Consequences of a voluntary psychiatric hold in Massachusetts?

April 10, 2015 1:18 PM

YANMD, but I'm in a bad way & wondering if I should be considering a voluntary psychiatric hold. This truly would be a proactive preventative move, but I'm concerned about future consequences affecting health insurance, life insurance, background checks, & things of that nature. Snowflakes after the jump.

First off, I don't think I'm an immediate danger to myself, but I'm concerned by things that have occurred in the past 24 hours. I have a therapist & am under psychiatric care with a long-term med cocktail that seems to work just fine, but life circumstances have sunk me to an emotional low that meds, behavioral tricks, & talking don't seem to fix. Part of that is my Mom, who is my anchor & the reason I've never attempted suicide even at my lowest moments, emotionally leveled me out-of-the-blue when I was already in a fragile state. I think it's definitely relevant to mention that we are both adults currently living together in her house, which is a temporary situation, but the timeline is TBD.

This was an atypical outburst from her, & logically, I know probably has more to do with whatever is going on with her than me. Realizing that doesn't seem to help. Typically, I can shake this stuff off to a certain extent, focus on what's essential during the day (& a lot of essential stuff needs to be happening right now), & then let myself indulge & process the lows when it's convenient/appropriate. However, I've never experienced such vitriol from her, who now seems to think we're fine, & I feel an unfamiliar internal shift. I'm no stranger to suicidal ideation, but I've never made concrete plans & always have known that I'd never follow through, if I ever did. That said, something's amiss, & I know as soon as I mention this to my psych, or more strongly to my therapist, they have a legal obligation to act upon what I say. I do not want that to happen.

So, how can a voluntary psychiatric hold, especially in MA, but also in general, negatively affect me in the long run? Would this affect health insurance (which I have), life insurance (which I currently don't have), or background checks? I imagine that background checks are a non-issue due to HIPAA, but I'm actively job searching, so I'm hyper aware of such things. Believe me, if I think a hold is necessary, I'm voluntarily doing that, consequences be damned. Still, I want to know what fall-out that could entail, if any. Today, I made the very healthy decision to reach out to a friend & felt 100x better, so I just may need to do more of that (but not the same friend, spread the wealth & all). I'm just trying to be proactive, smart, & thoughtful while I'm still capable of that approach. It just could be taking me longer than normal to bounce back from emotional whiplash, but if it's more than that, I want to move forward with my eyes open.

posted by anonymous to Health & Fitness (14 answers total)

Someone I am close to has checked himself into an inpatient psych hospital two separate times and it has had absolutely no consequences as far as the rest of his life was concerned: job, insurance, nothing. All it did was help him get better. Nobody outside of the family and close friends ever learned of it and he has had to pass stringent pre-employment background checks since.

Do what you have to do to get better.
posted by something something at 1:26 PM on April 10, 2015 [4 favorites]

This may help with a very small part of your question. I am employed in a position that required a background check, and I just applied for another position that requires one. The disclosure form states: "Background checks may include criminal history, identity check and/or fingerprinting."

That's fairly standard language for a fairly standard background check process. (For context, I deal with and have access to a great deal of confidential information and have fiscal responsibilities, so the process they run is fairly thorough.) It seems to me that nothing about a hospitalization would show up on any of those things. Besides which, some forms of mental illness (major depression and bipolar disorder, for example) generally have some ADA protections.

Hope that helps at least a little. Best of luck to you.
posted by mudpuppie at 1:26 PM on April 10, 2015 [1 favorite]

Not sure if you've seen this, but this appears to give a comprehensive overview of your rights as a conditional voluntary/involuntary patient in Massachusetts, including a section entitled "Are there advantages to signing in as a conditional voluntary patient" and a corresponding section on disadvantages.

It's from 2011, so not clear if any of this has changed since, but might be a practical starting point information-wise.
posted by terretu at 1:33 PM on April 10, 2015

I have some HR background and run background checks. As to your questions:

Would this affect health insurance (which I have)? Most health insurance offers up to X days of inpatient mental health benefits, and it should be clearly on your contract of carriage. Mine covers up to 35 days per calendar year, YMMV. It shouldn't be a concern unless you run out of days.

life insurance (which I currently don't have) Depends on whether you'll be getting the life insurance that most jobs come with as a benefit, or buying on the open market. Probably no problem, but there's a slight chance that if you apply on the open market, and you tell them you once had inpatient mental health services, they might deny you. But you're not obligated to disclose it, and if you don't, they won't find out.

or background checks? Definitely nope unless you're looking for federal government clearance or something with a very exhaustive background check. For a regular job, you're fine.
posted by juniperesque at 1:47 PM on April 10, 2015 [1 favorite]

A friend of mine did this. They were in NYC, and the situation may well be very different than in whatever part of Massachusetts you're in, but their experience was... not good. It was helpful in that they were locked in with people who were seriously mentally ill (the head nurse took one look at my friend and said "you don't belong here"), which gave my friend a lot of perspective. It was very unhelpful in that... we don't generally have very good public mental health facilities in this country, and they were locked in for several days with people who were seriously mentally ill. As in, this is where the cops throw people they find on the street that they can't throw in jail. It wasn't restful or a healthy or a caring environment. It was a mix of boring & terrifying. Their interaction with medical professionals consisted entirely of a 5 min evaluation on the last day, before release. And you do know that once you check it, you can't check out, no matter what, until that legal time limit has passed?

