(cw for talk of institutionalization/psych wards, laws around involuntary commitment, guns)
several of my coworkers at my current job--one of them a manager--were legitimately shocked when i told them i read the employee handbook and regulations in their entirety. i was surprised they were surprised. how are you supposed to know when the rules are being used against you if you don’t know them to begin with? why would you trust or expect the company to not use those rules to their advantage at every opportunity, especially when they feel threatened? organizations and institutions maliciously using their rules against individuals isn’t unique, not by a long shot. my experiences with that are a major part of why i make sure to read whatever rulebook i can get my hand on. but, unfortunately, i couldn’t explain that to my coworkers without getting into a much more revealing conversation with them than i wanted to.
i’m reminded of this because November 1st is the fifth anniversary of my (first) psych ward debacle, and i’m still pissed off about the fact that the hospital i was admitted to didn’t seem to exactly care about following the law particularly closely. from the text of the Lanterman-Petris-Short Act, California’s involuntary commitment law, 5150(i)(1) specifically:
Each person admitted to a facility designated by the county for evaluation and treatment shall be given the following information by admission staff of the facility. The information shall be given orally and in writing and in a language or modality accessible to the person.
My name is _____. My position here is _____.
You are being placed into this psychiatric facility because it is our professional opinion that, as a result of a mental health disorder, you are likely to (check applicable):
◻ Harm yourself.
◻ Harm someone else.
◻ Be unable to take care of your own food, clothing, and housing needs.
We believe this is true because (list of the facts upon which the allegation of dangerous or gravely disabled due to mental health disorder is based, including pertinent facts arising from the admission interview).
You will be held for a period up to 72 hours. During the 72 hours you may also be transferred to another facility. You may request to be evaluated or treated at a facility of your choice. You may request to be evaluated or treated by a mental health professional of your choice. We cannot guarantee the facility or mental health professional you choose will be available, but we will honor your choice if we can.
During these 72 hours you will be evaluated by the facility staff, and you may be given treatment, including medications. It is possible for you to be released before the end of the 72 hours. But if the staff decides that you need continued treatment you can be held for a longer period of time. If you are held longer than 72 hours, you have the right to a lawyer and a qualified interpreter and a hearing before a judge. If you are unable to pay for the lawyer, then one will be provided to you free of charge.
If you have questions about your legal rights, you may contact the county Patients’ Rights Advocate at (phone number for the county Patients’ Rights Advocacy office). Your 72-hour period began ____ (date/time) ____ .
(there’s also another section--(g)--that requires people being brought into a facility for a 5150 evaluation be notified at the time they’re brought in, though i don’t know if that would’ve necessarily applied to me, given how i ended up there: in a rather humiliating moment, i actually knocked on the locked door to the ward’s waiting room and asked to be admitted, as my therapist instructed me to do.
granted, it kept me from having to sit in the ER for hours. but also, had i sat in the ER for hours, the realization of “wow, i don’t want to be here, i want to go home and sleep in my own bed” would’ve hit sooner, and perhaps i would’ve been able to avoid the entire thing. of course, my judgment on whether or not the system will think i’m dangerous enough to be detained has never been particularly accurate*, so maybe not.)
i was notified that i was being held under 5150 the morning after it actually happened. i don’t remember any sort of notification outside of “by the way, you’re here on a 5150” that someone who worked on/for/at the ward tossed me when we met on the morning of the 2nd. (i do remember being really surprised about it, mainly because i’d agreed/”agreed” to be admitted to the hospital when the question came up during my intake interview the previous night, and how can you be held against your will if you want (”want”) to be there?) you’d think that they would have documents proving that i acknowledged being notified, if only to cover their own asses--except they’re not part of the complete medical record i requested from the hospital a few years post-institutionalization, so who knows if they even exist?
but is a lack of adequate advisement regarding a hold really that serious an issue? i would say yes; if an institution as bureaucratic and under as much scrutiny as a hospital is can’t get their shit together enough to at least follow the law to the letter in an area that’s really just about shielding them from lawsuits, it’s indicative of larger problems, at the very least.
