help me help my friend after involuntary hospitalization

January 7, 2010 11:33 PM

Tell me what I need to help a family where the mom has just been suddenly and involuntarily committed to hospital for psychosis in California.

I don't know many details. The woman is my dear friend, around 40, with a history of health problems and including eating disorders. Today, she went completely delusional and psychotic, resulting in the police being called and an ambulance taking her to the hospital. I spoke briefly with her husband. He does not know what to do and is caring for their young children (help is on the way to take care of the kids at home). They live in California.

What should I do to help the family? What supports do they need (friend and husband)? What do they need to know or should be aware of? What questions should they ask?

I've read the text of article 5150 (involuntary hospitalization), but it's pretty basic. What do I need to know that's between the lines? Do they need a lawyer (a relative is a lawyer in another state)? An independent psychiatrist or doctor? Other?

I want my friend to get the help she needs, but I am not aware of other psychotic episodes or mental illness (beyond anorexia), and I don't want her rights or opportunities jeopardized. I received several emails from my friend several days ago, and nothing was notable. I do not live nearby, and I can't go. Please feel free to interpret the 'what would be helpful to know' broadly. TIA

posted by kch to Human Relations (13 answers total)

It's ok and she'll be ok too. If she has insurance she'll probobly be taken to a private or contract psyciatric hospital; You shouldn't need to do anything other than be a friend; she probobly won't be able to take phone calls or see visitors for at least 24 hours.

The process is something like this:
She'll be admitted to a locked unit where if she's delusional she'll probobly be mildly sedated (lorazapam), if she's violent or in danger of hurting herself she may need to be restrained but that's pretty rare.
In the morning she'll be evaluated by a psyciatrist who will confirm or withdraw the 5150. If she's lucent she'll may be given the choice to stay voluntarily, if she refuses she'll be held for a minimum of 48 hours.
While she's there she'll probobly develop some close friendships with the people around her because there is a lot of "sharing" while there...
Bottom line, she'll probobly be OK and all you'll need to do is be a good friend and be available when invited to visit or when she calls you.... my2cents
posted by RENNER8592 at 12:15 AM on January 8, 2010

IANAPsychiatrist, but my understanding is that long-term mental illness usually develops much earlier in life. At her age, sudden and unprecedented psychosis is probably only a temporary condition with a fixable underlying physical cause -- drugs, or some sort of chemical imbalance from the eating disorder, or postpartum psychosis (how young are the "young" children?), or extreme stress, or prolonged sleep deprivation, etc. So she most likely will be able to make a full recovery once the underlying cause is addressed. Thus it may help her and her family to view this episode as a one-time mental health "injury" instead of as a disabling illness caused by some inherent defect in her, because thinking of yourself as irrecoverably "sick" tends to become a self-fulfilling prophesy. Also, framing it as a temporary, physical, medical issue that happened to manifest itself in her brain/behavior could also help diffuse any legal, CPS, employment, neighborhood, social, etc. problems that might arise from this incident.

For something immediate you can do, if I were you I would try to find out via online research what I could about the hospital or mental health facility that she has been committed to. Some of those places can be pretty bad and leave their patients worse off than when they went in -- back when I was in middle / high school, approximately a half-dozen of my friends, acquaintances, or friends of friends had each spent some time in the local mental health facility. (For a few years there was an unfortunate trend amongst parents in my town to have their disobedient pubescent or teenage children committed.) Every single one of those kids reported that they had either been sexually abused there or witnessed other patients being sexually abused. (And no one ever believed them, because they were "crazy.") So, if you find that she's been put in what seems like a bad place, you may want to do additional online research to help her family locate a suitable better facility (somewhere where the staff don't rape the patients or let the patients rape each other being one of the minimum criteria...) that she can be moved to if it looks like she's going to need in-patient treatment for a while. Although it's very possible that spending a day or two in the hospital, separated from whatever triggered this, may be all she needs to come back to her senses.