So, again, I don't know what it's like in MA. Hopefully a lot better. And I'm absolutely not discouraging you from doing it, if you feel it is necessary. I would recommend... alternate solutions if possible. Maybe a friend can be responsible for you, for the next few days? And I think you can definitely talk to your therapist about this. You sound very thoughtful and contemplative about your mental state, which is good. That you're even asking this question, suggests to me... an intermediate step is preferable, and that your therapist isn't going to be obliged to contact the authorities.
posted by danny the boy at 2:06 PM on April 10, 2015 [1 favorite]

Oh and the fallout consisted of losing several days of their life, and a huge medical bill to pay.
posted by danny the boy at 2:09 PM on April 10, 2015

Mod note: This is an answer from an anonymous commenter.

And you do know that once you check it, you can't check out, no matter what, until that legal time limit has passed?

This is generally only true with an involuntary psychiatric hold, though the lines get blurry in same cases based on what a person's insurance will cover (that is, some people end up voluntarily going on an "involuntary" hold because their insurance won't cover voluntary inpatient psychiatric treatment).

I am not in Massachusetts, but I was in voluntary inpatient psychiatric treatment a few years ago. It created issues with health insurance but only before all the Affordable Care Act prohibitions on pre-existing conditions were enacted; it has not been an issue since. I have a local government job and a professional license, both acquired after the hospitalization, that both required background checks and neither one was an issue (as in, no one brought it up with me, and I was awarded the licensure and got the job). I have not tried to get life insurance, so I can't comment on that. During my hospitalization, we were allowed to end the treatment at any point, though we were not allowed "in and out" privileges (basically, if we decided to check out, we couldn't be re-admitted).

posted by cortex (staff) at 2:28 PM on April 10, 2015

Yeah, I was going to say something along the lines of what danny said above. However, if your insurance will pay for a better type of facility it could be good. My mother spent time in a variety of psychiatric hospitals and they varied considerably. Talk it over with your psychiatrist. Find out what kind of place your insurance will pay for. Another possibility: do you have a trusted friend you could visit for a few days? Maybe someone who lives in a pretty rural setting?
posted by mareli at 2:30 PM on April 10, 2015 [1 favorite]

I've checked myself into inpatient psych care two times, once in Michigan and once in Texas, and in hindsight I'm quite sure it was the right decision. Both times, the hospital I was in had separate wards for people who were in acute-but-hopefully-brief crises and people who were violent or psychotic. My insurance paid for it both times, and there have been no serious consequences for me later in life — it hasn't made it harder to get insurance, hasn't shown up on background checks, etc.

If you are going to do this, it is best to try to find a hospital with a good reputation (your therapist may be able to offer advice on this). I got lucky both times and ended up someplace where I was… I mean, not pampered or given excellent care, but at least not in any way mistreated or neglected. I have heard much worse stories from people who have not been so lucky, and if I was going to check myself in again now, I'd ask some friends who work in mental health and get their suggestions for where to go to avoid ending up in a bad situation.

I'm no stranger to suicidal ideation, but I've never made concrete plans & always have known that I'd never follow through, if I ever did. That said, something's amiss, & I know as soon as I mention this to my psych, or more strongly to my therapist, they have a legal obligation to act upon what I say.

Yes, BUT. That legal obligation does not mean they are obligated to have you involuntarily committed. They will want to know that you have a plan in place to keep yourself safe. That plan could be "I am spending tonight at the house of a friend who I trust to keep an eye on me." It could be "I'm going to check in with my therapist tomorrow by phone and let her know if I'm feeling better." It could be "I am going to walk over to the hospital after this appointment and check myself in." Having someone involuntarily committed is a huge pain in the ass and an absolute last resort.

If you are already at the point of considering voluntary commitment, there is literally no reason not to talk to your therapist first. Either they will say "Yes, check yourself in voluntarily, that sounds like a good idea" (and, as I said above, possibly have advice on which hospital to go to in order to get decent care and have an okay-ish reasonably non-traumatizing experience) or they will help you work out some other plan to keep yourself safe.

