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Archive for Sunday, July 12, 2009

State addresses process of confining mentally ill

Workers: Involuntary commitment remains option of last resort

July 12, 2009

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Twice in the past few years a Lawrence-area woman named Cait has had her freedom taken away from her.

Cait, who asked that her last name not be published, didn’t commit a crime, but she suffers from bipolar disorder and required being involuntarily committed to a psychiatric facility after police stopped her from attempting suicide by jumping from a bridge. Police took Cait into custody and she was eventually taken to Osawatomie State Hospital.

The involuntary mental health commitment process Cait experienced remains a misunderstood, but regular process in Kansas. In 2008, an average of three involuntary commitment petitions were filed with the Douglas County court weekly, and last year nearly 400 people were involuntarily committed to Osawatomie State Hospital.

Last resort

Mental health workers and advocates say the process is an option of last resort for mentally ill individuals who pose a risk to themselves or others.

“It deprives someone of their civil liberties,” said Susan Crain Lewis, president and CEO of Mental Health America of the Heartland, a Kansas City, Kan.-based organization providing services to the mentally ill. Lewis said that’s why the process is reserved for cases where someone is an imminent threat to themselves or others.

She said that there remains a misperception that people acting bizarrely in the community should be hospitalized, despite the strict circumstances in which the involuntary commitment process occurs.

“It’s not a crime to be mentally ill,” Lewis said.

Kansas law mandates that in order for someone to be involuntarily committed for mental health reasons, they must pose a danger to themselves or others.

Ganice Heims, a mental health screener at Bert Nash, said this could include someone who is suicidal, poses a threat to someone else, or in cases when a mental illness severely affects people’s ability to take care of their basic needs.

In Lawrence, the process is usually initiated by mental health screeners at Bert Nash, who must first determine whether people meet the criteria for hospitalization.

If they meet the criteria, Heims said the first option is to convince them to go to a psychiatric facility voluntarily.

“Most of the time, they’re willing to go,” she said. But when not, mental health workers begin the process of an involuntary commitment by filing a petition with District Court. After the petition is filed, the person is taken into custody by law enforcement. The person is then cleared medically at a hospital and transported to a mental health facility, such as the state-run Osawatomie facility. Some may also go to a privately run psychiatric facility such as Cushing Memorial Hospital if they have medical insurance.

Once at a mental health facility, the goal is to stabilize the patient through medication adjustments and therapy, and the court continues to have authority to determine when someone should be released. Those committed are entitled to a hearing with a judge within 48 hours of their commitment to assess the need for continued in-patient treatment.

‘Not the solution’

While sometimes necessary, the involuntary commitment process is one that should be avoided, if possible, said Rick Cagan, executive director of the Kansas chapter of the National Alliance on Mental Illness.

“Going to the state hospital is not the solution,” Cagan said. “The goal is to treat them at the community level.”

Cagan said the expense, and trauma, of an involuntary commitment is too great, and efforts should be aimed at preventing hospitalization.

Those efforts should include educating family members, the public and police about how to deal with those experiencing significant mental health issues, Cagan said.

Traumatic experience

The involuntary commitment process can be a traumatic experience for those who go through it.

“One of the worst points of my life,” Cait said of the process. “(It’s) the ultimate feeling of hopelessness.”

Cait describes the humiliation of being handcuffed and transported to the courthouse with those going for criminal issues.

“It’s mortifying,” she said. “I didn’t commit a crime.”

Cait is now out of the hospital as her mental illness has stabilized, and she is assisting with efforts locally to organize crisis intervention training for police in how to handle encounters with the mentally ill.

And despite some of the problems Cait experienced, she said she is thankful she was committed and prevented from hurting herself.

“It was what was needed at the time,” she said.

Comments

Leslie Swearingen 5 years, 5 months ago

It is important that people learn to distinguish severe mental problems from annoying behavior. Few of us are qualified to diagnose others be it a physical or a mental illness. The families of those who have a serious illness should have more support in dealing with it.

Kathy Getto 5 years, 5 months ago

It is painfully obvious that there are at least a few of Lawrence's mentally ill that have not been committed. Some are dangerous, some are not.

pace 5 years, 5 months ago

Cagan said. “The goal is to treat them at the community level.” While we closed hospitals and beds for the mentally ill, we cut funding for community programs.

Dan Eyler 5 years, 5 months ago

It all depends on the level of illness. Depression is treatable. Personality disorders are far less treatable and are a sucking sound of resources for those more treatable. The mentally ill that I see on the streets of lawrence I think clearly fall in the catagory of personality disorders or psychosis. Stays in the hospital simply settles them down and outpatient therapy is for the most part a borderline waste of time and money.

Leslie Swearingen 5 years, 5 months ago

Now, now kansasfaithful, I have been diagnosed at Bert Nash with a personality disorder and my medication is doing the job just fine, thank you. Because of my therapy at Bert Nash and my meds I am doing well in my life. Obviously to me this was not a waste of time or money. I am sure my family and friends do not think so as they are very happy I have this treatment. I have a home, I pay my rent and bills on time. Your attempt to shame those with mental problems will only make it worse. Because of people like you I was too ashamed to seek the help I needed. I am glad I got over that. Mental illness is like diabetes in that it cannot be cured and the patient must be prepared to take medication for the rest of their life and stay on the treatment plan.

