Can You Detain a Patient Just For Being Manic?

Published

We have a pt who is not homocidal, not suicidal does not self mutilate. He is simply manic. He has filed a Right to Apply for Discharge and the discharge has been refused, so the doctor keeps Baker Acting him. The family wants him to stay in the hosp, but he is not a minor. This seems like an abuse of Baker Act and I cannot understand why they are not allowing him to be d/c'd. I mean, ok, mania isn't a really healthy state, and sure, maybe manic people don't make the best choices at times, but if that's all they are going on, we'd have to Baker Act every obese person who goes to McDonald's. The man does not have a job right now, but has an advanced degree. He has said he missed an interview already because they are refusing his release.

I have to say, I do feel that his rights are being violated. But am I missing something?

Up Vote Up Vote ×

Can you clue me in on what a Baker Act is? please?

Does he have anyone in his life who is particularly familiar with him and his past mania actions? Sometimes Manics will listen to those who they are familiar with, sometimes not. Does he have a Psychiatric Advance Directive?

If not, this is where people fall through the cracks in the system - Can you get someone within his family or support circle to 302 him?

In my state, the MD can petition for 302 in order to court authorize where necessary to bring pt. down to therapeutic state medically where other measures can be employed. Sometimes the judicial system needs to get involved to keep the patient safe and those around him even if there are no threats.(He may be aware that this is what can keep him there)or the harm could be discerned as to his actions in the interview if divulged to you. If he has a past history of psychiatric care then that may be a deciding factor if you can establish past behaviors conclusive to his current state. Yes, it seems hurtful to the patient to go some of these routes but most times afterward if there is discussion including the patient of decisons made and why it goes a long way.(After stabilization)

I agree it is hard to reason with a manic but if he is there in an environment where he can be helped even if it is against his will, it may be a different attitude once he's down and someone can communicate the irrationality of his behaviors and still maintain a therapeutic trusting relationship.

You could always threaten a transfer to a State Facility with months of treatment if he will not comply with the reasonable terms of medication your MD is suggesting. Unfortunately this is a difficult situation for the patient, the MD and you all the way around. The use of force, coercion,and manipulation is present here and may seem unfair but you may also be protecting him from undo embarassment, an exacerbation of symptoms, and actions he may not be able to recover from. Your professional opinion is valid here and goes a long way in the protection of your patient as well as the reasonableness of the physician and the possible outcomes of this matter.

I would say that you may need to be upfront with your MD as to both your concerns for the patients rights but as well as for the patient's overall stabilty in this matter and see if the two of you can come up with a possible solution and compromise that may faciliate trust all the way around including the patient in the decision/outcomes/concerns in the matter if at all possible.

My Best to you,

IMO,

Heather GN/5/13/06- "And part of a disabilities minority"

Up Vote Up Vote ×
Specializes in Maternal - Child Health.

Wow! In Illinois, you certainly don't.

Laws vary from state to state, but in IL, one may be detained for 72 hours if there is reason to believe that the person poses an immediate threat to his/her own safety or that of others. A court hearing must be held within that 72 hour time frame, and a judge's order is then required to hold the patient involuntarily beyond then.

In the situation you describe, it does not sound like this gentleman truly presents a threat to himself or anyone else. It concerns me that a patient experiencing a manic phase without the threat of violent or dangerous behavior continues to be held.

Up Vote Up Vote ×
Specializes in Psych, Med/Surg, LTC.

If he were in the hospital I used to work at, he would be d/c'd. If he denies thoughts or plans of hurting himself or others, why would he need to be inpatient? He didn't hurt anyone or himself, so he should be able to leave if he so desires. He can get outpatient treatment. If he wants it. Mania alone is not a reason for being an inpatient.

Up Vote Up Vote ×

Not sure, but how did he come across being an inpatient?

And what does the law say in your state?

Up Vote Up Vote ×
Not sure, but how did he come across being an inpatient?

And what does the law say in your state?

Thanks for the responses.

Truly, he comes across pretty normal. Some rapid speech, occasionally grandiose, but all in all, he comes across as a person who is experiencing a hypomanic cycle, who knows what he does and does not want in the way of treatment, and truly poses no threat to himself or others.

