I believe there is a hold period. For which they can hold them for evaluation. Duration?
How does a psychiatrist rate the level of danger a patient is to them self?
I'm also looking for if the patient is an unsure. Do they move them to a normal room, or to a specific psyche ward.
Does any one know the limits a person has at this level of evaluation: Phone calls, rights to leave, etc?
I need a few specifics to add believable detail to part of a story, and I don't really want to go spend time at one.
W.
www.azpsychologist.com/sourcebook_Crisis%20Management%20Chapter.doc
You can section someone under the Mental Health Act if you believe they pose a risk to themselves or others. The specific section you may use is dependent on the situation and each section may only be legally enforceable for a specific period of time varying from hours to days to weeks to months. Different professionals (nurse, doctor, social worker, approved doctor, policeman) have powers to section in certain circumstances for varying period.
To section someone because you think they are suicidal requires a high degree of certainty as you are restricting their freedom. Sectioning happens against someone's will--if they are willing to remain voluntarily in hospital then that is what happens. If they choose then to leave and you still have very strong concerns then you may section them anyway.
Assessment of suicidality requires a person with sound clinical experience. There are scales etc, that you can use but usually a psychiatrist will interview the patient looking for admissions of intent and planning: yes I want to kill myself because...and I have a stockpile of pills at home that I plan to take. The person also may have a history of previous serious attempts; plenty of people have taken overdoses or slashed their arms but have no intention of dying when all is said and done--although sometimes they do accidentally.
A recent incident (death of close member of the family; traumatic incident (war) of some sort) could predispose someone to make an impulsive attempt to kill themselves.
In the UK people often end up at the ER following suicide attempts; many are just sent home after seeing the on call psychiatrist. The attempt itself gave them a clearer viewpoint and they know they don't really want to die. More serious people may be sent to a psychiatric ward for observation...really seriously suicidal people may be put on observations which may be constant; quarter hourly etc. for a few days...
They are unlikely to be allowed leave until the psychiatrist is certain they are safe. They would be allowed contact with family. They would have their belongings checked on entry to the ward--politely--for things that may cause them or others harm.
Some people take paracetemol overdoses and then report it a day or two later, not realising that you ideally need the antidote within 12 hours. Fatal liver damage ensues and the only solution is a transplant. So despite changing their minds the still die.
Cheery stuff.
The laws are different in each state. In Virginia, where I live, there are two paths you can go by. With one, a TDO (Temporary Detention Order, the person goes semi-voluntarily. This involves the person going to either a medical or psychiatric facility (the voluntary part) and being evaluated by a licensed counselor or psychiatric personnel. The second, an ECO (Emergency Custody Order), involves going to the local magistrate and presenting a written and oral case that the individual is a danger to self and/or others. A policeman or deputy will basically arrest the person (without an actual charge) and take them to a facility to be evaluated for suicidal/homicidal thoughts.
An interesting dilemma is that if a person is under the influence of an intoxicating substance (drug or alcohol) they can only be held for a fairly short amount of time (can't remember - it's been a while). If the person doesn't become sober within this period, the psychiatrist will refuse to evaluate them and they will be released. Because of this, our law enforcement prefers to perform an ECO when the person is sober.
If they are evaluated and committed, it is typically for only a few days. It basically only takes the person to say, "I realize that I wasn't thinking clearly," for him or her to be released. They really have to be determined to kill themselves and be 100% honest about it in order to stay for any length of time. Most of these places are never reimbursed (unless by Medicaid) and they have people lining up at the doors. Get them in, get them stabilized, and get them out.
They are then let out the front door with whatever items they brought in. They have to arrange their own transportation or start walking.
Most of the people with whom I work are suicidal. Just about all of them have schizophrenia, bipolar disorder, or severe depressive disorder.
What role does this play in your story? Is it central to plot or merely detail you want to make sure is accurate?
The problem with most of these people is that they display manic behavior (severe swings in mood) and they are not very dilligent in taking medication. While in the hospital, their meds are strictly regulated (same with jail), but when they get out, they often forget or do not get them due to financial reasons.
