Great video. I do want to add that the process to give someone meds against their will CAN (in some states) be different and separated from the process of their ADMISSION to a psych hospital. Meaning someone can be forced to stay in a hospital, but also still be allowed to refuse medications for weeks-months before a judge can rule that these medications can also be provided against someone's will. This can make some hospitalizations particularly frustrating for both patients and staff, as much of it is just sitting in a deadlock waiting for mental health court to get to their case. This is the part I find almost more frustrating and icky, as it essentially wastes our patients time in a very uncomfortable, albeit safer, environment.
It's definitely frustrating from a frontline perspective. It seems ethically important to me that those remain separate. Just because someone is seriously ill shouldn't mean that they no longer have a say in what others do to their body. Permission to override such a basic right should be granted by someone independent. (And it's not even necessary in most cases.) Seems to me like the fix is to increase funding for mental health courts to speed the process up
Absolutely agree. This entire situation Would be a non issue if we could get to a judge within a business day or so for med against objections. It's also important these remain distinct
This is a tricky situation. Involuntary psychiatric holds are infamous for often being extremely traumatizing & harmful, but at the same time, for many of these situations it’s difficult to think of good alternatives. I’ve seen some arguments for specifically abolishing suicide-prevention involuntary holds, with the view that a person’s autonomy & control of their own life should come first… Even if their decision is to end that life. The suggestions I’ve seen in that regard have been to create systems that, if the suicide attempt is panic-induced and not really an informed personal choice, de-escalate the immediate situation, so someone doesn’t kill themselves in a state of panic, and then emotionally support the person in question and talk to them about their options & choices, with a guarantee that ultimately those choices will be respected… Even if they ultimately do choose death. Support without judgement, without fear of losing autonomy, etc. I personally found that quite compelling. Death is very scary, and we don’t want to lose the ones we love, but if the system to stop them from departing causes them tremendous distress, and often increases their chances of actually committing suicide in the long term… Maybe we should have a system that isn’t focused on immediately preventing their death at literally all costs. I was fairly moved by those arguments, but I don’t know anywhere near enough on the topic to be at all sure. That’s for suicidal behavior though… For other situations, like psychotic breaks, or violence towards others, I really don’t know if there’s any sort of good alternative. It’s one thing if someone is of clear mind and wants to make a choice about their own life that we might find terrifying, it’s another thing if they’re either out of their mind and currently incapable of making decisions for themselves, or if their decision is that they want to hurt someone else. (Which is obviously not a decision they should be allowed to make, autonomy doesn’t apply to decisions to harm other people, the safety of those people obviously takes priority in that case) At the very least, even in those cases the involuntary hold system likely needs massive reform, because from everything I heard, including from friends who were unfortunate enough to be in that situation, it’s a system currently riddled with horrors & abuses. Extremely strict oversight should be an absolute must, because situations of extreme power imbalance invite cases of extreme abuse. If you hold near absolute power over someone, and they have no say in what’s happening, it can become very easy for you to do whatever the hell you want to them, with little to no fear of consequences of any kind.
EMT here. Thank you for the vid and for the work you do. Also icky is the part where when someone reaches the point of emergency, the final available option is going to be 911. And if the person is violent, that means police. I don't know the answer, but I do know that I am not equipped or trained to safely transport a violent person without police. When these scenarios go wrong prehospital they go very, very wrong, but I think that we as a society need to really evaluate what it means for 1) letting people get to crisis and 2) how to structure a safe response to these moments. Because incidence is only going up.
Crazy to me that police are the ones who respond to mental health crises. They can't do and be everything, and their job should have a better defined scope. Police are meant to deal with crime - assault, theft, etc. People in crisis often need a whole different skill set than what a police officer with probably minimal mental health training can provide.
Hey Pres. Thanks for the vid. Wanted to include that these holds and their times change between States and their respective Welfare & Institutions codes. I'm a few minutes in and heard you mention an ED 48 hr hold- not sure which state you live in, but here in California under WI Code 50&51, our psych holds last 72 hours initially and are known as 5150 holds. I believe they're placed by police, social workers, or psych physicians. I also believe they can be lifted by social workers or psych physicians.
