Suicide, Self Injury and Hospitalization: Can your therapist have you hospitalized?
Suicide, Self Injury and Hospitalization:
Can your therapist have you hospitalized?
On March 7, 2009 someone posted this comment entitled:
"Distrust of Therapists"
"I was hospitalized for self-injury and thoughts (not plans) of suicide and while the increased medication and enforced hospital stay did not help, I am now very afraid to report my true feelings to anyone and have actively avoided therapy, leaving me with no one to trust.
In the US, ethics usually doesn't have anything to do with it: as my callous former therapist explained to me, he was having me hospitalized because federal liability laws encouraged him to do so. These laws permit relatives of suicides to sue mental health care workers for neglect, and that's why you see rampant over hospitalization of patients in America."
The anonymous writer of the posting cited above raises an interesting moral, ethical and practical dilemma for patients and their psychotherapist. The dilemma has to do with the question of when it is or is not proper to have a patient sent to the hospital emergency room?
Whether the therapist is a Licensed Clinical Psychologist, Licensed Clinical Social Worker, Psychiatrist or Licensed Marriage and Family Therapist, there is an obligation on their part to intervene under certain types of circumstances. By "intervene" is meant that they must report that someone is in imminent danger. This obligation overrides laws of confidentiality. The reason for this is that, under these circumstances, it is clear that a patient is in danger of committing suicide or homicide. If there is clear evidence that a child is being abused, the therapist must report this, as well. Outside of suicide, homicide and child abuse, the laws of confidentiality hold sway.
How does "reporting" really work?
In the case of a patient whom the therapist is convinced is in danger of suicide, a call can be made to 911 to report the suicide and have them go to the patient's home. In all of my years of practice there was one occasion where I asked 911 to come to my office and pick up the patient. I had to cancel my afternoon schedule to get this accomplished.
Other steps that can be taken are to call family, friends or neighbors and have them take the patient to the emergency room. One last possibility is to get the patient to go voluntarily go. The problem here is that, if someone is really suicidal and they are left to their own devices there is a good chance that they will attempt suicide.
Here is the KEY POINT in all of this:
Once sent to the emergency room of a hospital, there is absolutely no guarantee that a patient will be hospitalized. Instead, the hospital emergency room will do one of two things depending on where you live: 1. They will transfer the patient to a psychiatric hospital for evaluation or, 2. They have their own psychiatric emergency room and will do an evaluation right there.
In doing the evaluation, a group of psychiatrists, psychiatric nurses and clinical social workers, will decide whether or not the patient is truly suicidal and in need of hospitalization. Contrary to what the anonymous writer states above, it is not easy to be admitted to a psychiatric hospital. This is the reason why there is no such thing as "over hospitalization" in the United States. I have seen, on numerous occasions, where patients, brought to the hospital emergency room by 911 the emergency response team, were sent home.
In order to further elaborate on just how difficult it is to accomplish a psychiatric hospitalization, even if 911 is sent to the patient's home, the emergency response team does an immediate evaluation and can decide that a trip to the ER is not necessary.
In my opinion, the writer of the note above, was admitted to the hospital because she was deemed to be dangerously suicidal.
I cannot and will not defend the actions of every therapist because I do not know who they are or how well trained and experienced they may be. However, in the case of those therapists I have known, from New York to Colorado and California, the only time they will call 911 is when the fear for the safety of the patient.
What about self injury?
There are too many people, both male and female, who injure themselves. The most common type of self injury is probably self cutting, often with a razor. The cuts usually leave scars that bear witness to the self cutting. As a result and in order to hide the scars, people wear long sleeves even during the summer and long pants. Cutting occurs on the arms, legs and other parts of the body.
The goal of self mutilation is rarely connected to suicide. Instead, the strategy is to feel the sense of calmness that is followed by an episode of cutting. It is speculated that this calmness stems from endorphins that create a almost a euphoric state.
Therefore, it is unlikely that a therapist will feel impelled to report self cutting. Of course, there can be exceptions as for example, if it is believed that suicide is the intention. Just to repeat, suicide is very rarely the goal of self cutting. It should go without having to say it that there is always the risk of cutting in the wrong place, hitting an artery and causing a deadly bleed out. In my individual experience I have not come across or read about such an occurrence.
In by opinion, a psychiatric hospital will not admit a patient for self cutting unless the evaluating team lead by the psychiatrist, determine that the individual is suicidal. This even happens in cases of Anorexia Nervosa in which a patient will not be admitted unless the body weight places them in danger of death.
In an age where hospital and medical costs continue to surge and in which health insurance companies are reluctant to reimburse, it is unlikely that anyone will be admitted for frivolous reasons.
It is true that trust is a key element to the successful completion of a psychotherapy. There are those times where a therapist may decide that a visit to the emergency room is important for a patient. In my experience, that happens with mutual cooperation between therapist and patient. Even in the case where I asked 911 to come to my office, the patient was cooperative, In fact, that individual was admitted and remained for quite a lengthy period (by today's standards, one week) and was not angry upon returning to treatment.
Trust is important because only with trust, can a person be willing to talk about all that they are thinking about and feeling.
To answer the question within the title of this essay, a therapist can attempt to have you hospitalized if he has determined that you are in danger of attempting to kill yourself. However, in no way does that mean that, after being taken or going to the emergency room, will you be admitted. Only if you prove to the emergency room team and even the emergency response team, that you are suicidal, will you be admitted.
Your comments are encouraged.
Allan N. Schwartz, PhD
Self Harm Got me out - Todd - Mar 10th 2015
I was hospitalized and warehoused twice. Self harm behaviours emerged the second hospitalization. It was the reason I was released.
Note to Self - Self harm = freedom
Doctor I dont agree - gts - Oct 16th 2014
It is far too easy to get hospitalized. I had to *FIGHT* to keep my son from being committed. and all he was doing was pretending to have seen a castle up in the sky, which we all joke about from time to time, and because he did this on a couple occaisions, the stupid teacher actually thought he was serious. Plus, when he copied something from a movie he heard ("i wish I were dead!) he was joking there too but they took it all serious and It was all I could do to keep this under-experienced not-even-a-doctor-yet (yes, an ER PA like doctors even exist in emergency rooms most of the time anyways) from making him admitted. I hate the way the schools and the psych doctors are gung-ho to just throw any kind who doesn't act ""normal"" or actually has an imagination, into therapy. They did this same thing to my daughter too, they are forcing her to go to a counselor just because she is a little hyper and talks alot. I mean come on... these snoopy old ladies have nothing better to do (and men) than to try to ruin someone else's life because their life probaby is so darn boring that it must be for a thrill and the $$$. And don't tell me insurance doesnt pay, most people in my situation are on state-supplied insurance and they pay just fine, even before your actual date of start coverage! sheesh!!
wow - paul - Oct 9th 2014
people getting help is not easy to do hospitals are all booked up in phyic cant get a apointment at all a lot of people need help now............
