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?
So, if you were the family member, WWYD? Patient acting bizarrely, in manic or psychotic state, not dangerous to self or others but refusing treatment. This in someone who is otherwise a non-problematic person who has not previously exhibited any mental health issues.
So, if you were the family member, WWYD? Patient acting bizarrely, in manic or psychotic state, not dangerous to self or others but refusing treatment. This in someone who is otherwise a non-problematic person who has not previously exhibited any mental health issues.
Me, I'd do the "right" thing and have the pt eval'd for an involuntary committment. Not just urging the MD for continuous "temporary" holds.
If the family REALLY wants results for their "loved one" (and I am skeptical) that's what they'd do.
What is happening now is an abuse of the system, it is illegal, and it is CERTAINLY a violation of the Pts. civil rights.
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
Thanks for the kind compliments. My eyes welled up all over again, because I'm grateful for your words...if you missed my post in another thread, I spend too much time on our unit getting bullied (apart from screaming at me, this week I had a urine specimen thrown at me) but enough about me. I just thank you for your words, because the 'thanks' where I work are few and far between.
Anyhow, GUESS WHAT. Tonight the patient acted perfectly within his right, and called the police on the patient phone. Only reason I know this is because the cops called us at the hosp and told us to tell the patient to not call them again. That's it. Apparently, once the cops heard the words 'psych patient' they felt no need to investigate. Pitiful!
Your system up there sounds, well, scary. Orwellian even. I used to live in a communist country, and holding people against their will when they posed no threat was an everyday occurence. This really frightens me that any old person can say a person isn't safe, and off they go!
Now the question is...how do I advocate for him without losing my job??
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
The thing is, when someone is involutary for a certain amount of time, a second opinion must be done. All our docs work together, and I SERIOUSLY doubt that a doc would go against his colleague's determination that this patient should remain there involuntarily. It's a close knit bunch.
By the way, someone said that in their state a person can be committed even for SPENDING. Spending? What about all those college kids who get visas and mastercards doled out to them and rack up a maxed out bill? What's the difference between them and this guy?
A psych history. That's all they need, apparently to decide who is spending too much.
Specializes in Geriatrics/Oncology/Psych/College Health.
Now the question is...how do I advocate for him without losing my job??
You can chart your observations in your usual narrative notes. If no one is observing and documenting behaviors that meet the criteria of him being suicidal, homicidal or psychotic, then criteria for holding him gets pretty thin.
You might also take the time-honored tact of flat asking in report or rounds, "WHY is soandso still here on an involuntary? Maybe I'm confused. What criteria is he meeting to be held?" (Throw in the "I'm confused" as a less confrontational tool.)
Thanks for the kind compliments. My eyes welled up all over again, because I'm grateful for your words...if you missed my post in another thread, I spend too much time on our unit getting bullied (apart from screaming at me, this week I had a urine specimen thrown at me) but enough about me. I just thank you for your words, because the 'thanks' where I work are few and far between.
Anyhow, GUESS WHAT. Tonight the patient acted perfectly within his right, and called the police on the patient phone. Only reason I know this is because the cops called us at the hosp and told us to tell the patient to not call them again. That's it. Apparently, once the cops heard the words 'psych patient' they felt no need to investigate. Pitiful!
Your system up there sounds, well, scary. Orwellian even. I used to live in a communist country, and holding people against their will when they posed no threat was an everyday occurence. This really frightens me that any old person can say a person isn't safe, and off they go!
Now the question is...how do I advocate for him without losing my job??
Hi Meerkat -
First off, you call an organization bigger than yourself to ask for anonymous advice. An organization who is familiar with this type of story all too often. NAMI, NARSAD, NIMH, or anyone else you can google........