Longer-term, she probably needs to make some lifestyle changes to address the underlying cause and avoid whatever triggered this incident happening again. This may necessitate getting some household help, at least temporarily while she recovers from her "injury." Being a parent of young children is never easy -- I'm surprised that more mothers don't "lose it"! Can her family, you, her extended family, and/or her other friends afford to throw some money at the situation? If so, consider paying for services that will reduce her stress/responsibilities or help her feel better about herself: cleaning service, mother's helper, babysitter (so she can get a break and have some personal time), personal assistant to run errands, personal trainer (exercise is great for your mental health and could help her with her body image), healthy personal chef service (maybe she needs to turn control of her food intake over to someone else for a while), massage therapist, etc.

Good luck to you and your friend!
posted by Jacqueline at 1:01 AM on January 8, 2010

Also, you (and your friend, once she gets home) may find reading blogger Dooce's entries about her trip to the psychiatric hospital to be enlightening / comforting:
http://www.dooce.com/archives/daily/08_26_2004.html
http://www.dooce.com/archives/daily/08_28_2004.html
http://www.dooce.com/archives/daily/08_31_2004.html

She recovered and seems to be (mostly) fine now.
posted by Jacqueline at 1:14 AM on January 8, 2010

Wow, that was quick. It may well have been as said above, the chemical imbalance from the eating disorder... it's not uncommon.

Good luck to you both
posted by RENNER8592 at 2:00 AM on January 8, 2010

What were the broad circumstances of the 5150? I mean, was there an incident at home that caused her husband to call the police and get on board with having her admitted, or was this something that happened without his knowledge and/or consent and he's trying to get her out?

I ask because those are two very different scenarios that can play out very differently.
posted by DarlingBri at 5:20 AM on January 8, 2010

Tread lightly. You weren't there and don't know what happened. Offer any help the family needs.
posted by Carol Anne at 6:04 AM on January 8, 2010

Thank you all. Keep suggestions coming. I have no news yet. No history of sexual assault, but definite clear extreme stress focused around another issue that I had been directly helping her with. I wonder whether she stopped eating and this contributed to the break. But this is pure pure speculation. At this point, the tread lightly suggestion is well taken, but I'm hoping to be informed enough to be able to support the husband in the same way should wish that from me. Yes, there was a psychotic incident (not violent) which caused her husband to call the police and there was no real question that this was the right choice. And I want to make sure that IF HE decides that she should come out (or even if not), that I've got resources to support him to do that, and to help my friend. I welcome ongoing suggestions.
posted by kch at 8:06 AM on January 8, 2010

Psychotic and/or delusional symptoms can be generated from a slew of causes, and that job is for a mental health professional. The hospital's job is to help her recover and, later, to obtain the services she needs once she is out of the inpatient treatment, as well--I can understand wanting not to trust them immediately, but this is what they exist for, and everyone who works there is a very well-trained professional specialized in the area of inpatient mental health care. In general, it is not dangerous or harmful to her to be in the hospital, if she was experiencing psychotic symptoms.

I'm not sure that a lawyer is all that helpful or necessary (I'm saying here that most people in this situation don't involve a lawyer at all). A 5150 happens when an adult is determined to be a danger to herself or others--the legal aspect involved is that she is held for 72 hours (without her signing a piece of paper to say "I totally want to be here", which is what an adult must do if there is no immediage/emergent need based on dangerousness to self or others), treated in an attempt to get her as stabilized as possible, and continuously reevaluated to find out whether the hospitalization period needs to be extended.

What Husband can do is to get in touch with the hospital and/or Wife's case worker. They can offer a lot in the way of support services for the family members. Perhaps a way you can help is to encourage husband to seek out these services. Because of confidentiality regulations, you wouldn't be able to be part of obtaining those services for them, but you can be an excellent advocate! Husband will probably appreciate your presence and support via telephone right now. At some point, you may be able to have telephone contact with your friend, too--I would follow up with Husband about this once he knows more about how this situation will play out (as far as how long she'll be in the hospital, if she will transition to a partial-hospitalization plan afterward [which is like half-day in the hospital, half-day at home], or just be directed to individual therapy, etc.).

The services your friend may need once she is released from the hospital will vary based on what's happening. Please allow the mental health professionals charged with her care help determine what may be most helpful, rather than trying to decide based on the limited information you (and the rest of MeFi posters) have right now.
posted by so_gracefully at 10:19 AM on January 8, 2010

OK well here is the answer I wrote many hours ago, but on reflection didn't want to post if I was not understanding the situation correctly.