Too True - - Oct 1st 2014
there actually isn't a problem with over hospitlization, but with under hospitilization. A lot of people that are currently in jail would not be if they had gotten the proper help before commiting their crimes. The criteria for involuntary hospitilization is really very strict. Immenent danger.
I myself was placed on a 5150 hold a little over a year ago by my psychiatrist. I was getting out of a very bad relationship, and the things my ex said and did pushed me over the edge. There was enough left fighting to get through it that I called my therapist who saw me the same day, then got me scheduled to see her and the psychiatrist the following day. She asked me numerous times if I wanted to go into the hospital that first day, and I refused. I wasn't, at that time, an immediate threat to myself, so there was no justification to a hold.
The following day was a different story. The continued abuse at home from my now ex b/f was the straw that broke the camels back. I almost didn't go in, but there was a teeny teeny tiny little voice that didn't want me to hurt myself that made me go in. Managed to make it through the psychiatrist appt, but saw my therapist immediately after who didn't fall for what I was telling her, and ultimately got the psychiatrist to come in and reevaluate me, and long story short (without going into further detail) i was admitted against my will. Initially I felt horribly betrayed, but once I was out of that dark place, I knew they did the right thing, because I sure wasn't thinking clearly. They had my back when I didn't.
Yes, don't ever say you want to die - - Sep 15th 2014
That statement from 2 years prior was used against me by my daughter to the police. When i admitted it was a 2 year old statement and I no longer felt that way, they believed her lies of me having a sharp object, of having a gun and more. Even though they searched me and found nothing they still handcuffed me and took me to the hospital on a 5150 (I had no idea what that was). And since I was not insane or mentally disturbed as my daughter claimed, I co-operated and was released very shortly afterwards. I have no idea the ramnifications of a 5150 and what options are no longer options as a result of it even though I was evaluated as no threat to anyone or myself.
NEVER tell anyone that you want to die! - - Aug 19th 2014
After my husband walked out on me after 31 years of marriage, and I was sick with a bad infection, I told my divorce lawyers I just wanted to die. This was just talk! BAD decision. If anyone tells authorities that you MIGHT want to take your life, then you lose every right you have as an American citizen. These opinions of others are just that, opinions. They are not specialists, psychiatrists or even in the medical field. They have no idea of the HELL they are sending you to. Woe to the person who gets committed on a 5150 in California. Without any proof, anyone can get you committed for at least a 72 hour hold, and in my case, transported immediately to a desert hospital 4 hours away because I argued with \\
Brother committed horrific suicide attempt - Masha V. - Jul 15th 2014
Hello, my brother recently tried committing suicide leaving the most grotesque blood bath I have ever seen...it took several hours and numerous bleach cleaners to get rid of the blood stains. However he called me when he was already passing out from blood loss and convient left the door open to the apartment. I called the police immediately and they took several minutes to secure his wounds and gave him an oxygen mask. It was a scary experience but once they brought him to the emergency rooms none of the nurses nor the doctor wanted to hear my side of the events that might have lead to.this incident. My brother in his teenage years abused every drug known to man kind and than finally became.clean recently. He even.quit smoking however since his soberity he started to develop angry outbursts to the point where I can't remember him ever having a normal conversation without it turning into a violent rage. He doesn't live with me for those reasons. On.top of a short fuse he also told me about his deep paranoia of the government placing chips into his skull and his neighbors spying on.him everyday. His stories are quite entertaining but When I see fear in his eyes I know.he really believes this...like he once told me two girls were sitting on benches and saying he had aids while he was walking by them. He began to admit he wanted to hurt them or himself. but the worst incident happened when he took the family dog for a walk and started beating.her so badly that people walking by had to stop him. I've finally got a hold of his psychiatric and she told me to keep closer eye on him. He finally attempted suicide after an argument with my mother and now the hospital is keeping.him in the psych ward however they want a family meeting.and he is certain he will be released. I am extremly worried about this considering he has began.to threaten my mom with harm because he claims she is not his biological.mother which is not true. My question.is how do.you keep someone in the psych unit when they are a harm to others? If.some one told me he would be capable of being a serial killer I would not be surprised.
MENTAL HEALTH AND THE NAUGHTY - Kathy - Apr 3rd 2014
I read your article and I was astounded at how many things you said literally made me wonder if you WORK IN THE SAME SYSTEM I DO. I live and work In Rural AZ. I will tell you that the State of Arizona has the absolute WORST, I mean THE WORST PUBLIC MENTAL HEALTH SYSTEM I HAVE EVER SEEN IN MY LIFE.....however, often people are hospitalized WHO ARE DTS (danger to self). The law-it doesn't say suicidal, it says A DANGER TO SELF OR OTHERS, and I will be darned if cutting yourself with a dirty razor really IS DANGEROUS. YOU ARE LUCKY you have never seen the aftermath of a cutter hitting a vein or artery...it looks worse than a horror show! I have seen it with my own eyes...the lady lived in a camp trailer which was later condemned because of the amount of blood that was spraying from this lady! Also I have worked In Many different areas around the country, and whether a person is hospitalized or not depends MORE on the doctor that is tasked with decidling who gets admitted than the symptoms a person presents with. I have worked with doctors who admit anybody who DARES TO SAY THE \\
Suicidal or not?? - - Aug 2nd 2013
My son was taken to an emergency room after hanging over a motorway bridge and a member of the public called the police here in the UK. He was 18. He was given a brief assesment and was considered to not be clincally depressed and released in less then 24 hours. Our GP was not contacted before his release and my son had told the services he would not take his own life. Our GP was aware my son suffered OCD and was having violent outbursts at home. She at times would call our home and ask me if I could talk as I was so scared to even talk in front of him sometimes. He then unknown to myself missed a follow up apointment and I have been told mental health services tried to call him to no avail (again unknown to myself) I was told nothing! He then went on to commit suicide earlier this. I am ruined he was my youngest son. How can this happen. Why would so-called professionals take the word of a boy that was clearly so ill. I trusted there lack of contact with myself was a clear indication he would be ok as after all I am not a therapist. How is this even legal??
beating myself - - Jul 8th 2013
how about constantly beating myself to wear i loose vision and cause myself to have swollen face and black eyes and bruised body parts?