Dan Eyler 5 years, 5 months ago

Hey Irish glad to hear you are doing well. You hit right on it and from my personal experience with family the trick is staying on meds and therapy. But even you know as well as I do that most personality disorders do neither. Those are facts from bert nash. But I am very happy for you! As are your friends and family.

kansasrose 5 years, 5 months ago

I was witness to a friend being 'treated' for suicidal behavior not long ago at LMH and it seemed pretty obvious that LMH doesn't have the resources available to help people in crisis.

The room that this person was sent to, which apparently is supposed to be more private, more secluded, was just a little nicer, and that's all. And, it seemed that this person who was very very vulnerable, was asked all kinds of questions before being sent to the more secluded room and asked to make treatment decisions when they were clearly not in a state of mind to do so.

It bothers me a great deal that her treatment decisions were driven by her insurance card and the answers to the long list of questions she was asked. 'Why did you try to hurt yourself?' seemed like the sort of question a person might want to reflect on before answering, or, may not even know what the answer is. But, it was asked, within earshot of the nurse's station, the other e.r. rooms, with no curtain closed, nothing. Was she comfortable? She was never asked while I was there. Was she cold? Was she thirsty? Nothing. The emphasis wasn't on helping her, but, shipping her OUT to another hospital. That was the goal: get her OUT of here.

This system is so broken.

By 4 a.m., this person was just being transported to a KC area hospital! She had been in the hospital for 11 and a half hours, without a meal, with just occasional small glasses of water. But, she was asked very detailed questions, when she was clearly not very stable. It just doesn't make sense.

I don't blame the staff. In fact, I applaud them for doing what they could, with the nonexistent resources. But, asking a suicidal person 'why did you try to hurt yourself?' within earshot of the nurses station, within earshot of other patients, illustrated that the emphasis wasn't on the patient, helping them, protecting their privacy, but getting information.

Those with mental illness for the most part, continue to be treated as people with defects of character, and not sick people who need to be treated.

notajayhawk 5 years, 5 months ago

kansasrose (Anonymous) says…

"The emphasis wasn't on helping her, but, shipping her OUT to another hospital. That was the goal: get her OUT of here."

Well, um - yes. As you pointed out (a few times) LMH does not have the staff or resources to treat mental disorders. If the person in question was suffering from a cardiac condition that LMH wasn't equipped to handle appropriately, wouldn't the goal be to assess, stabilize, and transfer the person to a facility where they'd get adequate treatment?

"But, she was asked very detailed questions, when she was clearly not very stable. It just doesn't make sense."

And you suggest what - they should have taken an x-ray, done blood tests? Unlike physical ailments, we can't take a picture of what's wrong with a patient suffering from a psychiatric condition. We have to rely on what the person tells us (and from observable behaviors, from which we can infer some things). It may not seem like the patient can answer the questions, but sometimes the lack of an answer or a bizarre answer tells the clinician just as much (or more).

kansasrose 5 years, 5 months ago

No, I do not suggest taking an x-ray. Blood tests, yes. I think what would have made alot more sense is to let this person get some rest, become more stabile, perhaps let the medications she had ingested get out of her system and then go from there. Asking someone who is exhausted, emotionally very very fragile and half asleep, 'why did you do this?' seemed pretty useless. How about, 'what can we do to help you feel safe now?' And, for some people, they sure won't know.

I've been down this road with loved ones many many times and the system is very very broken.

notajayhawk 5 years, 5 months ago

kansasrose (Anonymous) says…

"No, I do not suggest taking an x-ray. Blood tests, yes. I think what would have made alot more sense is to let this person get some rest, become more stabile, perhaps let the medications she had ingested get out of her system and then go from there. Asking someone who is exhausted, emotionally very very fragile and half asleep, 'why did you do this?' seemed pretty useless."

Sorry, wasn't aware there's a blood-test that can detect suicidality. Maybe you're aware of what they'd be testing for?

'Why did you do this' is a pretty important question. For one thing, it helps determine whether there's a chronic vs. an acute condition, and/or whether the person is responding to an immediate stimulus (which may have passed) or if the condition is likely to linger. And it IS important to know what they are thinking right at that moment, not after they "get some rest [and] become more stabile." If there is any need for acute-care hospitalization and any chance of convincing a judge to grant an order for such, then you have to act while the person is in the condition that prompted the presentation.

LMH is not part of that 'system' you keep saying is broken. The purpose of any general medical facility's ED in such a case is to assess, stabilize, and refer. From your description, they did exactly that. It is not their job, and it would be beyond their scope of practice, to attempt to treat the individual you referred to, just as it would be for them to try a multiple-organ transplant they do not have the staff, facilities, or resources to do properly. Perhaps you believe they should have a psych unit there (as I believe they once did) - if there were enough patient bed-days to justify one, they'd still have one.

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