would be aware and open to that kind of thing. Where I went wasn’t that bad like other full places and hospitals I have heard of. I can’t think of that many ideas right now. They were good on the floor I’ve been to. A good example is when I was having a panic attack thing where I was crawling and couldn’t stand up. It was the OC(D or no D) scary styled disturbing kind of thing like if things were there that shouldn’t be there or they extend or multiply… That didn’t happen, but it was that kind of OC or whatever it was thing. The amazing nurse/staff told me to get up off the floor in a nice way. I asked why not sarcastically but really asking and she was amazing enough to say the right answer; because it was dirty. I couldn’t stand up though then I remember sitting on my bed then crawling again. I told them either the first or second crawling that I was having a panic attack. That morning when my memory came back I was manically trying to tell them that it was OC styled or whatever that is by moving up and down like bouncing saying OC over and over thinking ‘for some weird reason’ that they would actually think of or consiter what I mean, but the nurse/staff member who still worked there 3 years later in 2008 is one of the most amazing staff on the floor. Other places that are staffy like the school for the blind (including developmental disabilities) actually had worse more normalizing “correcting” staff members than the floor did. I think the main thing though is for the staff in 49 to be more understanding and other good qualities.

  17. It is my hope to work towards teaching people how to reground and stabilize themselves like with reorienting to their surroundings, and to self quiet in their home environment, and like another said to have a med plan that increases during increased stress and tapers down with feeling more stable. Experiencing mania myself I never want to face an inpatient hospital again. So I think a 12 step program would be helpful so patients with a diagnosis could link with others of same diagnosis and support each other at least by telephone and then make support groups where they live. This thought would break confidentiality boundaries for other diagnosis but with Alcoholism and Narcotic abuse they do it so why not for people who suffer from bipolar or depression? I am all for NAMI but I see it as advocates not at the ones experiencing the illness and its long enduring affect on ones life. We need coping skills like so many have mentioned from one who lives with it and deals with it every day. Any thoughts? I think there would be more advocacy if you had a “sponsor” like AA for example especially when you are on the outs
    with familly or having problems with “fair weather friends” I am still dealing with that one. I use meditation, affirmation, and light therapy to support taking a low dose anticonvulsant. But other thoughts are appreciated.

    • Hi Lynn,

      I am so glad to read that someone besides me sees the potential in a bp anonymous program! I wasn’t exposed to AA until recently, when I was taking a health psych. course ( I’m a pre-nursing student) and one of our homework assignments was to attend a meeting as an observer. The experience was nothing like I thought it would be, aside from the coffee, colored chips and introductions, it was amazing. When I left I remember wishing that there was something like that for people with BPD. I have tried going to support groups and ended up feeling enormously disappointed. The overall tone of the group was “supportive” I guess, but no one but me wanted to talk about making any real changes. Everyone wanted to share their frustrations and rail about injustice, but not much was said about doing anything differently. When I spoke up about neuroplasticity and wanting to find a treatment plan that would help me to rewire

    • … oops… Posted prematurely.. I was saying that I wanted to figure out a way to train my brain to work in a more orderly fashion, re wire it, so to speak and they all looked at me like I must be off my meds.
      In contrast, at the AA meeting, the whole thing was geared towards making positive changes, healthier choices, acceptance, and what could everyone do to help each other.
      I love the idea of a twelve step program for BPD! That may be just the ticket for some crisis intervention that happens before it escalates into a 5150 situation. The sponsors could be graduates of BP INorder.!!
      Tom, if I was to do some research and find out how one would go about starting something like that in my area, say by going to more AA meetings, and generated some interest, etc. would you be able to see if you have any graduates in my area who would be willing to volunteer their time to something like that??
      That would be a godsend!
      Thanks,
      Melissa

  18. all the times my partner has been hospitalised when having a severe manic episode he was just litterally doped up to the eyeballs and left shaking and dribbling this is in the uk he was in and out of hospital for several years missed a few christmas with our son which he still feels guilty for but it wasn’t intentional so he shouldnt feel guilty. when he was working in germany he got sectioned for 6 weeks and he said that they used to make them do exercise and talk and it was a much better aproach than he had had in the past when in the local ‘nutty ward’ as many ppl called it. i think it all depends on the person my partner seems to think he is more clever than any doctors he sees or psychiatrists its almost like he is arrogant about it. iv said in anothe rpost that he now sees a cpn mental health nurse who comes to see him twice a week more if he needs to talk and help with anything that is beyond me.