Yes, he has had a hx of spending sprees and stuff like that, but like I said, if we can detain people in a psych ward for having bad judgement, a heck of alot more of us would be in there.

I'm in FL, and as far as I can tell with the law, the person has to pose a threat to self or others. his family is really involved, parents monitoring his bank accounts and acting enmeshed and very neurotic. His parents have been pushing for continued hospitalization and i think that the doc is continuing to BA this patient based on the parents voiced concerns.

Pt is going on day 15 on hospitalization. The man has asked for release several times.

He just does not seem to me to meet criteria for BA and since he doesn't have insurance right now, I wonder why they will not let him go. Frankly, if I were he, I would be taking action for false imprisonment when I got out.

Up Vote Up Vote ×
Can you clue me in on what a Baker Act is? please?

Does he have anyone in his life who is particularly familiar with him and his past mania actions? Sometimes Manics will listen to those who they are familiar with, sometimes not. Does he have a Psychiatric Advance Directive?

If not, this is where people fall through the cracks in the system - Can you get someone within his family or support circle to 302 him?

In my state, the MD can petition for 302 in order to court authorize where necessary to bring pt. down to therapeutic state medically where other measures can be employed. Sometimes the judicial system needs to get involved to keep the patient safe and those around him even if there are no threats.(He may be aware that this is what can keep him there)or the harm could be discerned as to his actions in the interview if divulged to you. If he has a past history of psychiatric care then that may be a deciding factor if you can establish past behaviors conclusive to his current state. Yes, it seems hurtful to the patient to go some of these routes but most times afterward if there is discussion including the patient of decisons made and why it goes a long way.(After stabilization)

I agree it is hard to reason with a manic but if he is there in an environment where he can be helped even if it is against his will, it may be a different attitude once he's down and someone can communicate the irrationality of his behaviors and still maintain a therapeutic trusting relationship.

You could always threaten a transfer to a State Facility with months of treatment if he will not comply with the reasonable terms of medication your MD is suggesting. Unfortunately this is a difficult situation for the patient, the MD and you all the way around. The use of force, coercion,and manipulation is present here and may seem unfair but you may also be protecting him from undo embarassment, an exacerbation of symptoms, and actions he may not be able to recover from. Your professional opinion is valid here and goes a long way in the protection of your patient as well as the reasonableness of the physician and the possible outcomes of this matter.

I would say that you may need to be upfront with your MD as to both your concerns for the patients rights but as well as for the patient's overall stabilty in this matter and see if the two of you can come up with a possible solution and compromise that may faciliate trust all the way around including the patient in the decision/outcomes/concerns in the matter if at all possible.

My Best to you,

IMO,

Heather GN/5/13/06- "And part of a disabilities minority"

I don't understand this 302 thing...what is it again please?

Up Vote Up Vote ×

in NE we can do a 48 hour hold to determine safety,has to be initiated by a psychiatrist. In that the pt. is observed and evaled,recommendations made and if they are unwilling to go along voluntarily if considered a danger to themselves or others-this can include not eating,not sleeping,refusing meds,delusional activity,spending,promiscuity,influence on children etc..then the county has 72 hours to schedule a mental health board hearing to decide about committal. As our collegues have said,history and family/SO input can make a big difference. Does this pt. have a case manager or primary therapist you can get more info from,or your House Manager/Supervisor? I've seen what looked like really shakey 48 hour holds until I saw the dication about history an fam/SO input.

Oh,sorry I missed your post on the specialty board

Up Vote Up Vote ×
Specializes in Hospice, Med/Surg, ICU, ER.
His parents have been pushing for continued hospitalization and i think that the doc is continuing to BA this patient based on the parents voiced concerns.

Pt is going on day 15 on hospitalization. The man has asked for release several times.

He just does not seem to me to meet criteria for BA and since he doesn't have insurance right now, I wonder why they will not let him go. Frankly, if I were he, I would be taking action for false imprisonment when I got out.

Were it me, I'd call the police and state that I had been kidnapped - that would put the case before a judge soonest.

While I have no doubt that this fellow needs some help, to continue to hold him against his will when he is not a theat to himself/others goes against everything I believe in.

I darned sure would see the MD charged with a crime, and sued within an inch of his yacht for doing this.

