How do 'they' determine when a person is able to leave a Psych Hospital?
 

Hi again. We have somewhat of a dilemma with my husband presently. He has been in the hospital for almost two months now. Early on, he certainly needed to be hospitalized. He was acting erratically, was very paranoid (even thinking our son was stealing our money), delusional, and, on top of that, he blood pressure was sky high. As a matter of fact, we brought him to the crisis center, and, in turn, they brought him to the ER because of his high BP. He was hospitalized on the medical floor until his BP was under control, which took 3 days, then he went to the Psych floor. From there, he was transferred to the hospital he is presently in, which (I hope you can follow all this!) he was in for 6 days back in 2003, after he confessed to his boss that he felt suicidal and was depressed. When I brought him home from this place, I'll call 'HH', and, within hours, he had attempted suicide but cutting his throat with a utility knife.

So, now that I've laid the background, I wil go into the present dilemma :rolleyes:... This place was horrified to learn of that episode back in 2003, and, although these are TOTALLY DIFFERENT CIRCUMSTANCES, they seem very reluctant to D/C him. Their solution is to send him to a county hospital, which is generally for LONG TERM care (a nursing home-type place, with a Psych Unit). Problem is, they seem to be taking folks directly from ERs and crisis centers, and, even tho they changed DH's status to 'involuntary' to get him in faster, it's still not happening. I would like him to go there for a short while, only with the hopes of them giving him a try on another bipolat med, such as Ability, Lamictal, Geodon, etc. Here are the psych meds he is currently on: Depakote (1500 mgs,), Zoloft (25mgs, but he had been on 250 mgs for the past several years), Risperdal (2mg tid),Trazadone (50 at bedtime), and Vistaril (not sure dose, but it is PRN). The rest of his meds are for BP, w/ Zocor and Plavix, Claritin thrown in, too.

As to how DH is acting now, he surely is over his paranoia and mania. He is pretty low-key, not delusional, is totally coherent, has his memory, knows current events, etc. His main symptom that I see is still his depression.. Who wouldn't be depressed after what he's gone through? BTW, he had needed skin grafts on both his hands, and doesn't have full use of all his fingers, though they are very slowly improving. (Side note: he had left our bedroom the night of the fire, and, all of a sudden, the fire flared up at him, so he covered his face with his hands, probably saving his face, eyes, etc.) I have spoken with him numerous times, and, tho depressed, he is very happy to be alive, and has absolutely no thoughts He also has an excellent pdoc on the 'outside', who has seen him through since after his release from the hospital after is attempt in 2003. (Another sidebar: he has 12 ECT treatments back then which are not even a possibility now due to health issues). He is reading a book I brought him, reads the newspapers, and although not totally himself, he is getting back to his 'new normal'.

I know you all can't predict with certainty how he will do, nor do I expect you to, but I am asking for your thoughts on this whole situation?? He would be coming home to our new house, which he lived in with us for 2 months before his PTSD became a problem. I will be here, by his side, as we are both retired. We also have my 31 year old son, his wife, and their two kids, 5 and 3. There is no question that he would be much happier being out of that place (he's in the 'Older Adult' unit, is age 60). I really want to be more pro-active with his care, but HH is really not likely to take any med suggestions from me. I know his (and my) pdoc is well versed in all the new meds, and knows him better than the docs he is being treated by in HH.

Please share your thoughts and ideas with me. I feel like I am up against a brick wall here!! :icon_sad: :confused2: :icon_sad:

Thanks and have a good day all! Jacquie

Sorry this was so long, but I needed you to know as much about this situation as possible :grouphug:

Hi, Jackie,

Get a lawyer.

The facility has a social worker or a head nurse. Talk to both. Then find a lawyer. The pdoc's are keeping him locked up with a court order. You will need to get your own court order. Judges decide who stays and who goes. That's my thinking but laws vary from state to state.
The lawyer probably needs a pdoc who can say your husband is ready to go home.

M

Hi,

He should be taking med suggestions only from his pdoc. You can help him keep a mood journal / mood chart (some are on-line) and make observations.

You need to be working with his pdoc and tdoc. I would not take him home until he was on board with your having am ability to talk to his docs -- every doc. Has he signed the HIPAA paperwork so that you can talk to his caregivers?