Release from Claims - Cheryl - Mar 25th 2013
I am considering a counselor in Boulder who is asking me to sign the following. I hereby release XXX from any and all claims, causes of action, demands, or damages resulting from advice or direction given to me by XXX. I hereby agree NEVER TO INSTITUTE ANY SUIT OR LEGAL ACTION, OR AID IN ANY SUIT OR LEGAL ACTION, REGARDING THIS CONSULTATION. I UNDERSTAND AND AGREE TO THE FACT THAT XXX IS NOT RESPONSIBLE FOR ANY AND ALL CLAIMS, DAMAGES, OR LIABILITY, OR ANY KIND OR NATURE, INCLUDING CLAIMS OF NEGLIGENCE, RESULTING FROM INFORMATION RECEIVED IN MY PSYCHOTHERAPY WITH HER. I don't want to sign this document. I do not want to assume in advance that this counselor will not be negligent in caring for me. I do not want to release her from professional liability in caring for me. Any thoughts?
just curious - - Mar 21st 2013
I am 23 years old i have adhd ... sometimes i feel like hurting myself .sometimes i explode with anger ...i have an appointment with a therapist ..if i am honest about this will they commit me .
papers - snazzy Jain - Feb 9th 2013
i dont trust anyone when i comes to my mental health. My X-husband had me transported to a hospital for "eval" because my 14 y/o asked me why people do it, i wasnt telling him to do it, or that i wanted to, my son tried to tell the EMT's what was going on as did i but they took me away. no one believed me! im at the hospital and they had a judge infont of me saying sign these yourself, or he signs your court order to go. i couldnt leave the psyc ward till i told the docs exactly what they wanted to hear! 3 months later they let me go! 3 months of pure utter hell! i get out i learn im divorced, and can not have contact with my child!
Excuse to Violate your Rights - - Dec 28th 2012
A couple of weeks ago, I overdosed on prescription drugs. 4-5 days later I woke after being in an induced Coma for that time. I was tied to the bed, tubes going down my throat and nose and had NO rights what so ever. I could not even go to the bathroom without someone humilitaing me. After the hospital stay I was FORCED to go to a phyc hospital. I am filing suit against the hospital for violation of my rights, the ambulance for kidnapping and holding me against my will and the phyc hospital for the same grievences. I was forced to stay at the phyc ward that night and then cut lose the next day. I just told them what they wanted to hear. These people don't know me and afte I told them I would not pay a dime to be there against my will I was released. Humm sounds like a money game to me. My choices were simple: I let them transport me and put me in the phyc ward or I'm handcuffed and Ordered by a judge to do the same. What choices were those. The only lesson I learned is that NO ONE will EVER take my liberty away from me again. Now I have NO-ONE to talk to or express my feelings for fear that someone will try to kidnap me again and that would cause someone else besides myself to get hurt. I've never harmed anyone other then in war. But now what do you do when you hurt, only regret is that I did not die 2 weeks ago, but can't trust anyone to talk about it.
Reasons for admission - Dee - Dec 7th 2012
A counselor can (and should) have you taken to the ER for an evaluation to be admitted if you are suicidal, homicidal or if you are gravely disabled, meaning if you aren\\\'t eating or taking necessary meds or cannot care for yourself. My boyfriend was falling apart after the death of a friend, he had not showered in a while, looked disheveled and one day was at a bus stop crying. A police officer stopped to ask him if he was ok and my boyfriend at that time told the officer he was really sad ...he was not suicidal or threatening, but he was taken by the cop to a psych hospital since he was so disheveled dirty clothes and was standing there crying. The cop waited in the lobby until the admission nurse called my boyfriend d in to evaluate him. He stayed inpatient there that time from August to September of 2011...
Only a Psychiatrist or Counsilor can have you hospitalized? - Sayrah - Nov 20th 2012
What about regular family doctors or just regular people off the street? Can they report you to someone and have you commited to an institution or hospital to be evaluated? That was my main question and why I read this article, it might have been answered but I didn't read EVERY comment sorry. If you could answer this I'd appreciate it.
what the hell - - Aug 14th 2012
my girl friend and i live in wyoming she had a little to much to drink and claimed to have 7 flexarail or what ever and called 911 to get attatchen from me becase we were fighting ems took her to er. 8 hours later the sic came to see her and they wouldent let me see her when i asked and when she asked she thought i broke up with her and she was really down. i finnaly got to see her after the sic told me she was going to casper for a 72 hour hold. its weird becase the cops that were their said shes fine a nother doc came in and thought she was fine and wanted to let her go but the papers were sent and that was that. the sic was her old counciler from 2 years ago and i guess she dosent think people change.will she did she worked a job for a year and had 1 more test to take for a manager position. the doc at er said will i guess u have to go for the day , then i found out on friday night when she got their she had to stay sat sun before her 72 hour even began i have bipolar adhd my self and im not doing good my self becase i really cant take care of my self forget to take meds ate 1 pizza in 4 days i need her out any body no how to get her out
Not a therapist, but a MD - - May 13th 2012
I have a question or two, and a few statements for you Dr. Schwartz.
How is it possible for a M.D. to have someone committed? This happened to me just a few months ago. I Live in South Carolina, and i needed a family doctor.
I had only seen this doctor once. On our first visit she prescribed antidepressants because I told her i was feeling very depressed because I'd injured my back on my job, I was out of work, out of a relationship,and feeling really low..
When I had my follow up with the doctor she asked me how the meds were treating me, i told her that i did not really feel any different, It had been less than a month since I started taking them. she said she would prescribe something different for me..
she asked me during that visit (the second) if I felt like hurting myself, I said No.
She said "if you did think about hurting yourself, how would you do it"? The first thing that came to my mind was, 'well, i could drive my car into a tree'. and with that being said.
