“Just living is not enough. One must have sunshine, freedom, and a little flower.”
– Hans Christian Anderson
This story is true. Everything happened. To me. All the events listed occurred. All the opinions about them are my own.
Institutional mental health is a mess. There is no better way, no softer, gentler way to put that. And I say that with absolute respect and gratitude to the men and women of the staff who worked with me, who work every day with difficult patients under difficult circumstances, in the facility in which I stayed and in all the others.
Why did I get 5150’ed? I suffer from chronic depression, and for a variety of reasons it had become severe. I went to a psychiatrist and before our meeting I filled out a form. On it I indicated that I had frequent suicidal thoughts, and at the beginning of our conversation I indicated that I had a plan. That was all that was necessary for me to be hospitalized.
Did I want to be 5150’ed? No. I knew it might happen, but what I wanted was voluntary treatment. I had a plan, but I did not have intent. I wanted help, not death. Had I wanted to kill myself, the last place I would have gone was to a psychiatrist. Had I wanted to kill myself I would have attempted to kill myself. However, from the point of view of my psychologist, I had crossed a line. Even the potential for me to be a danger to myself was enough to trigger this response. There were, I believe, two reasons for this. The first was that the moment I had walked into the office, the psychiatrist had a duty of care for me – they became responsible, in part, for my current and future well-being. This is part of the cost of being a doctor. Because suicide is final for the victim, and a potential threat to individuals nearby when it happens, one must tread very carefully when it comes up. The potential for harm is great, and the response must be proportional. The second reason is that we live in a very litigious society. The potential for the psychiatrist to become embroiled in lawsuits were I to do damage to myself or others after reporting my issues was certainly significant, and could ruin their life and career. To protect themselves, they needed to act decisively and with an eye towards even a small risk of big litigation. This is the way the world works. Nevertheless it is sad that a decision that has such powerful and lasting effects on a patient should be made, even partially, with the well-being of the doctor in mind.
I don’t necessarily disagree with the decision to 5150 me. What I disagree with is the results of that decision, the care I was given, and the operation of the facility I was put into. Before I go anywhere further with that thought I want to say again what I have said several times – flaws in my care were for the most part not the fault of the staff who worked with me. They were dedicated, empathetic, and worked hard at their jobs. They truly seemed to care for the people under their charge – both their safety and their care. But for some reason people far above their pay grade had made decisions that were inappropriate with optimum care and treatment of the people in the facility, and that largely robbed my time there of potential value.
To their credit, they got my blood sugar under control. I do not underestimate this as a good thing. It was important, and I am thankful that they did it. They also brought my blood pressure down somewhat, which is also important. However, these are physical issues, and while they certainly impact on mental health they are by no means the sort of problems that require one to be put into a locked mental health facility and have their right to freedom or decisions about the length or scope of their treatment taken away. A day or two in the hospital would have had the same effect from a health viewpoint.
What they did not offer was any non-chemical treatment for my depression, or any opportunity (save one) to discuss the root causes of it or find any options that might improve it. From that perspective the stay in the hospital was a near complete waste of time, useful only in that I spent so much time worrying about how to get out that the issues that had made me depressed went to the back of my mind. The environment was not in any way gentle or conducive to my wellness – between bed checks and charting my blood oxygen monitor there was someone walking into my room approximately every five minutes for the whole of the night, and even waking me up if I had rolled into a position where my monitor was under the covers or face-down. Coupled with the noises made by other patients, the light level being high, and the overall difficulty of getting to sleep in a strange place with strange noises, it was impossible to get the sort of sleep that doctors actually recommend for good mental health. I never got more than 4 hours of sleep on any of the nights I was there, and the restfulness of even that was questionable.
Why was I 5250’ed? Honestly I have no idea. I have theories, but they would be nothing more than speculation without any facts to back them up. Should I have been 5250’ed? Absolutely not. The law is crystal clear on the matter – a person can be 5250ed as gravely disabled ONLY if they have no support structure in the outside world. A five-minute phone conversation with my wife would have revealed that this was the case, and she was listed on all my paperwork as a contact. The only way that the hospital, that my doctor, could not have known this was that they failed to make even a cursory examination of my circumstances or history before filling out the paperwork. But without examining my circumstances, how could anyone make the determination that I was gravely disabled?
