![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by Triolian on September 26, 2006, at 22:47:50
Take my advice - if you're considering suicide, don't ever ask for help.
Don't ask your doctor, don't ask a clergyman, don't ever go to a hospital
emergency room, and for God's sake, NEVER call one of those goddamned
suicide "help" lines. There are new laws in nearly every state in the US
which will allow you to be imprisoned, yes imprisoned, in a mental hospital,
for anywhere from 72 hours to 72 years. It's up to them. They're doing it
"for your own good", to keep you from "harming yourself". In my case they
threw me into an isolation room in a hospital emergency room, sprayed me in
the face with pepper spray, locked me in the room for hours, and then had me
taken off to a locked psychiatric facility. I remember sitting in the
isolation room with pepper spray on my face, wishing I had just done myself
in instead of calling a "help" line. Next time that's exactly what I'll do !
Posted by yxibow on September 27, 2006, at 0:24:33
In reply to Suicide Attempts, posted by Triolian on September 26, 2006, at 22:47:50
> Take my advice - if you're considering suicide, don't ever ask for help.
> Don't ask your doctor, don't ask a clergyman, don't ever go to a hospital
> emergency room, and for God's sake, NEVER call one of those goddamned
> suicide "help" lines. There are new laws in nearly every state in the US
> which will allow you to be imprisoned, yes imprisoned, in a mental hospital,
> for anywhere from 72 hours to 72 years. It's up to them. They're doing it
> "for your own good", to keep you from "harming yourself". In my case they
> threw me into an isolation room in a hospital emergency room, sprayed me in
> the face with pepper spray, locked me in the room for hours, and then had me
> taken off to a locked psychiatric facility. I remember sitting in the
> isolation room with pepper spray on my face, wishing I had just done myself
> in instead of calling a "help" line. Next time that's exactly what I'll do !
>
>
Assuming you're in the United States, and you were not under a PCP induced rage or anything of the above, you have the right to sue the hospital. That is totally improper practice -- the pepper spray and isolation room, provided you simply walked into the hospital and said I feel suicidal. If there's something left out of this case, I can't comment.The 72 hour hold is a standard in most all states -- that is for your own protection. But that is a regular, unrestrained hold in a locked part of a psychiatric institution. Once the 72 hours are over, you are either turned loose or better yet referred to additional counseling in the unlocked section of a ward.
So pepper spray, tasers, leather restraints, and other medieval devices are not part of a 72 hour suicide hold. Ever. The hospital would lose its JCHAO evaluation. Unless they were specifically using it on a patient in a unrelenting PCP psychotic rage armed with a machete.
-- tidingsJay
Posted by SLS on September 27, 2006, at 1:19:10
In reply to Re: Suicide Attempts » Triolian, posted by yxibow on September 27, 2006, at 0:24:33
Hi.
I was kept in restraints on several occasions during psychotic manic rages. No PCP. Involuntary. Not pretty.
- Scott
Posted by yxibow on September 27, 2006, at 1:57:02
In reply to Re: Suicide Attempts » yxibow, posted by SLS on September 27, 2006, at 1:19:10
> Hi.
>
> I was kept in restraints on several occasions during psychotic manic rages. No PCP. Involuntary. Not pretty.
>
>
> - ScottI was using PCP as a violent example, but hospitals are in their realm to use restraints if they feel they and the patient are endangered in a rage situation.
Nonetheless I feel sympathetic towards you. Its not pleasant for the patient and if the psychiatric nurses have any empathy in them, its not a job they really would prefer to do. I understand its a time you don't want to remember and I will recount a time I don't want to remember (no restraints, just practices.)