I was sent to a Pysch ward where it went from bad to worse. I was treated like an actual criminal. I was told by a doctor their that if I did not sign a paper saying that i wanted to be evaluated, she would have me committed anyway.
She said it would look better for me if I just signed the paper...Nothing -I told this particular doctor at the pysch hospital ended up in my file. What did end up in there was NOT what I told her or it was extremely twisted from what I said..
I was held for almsot 3 days because this doctor said that i told her that I had a plan to kill myself...that could not have been further from the truth...there was a whole lot of things that happened in between being committed and being released, none of them nice at all..i never knew someone could be treated so badly...
from the first doctors office, she callled an ambulance to bring me to the pysch hospital, and i was telling these guys what had happened up to this point, and was told by the EMT that this doctor was now doing a CYA move...what was that I asked..."Cover your a&&" move, I was told...This reference was also repeated by at least two of the nurses at the pysch hospital after i told my story up to that point..
How could this happen. I keep asking myself...I need to see a doctor right now, but thanks to what this doctor and subsequent doctors, did to me, I will just suffer through..
I'm afraid to say how I feel in fear that this will happen to me again...I never said I wanted to hurt myself, and that was not the question I feel got me committed by this doctork,but regardless of that, this was not right,and I feel like i've been violated...
Disagree - KO - Apr 12th 2012
Author states that it is not that easy to be sent to a psychiatric hospital. Actually, it is too easy.
I'm no stranger to mental illness, as I have a husband with combat related PTSD and an adult child (barely) with mental health issues. My youngest, however, is not effected.
But she's a normal teen, growing up with certain differences within our household, nothing major. She recently has been going through what I deem, "growing pains" and "character building" where some of her emotions are being dictated by circumstances, some of her own making and others of just plain life. When she confided in her older sister who is mentally unwell, and who is also an emotional danger to most of us in the house (she doesn't live with us) - and manipulative, clearly stating her goals to have us all in "therapy" because her perception of herself is that of us too... she ended up calling 911 on our youngest daughter after our youngest contacted her and said "Life is worthless". We don't have meds, alcohol, or guns in the home. My youngest made it clear she would not ever cut herself. She is extremely solid in her choices to not use drugs. And she has no mood disorder.
Yet... the cops "HAD" to take her in. They even said they were between a rock and a hard place. The arrogant overreaching "counselor" (who was dressed like she was going to the club after work, young, obviously personally inexperienced outside of clinical training) basically backed me into a corner and I felt as though I was facing involuntary vs voluntary if I agreed, so I took the later. Within 24 hrs the psych hospital that original ER counselor sent her to released her, no meds, and only a recommendation for counseling. THAT'S unheard of, as these places are big pharma mills.
Lesson learned for our daughter, be careful what you say because the system will jump at the chance to deem you unwell. Everyone feels sad, everyone has a moment of negative thinking at some point, especially teens. And, some parents are highly tuned into their own kids and would not allow harm to come, while others chose to look the other way and unfortunately, have faced a suicide of a young person (know many, who claim it was out of the blue, but quite obvious they weren't seeing a problem). I vehemently resented the process whereby my intuition about the situation was ignored and overridden, but in the end, that counselor has her indemnity, and my opinion was immediately accepted by the doctors there (in addition to my daughter's wake up call about saying stupid things in a moment of sadness).
agree with poster - student - Jul 20th 2010
The psychiatrist on campus had me hospitalized for the same reasons. I was told I could go willingly or be escorted off campus by the police in front of all of my peers. Of course I went voluntarily. Once admitted I immediately requested release and that I be evaluated by another psychiatrist to determine if he/she agreed with my hospitalization. The hospital staff and so called advocate ignored me. My psychiatrist whom I had made clear I did not want treating me, harrassed and bullied me relentlessly and no one on the ward did anything. He said if I did not withdraw my request to be discharged he would have me involuntarily commited, therefore being sent to a "lower class facility" where my safety would be questionable. I don't know about your state but DC has made it easier to commit people, that's how they keep the homeless off the street so they won't offend the tourists. And unfortunately we all get the same treatment. A clear abuse of power. I refuse to see any mental health professional now.
can't trust anyone - angry linda - Jul 10th 2010
the town i live in does not have qualifed mental health professional,s ,,,,they are struggling to keep their program going , I also was ina very scared way,since i have very high anxiety [panic attacks ] someof these people aren,t barely out of colledge,I was trying to talk about my problems and was commited and treated like a criminal and thrown into withdrawel ,from caffine ,nicetine ,have a very bad back, had a rock of a mattress and straight chairs ,cut my pain medicne and my anxiety med. i was also worse when i came out ,57 year,s old , have been told i was Agoraphobia ever since was in my 20,s , never bi polar,now i know what a night mare lithium is .GOD in Heaven ,step in and help us !!!!!
Self Injury - Allan N. Schwartz, PhD - Jan 14th 2010
Sadly, the Colleges and Universities are well aware of the problem of students self injuring. The reason is that self injury has become too common among college aged students. In my opinion, it is very important that you are honest and open with your counselor. That is the only way you will be able to get help.
Please understand that it is common for those who self injure to keep it a secret. You may believe you have a good reason for secrecy but, actually, its part of the illness.
I support your going to the counselor and hope that you get all the help you need.
Thanks! - CM - Jan 13th 2010
I am finally making the step towards seeing a therapist at my University and have an intake interview in a few hours. I have been on and off self-injury for the past 10 years or so, never to the point where my life was at risk (i.e. stitches). This is an issue I need to work on, and find healthier coping mechanisms to deal with my anxiety, but am afraid to mention in to the therapist, especially at a University, as I'm afraid they will misunderstand it, viewing it as a suicide attempt or immediete risk, and try to commit me somewhere. I think I will phrase it as something I have struggled with for a long time but do not currently engage in (which is nearly true, I only relapse occasionally) but am seeking therapy because I feel it looming around much closer than I am comfortable with. I am actually in the psychology/human services field and therefore understand the responsibility that the therapist may feel. I hope all goes well, this article was very helpful. Thank you!
update - karen - Jan 4th 2010
Hi- this is an update of invol hold fr last year. I finally got up courage to pick up medical records at behavioral hospital,. I found mention that I fell but, examing doctors did not list
bruises on arm. (I had a friend take pictures) later.