FYI, while in the the hospital, people are not usually confined to a room unless they are delusional. They typically have free reign of that ward - kind of like One Flew Over the Cuckoo's Nest without the shock treatment. They attend group sessions, watch TV, and occasionally meet with the psychiatrist. They all where hospital gowns and wrist bands until they are released. No reflection on skadder, but I have found many of the staff with similar dispositions to Nurse Ratched.
The important details are: a phone. Does she have easy access to one, does it require permission, are there restrictions at what time you can use them. She has none of her possessions at this time, so no cell phone, no money for a pay phone, but she would want privacy to talk to the main character.
Second: If she seems like a normal person, but seems unwilling to talk about events that lead her by witnesses to appear to try and jump off a cliff. How long can they hold her if she appears to be trying to act normal, refuses to talk about it, but states clearly she does not want to kill herself. I'm looking for the period of time the doctor could hold her to try and get the answer, but if they didn't what would happen?
If they held her for evaluation would she be moved to the psychiatric ward or just a regular room?
I can guess the details but I would like it to be as accurate as possible. So there are no future grumblings over specifics in the intros and clues.
County Hospital: I'm referring to the usual city hospital that take people without insurance. I've always known them by that name, but if there is a better term for them that I'm missing please let me know. The local is a medium ocean side city: population around 250,000.
Thank you all for the info it is very helpful. Any insight is appreciated.
W.
Anyways, the basic rule for forcefully (or chemically) restraining someone is if they present an imminent threat to themselves or others (homocidal, suicidal, delusional, etc.) OR if a screening practicioner (but not expert) thinks they need an expert evaluation to verify if they are a harm to themselves or others.
Paracetemol = British for Tylenol...
For your story, what gets her in the facility in the first place? The patients would usually have access to phones, and as long as the patient is merely "troubled" and not acting out or threating herself or anyone else, you could basically leave it up to the practicioner to determine if they are stable. This could be as simple as a basic assertion she doesn't want to hurt herself, so the doc lets her go, to a more in depth character trying to get to the bottom of things and realizing that he trusts her (at least enough to release her...)
If you need it merely for a transitional chapter, the basic scene would go like this for a suicide eval:
she enters the hospital ER and is stripped of all belongings (yes, including underwears to avoid secluding weapons or whatever) and put in a hospital bed with two limbs in leather or canvas restraints (think handcuffs) to the bed. One arm and one leg, on opposite sides of the body to prevent her from falling out.
The doctor sees her, and must screen for anything that would be a medical rather than psychological reason for suicide (is she drunk? On drugs? Old and suffering dementia? Have a stroke?) These tests usually take about an hour or two. Then, the doctor decides if she is threat to herself or others or if she is medically clear. Most ER practicioners don't want the liability of making this judgement for themselves, so a psychiatrist or social worker usually does a preliminary screen. If they decide she is safe, she now can no longer be legally restrained and must be discharged. If they decide she is not safe, she is kept restrained until an admission to a psychiatric facility can be made.
Also --> have you considered the possibility that she escapes instead? That could add drama and action if you need pacing and excitements... She may convince the nurse to let her up to the bathroom and then sneak out (maybe she sees where they stashed her belongings, or steals someone elses and uses their phone.) Restraints must be rotated periodically to prevent skin injury, maybe she could pull a houdini and flex her muscles at an odd angle so the restraint is looser, then pull free when noone is looking. Or, she may just find they weren't that tight to begin with (they usually aren't if the patient isn't struggling...)
Or, she nabs a key from a passing nurse by pickpocketing her when they lean over the stretcher to fix an IV or something (remember: one hand is free if the person cooperates...)
And yes, I've seen all those happen.
If she escapes, there is another obstacle exiting the hospital. If they have security, they would be alerted the instant a nurse noticed she was missing. So she'd have to get out quick, or find a way out through the basement. If she stole someone else's clothes, she should be able to walk right out the main or side exit...