I was in an unnamed tier 1 psychiatric facility with a fairly good reputation voluntarily for extreme OCD. Besides the sheer boredom of being in a place for 2 1/2 months (although they take people out on guided walks in the area), I was to reduce my shower time. There was an episode where large people of a certain race were used to pull me out of the shower when I was almost done. I felt both violated as I was forcibly removed from an area normally expected of some privacy naked, and "unclean" all over again as I was touched and the whole showering compulsion was "ruined." I was in the adult facility as a near adult minor because my intelligence and demeanor was felt to be coexistant with the adult population. I ran away (the door is open, but I was a minor) and when I came home my parents took me back and I was on a 72 hour hold on "the other side". Even more boring and mildly scary but uneventful. I was returned back to the unlocked ward. In retrospect, I needed definite treatment, but the "big men" could have been instructed to be more compassionate when I passed my shower reduction time.These days though restraints are used less than they used to unless of course as I was saying a out of some movie PCP rage scene. More humane approaches have been used in recent years, in the following articles, followed by JCAHOs position.
Psychiatric Quarterly, Springer NL, 76(1);51-65
"This paper describes the violence safety program instituted at Elmhurst Hospital Center in Queens, New York City in 2001, which significantly reduced the use of restraints and seclusion department wide, while providing a safe and therapeutic environment for patient recovery. The hospital service and program instituted is described, followed by restraint and seclusion data since 1998, and the programrsquos results through 2003. Concurrent data in areas that could be affected by a reduction in restraint and seclusion such as self-injurious behaviors and altercations; use of emergency medication; use of special observation and length of stay data are also presented. In addition, types and frequency of alternative methods utilized to avoid restraints and seclusion are described."
Psychiatr Serv 56:1105-1108, September 2005"Reliance on seclusion, restraint, and psychotropic PRN (as needed) medication for behavior management has been tied to a variety of untoward outcomes that detract from the quality of care in public psychiatric hospitals. A large body of evidence has accumulated to demonstrate that behavioral approaches to care can provide useful alternatives to reliance on seclusion, restraint, and psychotropic PRN medications. This article draws from the research to outline how behavioral approaches to psychiatric care can assist in realizing alternatives to these restrictive interventions. Strategies to assess the behavioral competence of direct care staff, improve it, and establish ward programmatic structures that facilitate competent behavioral applications are discussed as well as methods to enable expert consultation and demonstrate clinical and administrative support. These steps have had a positive impact in reducing reliance on seclusion, restraint and psychotropic PRN medication in the inpatient psychiatric setting. Given the wealth of supportive data to confirm the value of behavioral applications, there is no excuse for failing to aggressively pursue these options."
I can't actually post the whole articles as they require special access but the summary is fairly indicative of the articles in general.
This one has a whole articleAlternatives for Physical Restraint:
Myths and Truths about Physical Restraints; Including a Nursing Survey on Restraint PracticesThe University of Texas MD Anderson Cancer Center Restraints Improvement Group
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol3n1/myths.xml
This is JCAHOs position
Posted by Triolian on September 27, 2006, at 10:09:00
In reply to Re: Suicide Attempts » Triolian, posted by yxibow on September 27, 2006, at 0:24:33
> Assuming you're in the United States, and you were not under a PCP induced rage or anything of the above, you have the right to sue the hospital. That is totally improper practice -- the pepper spray and isolation room, provided you simply walked into the hospital and said I feel suicidal. If there's something left out of this case, I can't comment.
>
> The 72 hour hold is a standard in most all states -- that is for your own protection. But that is a regular, unrestrained hold in a locked part of a psychiatric institution. Once the 72 hours are over, you are either turned loose or better yet referred to additional counseling in the unlocked section of a ward.
>
>
> So pepper spray, tasers, leather restraints, and other medieval devices are not part of a 72 hour suicide hold. Ever. The hospital would lose its JCHAO evaluation. Unless they were specifically using it on a patient in a unrelenting PCP psychotic rage armed with a machete.
>
>
> -- tidings
>
> JayThe hospital was in South Carolina, and I can't find a lawyer in SC who will touch the case. They won't sue a hospital because it costs to much. I field a complaint with the state of SC and they "found no wrongdoing". (Of course not).
I even enlisted the aid of Dr. Thomas Szasz to no avail. I'm now reading his book "The Manufacture of Madness" which compares the present state of mental health care to the Inquisition and the persecution of witches. It was originally written in the 1960's, but it rings true today. Nothing has really changed. Instead of physical restraints, we now have chemical ones.