I also had a blood sugar reading of 193, I now know I'm prediabetic. I would have liked to have known that my blood sugar was that high. No one told me. also note that I was supposed to be under 15 minute .observations for 72 hrs. this only occured for 48 hrs. I was allowed to close door and left by self for 3rd day. This was fine with me, but I read the last 24 hrs report and it has intitials of staff checking on me.
I don't blame them for writing their initials even though
they didn't check room, just point it out.
I't too late to do anything about this report, but I just hope that doctors might consider that some patients might be vulnerable to some medical negligence when they involuntary hospitalize
no lawsuit, just mistrust
response to comments Oct. - - Nov 17th 2009
I wanted to thank you for your concern, but I have decided that not to pursue a complaint about the hospitalization as I really feel that the doctors that 5150 did not do anything illegal in their actions. I had some issues focusing that caused me not to undertand what was happening to me at the time.
I have other pressing concerns, financial and health that
I have been making a priority.
As a result of the hospitalization I now qualify for disability, my regular psychiatrict did an evaluation for me.
I tend to agree now that the "hospitalization" turned out to be a "good" thing as it helped my case for disability retirement.
It is unfortunate, however, that I still remain so "paranoid" that I can't imagine having therapy.
But, with PTSD it sometimes makes it hard for a person to focus and trust.
It's hard for someone who does not go through this to understand what paranoia can do to a person.
I want to thank Dr. Swartz for letting me participate in this forum.
Who do we trust? - - Oct 7th 2009
Therapists having the right to hospitalize patients makes it sometimes hard for honest communication. For this a reason I never tell my therapist I am in danger of killing myself. It's just one more thing I have to worry about. I undersand their resonsibility. I trust my therapist but this causes me great distress and forces me to find other means to talk about how to deal with suicide. It's just makes it hard for me and feel I need to keep it inside which is overwhelming. What is a safe outlet? Who do I trust, with a secret most will never understand.
Hospitalization - Allan N. Schwartz, PhD - Oct 7th 2009
Actually, the laws do not dictate hospitalization and a therapist cannot force a patient into hospitalization. I would even add that I did not answer purely in the affirmative. The only time when someone can be hospitalized is if they are clearly sucidal or homicidal. Even then, if the patient gets to the hospital emergency room, the staff will do there own assessment. If they deem that the person is suicidal or homicidal, they will hospitalize that individual.
Court orders??? This just does not fit. People come to psychotherapy because they choose to, of their own choice and volition. Remember, I am not discussing attending a clinic or out patient psych service. This is completely private practice and court orders do not fit or have any relevance. I, for one, would never accept a court ordered patient. Force is counter productive. People I work with and have always worked with are NOT ON THE LAMB, so to speak. So, I am puzzled about where you are coming from.
Private practice is a comfy and safe place. Even the few people who have been hospitalized from my practice, over the years, returned to me afterwards, pleased with the results and with no resentment because they knew it was necessary.
I really believe you are thinking of something very different.
Location... - Questioner - Oct 7th 2009
"court order" was meant as the courts directive to hospitalize a patient.
The confusion here (I see on other boards as well) as there are horror stories, there is also a balance of what happens.
Typical scenario is you go for help because of thoughts of sucide. You're told that honesty is necessary to 'heal' in therapy but then when you are honest, the laws can dictate hospitalization which might be more traumatic than the patient is ready to experience, especially in their current status.
So, can a therapist get a patient hospitalized (which you pretty much answered this as an affirmative) but what if they can't locate the patient due to 'a move' or a wrong address given, etc. Will they keep searching for the patient or will they let the patient go? The reason I think so many area asking is because the police is involved, does it state it on the records? How does this happen.
Thank you in advance!!
-inquiring minds want to know :)
Panic and Location - firstname.lastname@example.org - Oct 3rd 2009
I hope you win in court. After the way you were treated you deserve to win, not only on your own behalf but for many others who could end up being treated that badly.
I know people who prefer a male therapist or a female therapist and that is fine. In my experience, it is the quality of the therapist, as a human being and as a professional that is most important. However, I support you fully in prefering a female.
To the person who writes about a suicidal person not being located, I do not know what you mean by "court order?"
Unable to Locate - Questioner - Oct 3rd 2009
Thank you so much Dr. Schwartz, this is an excellent web site! However, I still am curious about locating those that perhaps did not provide a form, or perhaps lied about the information.
Additionally, how long does the court order stay open? Perhaps they can not locate the person but if the person surfaces months later, does this mean they have this on their record? Can they use insurance to locate the person?
Address - Allan N. Schwartz, PhD - Oct 1st 2009
Hello Questioner and others,
Any licensed and competent psychotherapist, whether a Psychiatrist, Clinical Psychologist, Licensed Clinical Social Worker, always, at the start of or prior to the first session, asks patients to fill out several documents. These documents include addresses, phone numbers, emergency contacts, etc. They also ask patients to complete a HIPPA form that informs them of the therapist's credentials and rights to privacy, including the state agency to contact if the patient has a complaint to file.
In thirty years of practice in the field of mental health there was only one person who flatly and absolutely refused to provide me with their address and phone number even after I informed them that I therefore could not see them.
Unless a patient has run away I cannot imagine not knowing where a patient is or where family or friends are whom I could contact.
I will admit this: If someone is absolutely, 100% intent on taking their own life (very rare) nothing much can be done. That is why suicide attempts can happen despite our very, very, very best of intents.
We, in this field, are not here to hurt people but to help. I have know many people who were close to considering suicide but with hard work realized that life was worth living and went on to live those lives.
If you are feeling suicidal please reach out for help. Help is available, especially today.
How do they find you? - Questioner - Oct 1st 2009
This question wasnt answered but I wanted to know as well:
What if they can't locate the patient? - Blair - Aug 26th 2009
What if a therapist reports that someone is suicidal however they do not have their home address or way to reach them? Then what? Do they research to find the person or do they just let it go? Do they trick the person into being 'caught'. How does this work?
an update - karen - Sep 27th 2009
This is an update. I made 10 copies of a photograph that was taken of my left arm last October 2, 2008. I fell and received very large bruises on my arm while in the mental hospital. I asked the staff for an ice pack and they never furnished me with one in three days. I am giving picutres of the arm to the pastor of my church, some close friends and my psychiatrist (not involved in the hospitalization, but helping with disability). The pastor of my church has worked in mental health settings and supports me in filing a complaint against the ER doctors to the California Medical Board. I know that I will probably not win a lawsuit, but I cannot live with what I believe is possible fraud on my medical record. I requested the medical records 100 pages and was told that it wa mailed to me in July, but apparently the whole record was returned to the hospital. I paid $37.00 for this so far. I cannot believe what appears to be either incompetence or "the runaround I have had to endure this year.
serious panic attack - karen - Sep 5th 2009
Hi- I had another really serious panic attack which lasted for almost a day this week. It was the first time I actually thought I was going to die alone in my sleep. I had not slept at all the previous night. I went to an ER where I was treated with respect, listened to and a gentlemen actually drove me as he is diabetic and was concerned about my driving. They tested my blood sugar and it was 113. They were extremely courteous and I appreciate the professionalism in the way I was treated.
