Falling Down (4)

Section 5250 is a section of the California Welfare and Institutions Code (specifically, the Lanterman–Petris–Short Act or “LPS”) which allows a qualified officer or clinician to involuntarily confine a person deemed to have certain mental disorders for up to 14 days, following being involuntarily held for 72 hours under a Section 5150 hold.

The hold is placed by psychiatric staff who deems a person to have a mental disorder that poses a danger to him or her self and/or others, or to be gravely disabled and require more than a 72-hour hold for treatment. 

– Description of 5250

White List

+70:30

There was a list.

If you were a good patient – that is, if you followed the rules, didn’t cause trouble, weren’t prone to outbreaks, and attended group activities, you could be put on what was known as the white list.  The major perk of being on the white list was that you could go to the cafeteria for your meals instead of receiving them in the ward in Styrofoam containers.  At the cafeteria you at least had the option of portion control, getting more of what you wanted and less of what you didn’t, and choice.  You also got to eat at smaller tables, and there were windows hat allowed you to see outside.  Patients from other wards were also eating at the cafeteria which gave you an opportunity to interact with someone different than the people you saw and heard and smelled all day every day.  Sometimes you could even go outside for a brief exposure to fresh air and sunshine in a courtyard (surrounded by heavy bars, but still….).

As a general rule, depressives got to go to the cafeteria (though being depressed, they often didn’t want to) and psychotics didn’t (though there were some exceptions – his roommate for example, who was apparently deemed unlikely to have an outburst.

It was an ingenious form of reward for good behavior, offering so much that those locked up on the ward craved, and costing the institution virtually nothing in exchange.  As a motivational tool it was powerful.  As a service offered, it was cheap.  This was the perfect combination for an institutional facility, and it impressed him as one of the few things that happened which did exactly what it was designed to do without adding much to the budget.

He was still surprised, angry, and frightened by the events of the previous evening, but tried not to let it show in his face, in his body language, or his behavior.  While he didn’t exactly know what would help his situation, he knew without doubt that there were things he could do that would hurt it, and strove to avoid them whenever and wherever possible.  This was an unspoken but near universally practiced law in the ward:  nothing negative, never, and nowhere.  Particularly relating to interactions with staff, but even with other patients or in isolation, there could be no indications of weakness, no sign that whatever had brought a patient to the ward was still manifest, nothing but relentless positivity in all things.  “Please”, “thank you”, a light and cheerful tone, enthusiasm (real or faked), instant and willing compliance with all staff instructions, helpful behavior:  these were to be practiced at all times and in all circumstances.  “I’m fine,” was not an acceptable answer to anything – it was too pedestrian and not nearly revealing enough.  The question of “how are you feeling” must always be met with an answer that was both positive and did not seem scripted – “Feeling great!”, “Doing really well today!”, etc.  During group sessions when the facilitator would ask this question, patients would listen hard to the answers given before theirs so that they could craft a response that sounded heartfelt, enthusiastic, and was not a repeat of what another patient had said.

Even the psychotics, lost in their own worlds, understood that politeness and positivity would benefit them.  He imagined what it must be like to live in a world where you could not tell if your head had been severed from your shoulders.   He thought about what sort of courage it must take to fight through the fear and disorientation of that to present a positive facade rather than screaming and running around.  This was exactly the sort of challenge that the psychotics faced on a daily basis to function in the ward.

It was the great, unsaid truth of the ward:  whenever it is to your benefit, lie.

75:20

For the first and only time on the ward, someone asked him about the reasons for his depression for therapeutic reasons rather than to fill out an answer on a form.  Just over three days since his 5150, and around three hours after his 72 hour hold had expired and his 5250 hold had officially commenced.

An art therapist had come to the ward to work with patients on the issues that had brought them there.  She asked them to envision the issues that had brought them in, to share them briefly with others of the group, and then to draw them in any way that they saw fit.  As such exercises went it was shallow for him (he had done art therapy and drawn his issues long before coming to the ward) but it was a good, solid piece of therapy, well-used and effective overall, and the very fact that someone had (finally!) shown some interest in the actual underlying issues with which he had struggled and which had brought him here (along with the damned form!) was such a relief to him that he nearly cried with joy.  It was like receiving a taste of a sacrament.  It was like standing in a sunbeam on a cloudy day.  It was a thirty-minute exercise and it turned out to be the only thirty minutes during his entire stay that he would be able to look back on and say “that really helped to address my underlying problem.”