[This message has been edited by Teraen (edited July 13, 2010).]
[This message has been edited by Teraen (edited July 13, 2010).]
The ambulance usually goes to whatever facility is closest.
Anywho, If you want to send me your scene or outline, along with questions you have, I'll try to give you some specific suggestions.
All right, I suppose I can accurately answer these questions. Roanoke, Virginia is my home town and has a population of around 250,000 people. The hospital, Lewis Gale Medical Center, has a decent psychiatric center that admits individuals with suicidal behavior on a short term basis.
Let’s say your character is picked up by police after allegedly “attempting to jump off a cliff.” The police themselves then will issue a TDO (or whatever term is used in that particular state) through the magistrates office. The person is then taken to the psychiatric ward of the hospital for immediate and relatively short evaluation or they could also use another source like a psychiatrist from a CSP (community service provider). Either way, let’s say your person refuses to talk, but denies suicidality. The psychiatrist might suggest holding them for 24 hours for observation.
They get an average size hospital room with a roommate. They get hospital scrubs (sorry, not a gown) with paper/cloth-like slippers. The door is unlocked and they have access to hallway. The hallway leads to a nurse’s station, which has a larger hallway that leads to a medium size activity room (not nearly as large as the ones in movies and television) with a mounted TV and some board games, including cards (cards and checkers are really popular). This often doubles as a dining facility.
They can usually receive calls during a wide range of time, but often are limited to specific times to make calls. They have a decent amount of privacy, but the phone is usually right outside the nurse’s station. The nurses stay busy. There will be someone who comes by and checks on them, even at night, every half hour to every hour, depending on policy.
They will participate in group sessions that often include both sexes (unless there are physical abuse concerns). The psychiatrist will get their medical history when they first get there and will make medication suggestions based on their behavior and responses. They can’t force them to take it. After 24 hours, if the person seems stable, denies suicidal thoughts, and appears reasonable, the psychiatrist will read about how they have done – the nurses and therapist, who conducts the groups, report on them throughout – and decide whether the person can be released. If they appear stable and coherent, then they will probably be released. They are asked to arrange transportation and given back their clothes and other possessions they came in with (unless illegal paraphernalia). The paperwork to actually get released takes forever (at least an hour) – several have to sign off.
Hope this helps.
My others went voluntarily. The next step was changing out of clothes into hospital garb - I don't think they were watched (not sure), but they might have been given an examination. The rest is as I've described.
quote:
Paracetemol = British for Tylenol...
Tylenol(TM) is trademarked in the US.
The generic term (which the trademark owners would prefer writers use if they are not going to include a trademark notification such as TM or R) is acetaminophen, at least in the US.
I don't know whether Paracetemol is the trademark in the UK or the generic, but the trademark symbol would help.
Which raises the question as to why another nonproprietary name is needed, when "acetaminophen" already exists (or vice-versa).
[This message has been edited by JSchuler (edited July 14, 2010).]
The phone was a real sticking point that I was worried wouldn't be believable if there was no way for her to get access to one.
The hard part was I didn't want to much focus going into the task of getting to a phone taking away the focus on why she needed to make the call.
The pace moves from her realizing in the hospital she's still alive, and sort of happy about that.
Then realizes what events actually happened to bring her there.
Then to feeling confused, trapped, and alone in a strange city.
To lastly taking a desperate chance on contacting a referral from a previous trusted source for help.
The character knows if she holds out and just acts normal that they will release her tomorrow, but the building anxiety of the trauma threatens to overwhelm her sense of surety in herself. She in a mental struggle about leaving the security of being watched over. She knows if she doesn't reach out to someone on the outside now, she might break and end up there for a much longer stay. Thus the need to find a phone that no one can over hear becomes imperative, which triggers the call to a stranger(Protagonist) that will intertwine their two fates.
It would be a late night time attempt at the phone, so that still presents some challenges. Originally I had it in her room, and made her just wrestling with whether to call or not.