I was able to use the phone and get a message to my psychiatrist ,which was all I needed last year.
Even though I was unable to focus, I at least had my medic alert bracelt and I felt more secure.
I would have gladly gone to a hospital for observation this time since I was allowed to contact friends to feed my cats if necessary, since I felt that I was being listened to. But I was released with sleeping pillsafter a few hours. So it is possible to listen to an anxious patient without trying to trick them.
I believe I now have agrophobia due to the incident from last fall perious 5150. The doctor listened to me and that helped a lot this time.
I had planned on going on a camping trip this weekend with a small group from church, and I think I could not deal with traveling out of town.
I haven't been able to travel any distance out of town for over a year now.
Thanks, for listening, it really does help.
I react badly to male psychologists - karen - Sep 1st 2009
Dear Dr. Swartz- I know you are only trying to be helpful. You are right that I am angry, but I have at least learned not to be trusting. That was my problem in the first place. I know now that I have episodes of hypoglycemia and I have taken precautions to make sure that my doctors have my up to date medical history and I have medic alert bracelets on me at all times. I think my anger is that I was retraumatized many times within a few hours and since I was 5150d I felt I could not be "myself" in the hospital. I would not have complained so much if they had just released me after a day or so, but it was a weekend. I did not get to see the psychiatrist assigned to me (the patients said he was very nice) and he was nice. I think the worst trauma was having to tell my sisters to go to hell as they yelled at me and blamed me for the hospitalization, when it was mostly a misunderstanding. THey were probably scared, but I feel that their behavior was totally "innappropriate"
When it comes down to it, I'm probably the most "sane" of my siblings as I at least respect boundaries. I'm glad they are out of my life. They are too critical of my daughters and I do not criticize my sister's kids at all. I should not have had to choose between my relationships with my siblings and my daughters, but I did.
I react badly to male psychologists, maybe not all as I have some friends that are psychologists ;as my personal perception is that they appear to me as condescending. I think I know myself better what is helpful to me most of the time.
I am also a battered woman and was labled as having symptoms of "boderline personality".as part of a custody evaluation. The psychologist did not understand the anger and anxiety that I suffered in my marriage was unfortunately a symptom of the fear and trauma of living with an extremely controlling spouse who battered me, sexually abused me, kidnapped the children at one point and threatened me with bodily harm for two years. The psychologist wrote (when I kept insisting on counseling for the minor children) that I should get my own therapy. Well, I was undergoing my own therapy, I think he just assumed I felt I didn't have any "problems". He made an assumption that I was not undergoing my own therapy. I even had to resort to taking my daughters to the therapist without his knowledge as I was afraid I was breaking our agreement. I finally told my attorney that I had done this and expecting to be in trouble she asked if anything had been learned by the sessions. This taught me to follow my own instincts and not listen to a professional. I play by the rules, but when the rules don't work then they have to be adjusted. I feel like I get the run around when I'm trying to be helpful. That is demoralizing.
And unfortuntely the psychologist did not following the court order and my exhusband moved the children to far away to make a 50/50 joint custody plan work at all. My two daughters are now victims. As far as I can tell, they have very few friends due to the fact that my exhusband was able to move them to numerous schools. I feel really bad for the youngest one as she knows that "no one likes her father." She has no friends. Children get their self esteem largely from their parents. I do what I can, but it's an uphill battle for self esteem.
As far as a lawsuit, I think I would really be satisfied with a written apology from even one of the doctors or head of a department. I'm not sure if I could withstand the trauma and I really don't want to hurt anyone. I just want to make sure that someone else is not hurt.
I really have not had any "bad" experience with any psychiatrist over the years, though sometimes I have felt they did not understand what I was trying to tell them. The one I have now, I met in 1991 and he has treated me very well. He has been an oustanding advocate for me at work and he's a great doctor.
thanks, for replying
Awful incident - Allan N. Schwartz, PhD - Aug 29th 2009
I thought I was being empathetic to your first comments but I guess that did not come across because you seem even more angry at me. No, I would not want to go through what you experienced. That was awful. I can't help but think that you may have a law suit against the hospital? Perhaps that could redress some of your concerns.
While I do feel empathetic I do have a concern about the level of your anger. This much anger is not healthy for anyone. What happened is awful and should not have happened, but, it did happen. Now, you need to take a deep breath and let go of the intensity of your anger. After all, you do have the legal system available to you if you decide to go that route.
In your anger you seem furious with me, and I am not sure why. You also seem furious at African Americans and I am not sure why. This is not a racial issue and should not be.
Let me just try to come across more clearly: I feel very, very empathetic and sympathetic about the awful things that happened to you. Because I am concerned I really do hope that you will reduce the level of your anger because it is not good for your health and well being.
Good Luck to You,
response to your comments - kare - Aug 28th 2009
I'll tell you why I'm angry. I guess it has to be spelled out to you as I making the "assumption" that you would enjoy being a victim of medical negligance, First of all, I was suffering from hypoglycemia and accused of drinking when I am a not a drinker. Then I was lied to by the ER doctor, he did not tell me I was going to be evaluated. This is legally assault. Then I was 5150d against my will, but first I offered to leave the ER in peace and let the doctors go on to treating patients with emergencies. I was prevented from leaving prior to the 5150. This is against the law.