And then it was over and the art therapist gathered up her materials and was gone.

+76:30

He was waiting for his physician to come when he was approached by a staff member who identified herself as the patient advocate.  He hadn’t called her.  He was a bit startled that she was there.  But there she was, short and wiry, looking tired and fierce.  She looked exactly like the sort of person that you didn’t want to mess with on a paperwork issue.

They went into one of the meeting rooms and sat down.  Did he understand why he had been 5250ed, she asked, and did he want to contest it?

He was shocked.

He explained his situation to her.  He was careful not to use the word “lied” or refer to his physician in anything less than politely neutral terms.  He held back any anger, any frustration, any fear, any hope and simply explained what had happened in a calm manner, as though he were reporting on someone else’s problems.

The patient advocate thought he had a case.  Although the 5250 had been filed with the concerns that he was still deeply suicidal and still had a plan to kill himself, the official reason listed on the form for 5250ing him was “gravely disabled” not “threat to self” or “threat to others”. Being gravely disabled was only a reason to be 5250ed if there was reason to believe that the individual would not have the resources to be supported outside of the ward – that the individual would be homeless, would be unsupervised, would be without the means to get food.  He was none of those things.  He had a home to go back to, and a wife who was willing to take him back.

He asked if it would help if his wife attended the hearing.  He was told that if she did there was no question that he would be released into her custody.

He agreed to the hearing.

The patient advocate warned him not to act happy, and not to discuss the matter with anyone except his wife.  He was so grateful, so profoundly grateful to have some hope interjected into the daily grind of his existence on the ward, that he wanted to dance.

But of course, he didn’t:  whenever it is to your benefit, lie.

+78:20

The patient advocate had been gone for just under two hours when things started happening quickly.  He was called into another interview with three people – his case manager (whom he met for the first time), the ward manager, and a doctor he had not met before.  They asked him questions:  did he know why he was here?  did he know where he was?  what was his name?  what was his birthday?  how was he feeling?  was he sleeping well?  He answered all the questions, keeping his game face intact throughout.  At the end of the meeting he was told it’s purpose – these were the people who would decide upon his treatment plan.

He kept his shock at the idea that it had taken the whole of his 72-hour hold and more before people would get together and decide on a treatment plan for him off his face and said nothing about it, but thanked his case manager, the ward manager, and the doctor.

Less than 30 minutes later his supervising physician – the person who had 5250ed him, came in and wanted to talk to him.  He had to pause to get himself under rigid control, to rehearse once again how he would ask the questions about his 5250 without sounding critical or angry.  To make sure that his temper was so far under control that it would not flare no matter the provocation.

They went into a conference room and sat down.

“How do you feel?” asked the physician.

“Feeling great!” he responded.  (You sound like Tony the Tiger, an inner voice admonished.  Careful, careful!)

“Ready to roll?” asked the physician.

“Ready to roll!” he responded (his heart gave a lurch in his chest.  He lied before, said the inner voice, careful!)

“OK then,” said the physician, “I’m going to go out and sign your release.  You can go home tomorrow.”

That was the end of the interview.

+81:00

His wife had warned him that traffic would be bad, and that she might not make it in time for the beginning of visiting hours.  In fact, she didn’t make it until near the end.  He had given up lurking by the locked doors of the ward, peering out through the glass into the entrance vestibule that was so close physically – only two steps away – but so far in terms of the larger reality of life on the ward that it might as well have been another continent.  So to calm himself, he had retreated to his bed to read a book.  Another one of the patients hurried into the doorway to his room, showing more animation than he had ever seen before.   He cried “Your wife is here!”

It was one of the most touching moments of interaction he would have on the ward.  He had never before seen the man exhibit such emotion or concern.  In a place of broken people, seeing that animation and interest in his welfare not by the staff (who did their jobs well, but were rather expected to) but by a fellow patient, someone with their own internal hurts and struggles that were severe enough to bring him to this place behind locked doors, was a moment of pure grace.  He thought he might remember it and honor it for the rest of his days.

He was able to tell his wife the events of the day.  They were able to plan.  She could pick him up tomorrow at 11:00.  She would be there at 10:00.  The world opened up and there was suddenly hope.

That night. playing the heart rate game on his monitor, he could keep his heart rate to the mid-seventies, but no lower.

He was getting out.  And someone had finally asked him about the causes of his depression.

Continued in “Falling Down” (5)

Back to “Falling Down” (3)

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