The effect was devastating and will have long-term consequences for me. The fact that I was 5250’ed after the doctor implied that I would be released, for reasons that were not even brought up in our short meeting beforehand, and that flatly did not apply to me – which could have been easily confirmed – functionally destroyed any faith I had in the doctor-patient relationship at the hospital, and damaged my faith in the doctor-patient relationship in general. Admittedly it was only for a single day, and from the moment I found out until the moment I found I would be released was only 19 hours, but that was enough. Nineteen hours of wondering what the hell happened and why, and facing up to fourteen days of additional involuntary hospitalization without any control over the matter, was terrifying, and the fact that the reasons listed on the paperwork seemed to be at odds with everything we discussed in our brief meeting made the whole institution feel suddenly like a sham – a ponzi scheme for the mentally ill. Had there been treatment, and had I stayed longer, I think it would have taken some time for trust to be rebuilt, if it could be rebuilt at all.
And therapy cannot proceed without trust. Trust between the therapist and the patient is one of the foundation principles of therapy. Now that it has been lost, it will take time and effort for me to feel it again. Subsequent to my release I met with a psychiatrist and a therapist. I didn’t, couldn’t, fully trust either.
The same issue also flows from the patient side in a locked institution like the ward. The institution rewards patients who give positive statements about their mental health, but lacks the resources to explore whether or not those statements are true. If you say you are doing well you get access to the cafeteria, for example, with its sugar and caffeinated coffee and portion control and access to brief visits outside the walls. If it isn’t true, if you say you aren’t feeling positive, if you are sleep deprived and depressed and frightened, you don’t get to go to the cafeteria. You lose the perks. And for many the chance to get off the ward, to take some control over a portion of their lives – if only what they have for lunch and how much – and to get a few minutes standing in sunshine and breathing fresh air are the most therapeutic things that the institution can offer them that day. The people who need these the most – the crushed and broken – are the ones least likely to receive them because these perks, which should be seen as therapy to help them, have instead been turned into a reward for appropriate behavior and response.
Truth and trust seem to be very tenuous in a locked facility.
The patient advocate, on the other hand, stands as one of the best and most inspiring parts of my stay. This is a person who works day after day for the rights of people who come in dazed, confused, and likely neither knowing or in many cases caring about their rights as patients. The patient advocate stands between these people and the institution, making sure that everyone’s rights are protected, and making sure that everyone knows what their rights are. Her job was speaking truth to power each day on behalf of some of the most powerless people in our society. I cannot but think that it must be a very thankless job working every day against the organization that signs your paychecks. Her dedication was amazing. I will never forget her. I wish I could have shaken her hand.
Issues of mental health are difficult and convoluted in our society. Much stigma remains towards those who are mentally ill or mentally disabled. There are no easy solutions. As I said before, it’s a mess. But there is progress. We have moved past the days of Bedlam Asylum. We now have doctors and nurses and staff and real facilities. Gone is the emphasis on warehousing the mentally disabled, at least in theory, though budget often constrains the sorts of treatments that are available. There are lots of good people who spend their professional lives trying to make a difference, and despite the failings of the institutions they work for, they should be honored for that.
I would like to thank and honor my wife for her unflagging support during this troubled time in my life. Though it was an hour’s drive each way to the facility in which I stayed, she never missed a visit, even in the face of terrible traffic. Support of friends and family is a critical component in dealing with mental health issues, and from what I saw far too few of the patients who shared the ward with me got enough of it. I was never made aware of the specifics of most of their cases, and I pass no judgement on their family and friends. Because beds in mental health facilities are few and far between, patients are sometimes transported long distances for treatment – distances that may make regular visits from their support network impractical. I am very lucky that this was not the case for me, and very grateful that my wife availed herself of every opportunity to be actively involved with me during my time in the hospital. She is a fantastic person.
I would also like to thank and honor all the friends who pitched in during our time of need to bring to both myself and my wife much needed support. A network is important at times like this. Not everyone can be or should be the person who comes for visits in the hospital every day – for one thing visiting hours are just too short for that, and the number of people allowed at any one time too limited. But rest assured I got all the messages you sent in support and was very grateful and humbled by the sheer volume of them. I am also grateful for all the support you gave to my wife during a time when she was also alone, confused, and having to bear up under considerable pressure and stress. All of you helped the situation immeasurably.
To the staff of the facility where I stayed – thank you. You were wonderful. You work hard at a difficult job, and your dedication makes a difference.
Finally, to those who shared the ward with me, thank you. Being put in a locked ward cannot help but be a frightening experience for anyone. Nevertheless, you took the time and energy apart from your own struggles to help support me when I was at my lowest ebb ever. I will remember you all with gratitude for the rest of my life, and I hope that you are well and recovering.
2 thoughts on “Falling Down (6)”
I am so mad I’m crying. You deserve to be treated with respect and dignity. All those people in there do. The system just does not allow for it.
It’s true. And it’s even true for the majority of the staff who try to work miracles with the mental health equivalent of chewing gum and duct tape.
It isn’t surprising that there are a few assholes in the system. What’s surprising is that not everyone is.