There are people within these organizations can proceed with telling you what the rights are for your state and how you can move within them for your particular patient. Sometimes things can be done and sometimes not, perhaps letting your patient know how difficult his situation is my be the empathy he needs to hear right now even if there is nothing that can be done. This is why much needs to be done in the attitudes we have directed towards those with mental illness. The cops have never been proponets of changing their superior attitude either. In hindsight after all this is over, you may want to encourage your pt to get to a lawyer and draw up an advance directive which legally states where the patient can go for treatment and which ones and who the power of attorney is who directs those decisions. This sometimes works but is awfully intimidating to those who want to wreck havoc with your life just because. Funny how pushing the legal limit stops people in their tracks, esp. if they know a lawyer is concerned. I protect myself in this way.
I am moved by your compassion for this man and see things from a different perspective than most and I encourage you not to let go of this and get on the net to www.nami.org for information on your state level. You can continue to be affected by this or take the next step of action and find out what you can do and what you cannot. Makes a better psyche nurse to know all the facts at least for yourself.......
And perhaps with an involuntary committment on the racks, the patient could see the light of day if they decide to take the 15 days already used and apply it to the 30 day committment or whatever it is in your state. This way, the family could be appeased, the MD inadvertedly glorified and the patient would know there was a means to the end of all this. Living in Limbo is not on the proactive side and does nothing but perpetuate this man's anxiety..Once you are in the system, there is little to be done except call a competent mental health lawyer to represent him in the hearing. Calling the coppers does nothing but moving within the realm of the law does..............GL...Find the loopholes.
You can chart your observations in your usual narrative notes. If no one is observing and documenting behaviors that meet the criteria of him being suicidal, homicidal or psychotic, then criteria for holding him gets pretty thin.
Unfortunately, "criteria" isn't always as good as gold in these cases and although it may be "thin", whatever info the family is feeding into this can change viewpoints dramatically and can be a wrench in the process.
Someone is making a fuss and who knows how influential they are to the persons in the decison making process....
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.
Hi there! This caught my eye since I was a health insurance broker in my 'former life' before going back to school for nursing. You are correct - it is the state legislatures that are to blame. Thing is, it's not that insurance companies are convinced that the mentally ill do not deserve compensaton for services rendered as you said above. I have had these conversations with insurance company executives. They have family members who are mentally ill, heck...some are mentally ill themselves, just like the regular population of course! It's not that they sit in their ivory tower offices and say "ah let's screw the mentally ill, it's not a physical problem." No! The problem is that if an item is not mandated by the state to be covered, then the insurance companies cannot be competitive with eachother and be the lone company covering an item. In fact, insurance companies would love to cover more, but it'll only work if all of them are mandated to. Colorado is a good example of this. Colorado mandates coverage for what they deem biologically based mental illness, so all the companies cover it. However with more and more employers dropping coverage because they flat out don't have the money, state legislatures are not about to start telling them to pay for more coverage.
Also - it's not just mental illness that is often excluded. Ask people with infertility how they feel about not having coverage. More and more companies are simply excluding coverage for organ transplants or simply limiting coverage to 100,000. Before the breast cancer issue became so publicized, many states did not mandate coverage for breast reconstruction after mastecomy. Now they do. That has nothing to do with the illness being physically based or not. So there is no huge conspiracy to disrespect people with mental illness in the US insurance system. The problem rather, is that the fundamental system of healthcare financing in the US is horribly broken. It is not specific to mental illness.
The average family policy for employer health insurance costs over $10,000 per year now in the US. It is employers who decide what their policy will cover. So you bet more employers are excluding coverage for certain items if their state will allow it. Otherwise they can't afford to offer insurance at all. People seem to have what I call ADHD of the copay. Meaning, they ask "how much is my copay?" and seem to refuse to look at coverage more in depth or pay more to cover more because "I just need a copay for my cholesterol pills and routine physical, I won't need all the other stuff, like organ transplants or psychiatric coverage." Until they do need it of course.
The problem is the system of healthcare financing in the US. The only folks left with good coverage are those working for the government, or large corporations. We might want to think about why those are the only groups with power.