Please MeMail me if you want to know more about what my experience was like. Laws are different everywhere and I have no idea if my experience will generalize to where you are, but I'm happy to talk about it.
posted by nebulawindphone at 2:37 PM on April 10, 2015 [5 favorites]

Not to get into an argument with another poster, but just to counter danny the boy's gloomy account -- I have a relative who lives in NYC and was admitted as a voluntary patient to a psychiatric hospital. The experience was life-saving, and the care was excellent. So please don't feel dissuaded from becoming a psychiatric inpatient if you think that's what you need to do to be safe.

Does your health insurance include coverage for mental health treatment? If so, and if you use a participating facility, it is possible you won't face large bills as a result of an inpatient stay. (My relative's ten-day stay was covered 100%.)

If you decide that an inpatient stay would be beneficial, you should work with your psychiatrist to facilitate the admission process.
posted by merejane at 2:46 PM on April 10, 2015 [2 favorites]

...I know as soon as I mention this to my psych, or more strongly to my therapist, they have a legal obligation to act upon what I say.

I'm in a neighboring state which undoubtedly has completely different rules; I just wanted to say that in my case at least, I was extremely underwhelmed by the response on the first occasion that I told my psych prescriber and therapist about my suicidal ideation.

In my anxiety about everything I had vaguely imagined that doing so, announcing that I was suicidal, would trigger some sort of societal machinery kind of like a lost hiker on a mountain finally deciding to use a cell phone to call for help. And hence because I didn't want to throw into action the comprehensive effort to protect me I expected would ensue until I'd exhausted other approaches to dealing with it, I put off talking about how frequently and thoroughly I thought about suicide.

Instead, they basically just said "okay, well, if you ever get to the point where you have definitely decided to act on these plans, please call us instead."

tl;dr So if the situation you're in is that you're expecting that you either do this voluntarily, or if you begin to explicitly discuss your suicidal ideation or these recent experiences the same thing will happen involuntarily, just be aware that quite possibly (probably?) is not the case.
posted by Sockpuppet Liberation Front at 3:08 PM on April 10, 2015 [2 favorites]

My friend had a psychiatric hold in her 20s and in her 30s when applying for adoption and foster parenting in the state of Maryland this hospitalization history prevented her from being eligible for adoption. There may be other things such as career options that become closed off to you forever if you've had a hospitalization.
posted by TestamentToGrace at 5:49 PM on April 10, 2015 [1 favorite]

A voluntary psychiatric admission is not usually referred to as a "hold" - the hold refers to the ability to keep someone for evaluation/treatment without their consent.

In terms of confidendiatlity, this is basically just a hospital admission for treatment of medical problem (mental health in this case) so only people that you authorize to have access to your health care information would find out about it. With ACA it is no longer a problem for getting future health insurance (Hallelujah!)

Just like people can need to be in the hospital without having to be in ICU, there are legitimate reasons for being an in-patient on the psych ward without having to be in actual, immediate danger of harming yourself or others. The psych wards I have seen, have had two levels of care - one with much higher level of security for people who might try harm themselves or others or were seriously out of touch with reality. The second level is for everyone else - the only security is that you can't leave the ward to go into other parts of the hospital without supervision (plus there are certain items that you can't have or can only have in the common room where you in sight of the staff)

When I went through this with a loved one, she told us she thought she might need to be admitted. We went along with her to see her therapist (who had been monitoring the deteriorating situation). The two of them (and her psychiatrist, by phone) agreed. and then we drove her to the ER where she told them her doctor advised she admit herself. (I think the psychiatrist called ahead).

The first day she was in the higher security section while they evaluated her situation and then she got transferred to the general psych ward. The higher security was icky just because it was uncomfortable being around seriously crazy people but the staff was fine. The rest of her stay was sort of like a low-rent cruise ship full of rather bored passengers with a few odd rules. Actually for her, it was a huge relief just to be in the safe place while the meds got adjusted and she figured out which way was up. All in all, she has had three hospital admits in 10 year and I think she would say that all three were helpful and appropriate.
posted by metahawk at 6:10 PM on April 10, 2015 [4 favorites]

forget all the extraneous, practical stuff. you come before all of that. you can't do any of that feeling like you do. so, your only priority at this moment is to take care of you, make sure you are safe, have time to get any meds straightened out, and remove yourself from the pressures and stress you are currently feeling. checking yourself in is a VERY good, and wise, choice.

i've checked myself into an institution three times - all three times were when i had reached the brink of not being able to stop a suicide attempt. my experiences varied, from horrible to helpful, but no matter what experience i had, i came out of it on the better side of things. sometimes, all you need is to be plucked out of your life for 3 days. if you want to memail me, please feel free.
posted by megan_magnolia at 4:40 PM on April 11, 2015 [3 favorites]