As I understand it, a hold can be placed by a variety of professionals that may vary even between counties, but only psychiatrists can lift them because only they can do the formal assessment
Preston, I started watching your content because it’s funny medical content; but I love you explanations of psychiatric concepts and it’s actually been really helpful with this being my psych rotation in nursing school. Just wanted to say thanks.
as an EMT as well let me tell you -- probably *the* most stressful situations I get into are the ones where I have to decide (or help decide) whether or not someone is going to go to a hospital against their will.
I'm an EMT as well. We have no training whatsoever that qualifies us to make that decision, and it's a violation of due process if the patient hasn't broken any laws. That is admittedly pretty rare, but think about some of your coworkers (i.e., the ones who steal the special k off the truck) - are they people you would want making this decision with your life?
You both said it perfectly. The only sure fire solutions on scene are medical control, law enforcement, calling your supervisor, and having witnesses/a good ass PCR.
I had an OPC placed on my last year. I was at my dentist having a procedure and was mildly sedated. After the procedure, I was completely unconscious and couldn’t be woken up. EMS was called after the reversal meds didn’t work. I was stable, but still unconscious while being moved to the ambulance. I started to stir a bit, but wasn’t able to respond to questions or commands appropriately. I started gradually becoming more “active”, but still not making sense. I began behaving panicked and couldn’t be calmed. I wasn’t combative or volatile, just distressed and still not making any sense. As soon as I was wheeled into the ER, things changed. I became inconsolable and wouldn’t stop trying to escape from the team helping me. This is when shit hit the fan. My SpO2 suddenly dropped to 88%, BP 190/120, and HR of 210. I have Ehlers-Danlos Syndrome type 3, which causes me to be freakishly flexible and my joints freely dislocate. (I’m also a type one diabetic, but my levels were fine.) Because of my EDS, when my behavior escalated, manual restraint didn’t work since my joints would just dislocate and allow me to keep trying to escape. Chemical restraint didn’t work either because my health issues cause a high tolerance for them. After 4 rounds of sedatives I finally called down. An IVC order was placed, but since I was unconscious, the ER doc filed the papers himself and didn’t alert a psychiatrist. I kept suddenly coming out of my sedation and required re-dosing about 7 times over the next few hours. Eventually, I was admitted to the ICU because of the sheer amount of drugs that had to give me to keep me sedated. They said it neared 1.5X what they’d use for general anesthesia, and while I was still breathing adequately with a nasal cannula, they wanted to have a specialist and team nearby incase I needed to be intubated. Long story short, I had an exceedingly rare medication reaction that caused Acute Toxic Encephalopathy. I woke up in the ICU the next day, groggy, confused, pretty banged up, but otherwise fine. I was told I was under an IVC order, and being pre-med interested in emergency med, I knew exactly what that was and asked what the psychiatrist said when I was evaluated. “IVC order placed in error and subsequently rescinded” is what it says on my chart now 😂
Thank you for taking the time to explain all this. It is quite confusing, even for those of us is medicine (who aren’t in psychiatry). It’s good to understand this process instead of it being a black box of mystery.
This was a super helpful explanation! I work in an ER where we regularly have up to 15 patients awaiting inpatient psychiatric placement, it’s always challenging to have to restrict their rights if they are a clinical hold, particularly when the patient has difficulty understand into the process of being held for an evaluation. Do you have any suggests for navigating this tricky part of the process?
Me watching a Preston video is like me watching a Hollywood film with an A-list celebrity. Not saying he’s acting, but rather that he’s gorgeous, and I love seeing all of his work. Plus, I get to learn.
Can you comment on how partial hospitalization programs fit into this decision tree? Thank you for these informative videos breaking down the physician thought process!!