a second round: during my second hospitalization, the attending psychiatrist noted several times how i “reluctantly” agreed to be admitted voluntarily, and specifically required in my initial evaluation that i be “assessed on a shift basis as to whether [i met] the criterion for involuntary hold or not.” i found out about that exact wording in the records, but i (somewhat unintentionally, on their part) found out that i was teetering on a very thin cliff’s edge between voluntary and involuntary while actually on the ward, when the receptionist told me that my 5250 (14 day hold, an actual certification versus the 5150′s 72-hour assessment hold) paperwork was “already filled out” and basically just waiting for my attending psychiatrist to have a reason to sign off on it.
i was voluntary! the main benefit of being a voluntary patient is the fact that you should be able to leave when you want, which i tried to do several times (though, thankfully, not too aggressively until the very end)! being listed as voluntary doesn’t mean much when any attempts to take advantage of your rights as a voluntary patient would cause you to immediately get reclassified as involuntary! how i managed to avoid being certified is still a mystery, especially given that my last day i got in trouble for reading my file that they’d left laying in a binder on the counter, cried for hours and refused to talk to anyone, and only said “i want to leave” when my psychiatrist came by for our session (”session”) that night.
the point is that part of the reason i realized/am realizing that the way these institutions treated me was fucked up and wrong is because i now know about and have read the rules that they used to do it, or that set up a pathway for them to do what they did. without that knowledge, it was much harder to protect myself. had i had this knowledge before i got institutionalized, perhaps things would’ve turned out differently. if i get institutionalized again, i’ll know enough to be able to fight back to some extent. obviously i shouldn’t have to be almost obsessively worried about this--the ideal scenario would be that these institutions wouldn’t have this much power, or even be around in the first place--but that’s not the world we’re living in right now. so i’d rather have their own words to use against them, however much that’s actually possible.
which is why i pay attention to rules, and don’t get why people are surprised when i do, especially ones set by people who have power over my life. i mean, i also have an interest in rule systems in general--you can tell a lot about a group by the rules they set and don’t set for themselves, and there’s a lot to be said for how rules are written versus the ways they’re interpreted and applied--but there’s a big chunk of it that’s survival instinct (ha), now. that’s a little much to explain in the span of a two minute conversation during closing, though.
*--i’m mainly thinking of the fact that when i had my intake/assessment for my second hospitalization, i walked in almost positive that i’d be walking back out in a few hours. not so, obviously. also, reading back through my psych records from my university, i apparently narrowly avoided being 5150′d on at least two different occasions, neither of which i knew about until i read the session notes. the possibility was still very much there, of course, which i knew and acknowledged and talked about (a lot) to most of the different psych professionals i saw there, but i didn’t fully recognize the threat as being as so imminent. there’s something to be said about all that, i’m sure, but this post is long enough as it is.
on another note, you’d think that five years out of a psych ward would be a bigger milestone, but nothing about it has been particularly notable aside from the fact that my 5150-imposed restriction on being able to buy and own firearms is technically supposed to be over. i haven’t found any sources that definitely answer whether or not that restriction ends automatically or not, though. i can do a Personal Firearms Eligibility Check through the California Department of Justice to find out about my eligibility, if i feel like spending $20 and waiting a month or two.
i bring that up mostly because it’s been the only post-institutionalization milestone that i have. (the only reason i even know the restrictions had a five year duration is because i remember reading it on the paper they had me sign the morning they 5150′d me. it’s good that i remember it, because the paper isn’t in my record, of course.) for people that seemed really concerned about my lack of future planning, no one really seemed to be interested in helping me identify or plan any concrete things to look forward to. not that i would’ve been able to really actively participate in that kind of activity at the time, though, so maybe it’s a moot point.
nothing really feels like it’s substantially changed since 2013, aside from my raised tolerance and knowledge of how depression manifests in me/my life. i feel less like i’m going through a psychic meat grinder on a day-to-day basis, at least. progress? luck? i’ll take it.
and then i'm just like....i'm actually embarrassed of telling her just how bad mine was. she's this super bubbly person who's super happy all the time, like i feel like she'd be a bit disturbed if i told her there was a point during my high school experience that i seriously considered killing myself