Then I was mistreated by two African American staff members who were gruff with me. I offered to watch my person belongings, but a security guard, very gruff and condescending with me, would not allow me to watch my tote bag. No one bothered to lock my property up. When I arrived at the mental hospital in the middle of the night, the first thing I noticed was that my some of my property was missing (inventory lists did not match) I was prevented from having pain medications or antidepressants for that matter, for a whole night. I cried and was given tylenol by a nurse (this was refused to me in the ER even though they KNEW I HAD CHRONIC PAIN) In chronic pain at the mental hospital (denied medication for eights hours in hospital) I decided that I should get out of the very uncomfotable bed and stretch my legs. I became very dizzy (from stress and misdiagnosis of hypoglycemia) I fell and landed on a wooden floor. I received terrible bruising to my left arm and received no first aid, even though I requested an ice pack for the bruising. The hospital denied I had bruises (even though visitors saw them, I pointed it out to staff and I had a friend from church take a picture of it.) So this is medical negligance.
Then I was prevented from contacting my workplace, (I was a first grade teacher and needed to arrange for a substitute) I was forced to attend group "therapy" against my will sitting on very uncomfortable furniture for an hour at a time when I was demoralized and could have used some sleep. I did not get any sleep for the first two days at all. I have chronic pain and the beds were very uncomfortable. The temperature of the locked unit was very cold and I was not given any extra blankets, had to beg for one in the dayroom.
I have sleep apnea and no one bothered to get me a CPAP machine to sleep at night. My rescue inhaler, I have epsisodes where I literally wake up in the middle of the night when I cannot breathe at all, was locked up. I was terrified that I would stop breathing in the middle of the night and not be able to get any staff assistance. I thought that I was going to die.
I put that I wanted my daughters to be notified of my whereabouts and , of course, no one bothered to let me know where I was. (they were extremely angry about this) This is another violation of the law. I ended up coughing up $200.00 in long distance toll calls trying to get people help me with many issues. No on bothered to talk to me about what happened to me prior to the hospitalization at all. I was frightened, humiliated and very upset, but I could not be "myself" lest I appear "mentally ill or unstable"
My older sister came charging down to my home and intruded into my affairs even though I told my other sister not to notifiy her. She verbally abused me and accused me up being taken in by the police even though I was the one who called 911 myself after being threatened by two large African American men in a very dangerous neighborhood. I was so upset by her abuse after I was let go that I have severed all ties with her and my other sister since they yelled at me over the phone and in person. They did not understand why I was in the hospital (apparently someone had probably told them I had made or threatened a suicide attempt) when I had done nothing of the kind. I was very embarssed that my oldest sister called my younger brother to my home without my permission and they got into my things.
Furthermore, just as I predicted, I got in trouble when I got back to my school, (missing two full days of work with no substitute). I was given a written reprimand for not being at work which today is still in my personnel file. (I had never been written up before in 20 years of teaching) I was so traumatized my daughter (who had to leave her job from out of town and babysit me) thought I should not return to work permanently.
I have received over 60 verbal apolgies from the hospital about rude and deceptive behavior, but not one word from either of the doctors who used bad judgement in the interactions with me. (this is because I was told by two different legal opinions that I have a claim about "unlawful imprisonment" and they would want to avoid a lawsuit) My therapist (also African American) tried to blame me for my "impulsive behavior" and became defensive when I was angry. She then encouraged me to file a complaint and then turned around the next time I saw her and wrote that she couldn't help me. I never wanted to file a complaint in the first place.
I have discontinued therapy with her, as I am tired of explaining things I should not have to explain. In other words, I'm tired of doing other people's jobs for them.
Since this time, as part of my complaint with the state I have obtained medical records from four parties and I found substantial errors and comments taken out of context by three out of the four. I have had to spend many hours correcting mistakes by people who are supposed to have liscenses, training and should have basis listening skills.
How many times have I been victimized?
Perhaps this is the way you would have liked to have been treated?
Oh, yes, how would you like to have to go to court like I now have to and try and explain that you would not like to be on a firearms prohibition list as you were a victim of deception, hypoglycemia and medical negligance?
Would you like to be a woman living alone and be told that you are not elligible to defend yourself for five years if someone tried to break into YOUR home? Please note, I have never owned a gun and I hope to never have one, but now I'm on a list.
Perhaps you would like to have cried yourself to sleep for months, hurt and humiliated living by yourself? I was so depressed I was unable to do anything but go to work. I did not celebrate Christmas, was unable to pay bills, work on back taxes or do any housework. I lived in constant squalor and have now had fees for past due bills and taxes not filed.
I have told my psychiatrist, who no one bothered to contact, of course, even though I have been a patient of his for over 15 years:,that I now suffer from even greater PTSD then I ever had before. He is sympathetic, but cannot do anything other then to make sure that I am not "victimized" again. HE IS THE ONLY ONE THAT BOTHERS TO LISTEN TO ME, HE IS THE ONLY ONE THAT I REALLY TRUST AND I WAS PREVENTED FROM ANY CONTACT WITH HIM IN A CRISIS. What was the medical rationale for not contacting him? There is none.
Oh yes, I tried to get messages to some of my doctors while I was in the ER concerning my chronic medical conditions and hope they could help US, but I was told by an advise nurse in a very ugly tone of voice that I could not communicate with my doctors because I was "5150d" The hospital wrote me a letter explaining why my phone calls were not relayed, but it doesn't make any sense as my doctors are mostly female and they said a male doctor (no name supplied) was supposed to be looking out for me.
I gave plenty of suggestions and tried to help those in charge of my "medical care" some assistance in helping me, but I was condescended to, ignored every step of the way. At any point in the ER if someone had taken 5 minutes to listen to my legitimate concerns, I would have agree with you not to be angry. But the point I'm trying to make is that my health and well being were not considered and I could have ended up a lot worse physically with an untreated asthma attack leading to a serious medical crisis.
I don't know you personally, but you sound like an insensitive jerk and I think your reasoning is a rationalization that makes excuses about mistakes that are made. And these are excuses.
What if they can't locate the patient? - Blair - Aug 26th 2009
What if a therapist reports that someone is suicidal however they do not have their home address or way to reach them? Then what? Do they research to find the person or do they just let it go? Do they trick the person into being 'caught'. How does this work?
Hospitalization - Allan N. Schwartz, PhD - Aug 22nd 2009
Clearly, you are very angry but I am not sure why. You wrote that "I should not tell you about over hospitalization..." Well, I was not telling you. We write to the person asking a specific question and for the general public. Surely you must know that there are always exceptions to anything and everything. Hospitals are not perfect, Doctors are not mind readers and everyone makes mistakes.