I say this as gently as possible: you sound a little panicked. That is understandable. But, it's also possible that this situation doesn't look like and is not operating the way you think it does.

The fact that your friend has been involuntarily committed sounds, I'm sure, draconian and terrifying. What it is most likely to mean is not that she was necessarily sent in against her will, but that at the time when going in became a good idea, she was not in a fit mental state to be able to consent. That means someone else - her husband - had to make that call for her. Psychosis does that to you.

It also doesn't mean she doesn't want to be there and is banging on the door and wailing to get out. It is entirely possible she's hugely relieved to be there. The idea of a locked psychiatric ward sounds horrendous but for many, many people who have been through them, it's a godsend. It can feel very safe. You don't need to do anything except turn up for group and do the occasional arts and crafts. Nobody expects anything of you except safe behaviour. You can cry all the time and nobody asks you what's wrong.

The 48 hour minimum hold also sounds dreadful, but it's exceedingly unlikely that a "long-term involuntary stay victim" scenario will come anywhere near happening. This kind of care is expensive, and neither the state nor the insurance company wants to pay for it. It is far more routine to be kicked out prematurely because they need the bed or because the insurance company is putting on the breaks. It is more likely that you will have to fight to get appropriate follow-up care covered than that you will have to fight to get her out.

Also know that while a crisis incident precipitated her admission, you don't have to maintain ongoing crisis red alert status. It's entirely possible that by now, a few hours later, she's much more rational and feeling vastly better. This can be a good opportunity for her to review with some professionals what's really going on and get a diagnosis and appropriate meds and support in place.

So in other words: the chances are high that your worst fears will not come to fruition and this will proceed much like any other unexpected hospital stay. In the short term, I would opt to react that way - provide calls, food, flowers, and whatever else the family asks for. Offer to help untangle insurance coverage if you're in a position to do that. But, don't hit the panic button - you are unlikely to need a lawyer or a hand-selected doctor or anything other tools of adversarial process.
posted by DarlingBri at 3:11 PM on January 8, 2010

Thank you all! It looks like we've come through the woods. Yes, DarlingBri, you were exactly right. I did not post my totally panicked descriptions of the horrifying details of psychosis. Between these, my total unfamiliarity with what she was heading into, and my distance (physical, plus social for her husband), I knew I couldn't let those be the basis for understanding this situation or moving forward, and that's why I came to askme. And yes, it has proceeded much in the ways that you described. Thanks again for setting me straight until the pieces could come into place.
posted by kch at 9:17 AM on January 10, 2010

Oh, and I just processed that this may have been one of the threads with missing answers. If you provided an answer that isn't now listed above, I would indeed welcome reading it if you want to re-type (and if you don't, of course, I understand, but thanks anyway).
posted by kch at 1:24 PM on January 10, 2010

kch: Thanks again for setting me straight until the pieces could come into place.

The fact that the most common idea of psychiatric hospitals we have is One Flew Over the Cuckoo's Nest is a great disservice. My experience of psych stays is limited to two and blessed by good insurance, but I can tell you my stay here was relatively plush, very safe, and an enormous relief. It also remains one of the most interesting things I ever went through, in addition to being incredibly helpful to me at a time when I really needed help. Another family member's stay here was a similarly positive experience. It can help to look at it as the equivalent of an intervention for people going through a mental health crisis - certainly that's how I experienced it and I'm glad I did.

I'm glad your friend is doing better.
posted by DarlingBri at 10:17 PM on January 10, 2010

Thanks DarlingBri. I wasn't working from the Cukoo's nest frame problem, but I have had mixed actual experiences with professionals in the autism field, some of whom seem to be Cukoo-esque in their orientation.

She's home again and asked me to edit her letter to her family and friends, some of whom were probably as panicked as I was. Your collective responses helped greatly with that editing, to help frame her own response to what happened, and now moving forward to put supports in place.

Thank you all again.
posted by kch at 10:02 AM on January 11, 2010