Posted by Phillipa on September 27, 2006, at 11:01:01
In reply to Re: Suicide Attempts, posted by Triolian on September 27, 2006, at 10:09:00
Sometimes unfortunately for all involved it's necessary. Love Phillipa
Posted by yxibow on September 27, 2006, at 14:27:59
In reply to Re: Suicide Attempts » Triolian, posted by Phillipa on September 27, 2006, at 11:01:01
> Sometimes unfortunately for all involved it's necessary. Love Phillipa
I have to agree, it is sometimes necessary, but not always the most visibly compassionate. That's why some hospitals are reviewing policies as noted in the article which may make it unnecessary except in the worst situations.
I wasn't suggesting that you have to sue the hospital but you do have a "patients bill of rights" at any hospital regardless of your mental competence. If they don't have such a statement, they're not only not doing their own CYA, they invite people to sue them.
e.g. in the state of NYhttp://www.health.state.ny.us/nysdoh/hospital/english2.htm
the state of FL
http://www.doh.state.fl.us/mqa/Profiling/billofrights.htm
etc.
This doesn't mean that when necessary, one may be placed in restraints for an hour before a doctor evaluates if the hospital is JCHAO accredited (which hospitals strive to be if they have any credibility), but that you still have dignity.
I'm sorry that you had a rough go there in the hospital, as I said, you don't have to sue and it may be counterproductive but lodging complaint(s) against the parties that were involved in your direct and indirect care between wherever you came from and including the hospital will ensure that the next party may not have such treatment revisited unnecessarily.
Best wishes-- Jay
Posted by fca on September 27, 2006, at 14:53:31
In reply to Suicide Attempts, posted by Triolian on September 26, 2006, at 22:47:50
I am not aware of any accedited psychiatric facilities that use (or would use) pepper spray as part of security or risk management. I have seen patients where a spray was used by police or private security but never a health professional. Almost any facility that accepts medicaid or medicare (which is almost all of them) must be accredited or at least licensed. Further, no one is ever going to be held for 72 years. All States have standards for involuntary emergency detention before a court hearing--these are usually 24, 48. or 72 hours depending on the specific situation and who is doing the involuntary holding. Once there is a hearing I am unaware of any Court ordered hospitalization in excess of 90 days (most of 30 days) unless it is a forensic patient. In the case of the latter there would have been numerous due process protections as part of the criminal process. It has been my experience that a much more frequent complaint is being unable to get into, or stay, in hospital rather than being detained or not admitted. I am sorry it was traumatic for you--there are very humane and civil ways to accomplish involuntary detention.
You are right on one issue--if you really want to commit suicide one should expect any professional to take steps to interfer with that decision. I am not discussing suicide associated with euthanasia and terminal illnesses. I am only talking about those associated with mental illnesses. Common law (in some cases statutory law) and most professional licensing bodies would require an affirmative action on the part of the professional to prevent the suicide.
Posted by Triolian on September 27, 2006, at 15:44:57
In reply to Re: Suicide Attempts, posted by fca on September 27, 2006, at 14:53:31
fca,
I disagree entirely with the idea that any "professional" should interfere with a person's decision to live or not. It is a personal decision, not one to be made by someone else. It is the same as if I decide to have chemotherapy for terminal cancer or not. With chemotherapy I might live. Without it I might not. Perhaps I don't want to live any longer because life no longer holds any joy and "professionals" have nothing to offer. That is the choice my father made. That is the choice anyone should be allowed to make. "Interventions" often do more harm than good (it certainly did in my case - I've been severely traumatized by my "intervention" for 6 months) and should not be permitted without the express consent of the patient. Otherwise you are denying the basic human right to self-determination. And don't give me the jazz about the suicidal person not being in a sound frame of mind. Some of us are.
