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?
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?
Ok I'm not familiar with the wording of the "Baker Act". I presume it is a state law empowering MD's to involuntarily hospitalize a person. In general it is illegal to involuntarily hospitalize someone unless he is a danger to himself or others. Presumptively this client is being considered a danger to himself by virtue of being unable to care for himself. He may need a lawyer .
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.
You could be right...but even if that's so, since when do we incarcerate people for not keeping a job? Millions of us would be locked up. I just feel this is a very slippery slope.
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.
In TX, the rule for involuntary is immediate danger to self or others. 'Loosing everything' isn't a reason to confine someone, or everybody that files for bankruptcy should be committed.
So the short answer is you can't detain someone for just being manic. Or schizophrenic for that matter, or (name your mental illness here.)
If I told you that I was going to take all the money out of my bank account and buy lotto tickets for tomorrow's drawing, that would be an incredibly off-kilter thing for me to do (unless I won, then it'd just be genius), and might be a glaring sign of mental illness.
But the immediate danger rule is PHYSICAL danger, not financial.
Specializes in Geriatrics/Oncology/Psych/College Health.
Agreed with Tim here. My Dad has been manic for years, but has had very few instances (2) where he was a physical danger to self or others and was hospitalized.
And I do understand the notion that sometimes a dragging of heels occurs to buy a little more time for meds to work, but it's wrong not to follow the process. Either file for the committment and prove your case or don't, but don't leave this guy with the impression that the mental health system will lock him up for an indeterminate length of time without legal recourse if he seeks help in the future.
You could be right...but even if that's so, since when do we incarcerate people for not keeping a job? Millions of us would be locked up. I just feel this is a very slippery slope.
Ahhh, In here lies the question - The System wherever you may be tends to know what it states : "Physical" Danger to self or others, then one can be detained. But among that description, there are statements added such as If they don't eat or sleep or in essence do not take care of self. Even if that itself is not objective enough the implied threat is still there. So, the mental health rules can say one thing, mean another and when questioned can be brought to any other significant meaning that a judge would then consider. Point is there is not much point in fighting a system when it keeps changing the meaning and validity of its own rules. And again I am not sure what is going on with this situation. As one poster said, there may be things we do not know and I can only rationalize from my own experiences being detained in mental health "jails" as I would call them....and how hopeless It can get.
So I do have empathy for this gentleman because I know how difficult it is to get out once they've got ya, regardless of what the "rules" say because unfortunately they can change at any given moment and you are overpowered by whomever the "authority" may be and wherever the interests lie and this is not always the patient's interests-you are looking at community/political interests, authority's reputation and legal ramifications of where responsibility lies "if" the manic takes a turn. Possibility Yes Probability No. Depends on how authority sees situation, their influences and who's pushing. Lots of Factors at work. This thread may be at the beginning of seeing what really happens within the system for someone who is mentally ill and non-violent. I don't think the system has guidelines for non-violent or violent persons but most end up fending for themselves. They just lump em all together...Yes they do say danger to self or others but there are alot of interpretations to that. Rules/Laws can be bent, have unknown exceptions and be stretched. Lots of Grey Areas within MI system......
That's the "beauty" of the system. (sarcastic)
Lots of issues of Power and Control, submission and allowance.
Will continue to pray for his outcome...................HB
Again, thanks for the truly insightful and wise thoughts. You are a smart bunch. I did bring this up in report and another nurse agreed with me but in a very noncommital (pardon the pun) way. She shrugged and said "I don't know why he's still here either'. The new plan is for him to transfer across the street to a CSU when they have a bed. I've been told it's because of insurance issues.
Could I suggest to him that he make a psychiatric advance directive so that he has some say in the matter next time? I almost went to suggest this yesterday. but I floated to the children's unit.
Again, thanks for the truly insightful and wise thoughts. You are a smart bunch. I did bring this up in report and another nurse agreed with me but in a very noncommital (pardon the pun) way. She shrugged and said "I don't know why he's still here either'. The new plan is for him to transfer across the street to a CSU when they have a bed. I've been told it's because of insurance issues.
Could I suggest to him that he make a psychiatric advance directive so that he has some say in the matter next time? I almost went to suggest this yesterday. but I floated to the children's unit.
Hi Meerkat,
I am very glad to hear that your patient will be transferred hopefully to a place where he feels he can participate in his tx. Yes, a PAD would be appropriate if he can locate a POA who would be willing to act on his behalf and it is always helpful to have someone who is knowledgeable either you or someone else who can identify certain treatments that he would be willing to participate in to regain his health i.e - prn's, anti-psychotics,anti-depressants, etc. Also included would be which particular facility(s) he feels comfortable in an perhaps a phone tree of relatives/friends that may be called upon to retreive clothes and personal items while at the hospital. And possible behavior modifications that would or would not be allowed in reference to that facilities standards and what would be allowable. And also timelines for rehabilitation if he knows his illness cycle and down time period in order to request certain tx at certain times all overviewed by an MD. Copies of PAD's are to be given to current Pdoc, faciltyMD, therapist, all who are named, and held on the person afflicted, and even the mental health judge in that particular area. Mine is always with me.