Here are the meds you listed.
The success and failure of meds can depend on a person's age. Does your husband have a pdoc with experience working with patients who are 60?
I have not taken these meds but I am free to comment anyway:) :

Abilify and Geodon -- both have anti=depressant qualities.

Lamictal -- not the best med. It barely passed the drug trials (and only with lots of finagling by the drug company. It works for some people who are depressed. It can be agitating.

This site is useful except the pdoc admits to getting paid to study Lamitcal:
http://www.psycheducation.org/depres...ds/2ndGens.htm

Also check http://crazymeds.us/pmwiki/pmwiki.php/Main/HomePage

I'm wondering if the pdoc would lower a dose a bit for him.
The meds are keeping him out of mania apparently. Now he is depressed. Is that right?

M.

Thanks, Mari, but the truth is, he is still in this hospital voluntarily. As far as getting to this next hospital, before I consented to changing his status to 'involuntary' just to get a faster in to this other place, I made sure that, by doing so, it wouldn't make it a legal situation to judge his competance. Maybe I'm being naive here, but I would guess they would re-evaluate him if and when he ever gets to the county facility. He doesn't ACT like a person that needs to be involuntarily committed. His thinking is clear, as is his judgement. He's nothing like he was when he first arrived!?

Hi,

Voluntary is not really voluntary.
I was in voluntarily and I was not allowed to leave. . .. . not really voluntary.


I have instructed my sister to call a lawyer as soon as she hears that I am ever in a hospital. That is her first call.

M.

we cross posted
 

Hi,
Have you investigated the hospital? Some hospitals keep patients in order to rack up payments.

I'm concerned that you say he is mostly fine? Have you spoken to his pdoc/s? What do they say?

M.

Hi,

What are the criteria for
1. getting admitted
2. keeping a patient?

This varies from state to state.

For admittance they all have something about potential for harm to self and others. Some states add something about being able to manage their day to day activities.

Keeping a patient is a different sent of criteria I believe -- probably has to do with progress in the first set.

=-=-
I had a family member who was in a state hospital for a while (six months or a year maybe ---- I was not close to her at the time.) The social workers and other care givers had to approve her home situation. They wanted to make sure that she would continue to improve after she left the hospital.

You need to talk to the professionals. We are professional patients. .. .. . not the same thing.
Maybe go directly to the chief pdoc of the facility/ies.
You are mostly asking legal questions.

in most states, no pdoc can keep a patient more than 72 hours unless the pdoc gets approval from a judge. Mental patients have these civil rights since the laws went on the books in the 1960s and 1970s -- mostly the 1970s for what we are talking about here.

M

Thanks, Mari, for all of your info and concern. This whole process has been very confusing and frustrating. I have never once spoken with my DH's pdoc; all the talking has been with the social worker. I believe that, at this point, I need to speak with DH's pdoc at this present facility to get his take on what is going on with my husband, and how he feels his progress has been.

I will let you know what happens when I finally get to speak with him. That conversation should be interesting, to say the least!

Hey there, Jacquie. Sorry for all the frustration!
 

Everything Mari's said is in line with my experience. When I admitted myself, I was not in good shape at all; however, I made sure friends knew I was going in & at least 1 visited me each evening. I really didn't want to be sent home after 72 hrs, & by then I'd found out that my voluntary admission didn't have beans to do with my getting out. Also, I was beginning to hear about the pdoc I had.

Her reputation was that she kept people for weeks. That 3rd evening I called my lawyer. If I hadn't, I might still be there:D:eek:. Granted, she did come out with the right dx, but it took her long enough. After a month, I thought I was ready to come home--so did my lawyer & my friends. But pdoc dragged it out. & dragged. My lawyer's good, though. He'd set something up early on.

The hospital didn't permit any computer use by patients. Not even smart phones. I pay my bills online & the 1st of the month was coming for the 2nd time. I had phoned the 1st time, delaying everything without financial "punishment"; I can do that 1ce a yr. My lawyer got a judge to tell them to let me use my laptop now--or else.

I guess the possibilities of this precedent shook them up so much that the next morning I got my walking papers!:ROTFLMAO:.

You just never know what's going to do the trick. Unless you're a lawyer, that is.:rolleyes:

yes I agree with mari, you need to speak to his pdoc.
Are you ready for him to come home?
bizi