Posted by JOP on September 27, 2006, at 15:47:00
In reply to Re: Suicide Attempts, posted by Triolian on September 27, 2006, at 15:44:57
> fca,
> I disagree entirely with the idea that any "professional" should interfere with a person's decision to live or not. It is a personal decision, not one to be made by someone else. It is the same as if I decide to have chemotherapy for terminal cancer or not. With chemotherapy I might live. Without it I might not. Perhaps I don't want to live any longer because life no longer holds any joy and "professionals" have nothing to offer. That is the choice my father made. That is the choice anyone should be allowed to make. "Interventions" often do more harm than good (it certainly did in my case - I've been severely traumatized by my "intervention" for 6 months) and should not be permitted without the express consent of the patient. Otherwise you are denying the basic human right to self-determination. And don't give me the jazz about the suicidal person not being in a sound frame of mind. Some of us are.AMEN!
Posted by fca on September 27, 2006, at 17:00:03
In reply to Re: Suicide Attempts » Triolian, posted by JOP on September 27, 2006, at 15:47:00
You can disagree all you want--I just said don't expect it. You are ignoring my comments regarding common law, statutory law or professional licensing boards. I am not arguing at all about whether they should or should not from an ethical or moral standpoint ( I happen to think one should intervene as a professional) but that is not the issue. I am saying that any professional who does not assertively intervene to stop a suicide is subject to the real possibility of horrendous litigation, possible loss of their license and termination of their employment. In day to day practice I can not imagine the liability of running a MH agency that did not have a policy that required staff to intervene in an affirmative way if in their professional judgement a person was suicidal. The reality is, if you want to successfully commit suicide don't tell a professional and expect them to be supportive or not act. And it begs the question--if you have rationally considered suicide and have decided it is the most appropriate action why would you engage someone else in this discussion. Who would want the responsibility of deciding whether a persons desire to commit suicide is the result of active depression. alcohol/drug abuse or the end product of a rational assesment of quality of life. This kind of decision can not be made in an emergency room or crisis program. Even States and Countries that allow assisted suicide have well established protocols and second opinion processes.
I ask your patience in understanding it from the professionals point of view--can you imagine documenting a patient told you they were going to commit suicide, you take no affirmative action, and then trying to defend (and support that action) with the persons family members, children,
and attorney when they request the records and begin litigation. The real issue is that in every jurisdiction of which I am aware (including the UK) the statutory law and/or Administrative code are very clear of what is expected if one(a professional or other person designated by law (police etc) believes a person is dangerous to themselves or others by virtue of a mental illness.
If you want to have a discussion about the issue from a moral, ethical or philosophical point of view that is an entirely different issue.
Posted by Triolian on September 27, 2006, at 17:04:54
In reply to Re: Suicide Attempts, posted by fca on September 27, 2006, at 17:00:03
The sum total of it, then, is to do what you want, make your own decisions, and avoid mental health "professionals" (I have yet to meet one) at all costs.
Posted by fca on September 27, 2006, at 17:34:02
In reply to Re: Suicide Attempts, posted by Triolian on September 27, 2006, at 17:04:54
No that is not what I said at all--to sum it up what I am saying is: if you have rationally and dispassionately decided that suicide is the most
appropriate solution for your life situation do not bring this up to MH professional and expect them to be supportive and/or take no affirmative action. And, raise the question with yourself as to why you are even involving them. If you ever want help ask for it but successfully dying by suicide is usually a very lonely business. I am sorry you have been so disappointed by the MH professionals with whom you have worked or know. I would hope that your experience is not reflective of the entire field of nurses, physicians social workers etc.
My Best wishes fca
Posted by Triolian on September 27, 2006, at 17:52:10
In reply to Re: Suicide Attempts, posted by fca on September 27, 2006, at 17:34:02
>>would hope that your experience is not >>reflective of the entire field of nurses, >>physicians social workers etc.
Unfortunately, that seems to be the case, at least in the US, where medical care is regressing and hitting new lows.