Licensed counselor in FL. PHP is a lower level of care than inpatient. Usually these programs are voluntary *. Some patients step down to them after being in inpatient or residential. Some people who choose to go to treatment will be assessed by the intake clinicians to be admitted at the PHP level, depending on the severity of symptoms. The step below PHP is Intensive Outpatient (IOP), and then another step below that is (regular) Outpatient treatment. *Some people will go to a higher level of care (PHP or IOP) as part of a court order (probation requirements, diversion programs, etc), so they aren’t ~technically~ voluntary, but it’s not the same kind of voluntary/involuntary as an order of protection. Court-ordered patients in any non-inpatient setting still technically have a choice to attend treatment or not…it’s just that their choice is between treatment or jail. With involuntary hospitalization, you literally are not allowed to leave the hospital until a psychiatrist or judge says so (ie “locked units”).
Hi Preston, awesome content as always! Could you make a video on how you interact with patients that are angry/aggressive for various reasons (healthcare system not working for them, feeling misunderstood, but also instrumentally to gain something from you as a caregiver)?
i work as a psych tech in Maine. From my experience 9/10 when someone is involuntarily committed on my unit, they have a pretty obvious psych issue i.e severe psychosis or severe mania. the times it gets tricky is with schizophrenic/affective people where sometimes the symptoms aren’t super obvious. overall though, i agree with most involuntary holds and the patient almost always leaves the hospital significantly better than when they came in.
You follow up with these patients? The majority wind up significantly worse but the majority also possess enough mental faculty to conclude that they must "play the game" in order to be let go. Are you too dense to realize that you put people in a position where they have to act and lie and stroke the staff's egos in order to escape confinement and escalation of "treatment"? This is an absurdly common phenomenon and it skews any data based on the biased perspective of an authority that punishes those who refuse to appear "well".
The most absurd thing I’ve ever seen is we had someone involuntarily placed and it went through the whole process and was approved by a judge, but their insurance said they didn’t meet inpatient criteria and they didn’t want to pay for it. The other thing is, at least in Florida, the overwhelming majority of involuntary psych holds are for suicidal ideation, not for psychosis.
In my state it’s a tad different, no second psychiatric opinion required, but the coroner’s office does need to sign off on a commitment longer than 72 hours. The coroner’s certificate buys us fourteen days before we have to file for judicial commitment.
Have had to be placed on these more than once unfortunately. Where I am in Texas, it’s issued by a judge and depending on the situation, can be immediate transfer to a behavioral health center or hospitalization with transfer after discharge. I’ve had the latter multiple times and they do have a police officer stationed outside the room at all times and you can’t even go to the restroom without supervision. Not a pleasant experience but it’s one that I just keep finding myself in.
PA student here who is currently in their Behavioral health rotation, i think the involvement of mental health with the court system kinda blew my mind as i learned more about this branch of health care. There’s a really good video that vice just released that might be interesting to people who make it here in the comments. ruclips.net/video/R1lC01WJVaw/видео.htmlsi=-SCmrvS103GuOQoD Thanks Preston for making these videos, ive found them very insightful now that I’m in my BH rotation
preston im sorry. i know you are a resident. but you embody EVERYTHING i want to be as a doctor. and think you should be on every major medical review board in psych. Please continue to be the leader that our field needs--repairing the damage of the last hundred years
I knew someone who went to the hospital voluntarily for mental health issues and they waited in a locked reception area for hours to see a doctor and when they expressed their frustration quietly under their breath two security guards stood over them with no water or food and couldn’t step out for any fresh air. This happened in British Columbia, which doesn’t have a great reputation for medical care lately so it could be different than it is in the states but my heart really goes out to everyone who has experienced something similar.
Interesting to see this step by step, I didn't know what was happening when it happened to me. I said I was good to go home, they said they'd force me to stay but I'd see another psych in 24hrs. That psych committed me but I wanted to leave, had to go to court, lost, then was forced injectible meds, then was almost sent to the state hospital but my parents intervened and I went to a residential treatment instead.
I was involuntarily committed for 10 days. At no point did anyone explain what was going on or why i was there. Before i was discharged they made me sign a contract saying i would do 6 months of therapy. At that point i honestly didnt even know what hospital i was at. Edit: it wasnt till about a year later that i finally "understood" that there is no free will and everyone is being controlled.
