A friend of mine, who is a mental health professional, wrote and posted this on Facebook today: what it actually takes to get someone admitted under a 5150, or an involuntary psychiatric hold. It's pretty intense, but worth reading, if only to highlight the state of mental health care in this country, and California specifically.

5150

Now that Robin Williams, suicide, and the crisis of mental health is once again in people's minds, I would like to grab some of this attention to bring to your awareness what actually happens when a suicidal person or a person in an acute mental health state faces when they need help in our current mess of a health system.

I have found that there are many mental health professionals who do not really realize how hard it is to actually hospitalize someone on, what is called, a 5150. That is the term for an involuntary 24 hour to 72 hour hold. Most people seem to assume that when a person is severely depressed to the point of planning suicide or a person is so deep in their psychosis that you are worried they will hurt themselves or someone else that it's just super easy to call the police or some other form of help (like mobile crisis) to get them evaluated and put into a psychiatric hospital where all the issues will be magically whisked away and the person will return to their previous state with a spring in their step and a rose in their teeth.

It doesn't go that way.

First off, it is really quite difficult to get someone 5150'd. Pretty much someone has to be already in the act of stabbing themselves or lighting another person on fire before they will be taken in. On some rare occasions, their psychiatrist has pushed and gotten the referral. Most psychiatrists don't spend very much time with their clients and are not particularly involved enough to advocate for an involuntary hospitalization even if their client really needs it. Even if the person is legally conserved because of their history, the conservator may not be able to have the power to 5150 the client. I have so many stories of people on the brink of hurting themselves or someone else, but they were not taken in on a 5150 because they did not meet criteria. Some of these people, only an hour or so after the police left, hurt themselves so badly they needed months in the hospital.

In America, we don't prevent. We patch up what has already happened.

Lots of people think that someone who is extremely delusional and talking about all sorts of disturbing visions or thoughts or possible actions should certainly qualify as gravely disabled.

Well..... no.

Gravely disabled means that they cannot take care of their basic needs. This means that they cannot feed themselves and that they cannot take care of their own hygiene. If they can get a part of a sandwich out of a garbage can then they can feed themselves. If they can wear clothes at all, even if it has been on them for weeks, then they can clothe themselves.

Once you do succeed in the amazing achievement of having someone admitted to the hospital before anyone is hurt, there is entirely another battle ahead.

Will they actually get help?

You should know that, at least in Alameda County, a person is admitted to the Psyche Emergency Services waiting room and then they will sit there for hours. When I say hours, I don't mean like "Dude! I waited 8 hours to get a ticket for the John Bon Jovi Reunion tour!" I mean, like 32 or 75 or 96 hours. And, don't think you can relax and watch some of your favorite movies to pass the time. People are screaming in PES, they are masturbating, they might be having sex, they might be shitting themselves, they might be aggressive. You just have to sit there. If someone gets too rambunctious then they will get a shot and get strapped down. None of this is fun. None of this is really great if you are a suicidal person with a trauma history just waiting to be evaluated.

Normally a person will be evaluated around 12 hours or so. At this time, the doctor decides if they are okay to leave or if they should stay longer. Often the staff prefer to have the person leave. There is rarely any room anywhere for anybody and they don't know where to put a person. If a person tells their mother that they are going to act normal in order to get out so that thy can commit suicide, and then they say all the right things to the psychiatrist, even if the mother relays the info that the patient gave them, the psychiatrist on duty may solely rely on the patient presentation and then release the client. And sometimes the client will then commit suicide.

AND just because they have been evaluated does not mean that there is a bed. They may be tossed back to PES for days and/ or nearly a week until a bed opens up. While they wait they cannot have any personal items lest they harm themselves. This makes good sense… except for the fact that it is insane to ask a person to sit in a waiting area with nothing for four or five days.

This practice is called "boarding." Boarding has been a national problem for quite some time.

"Overcrowded U.S. emergency rooms have become a place of last resort for psychiatric patients. Psychiatric boarding, defined as psychiatric patients' waiting in hallways or other emergency room areas for inpatient beds, is a serious problem nationwide." September 2010

http://content.healthaffairs.org/content/29/9/1…

Once they actually get into the actual hospital they might have a bed there for a week or two weeks. Maybe they can get transferred to a longer term hospital for a month. Maybe even six months. Most of this relies on room. There is never very much room. And if there is not enough room, then they wont be admitted. Or if they don't want to be admitted, then they probably won't be admitted unless they can continue to meet the criteria for extended involuntary hospitalization, called a 5250. And so then it is back on the streets with two weeks of psych meds which they may or may not take and which may or may not help. They don't get cab fare or bus money when they get out. They just have to figure out where to go and how to get there when they get out the front door all by themselves. So, think about it. You have this person who has felt terrible, and because they felt terrible they were put in this horrific situation in order to help them, and then they were evaluated and then just released out the front door with a new bottle of meds and no supports.

I just want to ask you, is this a system that is working to help those with mental health issues?

by Katie K., LMFT