Posted by fca on September 27, 2006, at 18:07:34
In reply to Re: Suicide Attempts, posted by Triolian on September 27, 2006, at 17:52:10
For many many persons that is unfortunately true. I just returned from visiting the UK several months ago and it is the first time that I honestly believed that if I had a long term and persistent mental illness I would be better off in the UK than the US. I would not have said that 10 years ago. However, that is not only because of the accessibility of health care and the insulation from financial disaster it as also because there is a much more humane and supportive social support system (housing. client advocacy, drug abuse as a publuc health problem, etc). The best of treatment and, more and more the worst of care is what we have. The sad erosion of care for most and the paradoxes of America. If you read this and live in the UK you may not believe me. In the US it depends on where you live, who you are whether you have resources or not. As I said, the best and sometimes the worst. Thanks for permitting the OT post(s)
Posted by Triolian on September 27, 2006, at 18:31:46
In reply to Re: Suicide Attempts, posted by fca on September 27, 2006, at 18:07:34
Case in point: In the US many people die waiting for transplant organs, some having waited on lists for years. In our state, a fomer governor received a heart, lungs, and a liver after being on a transplant waiting list for one, that's right, one, day. The hospital claimed the proper organs "just happened to be available".
Posted by Racer on September 27, 2006, at 19:45:38
In reply to Re: Suicide Attempts, posted by fca on September 27, 2006, at 18:07:34
> In the US it depends on where you live, who you are whether you have resources or not. As I said, the best and sometimes the worst.
Yep, I've experienced both. I'd like to add, though, that in a situation in which access to care if not an issue, it also depends on being willing to act as an advocate for yourself. In the case of mental health, that's not always possible, of course.
I'd also like to say I agree with you, fca, about professionals and suicide. I'd go a bit farther -- if someone told me that he/she had a plan to commit suicide, I'd call the police myself. I've attempted suicide, and while I'm still not exactly *in* remission, I've come close enough to it that I'm glad I failed. Hell, even as bad as I feel today, much as I wish I didn't have to keep plodding and struggling and hurting, I'm still glad I'm alive. There are a lot more options available to me alive, much more likely to find relief while I'm alive.
When I did try it, though, I certainly didn't tell anyone. When I was still hoping to find help, when I was still looking for alternatives, *that's* when I made contact with mental health professionals. (No insurance -- remember what you said about "the worst of care?") Once I made the decision, I acted. {shrug} At the time, I figured if there was help available to me, I'd have found it already.
Now I'm rambling, so I'll be done...
Posted by Triolian on September 27, 2006, at 21:14:55
In reply to Re: Restraints, Articles, and the JCAHO » SLS, posted by yxibow on September 27, 2006, at 1:57:02
JCAHO lays out guidelines, but hospitals don't give a hoot about them because they are never enforced. The idea that sanctions of any kind would be taken against a hospital that uses substances such as pepper spray against a patient is purre poppycock. Hospitals (and medical people) get away with murder - sometimes literally.
Posted by Phillipa on September 27, 2006, at 21:34:19
In reply to Re: Suicide Attempts, posted by fca on September 27, 2006, at 17:00:03
You're l00% right like it or not. Any suicidal pt may be held for 72hours for a court hearing at usually the hospital. An assessment in person by a doc must be made within 24hours. The staff calls the doc immediately to report the patient behavior condition. And every 5-l0minutes a note is written on the above. No one likes to put a pt in restraints or medicated against their will but the other patients safety and staff have to also be considered. Hospitals have standing orders and policies on each unit depending on the conditions treated on that floor or unit. Love Phillipa
Posted by Phillipa on September 27, 2006, at 21:38:20
In reply to Re: Suicide Attempts, posted by fca on September 27, 2006, at 18:07:34
Yes sorry to say it's true not only in situations like this but who do you know what type of insurance. I've seen people removed from a ventilator cause someone else was waiting for one. The one taken off had the worse prognosis and worst insurance. Very very sad. Love Phillipa
Posted by Triolian on September 27, 2006, at 21:41:33
In reply to Re: Suicide Attempts, posted by fca on September 27, 2006, at 17:00:03
>>it begs the question--if you have rationally >>considered suicide and have decided it is the >>most appropriate action why would you engage >>someone else in this discussion.
A well-known psychiatrist of some 60 years experience asked me the same question. Next time I will not discuss my intent or reasons with anyone. Death is preferable to "intervention" by pretenders who are only interested in covering their legal *rses.