It was far more draconian in the past and the field is continuing to evolve and reform. There has to be a balance between letting violent people run amok versus protecting against pseudo-jail without a trial
And what do you think is a regular state of mind? What if the person has issues that cannot be solved by any medicines, yet you still force meds on them against their will and expect them to change and magically become normal? What if your complacency with your least favorite part of psych is perpetuating a broken system that can't help everyone and needs to change to be more accommodating to different types of people and their different brains? This content, not just the video, but the reality of the US medical systems and how we treat those mentally different and exploit them in for profit health facilities treating them against their will, disgusts me.
We are talking about severe cases of psychosis, mania and/or suicidal behavior. Not some adhd. It was also explains that the judge will rule fore the patient relatively often, against the recommendation of the psych team
I'm not talking about ADHD I assure you. I'm talking about genetic incurable neurodegenerative disease, that runs in my family. You can be institutionalized for even mentioning you want enough control in your life to be able to stop living your continued progressive suffering. Duty to report and everyone scared and forced to cover their ass for their job doesn't help everyone that is for sure. By these guidelines you'd be detained, held for a week against your will, forced medications against your will, and then people who rule on you like a psychiatrist or a judge have barely even heard of this rare disease let alone how to handle a situation like this will expect you to be 'normal enough' for you to be able to have your autonomy be respected and not just have everyone proceed like you're an unconscious person. Not that any of this even helps. Reform mental health in the US. Look at the 'off button' rates increasing.
@@ablakefree Your argument is a straw man. What you are referring to is voluntary euthanasia/doctor-assisted suicide in relation to terminal illnesses (like Huntington's disease, etc.) That is not what this video is about as the other user said. Firstly, wanting control in wanting to end your life due to an incurable terminal disease IS permitted in a few states in the US (the guidelines differ by state), and is also not representative of someone being altered mentally from their baseline. And Preston is not saying there is a "normal state of mind," he literally says the goal is to return that person to THEIR ordinary state of mind, i.e. their baseline. That by definition will be different for everyone. Someone in a psychotic episode is quite literally not in their "ordinary" state of mind. Your scenario involves someone who IS at their baseline and whose desire over control to end their life is directly related to their known and verifiable medical situation, which again IS legal in certain states (and overseas). Involuntary holding someone due to plans of suicide due to that is a very different argument than what this video is referring to.
It is in a few states but if you aren't in one you can't even address these topics without fear of these policies. And you'll never return someone to their baseline as they're progressively getting worse from a disease or changed forever from forced treatments. A lot of voluntary stays are coerced in that they offer people to go voluntary or they'll force them involuntary. This does not respect an actual right to refuse and the individuals autonomy when offering these two ways forward. You say certain states like people can just snap their fingers and be there, but another issue for maid is needing 6 month prognosis which isn't actually super verifiable for someone with one of these diseases and there is a large stigma around ending a life that is only met negatively and changes geographically. And no one in politics is playing to help any of these types of people. Let alone worse personal circumstance restricting overcoming these limitations, and personally damaging policies, such as poverty, no traditional support systems, or past traumas.
Very good it's not uncommon judges side with your victims. You don't even know what you're doing to these people. Every time you screw up, you blame everything on someone's "mental illness", instead of admitting you're such doctors, you don't even know what you're doing.
I... Don't think you've watched very many of his videos before, since he has consistently leveled critique towards for example, how assistance like social care is neglected in the U.S such as providing unhoused people a place to live and sufficient ability to take care of their own basic needs as conditions to proceed in any treatment of conditions that severely restrict their quality of life.
@@FlyingVolvo As a shrink, it's probably not odd he too needs that booze before bedtime, just to fall asleep because of the guilt. If I know what things like Loren Mosher's Soteria Project was, and what was done with, why is he still interested in "open skull surgery" on something he doesn't even understand? If you're not interested in these people's well-being, therefore will best leave them alone, they'll leave that conscience of yours alone ☺️. Trust common sense, he knows much better what harm psychiatry is doing, than the likes of 100 of us combined!
Great video. I do want to add that the process to give someone meds against their will CAN (in some states) be different and separated from the process of their ADMISSION to a psych hospital. Meaning someone can be forced to stay in a hospital, but also still be allowed to refuse medications for weeks-months before a judge can rule that these medications can also be provided against someone's will. This can make some hospitalizations particularly frustrating for both patients and staff, as much of it is just sitting in a deadlock waiting for mental health court to get to their case. This is the part I find almost more frustrating and icky, as it essentially wastes our patients time in a very uncomfortable, albeit safer, environment.