1
Up Vote Up Vote ×

Meerkat -

A 302 petition is for involuntary commitment. I will tell you that in PA this can happen very easily. Words true or untrue can be said against you and if a judge or representative of that judge deems those words to be credible or convincing enough, a judge can order law enforcement or designated emergency response to act with each other to detain an individual and bring that individual to treatment against their will even if they claim to be non-threatening. Usually in the case of the individual with a past history, the words or claims of the individual become non-existent and the petition for finding and detaining the individual is enacted and followed through to a 30 day minimum visit to a corresponding facility which has a bed available. A "court" is held with a mental health judge who reviews findings from the physician, nurses and family after a 10 day period to determine appropriateness of treatment and whether that individual needs further treatment in a state facility. Usually at this point if an individual is transferrred to a state facility, the treatment period consists of no shorter than 180 days or when appropriate housing/treatment is established.

I am not sure what state legislature says in Florida but a little investigating should go a long way in your situation to uphold this gentlemen's rights and whether or not you have a way to intervene on his behalf.

From my personal experience, a psychiatric history even non-violent is enough to warrant fear in decision makers sometimes looking more at what could happen then what will. Unfortunately in Pennsylvania we are barbaric and unrelenting and in the stone age when it comes to legislature and the proper treatment of the mentally ill. This is why there are so many groups advocating for these people in order to change the laws to reflect advances in humanistic treatment of those with mental disabilities. Today we even have insurance companies who are convinced the mentally ill do not deserve adequate compensation for services rendered but a heart bypass or chemotherapy session is covered with no problem. The insurance companies follow the legislature which governs the system which continually disqualifies the physical origins of mental illness and keeps society demoralizing those who are in desperate need of treatment and equal parity.

Not sure what's happening there in Florida but if there is FEAR here, it is probably there as well. I am convinced there are two fears in life - That of death and that of having mental illness............

You sound as though you may just be an "angel" for this man by your selflessness and concern for his welfare. I hope you find there is something you can do...........

Remember every patient needs a strong advocate and you sound like you are willing to fit that need.

Let me know how it goes......HB

Up Vote Up Vote ×
Were it me, I'd call the police and state that I had been kidnapped - that would put the case before a judge soonest.

While I have no doubt that this fellow needs some help, to continue to hold him against his will when he is not a theat to himself/others goes against everything I believe in.

I darned sure would see the MD charged with a crime, and sued within an inch of his yacht for doing this.

Clee-

From where I come from, this type of "kidnapping" happens more than one would realize. People in these types of situations are held against their will all the time and their little resources do nothing against institutions and MD's that are rolling in the green stuff and the connections.....Little can be done except to change the attitudes, responses and thoughts we have towards people with mental disabilities. Enough outrage can turn the system around if enough people push for change.........A system is only made up from the sum of its parts - General Systems Theory....

If your outraged enough as I have been, join NAMI in your area to help change laws and legislature regarding humanistic treatment of those afflicted. We can't do it alone.............HB

Up Vote Up Vote ×
Specializes in Hospice, Med/Surg, ICU, ER.

If your outraged enough as I have been, join NAMI in your area to help change laws and legislature regarding humanistic treatment of those afflicted. We can't do it alone.............HB

What is NAMI??? (I'm guessing Nat'l Assn of Mental Illness)

Stories like this one make me sick to my stomach! :angryfire People being detained on the flimsiest of excuses; especially when the "family" pushes for it. Just WHO is the patient here???

I get similarly outraged when criminals (such as molesters or rapists) get "detained" again immediately after their release from jail/prison because "statistics show that such offenders will reoffend". Prosecutors do their darnedest to keep them in jail indefinately after their sentence has been served. (Don't get me wrong: I see no problem with locking away such scumbags permanently or just shooting them on the spot when they committed the offense that sent them to jail in the first place.)

My problem is the abuse of legitimate processes. If they can lock away this manic pt, or keep a criminal locked away after his/her sentence is served, TPTB can decide YOU or I am a "threat" and lock us up w/o cause too.

This MD that just keeps signing Baker Acts, the hospital that allows him to do so, and the loving "family" that wants their problem-child black sheep hidden away in an asylum literally make me violently angry. (whups... better watch it or somebody will try to BA me. :eek:)

Up Vote Up Vote ×
+ Join the Discussion