If she has to make it unobserved to by the nursing station and call this presents problems. I need to make it fluid so it doesn't bog down the pace. No more than a paragraph from room to phone.
Here's a question you might be able to answer. Do the nurses ever leave there cell phone unattended at the nurses station? Or are there rules about them?
Thanks for all the help,
After I sort out what happen here and do a rewrite I'd be happy for some Critique.
Feel free if you do to be brutal and honest, I have a pretty good mental filtering system being an artist also. There's nothing quite like having something hanging in a gallery, or a wall mural, and not being known and overhearing straight honest Critique from hundreds of people. It at times can feel just like your being booed off a stage. Over time you get a pretty thick skin as I'm sure most here know and have experience before. I tend to follow the rule of being encouraging, but for my own work
I like to hear just straight talk, it helps me move forward, and not waste years, on repeating the same mistakes over and over again. I've wasted to much time already doing that, so I'd like to put out some quality work before leaving this rock.
Cheers and thanks,
W.
Because the English people from England-land are weird like that. They tried to spread their culture and language around the world, and were so surprised when people started actually using their language that they had to invent new words so as to maintain a sense of superiority. For instance:
http://www.cockneyrhymingslang.co.uk/
http://www.associatedcontent.com/article/1039920/how_to_fake_and_maintain_a_british.html
Anyways, Philo, as far as strapping to the bed goes, that is an Emergency Room thing as far as I am aware. Patients actually must be out of the restraints by the time they are admitted to the psych ward. That is because the ED doesn't have locking rooms or units - whereas most psych wards I am aware of at least have padded rooms in cases of patients who are an iminent threat to themselves or others.
Do nurses ever leave the phone? All the time. In fact, most places have phones in the rooms or hallway that are open for use. The only situation I can imagine (and I can't imagine a whole lot, mind you...) where a phone would be denied a patient is if it interfering with their treatment, ie, a patient loudly demanding to use one and refusing all attempts to engage in conversation and otherwise calm them down or get them to cooperate. Loud and boisterous patients who cannot be reasoned with are by definition unpredictable, and since an exam and evaluation cannot be done if they are uncooperative, they may be restrained until a medical clearance can be done.
I actually used the taboo name because I couldn't remember how to spell the generic off the top of my head. Everytime I tried, it looked funny:
acetiminophen
acetaminophen
thatlittlewhiteonewiththegrooveinthecenterthatcomesintheyellowpack.
See what I mean? I didn't know mentioning brand names would get the trademark police investigation. I'll have to watch that in the future...
quote:
Because the English people from England-land are weird like that. They tried to spread their culture and language around the world, and were so surprised when people started actually using their language that they had to invent new words so as to maintain a sense of superiority. For instance:http://www.cockneyrhymingslang.co.uk/
]http://www.associatedcontent.com/article/1039920/how_to_fake_and_maintain_a_br itish.html
Is this humour? Just because you feel inate sense of inferiority to English people doesn't mean they would feel superior to you. I am certain if you met one they would immediately take pity on your plight and feed you some nuts through the bars of your cage.
[This message has been edited by skadder (edited July 14, 2010).]
[This message has been edited by skadder (edited July 14, 2010).]
Acetaminophen is a United States Adopted Name (USAN).
[This message has been edited by skadder (edited July 14, 2010).]
Anyways, what do you do with combative patients across the pond over there? A sitter doesn't help much when the patient is delusional and taking swings, spitting and biting.
Or does "offer them medication" mean "We'd sneak up behind them and jab a few milligrams of haloperidol into their backside" in real English?
Or would this be more of something logged in a police record? Do police have to keep a record of a possible suicide, even if they don't act on it? For example someone else reports a possible event, but when it is check out everything appears normal. Do they keep a record of that report, or is it just dismissed?
Thanks everyone,
W.
Quite what cockney rhyming slang, or a weird and facile article on "how to fake a British accent", have to do with anything previously in this thread is utterly beyond me.
