Last week I discussed suicide and the challenges often faced for sufferers or those who are connected to the sufferer. But this week I will engage us in exploring the topic of hospitalization, which is often something that occurs for those who are having suicidal thoughts.
For people who have experience with psychiatric hospitals they understand that there are only a few things the hospital can actually do to help, which is why many people decide to say away. This article with highlight 6 things the hospital is not obligated or capable of doing.
For most people, the hospital for psychiatric distress is the only safe-haven for symptoms that have taken control of the individual (i.e., depression or anxiety symptoms, psychotic behaviors or delusions, traumatic stress, etc). But for a small segment of people in today’s society, the psychiatric hospital is still a whole lot worse than going to the hospital for a medical condition. Stigma has a lot to do with this.
Getting a child or adolescent psychiatric treatment in a hospital can also pose great barriers. I have had the experience of defensive or unbelieving parents to refuse to sign their child (who was hallucinating or experiencing severe urges to kill themselves) into a hospital. I have also seen colleagues struggle with convincing parents that while some hospitals are very scary prisons, there are some that are very clean, welcoming, and helpful. But for adults, hospitalization can also be very difficult.
A few reasons why includes but is not limited to the fact that hospitals cannot:
- Admit you just because you need it: This has always been a dilemma for mental health providers since the time of de-institutionalization in the 1950s. De-institutionalization occurred for many purposes but most people understand it to mean that hospitals did not want (or could not) hold patients for long periods of time. A move toward community mental health led to this exodus. Sadly, hospitals still operate on this foundation and will not admit an individual unless they are a “clear and present danger” to self or others. What this means is that the individual (right now, in this moment) must be dangerous to themselves or to other people. The person, even though dangerous or ill, if calm will not be admitted to a hospital. The hospital does not operate on the premise of “what ifs,” they operate on the premise of “right now I want to die” or “right now I want to kill someone.” Sociopaths or pathological liars are good at evading hospital staff and calming down or using charm to avoid being admitted. Clients with borderline personality disorder may lie, triangulate, or manipulate to avoid hospitalization.
- Remedy the problem: Hospitals do not hope to “remedy” the problem. They hope to gain control for a short period of time so that the person can be released into the community. In many cases, the individual may be discharged back into the community only to experience worsening symptoms at a later time. Think of hospitalization as “momentary containment” of danger and threat.
- Continue treatment beyond 48-72 hours: For individuals who are viewed as a danger to self or others may be admitted but only for a short period of time. Hospitals work like factories. They want to get people in, to stabilize them, and then get people out. I hate to say this but most hospitals work like a conveyor-belt. They send people down the same “belt” and out the same revolving door. Some people leave the hospital one week only to return a few days later stating that they are having homicidal or suicidal thoughts, delusions, or hallucinations. Medication is the only “remedy” for the person in the 48-72hr window. Sadly, most people stop the meds or even sale them once released from the hospital.
- Refer you to a good provider: Hospitals have a goal. The goal is to, as stated above, get patients down the conveyor belt and out the door. In order to get patients out the door, they need to set up aftercare services. Some hospitals are really good with this while others are not. Some hospitals contact local private practice owners or group practices (such as the one I am in) to ask if a therapist may treat the individual on an outpatient basis. It has been my experience that hospitals seek therapists who can see the individual for more than 1x a week to help them “transition” from a very high level of care to a very low level of care. I am seeing clients more than 1x a week to help stabilize them. But I’ve learned, in some cases, that outpatient therapy just isn’t enough for some and they are likely to re-enter the hospital at some point. Hospitals stabilize the patient (temporarily), transfer them to someone else outside of the hospital, and close the case. The end.
- Connect with trusted family and friends without consent: Hospitals are held liable for breaches of confidential information, even information shared with close family and friends. HIPAA (the Health Insurance Portability and Accountability Act of 1996) prohibits healthcare providers and business entities offering healthcare services to release any information on a patient to anyone who may ask for the information without a consent. A ROI – release of information or consent form must be signed by the patient to allow “outsiders” to receive information about their health and treatment. In severe cases of psychosis, schizophrenia, or bipolar disorder, the individual may not sign the consent or may refuse to communicate with family and friends. This often leaves everyone in the dark. Sadly, hospitals are not to blame. So who do we hold liable for the lack of information families and close friends have access to? The State and Federal Government. But we also cannot fully blame them because they are seeking to provide protections for people who are receiving mental health care. For most people, the entire system needs help. I couldn’t agree more.
- Admit you against your will unless you are a threat: Admission to hospitals usually occurs in 2 ways. 1.) Voluntary commitment (signing yourself in for treatment) and 2.) being 302’d or involuntarily committed by the police or a therapist. I have had to initiate and complete a 302 for at least 2-3 clients in my almost 10 years in the field. It isn’t an easy process and I often feel I need to “prove” my clients needs immediate help and attention. It is a tedious task for everyone involved, including the police because they never know what to expect from the person being admitted. Hospitals cannot admit individuals against their will unless they are a “clear and present” danger to self or others. There must be “evidence” that the person needs to be committed. If there is little to no evidence, the individual will be sent out that revolving door.
- Admit you right away: Some hospitals take between 12-24 hours to admit an individual who presents to the emergency room. I once called a hospital in advance to have my young adult client admitted to the hospital voluntarily and was told there was a “long wait for a bed.” Shocked, I asked “well, what should my client do?” I was told that she could either avoid the hospital and stay in outpatient therapy with me until her symptoms subside or come to the hospital and wait a few hours. Thankfully she was able to contract for safety (“promise” not to harm herself), stay in frequent contact with me, and go to the hospital at a later time. In some cases, hospitals may send you out of the state to be hospitalized.
What has been your experience with this topic? Do you know someone in this situation?
As always, looking forward to connecting with you.
I wish you well
Photo by orsorama