It's definitely frustrating from a frontline perspective. It seems ethically important to me that those remain separate. Just because someone is seriously ill shouldn't mean that they no longer have a say in what others do to their body. Permission to override such a basic right should be granted by someone independent. (And it's not even necessary in most cases.) Seems to me like the fix is to increase funding for mental health courts to speed the process up
Absolutely agree. This entire situation Would be a non issue if we could get to a judge within a business day or so for med against objections. It's also important these remain distinct
This is a tricky situation. Involuntary psychiatric holds are infamous for often being extremely traumatizing & harmful, but at the same time, for many of these situations it’s difficult to think of good alternatives.
I’ve seen some arguments for specifically abolishing suicide-prevention involuntary holds, with the view that a person’s autonomy & control of their own life should come first… Even if their decision is to end that life.
The suggestions I’ve seen in that regard have been to create systems that, if the suicide attempt is panic-induced and not really an informed personal choice, de-escalate the immediate situation, so someone doesn’t kill themselves in a state of panic, and then emotionally support the person in question and talk to them about their options & choices, with a guarantee that ultimately those choices will be respected… Even if they ultimately do choose death.
Support without judgement, without fear of losing autonomy, etc.
I personally found that quite compelling. Death is very scary, and we don’t want to lose the ones we love, but if the system to stop them from departing causes them tremendous distress, and often increases their chances of actually committing suicide in the long term… Maybe we should have a system that isn’t focused on immediately preventing their death at literally all costs.
I was fairly moved by those arguments, but I don’t know anywhere near enough on the topic to be at all sure.
That’s for suicidal behavior though… For other situations, like psychotic breaks, or violence towards others, I really don’t know if there’s any sort of good alternative.
It’s one thing if someone is of clear mind and wants to make a choice about their own life that we might find terrifying, it’s another thing if they’re either out of their mind and currently incapable of making decisions for themselves, or if their decision is that they want to hurt someone else. (Which is obviously not a decision they should be allowed to make, autonomy doesn’t apply to decisions to harm other people, the safety of those people obviously takes priority in that case)
At the very least, even in those cases the involuntary hold system likely needs massive reform, because from everything I heard, including from friends who were unfortunate enough to be in that situation, it’s a system currently riddled with horrors & abuses. Extremely strict oversight should be an absolute must, because situations of extreme power imbalance invite cases of extreme abuse. If you hold near absolute power over someone, and they have no say in what’s happening, it can become very easy for you to do whatever the hell you want to them, with little to no fear of consequences of any kind.
EMT here. Thank you for the vid and for the work you do. Also icky is the part where when someone reaches the point of emergency, the final available option is going to be 911. And if the person is violent, that means police. I don't know the answer, but I do know that I am not equipped or trained to safely transport a violent person without police. When these scenarios go wrong prehospital they go very, very wrong, but I think that we as a society need to really evaluate what it means for 1) letting people get to crisis and 2) how to structure a safe response to these moments. Because incidence is only going up.
Crazy to me that police are the ones who respond to mental health crises. They can't do and be everything, and their job should have a better defined scope. Police are meant to deal with crime - assault, theft, etc. People in crisis often need a whole different skill set than what a police officer with probably minimal mental health training can provide.
Hey Pres. Thanks for the vid. Wanted to include that these holds and their times change between States and their respective Welfare & Institutions codes. I'm a few minutes in and heard you mention an ED 48 hr hold- not sure which state you live in, but here in California under WI Code 50&51, our psych holds last 72 hours initially and are known as 5150 holds. I believe they're placed by police, social workers, or psych physicians. I also believe they can be lifted by social workers or psych physicians.