Tchern - the acetaminophen comment was a little off track, but I mentioned it because skadder mentioned the other name, which I assumed was not as familiar in America here. Then the conversation sort of derailed into comments about British vs. American English when Jshuler asked about it. However, I do not think that entirely qualifies as hijacking the thread because I kept on topic after the side comments as well. Sorry if the comments sounded snarky, it was meant to be a sarcastic attempt at humor. It seems I failed at that attempt... although skadder seemed to get it, and as our resident Brit, I suppose its good I didn't offend him
[This message has been edited by Teraen (edited July 14, 2010).]
Thanks again,
W.
quote:
I actually used the taboo name because I couldn't remember how to spell the generic off the top of my head.
If you reread my Trademark Police comment, you may see that I tried to indicate it's okay to use the trademarked name (so that it's not taboo), if you put a trademark symbol next to it.
You would have been fine to write "Tylenol(TM)" where the name without the (TM) is what might be considered "taboo."
It behooves everyone to remember that on the internet, no one can see your expression, or hear your tone of voice. Dry and sarcastic wit are very often "lost in translation".
And I didn't say anything about hijacking the thread, it was merelythe relevance of those links that completely puzzled me.
[This message has been edited by tchernabyelo (edited July 15, 2010).]
The thing that offended me most was:
...They tried to spread their culture and language around the world...
Tried? Wasn't it the biggest empire EVER? We did!
[Puts away the flag]
[This message has been edited by skadder (edited July 15, 2010).]
(The glasses are so you can't see my expression)
[This message has been edited by philocinemas (edited July 15, 2010).]
In between working various jobs in the mental health field, I sold cars for several years. The following is absolutely true - I was right there when the following situation occurred. A guy once called in a credit application (back when that could be done) in an attempt to purchase a vehicle. His credit was a little rough, but the salesman was able to get an approval after a day or two of working with various lenders. He called the guy back and (I'm sure you've guessed it by now)...the guy was a patient in the psych ward of the local Veteran's Hospital.
"The thing that offended me most was:
...They tried to spread their culture and language around the world...
Tried? Wasn't it the biggest empire EVER? We did!"
Exactly. See? You understood my sarcasm prefectly
But back to the main thread:
Another thing to remember is that the patient can often get belongings back if they have been removed. For instance, a patient who is acting calm and cooperative may request that we get their cell phone from their belongings. It is a specific item (not a weapon) and the staff is getting it (not the patient, so they won't take other stuff) and often using priviledges in a reward system is a good way to help a patient cooperate...
Phones wouldn't be in the room: they have wires and could be used for self harm. The phones would be in a public area - either on a wall near the nursing desk or they may have a wireless one that they let people use to make calls.
Also, if you scene takes place in an emergency room rather than a hospital ward, the setting will be totally different. In fact, you could probably call up your local hospital and tell them you are a writer researching this, and ask to take a quick mini tour.
and the large guys in white usually around to help restrain people are those orderly's?
Thanks, w.
quote:
given that "paracetamol" is the INTERNATIONAL name (as approved by the WHO, not an English organisation), whereas "acetaminophen" is the US name (though used in a number of other countries). one could as cogently argue that it was the Americans who "had to invent new words".
I was unable to find a chronology of the naming sequence, but would interested to know what it was named first. You mention WHO named it sixty years later--I assume you have a source to prove acetaminophen was coined first. It is flawed to believe that just because Americans call it acetaminophen now, and, since it was first invented by an American, it must have been called 'acetaminophen' first.
Besides, I guess it's tough...if WHO support the use of PARACETEMOL as the official name and in 100 years no-one (except some pharmaceutical geek) knows the other names...who cares? If it was the other way round I wouldn't care.
[This message has been edited by skadder (edited July 16, 2010).]
And the earliest reference I can find to the drug is in a German medical journal, published one year after its synthesis, where the drug is referred to as "Acetylamidophenole"
[This message has been edited by skadder (edited July 16, 2010).]