Tuesday, October 06, 2009

Afraid of Commitment?

Posted for Roy (taken from his comments on the Demystify Me? post)

So is knowing your doc got a cute new puppy who likes cat toys TOO demystified?

And, to AA's point, civil commitment to prevent a suicide is indeed a proper concern, though I'd argue that ignoring a suicide risk is also of concern. Most states require us to hospitalize if there is a risk, but how that risk is defined varies from state to state.

The area of consternation is likely that different docs interpret "risk" in different ways, so one could go to an ER on 2 different occasions after overdoses taken while drunk, and end up committed one time and released another.

Commitment demystification: factors that increase the chance of hospitalization after a suicide attempt:
-lethality of the amount/drug type taken
-planning it out over several days
-a suicide note
-taking it in a manner that reduces the chance one is found in time
-buying the pills for that specific purpose (versus finding them in the medicine cabinet)
-living alone/limited social supports
-attempted hanging
-not having anyone to corroborate story with
-lying (thus how would one know you were being truthful about being safe)
-not having access to aftercare over the next several days to week

FYI: coming in to ER via police petition does not appear to increase risk of hospitalization.


Dinah said...

Um, Roy, that wasn't your puppy (I don't think). I'd never post a photo of your actual puppy, you don't know what kind of puppy-poachers lurk on the internet waiting for the moment.

I googled bishon puppy in images, and borrowed this one. Is that your rug?

moviedoc said...

Hospitalize? Require us to hospitalize? Not Washington. In Wa. State it means send the patient to the ER after instructing them on what they will need to say, and what kind of evidence of insurance they will need. Hospitalize is not something a psychiatrist can do here. We have county designated mental health professionals whose job it is to find ways to justify keeping a patient out of the hospital. Like, "The gun is only .38 caliber, and he only has 3 bullets. He couldn't be seriously at risk."

How did we psychiatirsts allow ourselves to be thrust into the role of responsibility for the behavior of others anyway? Sounds more like what they did in Soviet Russia. We should stick to treating mental illness. Like that isn't enough of a challenge in itself.

Marsha Linehan makes a pretty good case for the idea that we delay suicide at best, even when we can "hospitalize."

Anonymous said...

I think AA's point was about the possibility of being hospitalized for having suicidal ideation, not for an attempt. I can tell you that I avoided telling two different pdocs about ideation, even in the one case where I was working on a fail-safe plan, because I didn't want to be hospitalized. It was hard to go through that alone.

A while ago I got up the courage to tell my current pdoc about the past experiences and then some more recent ones. But it feels safer to have this conversation when you aren't currently having ideation, and thus can't be hospitalized for reporting it.

Anonymous said...

Thanks anonymous, you nailed the situation precisely.

Thanks to severe rebound insomnia from tapering my remaining psych med, I couldn't articulate my thoughts very well. But it was so frustrating to see what I had said be totally misinterpreted.

I am sorry you had to go through having suicidal ideation alone and I hope you are doing better.


ChristinePAS said...

Hm... interesting timing...

I'm a PA student, and while I was doing my psych rotation two weeks ago, my preceptor (a psychiatrist) noticed that I hadn't quite been myself. She asked me a bunch of questions about what was up, I answered a bit too honestly, I guess, and she and another psychiatrist at the site had me involuntarily admitted for suicidal ideations WITHOUT plan or intent. Honestly, I didn't think I could be involuntarily hospitalized for that. I was released yesterday.

It was pretty darn weird to go straight from treating psych patients to being a psych patient. Awkward.

Anyway, what are the rules for involuntary admissions? Does it vary state to state? I'm in NY and it took two psychiatrists' evaluations to make me "involuntary status." I've never looked into what the guidelines and rules are for that sort of thing...

(PS - I'm doing fine. I'm bipolar and I get that depressed multiple times per year, so I thought/think the whole ordeal was rather silly. My mood has partially improved spontaneously, so now I have outpatient appointments, I'll start an MAOI next week, and I'm trying to get my schooling back together. Eek.)

Dinah said...

Christinepas-- if you're still out there, can you shoot me an email at shrinkrapblog at gmail dot com ? I would like to chat.