As I understand it, a hold can be placed by a variety of professionals that may vary even between counties, but only psychiatrists can lift them because only they can do the formal assessment
Preston, I started watching your content because it’s funny medical content; but I love you explanations of psychiatric concepts and it’s actually been really helpful with this being my psych rotation in nursing school. Just wanted to say thanks.
as an EMT as well let me tell you -- probably *the* most stressful situations I get into are the ones where I have to decide (or help decide) whether or not someone is going to go to a hospital against their will.
I'm an EMT as well. We have no training whatsoever that qualifies us to make that decision, and it's a violation of due process if the patient hasn't broken any laws. That is admittedly pretty rare, but think about some of your coworkers (i.e., the ones who steal the special k off the truck) - are they people you would want making this decision with your life?
You both said it perfectly. The only sure fire solutions on scene are medical control, law enforcement, calling your supervisor, and having witnesses/a good ass PCR.
This was great because I didn’t know it was this many steps. Great video again & insight.
It is not. Every place does whatever it pleases and the patients cannot say boo.
I had an OPC placed on my last year. I was at my dentist having a procedure and was mildly sedated. After the procedure, I was completely unconscious and couldn’t be woken up. EMS was called after the reversal meds didn’t work. I was stable, but still unconscious while being moved to the ambulance. I started to stir a bit, but wasn’t able to respond to questions or commands appropriately. I started gradually becoming more “active”, but still not making sense. I began behaving panicked and couldn’t be calmed. I wasn’t combative or volatile, just distressed and still not making any sense. As soon as I was wheeled into the ER, things changed. I became inconsolable and wouldn’t stop trying to escape from the team helping me. This is when shit hit the fan. My SpO2 suddenly dropped to 88%, BP 190/120, and HR of 210. I have Ehlers-Danlos Syndrome type 3, which causes me to be freakishly flexible and my joints freely dislocate. (I’m also a type one diabetic, but my levels were fine.) Because of my EDS, when my behavior escalated, manual restraint didn’t work since my joints would just dislocate and allow me to keep trying to escape. Chemical restraint didn’t work either because my health issues cause a high tolerance for them. After 4 rounds of sedatives I finally called down. An IVC order was placed, but since I was unconscious, the ER doc filed the papers himself and didn’t alert a psychiatrist. I kept suddenly coming out of my sedation and required re-dosing about 7 times over the next few hours. Eventually, I was admitted to the ICU because of the sheer amount of drugs that had to give me to keep me sedated. They said it neared 1.5X what they’d use for general anesthesia, and while I was still breathing adequately with a nasal cannula, they wanted to have a specialist and team nearby incase I needed to be intubated. Long story short, I had an exceedingly rare medication reaction that caused Acute Toxic Encephalopathy. I woke up in the ICU the next day, groggy, confused, pretty banged up, but otherwise fine. I was told I was under an IVC order, and being pre-med interested in emergency med, I knew exactly what that was and asked what the psychiatrist said when I was evaluated. “IVC order placed in error and subsequently rescinded” is what it says on my chart now 😂
Thank you for taking the time to explain all this. It is quite confusing, even for those of us is medicine (who aren’t in psychiatry). It’s good to understand this process instead of it being a black box of mystery.
This was a super helpful explanation! I work in an ER where we regularly have up to 15 patients awaiting inpatient psychiatric placement, it’s always challenging to have to restrict their rights if they are a clinical hold, particularly when the patient has difficulty understand into the process of being held for an evaluation. Do you have any suggests for navigating this tricky part of the process?
Me watching a Preston video is like me watching a Hollywood film with an A-list celebrity. Not saying he’s acting, but rather that he’s gorgeous, and I love seeing all of his work. Plus, I get to learn.
Can you comment on how partial hospitalization programs fit into this decision tree? Thank you for these informative videos breaking down the physician thought process!!
Licensed counselor in FL. PHP is a lower level of care than inpatient. Usually these programs are voluntary *. Some patients step down to them after being in inpatient or residential. Some people who choose to go to treatment will be assessed by the intake clinicians to be admitted at the PHP level, depending on the severity of symptoms. The step below PHP is Intensive Outpatient (IOP), and then another step below that is (regular) Outpatient treatment.