  19. PAD: psychiatric advance directive

    From the most excellent blog post and comments, here are some of the main themes that have emerged:

    Essential needs:

    Dignity protected
    Respectful
    Family/significant supporters’ unrestricted presence
    Advocate present
    Comforting
    Reassuring
    Coaching
    Partnering
    Truthful and transparent information
    Autonomy preserved
    Planning for post-crisis self-management
    Safe medication administration (right drug, right dose, right route, right time, affordable, accessible, acceptable)
    Tools for successful disease management and healthy living provided

    Environment:

    Medically therapeutic
    Eliminate law enforcement/incarceration/containment aspects
    Clear written rules – same as hotel room/gym/spa rules of conduct – NOT punitive/control/power-based

    Health:

    Healthful foods served appealingly: open kitchen
    Privacy for rest and sleep
    Ability to get sun, green space/nature and fresh air as desired
    Meeting rooms and lounges for care, socialization, quiet activities (meditation/exercise/reading/contemplation) and care planning
    Clean, attractive and non-odiferous patient care areas

    That doesn’t look like to much to ask. In fact, it looks like the run of the mill hospital quality standards for every other service except psychiatry.

    You might approach the Joint Commission about these ideas to see how they can be translated from the already existing standards of care and practice in general hospital units to psychiatric units. That would formalize the standards, and it also ties meeting them to institutional accreditation and federal and state reimbursement eligibility. In other words, $$ talks. (grin)

  20. I’ve heard lots of stories about how bad involuntary confinement can be, but what other options are there besides a 5150 when the person with the problem refuses to admit it? She has a psychiatrist and is taking some meds, but the meds don’t seem to be doing enough and she won’t tell the psychiatrist all the details of what’s going on. She’s hurt herself, she’s talked about killing me and herself, she’s done a couple things which seem borderline suicidal though she always denies it after the fact. She screams a lot. A couple days ago it all started getting worse and i set up an emergency visit to her psychiatrist but she refused to go and yelled at me about it. A little later it looked like she was trying to burn herself and she refused to give any explanation when i asked her about it, so i tried to take the lighter away. She started screaming again, this time so loudly the police ended up getting called. But when they got there she said it was just a misunderstanding and nothing was wrong, and even though i told the police, and later a CAT team, about what was going on they said there was nothing they could do as long as she said she didn’t need help and didn’t appear to them to be a danger to anyone.

    She was so angry at me she left the apartment and hasn’t been back since, we know where she is and she’s been sending us text messages, but some of them are very strange. She’s still insisting there’s nothing wrong, and if she comes back and starts screaming and/or hurting herself again i’m afraid that i’m going to end up in jail for supposedly abusing her :( If she won’t go to the ER or talk to her psychiatrist on her own then what else can i do???

  21. There has certainly been some major developments in how the world interacts”

  22. It can be very usefull to remind an abusive staff member that mabey right then they have the ability to be abusive but to think about when you see them outside on an even playing field. Be descriptive about how abusive you can be towards those who abuse you first. Now you may be thinking is it wise to make threats ? If they take you to court over it tell them you were crazy at the time. Case dismissed.

  23. Tom:

    “5150” is not “police code” as you state.

    It refers to Welfare and Institutions Code 5150, which was developed in response to the *truly* horrific conditions that mentally ill persons were subjected to, *before* we had legislation that attempts to address real-time mental health crises in the community. It is far from perfect, no doubt, but, it is a great improvement on what came before. Please investigate what predates the birth of that 5150 legislation if you want to be truly horrified. There are a lot of imperfect persons, writing imperfect legislation, actually attempting to make the world a better place. That includes the doctors and law enforcement working to fulfil obligations and meet overwhelming demands on staff, budgets, and bed space. Look at funding patterns and decisions if you want something to be mad about. Dr. Bea Madd

  24. Tom:

    One more thing. I am not sure of your professional background, or how long you have spent in forensic mental health settings, but, I would encourage you to form a partnership with a psychologist and join them at the hip for 6 months. Not one day, one stay, or one individual.

    Everything. Everywhere. Every admit. Every time. Permit yourself to see a) the enviornmental conditions, b) the staffing/education issues, c) the funding and related issues, and d)the reality of working with ill and sometimes violent or dangerous individuals. Not discounting the very real criticisms that can be launched at the system, but, until you actually know the system, then, well…

  25. A. A. That will just win you more time in ‘the bin.’ The point is that staffers shouldn’t BE abusive. One shouldn’t have to threaten (which is what your post sounds like – a not-so veiled threat) to have a staffer pay attention to you / your needs. I have not been hospitalized, but I have seen enough just going to the doctor’s offices to know that. Where I go, the clerk just points to row of chairs and tells you to ‘wait.’ Nevermind that you have an appointment a ‘x’ time. They don’t give a crap. What would happen if, instead of saying ‘wait until we are outside,’ you looked him/her in the eye and said “I am a human being and although in here, still worthy of dignified and decent care?” I think they might not know what to say. The more obtuse among them might just mumble that you’re crazy and walk away, but there’s not much you can do about them.

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