I fully understand and am sympathetic if you were treated badly at the hospital. Unfair and unjust treatment angers me as well.
We here at Mental Help.Net are not the enemy. We are just trying to be helpful. I regret the fact that you had such a bad experience.
In point of fact, I have seen people who I believed should have been hospitalized but were not, and I have seen situations where people who were not hospitalized and who should have been. It is not a perfect system.
Thank you for your comments,
hypoglycemia - karen - Aug 21st 2009
Well, guess what I was a threatened with bodiy harm by two men last year in a dangerous neighborhood. I called 911 and the police responded and took a report as the men were intoxicated. I have hypoglycemia and hadn't eaten much that day. I didn't realize I had "slurred speech" and the ER doctor tricked me into talking to a psychologist and I ended up 5150d for "suicidal ideation". I ended up having to file a complaint with the state for unlawful imprisonment, spending countless hours amending medical records with many mistakes, having property stolen at the hospital, no right to contact family, or even my doctors for that matter. Then on top of that I was coerced into a followup appointment with my therpist who added insult to injury by blaming me for the hospitalization.
My two sisters were told that I was on a "behavrioral hold" and someone jumped to the conclusion that I had threatened a suicide attempt and yelled at me so badly that I have told them I never want to have anything to do with them. If it hadn't been for my daughters, my psychiatrist (who was NEVER CONTACTED AT ALL EVEN THOUGH HIS NAME IS LISTED ON MY MEDIC ALERT CARD and some good friends, I would have truely been suicidal. The stay at the hospital made me miss two days of work and since I was forced to attend group "therapy" I was not allowed to fill my supervisor in about when I would be able to go to work. I was traumatized, embarssed and extremely depressed for months.
Don't tell me about overhospitalization. You don't know what you're talking about. I was treated like a "naughty child" because the ER doctors couldn't rule out my "panic attack" as a side effect of hypoglycemia. DOn't they teach these things in medical school? Oh, by the way I fell and hit my arm against hard wooden furniture the first night I was imprisoned and even though I pointed out the extensive brusing to a nurse and other staff member and asked for some ice, I was not offered first aid.
another garbage "mental" patient injured and retraumatized by so called
Hospital Admissions (Involuntary) are Extremely Difficult - - Jun 29th 2009
My experience has been that unless you tell your therapist "I am going to go home and kill myself tonight" it is almost impossible for someone to put you in a psych ward. I have a long history of serious self-injury, chronic suicidally, heavy substance abuse, and extremely dangerous and reckless behavior. I don't have to lie to my therapist about any of it. He is always compassionate, empathetic, and understanding.
We have agreed (a mutual understanding between us) that if he feels I am in danger or that my safety is compromised, he will call 911 and have me hospitalized. I would not in any way be angry with him for this. Despite my aversion to being hospitalized, if I am telling my therapist something that clearly indicates that I am in danger then I probably on some level really do want to be safe and protected. Even if I don't recognize that at the moment.
I firmly believe that people who think that they have been treated unfairly, don't realize or act on their personal right to say no. People should be more informed about what their rights (and responsibilities) are regarding the treatment of their mental illness.
afraid to go to the emergency room because of self-injury - Pog - Mar 18th 2009
I injured myself in my leg fairly severly and was actually afraid to go to the emergency room because of their right to detain people for such behavior for a 72 hour period (extended upon evaluation).
Hospital Admissions - Allan N Schwartz - Mar 9th 2009
It is true that once patients become known to the emergency staff at hospitals, it becomes easier to achieve admission. Most often, what happens is what the other fellow before you mentioned and that is people are held for roughly 72 hours for observation and evaluation. Sometimes they are hospitalized after that and often they are not. It all depends on whether or not a person is considered to be a threat to themselves. The same is true about self inflicted wounds. If the wounds are of a dangerous and life threatening nature, the likelihood increases that they will be admitted to the hospital.
With regard to mental health professionals, they may not live the same life as those with psychiatric problems but they are able to learn, empathize and try to be helpful. As in every profession, there are those who are more talented and capable than others but, from my observations and experiences, most try very hard, have good intentions and do very well by their patients. Remember, a lot depends upon the match between therapist and patient in addition to the skill of the therapist. Just to let you know that I do understand, it is true that there are a few therapists who do not seem to have empathy, or even care. But, again, that is true in every career.
just a comment - - Mar 9th 2009
i think it's absolutely untrue that it's difficult to be admitted to a psychiatric hospital in the united states. i've been hospitalized over a dozen times, and will admit that MOST of them were justified based on my actions. however, there were a couple where i simply should not have been hospitalized. the very first time i was sent to the crisis center of the ER was because i had told my therapist i felt like dying but did NOT have a plan and at the time was not engaging in any self-injury. yet the therapist said that since i didn't have a plan, i couldnt' sign a safety contract, and therefore had to be hospitalized. i was also ambushed one time when i thought i was doing better and committed to a psychiatric hospital for "medication adjustments" because the doctor felt i was unstable. at the time i had not cut myself for weeks and was not actively suicidal.
unfortunately, professionals do not experience the same world that patients do. professionals also believe that they are the only ones who can be right, and that patients just do not understand the process because we are ill. make no mistake, it's extremely easy to be unfairly hospitalized in the US, and difficult to appeal a formal commitment.
Self Injury & Hospitialization - mscat - Mar 8th 2009
I have personal experience regarding this topic .
I had self injured fairly severely and went to therapy , I felf confident that the therapist was going to be nonchalent about it , because Self injury is not considered a suicide attempt. To my surprise the therapist asked for my brother's phone number and called him into the office. He asked my brother to take me in to the hospital for treatment for the injuries. My brother takes me to the nearest ER, and then I end up getting 5150'D to A different City, being carted off in an ambulance. This has happend A couple of times....
Other experiences have been , due to the severity of the self inflicted injuries I've been place directly on psych holds in the Critical Unit of A trauma ward. Then have been evaluated by A Psych team. This has also been done after A 5150 .... The severe injuries that had been inflicted were not the standard SI though, however not suicide attemtps either. I go through these eposoides 2-3 times a year, and many of the staff know me , unfortunately. I also know nOT to ever mention the word suicide or wanting to die either. Typically after A severe self injury, I am feeling much better anyway, and can answer questions coherently .... not behave nutty and able to to feel right again. The SI , typically knocks me back into reality and everything is ok again.