*Some people will go to a higher level of care (PHP or IOP) as part of a court order (probation requirements, diversion programs, etc), so they aren’t ~technically~ voluntary, but it’s not the same kind of voluntary/involuntary as an order of protection. Court-ordered patients in any non-inpatient setting still technically have a choice to attend treatment or not…it’s just that their choice is between treatment or jail. With involuntary hospitalization, you literally are not allowed to leave the hospital until a psychiatrist or judge says so (ie “locked units”).
Hi Preston, awesome content as always! Could you make a video on how you interact with patients that are angry/aggressive for various reasons (healthcare system not working for them, feeling misunderstood, but also instrumentally to gain something from you as a caregiver)?
i work as a psych tech in Maine. From my experience 9/10 when someone is involuntarily committed on my unit, they have a pretty obvious psych issue i.e severe psychosis or severe mania. the times it gets tricky is with schizophrenic/affective people where sometimes the symptoms aren’t super obvious.
overall though, i agree with most involuntary holds and the patient almost always leaves the hospital significantly better than when they came in.
You follow up with these patients? The majority wind up significantly worse but the majority also possess enough mental faculty to conclude that they must "play the game" in order to be let go.
Are you too dense to realize that you put people in a position where they have to act and lie and stroke the staff's egos in order to escape confinement and escalation of "treatment"?
This is an absurdly common phenomenon and it skews any data based on the biased perspective of an authority that punishes those who refuse to appear "well".
The most absurd thing I’ve ever seen is we had someone involuntarily placed and it went through the whole process and was approved by a judge, but their insurance said they didn’t meet inpatient criteria and they didn’t want to pay for it.
The other thing is, at least in Florida, the overwhelming majority of involuntary psych holds are for suicidal ideation, not for psychosis.
Insurance finally doing something right
In my state it’s a tad different, no second psychiatric opinion required, but the coroner’s office does need to sign off on a commitment longer than 72 hours. The coroner’s certificate buys us fourteen days before we have to file for judicial commitment.
Have had to be placed on these more than once unfortunately. Where I am in Texas, it’s issued by a judge and depending on the situation, can be immediate transfer to a behavioral health center or hospitalization with transfer after discharge. I’ve had the latter multiple times and they do have a police officer stationed outside the room at all times and you can’t even go to the restroom without supervision. Not a pleasant experience but it’s one that I just keep finding myself in.
PA student here who is currently in their Behavioral health rotation, i think the involvement of mental health with the court system kinda blew my mind as i learned more about this branch of health care. There’s a really good video that vice just released that might be interesting to people who make it here in the comments. ruclips.net/video/R1lC01WJVaw/видео.htmlsi=-SCmrvS103GuOQoD
Thanks Preston for making these videos, ive found them very insightful now that I’m in my BH rotation
Psych holds, while maybe well intentioned, are abused by cops WAAAAY too often.
preston im sorry. i know you are a resident. but you embody EVERYTHING i want to be as a doctor. and think you should be on every major medical review board in psych. Please continue to be the leader that our field needs--repairing the damage of the last hundred years
Cute cat 🐈☀️🧸☀️🧸
I knew someone who went to the hospital voluntarily for mental health issues and they waited in a locked reception area for hours to see a doctor and when they expressed their frustration quietly under their breath two security guards stood over them with no water or food and couldn’t step out for any fresh air. This happened in British Columbia, which doesn’t have a great reputation for medical care lately so it could be different than it is in the states but my heart really goes out to everyone who has experienced something similar.
Yeah mental healthcare in BC is awful.
Interesting to see this step by step, I didn't know what was happening when it happened to me. I said I was good to go home, they said they'd force me to stay but I'd see another psych in 24hrs. That psych committed me but I wanted to leave, had to go to court, lost, then was forced injectible meds, then was almost sent to the state hospital but my parents intervened and I went to a residential treatment instead.
Great video
This is so draconian, jesus christ
Does attempted suicide warrant for involuntary admission?
I was involuntarily committed for 10 days. At no point did anyone explain what was going on or why i was there. Before i was discharged they made me sign a contract saying i would do 6 months of therapy. At that point i honestly didnt even know what hospital i was at.