For people who have dealt with MI on a continuous basis, who are aware of what works for them/what does not and can find a facility who is willing to work with a PAD or is also aware of the legal ramifications, this can be an appropriate way to take control of your healthcare, be proactive, and protect yourself against those either have fear and are needlessly trying to protect themselves from you by calling in the "calvary", this document says,"Yes I have a problem and Yes I am being responsible in taking care of that problem by the following outlined procedures. And here are the numbers of the people who follow my care."
Similar to a living will- I have found it stops those overagressive "I know what's best for you people" once they realize they could be entangled into a legal mess. Just a way to say "Back Off" You are crossing the line....
Best thing I ever did - eliminated all those unnecessary bills of thousands and thousands of dollars that I was responsible for because someone else deemed it necessary to make havoc of my life.....b/c of MI/lack of ins.
Shouldn't we all be responsible for our own healthcare?
Just because someone is not using the words "i'm suicidal or I wanna kill someone doesnt' mean they aren't. Most have figured that out and when you want out of the hospital unless you are an ididot, you won't use those words. In my state the law for 72 hr hold states 'danger to self others or gravely disabled". It sounds like he was gravely disabled to land there.
I meant the psychiatrist and the family may have seen/know more than what you are seeing. I'm stunned to see people (nurses!?!) comparing trips to McDonalds and bankruptcy to Severe Mental Illness. c'mon! I wasn't just referring to financial loss, I meant relationship loss/loss of self. What good do your civil rights do you if you are dead? The medical system is screwed up especially where MI is concerned. If the man is truly ill, and his family is a caring one (not the demonized one with nothing better to do than mess with this guy) they are just trying to work with a broken system the best way they know how, while being scared poopless. Hopefully he will get an AD when he is stable and able. The link below has lots of info, Advance directive stuff at the bottom...
Well since I am in Florida I can provide the OP and others a little insite.
First of all a Baker Act is the Florida process that allows a licensed physican or certified law enforcement officer to detain a person that they believe is a danger to ones self or others to have a psychiatric evauation.
This is required to occur in a 72 hr period of time- ah but this is where it gets tricky. As I have recently found out through experence that 72hrs does not typically include holidays or weekends. It also does not include the time the patient is in the ER waiting to be transfered to the psych facility that is going to do that said evauation. So potentially one can be held for quite some time prior to that time starting to run down. Also from experence only the doctor that initiated the process or a psych doctor can lift it.
Another thing though is that it is rare that someone actually gets held that long. As an example I treated a patient in the ER that knew the system. This particular person was having family/wife problems. He worked Monday through Thursdays so one night after he left work he went home, threatened self harm the wife called the law, who brought him to the ER for intake. He told me personally he had done this prior and that he would be discharged in time for work on Monday. I have also taken care of patients on who were held on Friday, discharged by the psych unit Sat, and back with the sheriff on Sunday.
Just because someone is not using the words "i'm suicidal or I wanna kill someone doesnt' mean they aren't. Most have figured that out and when you want out of the hospital unless you are an ididot, you won't use those words. In my state the law for 72 hr hold states 'danger to self others or gravely disabled". It sounds like he was gravely disabled to land there.
I meant the psychiatrist and the family may have seen/know more than what you are seeing. I'm stunned to see people (nurses!?!) comparing trips to McDonalds and bankruptcy to Severe Mental Illness. c'mon! I wasn't just referring to financial loss, I meant relationship loss/loss of self. What good do your civil rights do you if you are dead? The medical system is screwed up especially where MI is concerned. If the man is truly ill, and his family is a caring one (not the demonized one with nothing better to do than mess with this guy) they are just trying to work with a broken system the best way they know how, while being scared poopless. Hopefully he will get an AD when he is stable and able. The link below has lots of info, Advance directive stuff at the bottom...
And just how do you measure loss of self? There's no categorical definition! And I wasn't comparing MI to going to McDonald's. I was talking about poor judgement. If poor judgement means 'loss of self' well then I guess you're right. But there are plenty of people walking around who might meet your definition of 'loss of self', whatever that is, who don't get locked up. And no one demonized the family. I simply questioned their involvement in their grown son's personal life, like checking his bank accounts and monitoring his every choice.
I am advocating for a patient who may or mat not be suffering from a label of 'incompetant' that essentially renders him helpless in this situation.
I'm not saying that I know empirically that he doesn't belong there; that's why I'm asking opinions and experiences with this law in Florida. Thanks for the link.
CharlieRN
374 Posts
Ok I'm not familiar with the wording of the "Baker Act". I presume it is a state law empowering MD's to involuntarily hospitalize a person. In general it is illegal to involuntarily hospitalize someone unless he is a danger to himself or others. Presumptively this client is being considered a danger to himself by virtue of being unable to care for himself. He may need a lawyer .