[Guest post from Nephron -MN]
For the past fortnight I have been an inpatient at a very pleasant private hospital for a manic episode. In my state, private hospitals are not legally allowed to take involuntary patients, so I had to come in voluntarily and agree to stay there.
However, about 18 hours into my stay, it occurred to me that I really didn’t want to be in hospital, and that I would rather go home. I was going to tell the nurses that I was going to head off, when something else occurred to me- while I was a “voluntary” patient at this hospital, that doesn’t preclude the nurses from putting a 6 hour emergency hold on me while I’m transferred to a less pleasant public hospital where I can be held involuntarily.
I considered trying to lie to the nurses about my plans*, but I didn’t think my ability to keep my mouth shut was up to the task. In the end, while the urge to attempt to discharge myself against medical advice was in the forefront of my mind for 3 or so days, I never did attempt it.
(I’m a bit better now, and I’m rather glad I didn’t tempt fate, as it were)
I’m not sure what I’m hoping to achieve by posting this? Other experiences in the same vein? Ethical discussion? Stream-of-consciousness rambling?
*I suspect I might have been able to be held under the “risk to self” and “risk to reputation” criteria.
** I probably wouldn’t have been held involuntarily anyway, a nice nurse would probably have listened intently to my concerns and given me a very large dose of PRN medication. Shortly after, my major concern would have been finding my pillow.
Good post Nephron. Intrigued by “risk to reputation”
I was likely to go to work in a day or two convinced that I was cured (I’d called in sick to work because I felt a bit scatterbrained but had planned on going the day after) being completely incompetent. No one would have let me practice after seeing me in action for 2 minutes, but given my reputation as a hermit, I don’t think my colleagues needed to hear that my one-night stand was fine in bed “but he wouldn’t stop talking, is there a way to just make them shut up? I’m not interested in his brains”
Uh, colleagues, patients and visitors, at full volume and high speed of course.
Well, I have been told, on being presented with the Irish 1947 Mental Treatment Act form, ‘listen, you can sign this, or someone else will’. Technically I was voluntary, but if I had tried to leave I would have found myself at the bottom of a rugby style ruck.
Still, the whole point of a hospital for me is that I can’t run out and jump in the river or in front of a bus, so I wasn’t bothered at the time….
Risk to reputation is a clause used in some Mental Health Acts – which covers things like hypomanic spending or sexual behaviours or just acting a Dilbert in public. (Not read up on it as it’s not in my geographical area – just educated guessing)
It’s contentious – as it says more about social intolerance than mental incapacity.
Well, part of the risk to my reputation was that I might go to work, make an utter (potentially dangerous, but certainly humiliating in retrospect) boob of myself and lose my nursing registration which would have been a bit of a disaster.
“Supported. It is recommended that in amendments to Section 3 (Interpretations) a definition of ‘danger’ is included and covers the concepts of “risks to health, financial security, social standing and risk to reputation”. This would enable treatment to be commenced before an actual act of self-harm or harm to others occurs. ”
A quick Google search gave me this post, then the above comment (dredged from Google cache). I thought Nephron was suing the phrase … ummm … non technically.
You live and learn.
The closest I’ve ever come to being admitted was that old chestnut, “Do as I say, or I’ll have you sectioned and get it done that way.”
That was close enough, and unpleasant enough of an experience. Shame for the doctor in question that I was wholly unsectionable, he must of known that and was probably banking on the fact that I wouldn’t (he didn’t bank on the wonder that is Google).
I changed doctors after that.
Differently
I’d just like to say that in this case I’m glad I was held “voluntarily” rather than placed in the public mental health system as an involuntary patient- I’d still be there, probably lingering as an involuntary inpatient for some time, while some fine fellow decided to label me with a personality disorder diagnosis on flimsy evidence and based on my mother’s personality and treat me thusly. Eventually they might allow me to leave on a community treatment order compelling me to take their ridiculous medication regimen for 28 days.
I don’t like the public system :/
Nephron> was this in the USA?
Australia.
ta- I asked as pretty much all hospitals in the UK and Ireland will take sectioned patients and voluntary ones, state funded or private.
I guess it’s sort of a good thing that private hospitals can’t take sectioned patients- can’t forcibly have patients paying to stay or some such?
There are probably three main times I can think of where an “involuntary voluntary” status is used (ie – stay or we’ll make you stay)
1. I don’t have enough collateral to make an order – but once you’re in hospital another doctor or the nurses can stop you from leaving and I’ll let someone else assess you and take responsibility for not-sectioning you.
– This is bad.
2. You’re doing all the right mental things to get the label – except you’re not a danger yet. So we’ll take you in and just see how we go, eh? If you decide to leave when I say you need to say; that means you’re lacking insight – and you became more dangerous for not agreeing with me.
– This is bad.
3. You tick all the right (?wrong) boxes – but I’d much rather not put you on an order – because that shit sticks and yo’ve got enough to deal with. So how about I tell you to stay – and you choose to agree with me?
– Is this still bad?
I think it was mostly 3- I have a history of admissions to this hospital, I know the staff and I’m generally happy to follow their direction (even if I knew they were blind wrong as in this case) since I respect them know they’re trustworthy people and would never do anything to harm me.
I think the premise is “You’ve voluntarily shown up to hospital even though you might meet criteria to be an involuntary patient, it’s a lot less distressing to voluntarily accept treatment than be compelled to take it, and our environment is miles better than the public hospital system”.
And I would argue that 3 is the lesser of two evils- it’s not good practice to be duplicitous, but at the same time it’s not nice to put someone through the experience of being an involuntary patient in the mental health system.
It is the one argument that causes me to take pause when I hear of doctors saying – He’s involuntary until he tries to leave – because it’s in the patient’s favour in the face of society’s somewhat petrified frigidity on what to do with people with the mental lurgy.
But I wouldn’t have a problem telling that to the patient as you are offering them a (lesser evil) choice.
Mr Ian> my view on this is that if I am ok to not to myself outside hospital, then I don’t need to go in. I need to go in if I am in imminent danger of killing myself. I am little miss insight just now but assure you I am not when I have been admitted!
If I can therefore do a runner as I please the hospital is no good tome. However the voluntary patientarrangement suits me as it means no inconvenient questions on immigration land cards for places such as NZ, no having to tick a box to answer ‘Have you ever been sectioned’, and so on.
Indeed D-D – but not all possess that same conviction or confidence in themselves and sometimes the patient seeks the service to take the decision-making process out of their hands – sort of ‘sick role’ stuff; or like having ya mum take care of you.
In those circumstances the doc may well make you feel as if you have no choice but to ‘choose’ to stay – but in reality, they perhaps wouldn’t go as far as sectioning. Not a lot different to how ‘normal’ patients are ‘held’ in general health wards – when “the doctor says you can’t go home yet” …. as if they actually have that authority.
From an anal perspective – either section or don’t is a far easier scenario to deal with in the moment, probably more for the staff than the subject person – but there are longitudinal consequences that occur and once the sectioning/detaining process is started it’s not so easy to say – “hang on, perhaps I’m being a bit rash”
nephron, I live in Australia too and I have been in a private pleasant psychiatric hospital – the major difference between a private hospital (apart from better food, cleaner showers etc) is that when you go to a public hospital you will almost always get given a label of personality disorder.
The only time you can ever be scheduled (sectioned) when you are a voluntary patient in a private hospital is if you expressly threaten self harm. If you are at risk they will get you to sign a discharge against medical advice and guarantee of your safety. Its all about protecting their legal behinds otherwise you can discharge no matter how unwell you are.