Hi there! This caught my eye since I was a health insurance broker in my 'former life' before going back to school for nursing. You are correct - it is the state legislatures that are to blame. Thing is, it's not that insurance companies are convinced that the mentally ill do not deserve compensaton for services rendered as you said above. I have had these conversations with insurance company executives. They have family members who are mentally ill, heck...some are mentally ill themselves, just like the regular population of course! It's not that they sit in their ivory tower offices and say "ah let's screw the mentally ill, it's not a physical problem." No! The problem is that if an item is not mandated by the state to be covered, then the insurance companies cannot be competitive with eachother and be the lone company covering an item. In fact, insurance companies would love to cover more, but it'll only work if all of them are mandated to. Colorado is a good example of this. Colorado mandates coverage for what they deem biologically based mental illness, so all the companies cover it. However with more and more employers dropping coverage because they flat out don't have the money, state legislatures are not about to start telling them to pay for more coverage.
Also - it's not just mental illness that is often excluded. Ask people with infertility how they feel about not having coverage. More and more companies are simply excluding coverage for organ transplants or simply limiting coverage to 100,000. Before the breast cancer issue became so publicized, many states did not mandate coverage for breast reconstruction after mastecomy. Now they do. That has nothing to do with the illness being physically based or not. So there is no huge conspiracy to disrespect people with mental illness in the US insurance system. The problem rather, is that the fundamental system of healthcare financing in the US is horribly broken. It is not specific to mental illness.
The average family policy for employer health insurance costs over $10,000 per year now in the US. It is employers who decide what their policy will cover. So you bet more employers are excluding coverage for certain items if their state will allow it. Otherwise they can't afford to offer insurance at all. People seem to have what I call ADHD of the copay. Meaning, they ask "how much is my copay?" and seem to refuse to look at coverage more in depth or pay more to cover more because "I just need a copay for my cholesterol pills and routine physical, I won't need all the other stuff, like organ transplants or psychiatric coverage." Until they do need it of course.
The problem is the system of healthcare financing in the US. The only folks left with good coverage are those working for the government, or large corporations. We might want to think about why those are the only groups with power.
Perhaps the power may very well be in the large corps. and the government but this will only change as more people who are aware of it, decide these sources are acting in unequal fashion and demand for more coverage to those services such as you listed. Pressure goes along way and now we have seen reconstruction being covered where it wasn't before. This is because society came together and said "That's enough!!!!" So Yes the power for change still remains in our hands in order for mandated legislation to change we have to take Action towards that Reality...
It can be done!!! Maybe not for me but those who come after me....
I think the doc might know something you don't about this guy.
If the man is manic, one of the symptoms is not being able to see one is ill. Throw in the very good acting and manipulation that many MI people develop....This is a man with an advanced degree that can't keep his job. Sounds to me like his family has been thru this before and is trying to keep him from loosing everything. It's hard enough to get manic folks hospitalized/treated. He's lucky to have a family (and a dr. that takes it seriously) that has stuck around to help him and advocate for him.
I think the doc might know something you don't about this guy.
If the man is manic, one of the symptoms is not being able to see one is ill. Throw in the very good acting and manipulation that many MI people develop....This is a man with an advanced degree that can't keep his job. Sounds to me like his family has been thru this before and is trying to keep him from loosing everything. It's hard enough to get manic folks hospitalized/treated. He's lucky to have a family (and a dr. that takes it seriously) that has stuck around to help him and advocate for him.
I would have to agree with Tiny here, Lots of Manic Patients are good at convincing otherwise, make sure he hasn't convinced you.....But still be objective about it from his point of view. You still want to advocate for him, just within reason...........Better to air on side of caution in this case....
Until they do need it of course.
JeanettePNP, MSN, RN, NP
1 Article; 1,863 Posts
So, if you were the family member, WWYD? Patient acting bizarrely, in manic or psychotic state, not dangerous to self or others but refusing treatment. This in someone who is otherwise a non-problematic person who has not previously exhibited any mental health issues.