Posted by Phillipa on September 27, 2006, at 21:44:04
In reply to Re: Suicide Attempts » fca, posted by Phillipa on September 27, 2006, at 21:34:19
Change in above post I forgot each state probably has a time limit for holding the patient against there will. But Racer said it all She was in a bad place emotionally and courageously reached out for help. And is glad she did. I'm sure she wasn't happy at the time. But now she's glad to be alive. Love Phillipa ps the assessment times by docs may have changed too. It could be sooner. When I was working the staff or crisis or ER did the assessment for admission.
Posted by yxibow on September 28, 2006, at 1:34:21
In reply to Suicide Attempts, posted by Triolian on September 26, 2006, at 22:47:50
> Take my advice - if you're considering suicide, don't ever ask for help.
> Don't ask your doctor, don't ask a clergyman, don't ever go to a hospital
> emergency room, and for God's sake, NEVER call one of those goddamned
> suicide "help" lines. There are new laws in nearly every state in the US
> which will allow you to be imprisoned, yes imprisoned, in a mental hospital,
> for anywhere from 72 hours to 72 years. It's up to them. They're doing it
> "for your own good", to keep you from "harming yourself". In my case they
> threw me into an isolation room in a hospital emergency room, sprayed me in
> the face with pepper spray, locked me in the room for hours, and then had me
> taken off to a locked psychiatric facility. I remember sitting in the
> isolation room with pepper spray on my face, wishing I had just done myself
> in instead of calling a "help" line. Next time that's exactly what I'll do !
>
>
I can't believe what I'm hearing... this goes beyond the pale. If you're suicidal and you want to go off yourself, why make a discussion, its almost a self-fullfilling troll. Laws are there to protect the patient whether you see it or not. 72 hour holds are perfectly common in most all states and nobody is held in institutions for 72 years, this is not the 1950s or even the Road to Wellville.
If you want to discuss other types of abuses at mental institutions, like the ones in the past several decades where gay teenagers were held on mental holds in the bible belt because they were not of age or could not obtain the status of an emancipated minor, then we have a story.But no sane doctor, however pitiful a mental facility, is going to say oh, sure, go home, when you walk into the door willingly and say with a forlorn face that you feel troubled and suicidal. They will place you under watch and a 72 hour hold, evaluate you, take your medical history, and attempt to do as best as the facility can.
This does not include pepper spray, mace, ninja stars, or any devices of medieval torture. That is, unless the individual is also under a "manic rage" as presented before or some other type of psychotic breakdown.
After the 72 hour hold, an evaluation will be taken place, medications if necessary will be given -- Lithium, regardless of its age is still one of the best preventions against suicide. But medication plans aren't typically instituted because that is something to be followed up by your own practitioner.
Posted by ed_uk on September 28, 2006, at 14:43:34
In reply to Re: Suicide Attempts » yxibow, posted by SLS on September 27, 2006, at 1:19:10
> Hi.
>
> I was kept in restraints on several occasions during psychotic manic rages. No PCP. Involuntary. Not pretty.
>
>
> - ScottHi Scott,
What happened next? Were you given a neuroleptic?
Ed
Posted by SLS on September 28, 2006, at 15:34:29
In reply to Re: Suicide Attempts » SLS, posted by ed_uk on September 28, 2006, at 14:43:34
> > Hi.
> >
> > I was kept in restraints on several occasions during psychotic manic rages. No PCP. Involuntary. Not pretty.
> >
> >
> > - Scott
>
> Hi Scott,
>
> What happened next?Understand, that at this time, I had been responsive to Nardil. I had been in a mixed-state hypomania for quite some time on 30mg. It was when I discontinued the Nardil that I became psychotic. It was a Nardil-discontinuation-induced rebound manic psychosis.
> Were you given a neuroleptic?
Yes.
Then I became depressed.
Then I was given Nardil.
Then I began to respond to Nardil.
Then I shot up into an even more severe psychosis.
Then I was put into restraints again.
Then I was given a neuroleptic again.
Then I was became depressed again.
Then I was given Lithium.
Then I was given Nardil again.
And I never responded to anything again.
My brain got fried.
- Scott
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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