Edit: it wasnt till about a year later that i finally "understood" that there is no free will and everyone is being controlled.
my invol mostly taught me to lie to doctors lol
Wow this is a lot more draconian than I expected, yikes
It was far more draconian in the past and the field is continuing to evolve and reform. There has to be a balance between letting violent people run amok versus protecting against pseudo-jail without a trial
And what do you think is a regular state of mind? What if the person has issues that cannot be solved by any medicines, yet you still force meds on them against their will and expect them to change and magically become normal? What if your complacency with your least favorite part of psych is perpetuating a broken system that can't help everyone and needs to change to be more accommodating to different types of people and their different brains? This content, not just the video, but the reality of the US medical systems and how we treat those mentally different and exploit them in for profit health facilities treating them against their will, disgusts me.
We are talking about severe cases of psychosis, mania and/or suicidal behavior. Not some adhd. It was also explains that the judge will rule fore the patient relatively often, against the recommendation of the psych team
I'm not talking about ADHD I assure you. I'm talking about genetic incurable neurodegenerative disease, that runs in my family. You can be institutionalized for even mentioning you want enough control in your life to be able to stop living your continued progressive suffering. Duty to report and everyone scared and forced to cover their ass for their job doesn't help everyone that is for sure. By these guidelines you'd be detained, held for a week against your will, forced medications against your will, and then people who rule on you like a psychiatrist or a judge have barely even heard of this rare disease let alone how to handle a situation like this will expect you to be 'normal enough' for you to be able to have your autonomy be respected and not just have everyone proceed like you're an unconscious person. Not that any of this even helps. Reform mental health in the US. Look at the 'off button' rates increasing.
@@ablakefree Your argument is a straw man. What you are referring to is voluntary euthanasia/doctor-assisted suicide in relation to terminal illnesses (like Huntington's disease, etc.) That is not what this video is about as the other user said. Firstly, wanting control in wanting to end your life due to an incurable terminal disease IS permitted in a few states in the US (the guidelines differ by state), and is also not representative of someone being altered mentally from their baseline. And Preston is not saying there is a "normal state of mind," he literally says the goal is to return that person to THEIR ordinary state of mind, i.e. their baseline. That by definition will be different for everyone. Someone in a psychotic episode is quite literally not in their "ordinary" state of mind. Your scenario involves someone who IS at their baseline and whose desire over control to end their life is directly related to their known and verifiable medical situation, which again IS legal in certain states (and overseas). Involuntary holding someone due to plans of suicide due to that is a very different argument than what this video is referring to.
It is in a few states but if you aren't in one you can't even address these topics without fear of these policies. And you'll never return someone to their baseline as they're progressively getting worse from a disease or changed forever from forced treatments. A lot of voluntary stays are coerced in that they offer people to go voluntary or they'll force them involuntary. This does not respect an actual right to refuse and the individuals autonomy when offering these two ways forward. You say certain states like people can just snap their fingers and be there, but another issue for maid is needing 6 month prognosis which isn't actually super verifiable for someone with one of these diseases and there is a large stigma around ending a life that is only met negatively and changes geographically. And no one in politics is playing to help any of these types of people. Let alone worse personal circumstance restricting overcoming these limitations, and personally damaging policies, such as poverty, no traditional support systems, or past traumas.
Very good it's not uncommon judges side with your victims. You don't even know what you're doing to these people. Every time you screw up, you blame everything on someone's "mental illness", instead of admitting you're such doctors, you don't even know what you're doing.
I... Don't think you've watched very many of his videos before, since he has consistently leveled critique towards for example, how assistance like social care is neglected in the U.S such as providing unhoused people a place to live and sufficient ability to take care of their own basic needs as conditions to proceed in any treatment of conditions that severely restrict their quality of life.
@@FlyingVolvo As a shrink, it's probably not odd he too needs that booze before bedtime, just to fall asleep because of the guilt. If I know what things like Loren Mosher's Soteria Project was, and what was done with, why is he still interested in "open skull surgery" on something he doesn't even understand? If you're not interested in these people's well-being, therefore will best leave them alone, they'll leave that conscience of yours alone ☺️. Trust common sense, he knows much better what harm psychiatry is doing, than the likes of 100 of us combined!