Have You Ever Spent 72 Hours Behind Locked Doors?

Note: Trigger alert for those who may themselves have been hospitalized.

A question that strikes fear in the hearts of many who could not conceive of a mental health crisis and an all too real experience for numerous people in the United States. Involuntary commitment is defined as: “a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is court-ordered into treatment in a psychiatric hospital (inpatient) or in the community (outpatient).”

In Florida, it is referred to as the Baker Act, so named for Representative Maxine Baker who was dedicated to the wellbeing of those with psychiatric conditions. California’s code is known as 5150 and Pennsylvania calls it a 302 Commitment. What it comes down to is that if a person is a danger to themself or another, the code is invoked. A petitioner, who could be a friend or family member, a police officer or medical professional files paperwork to assist with acquiring treatment for someone they perceive falling into that category.

Having worked for more than a dozen years as a licensed social worker in inpatient acute care psychiatric hospitals, I have witnessed my share of involuntary hospital stays. I have attended countless 302, 303 and 304 hearings and have solidly supported some and questioned the necessity of others. Entry into the hospital may commence with a 72 hour stay that can enable a treatment team to evaluate the person to determine if they are to be imminently discharged or compelled to remain longer.  A bio-psycho-social evaluation is completed by a nurse, a social worker and psychiatrist. It is meant to assess the functioning of the individual on all three realms and may include questions about mental health history, current symptoms, support system, spiritual concerns, as well as personal safety for self and others. Once the person is settled in to the hospital setting, a treatment plan is created and adapted depending on needs. A multi-disciplinary team which includes the aforementioned professionals, as well as mental health techs, dieticians, psychologists and allied therapists begins the work of commencing the healing. Group therapy was the primary modality in the settings where I was employed, with one to one sessions less prevalent. It was my contention that more clinical work would have yielded better outcomes. As a social worker, much of my role was case management and discharge planning. Feeling like a concierge, I would joke that I was a real estate agent, since I assisted people in finding a place to live, a transportation coordinator, since I helped them get rides to their destination, a peacekeeper, since I offered family and couples counseling, a personal assistant/scheduling secretary and (tongue in cheek), a ‘drug dealer,’ since I made sure they had their medical and psychotropic prescriptions filled with they were discharged (enough to carry them through until they could see an outpatient psychiatrist).

My intention always, was to treat patients the way I would want to be treated if I was in need, and adhering to the ‘mother standard of care,’ the way someone would want a family member tended to. Most of my colleagues would be in alignment with that paradigm. Sadly, this is not always the case with other clinicians I encountered over the years. Because of their own perceptions of mental illness, some were lacking in compassion. That sometimes led to reactions from patients that could have otherwise been prevented or de-escalated in a safer manner for all concerned.

National Alliance on Mental Illness (NAMI) is an educational and advocacy organization that provides support those living with mental illness, as well as for their families and friends. It is an important resource for those who want to support someone new to the.  They conducted a survey that inquired of respondents their impression of the care that they and family members received when seeking ER services in a psychiatric crisis.

One response was, “I felt like I was criminal. There were guards around me that did not talk to me at all…I was made to feel as if I had done something wrong.”

Such experiences prevent people from seeking the help they need to regain and maintain stability. The shame and stigma involved with mental health diagnoses also infiltrates the beliefs of those charged with providing care.

A few weeks ago, I discovered a game that is called Inpatient, designed by Alana Zablocki, who herself had been ensconced behind those locked doors. The designation may be misleading, since it is more a ‘what would you do?’ series of exercises/questions when faced with choices based on circumstances in the hospital. I paged my way through it and found myself nodding with agreement with the accuracy of events and interactions, and becoming frustrated and dismayed with the professionals who were interacting with patients in ways that were not adhering to what I would deem appropriate treatment. It is available for anyone to experience by going on the website. Those who offered feedback on the simulated journey, find it to be true to their own experiences.  

Mental health professionals would find it helpful to put into perspective what clients experience, by diving into the narrative. Knowing this might assist with essential advocacy for those with psychiatric diagnoses and make for more compassionate treatment alternatives.

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