Anyone in the Psych field? I have a question

If someone has "tried" to commit suicide several times, and they are taken to the hospital each time via ambulance, can they just sign out AMA or is there a law that says they can be held against their will? This is for NY.

Re: Anyone in the Psych field? I have a question

My DH is a psychologist and did a rotation in psych ER. He says if they get there and still say they plan to commit suicide, they can be held against there will for a limited period of time (like 3 days, at least here in PA, NY may have slightly different time frame).

To be held against your will you have to be deemed a danger to yourself or others.

Re: Anyone in the Psych field? I have a question

If the professionals in the hospital deem that the person is truly at risk of hurting himself or others, they can involuntarily keep the person in the hospital. I'm not sure how long they can keep them though. I think it's probably around three days.

Re: Anyone in the Psych field? I have a question

Depends, even if they have a history of attempts if they are not currently a danger to self or others they do nto meet requirements for involuntary admission.

That being said, a history from the family goes a long way. If a fmaily member, or roomate is present, can report the history, current alarming behaviors and concern for immediate safety despite patients self-report of not being suicidal. Often the MD will take that into consideration in addition to their mental status exam.

If said family member is willing to do an application for admission, often 2 physicians will agree and pt can be 2PCd.

If no family is present, but MD believes pt is a danger despite patients report they can be admitted on an emergency (involuntary admission) (939 in Queens).

In both these cases you can not sign out AMA.

Finally, if the patient agrees to admission and signs a voluntary admission, you still can not sign out "AMA", it doesnt exist for psych treatment. What the patient can do is write a letter requesting to be discharged and give it to any staff. Upon receipt of that letter the MD has up to 72 hours to evaluate the patient and determine if it is safe for them to go home. If they feel it is safe, they must be discharged. If not they can be converted to 2PC, but MD will have to go to court.

I hope this answers your questions. FM me if you need more info.

Re: Anyone in the Psych field? I have a question

Thanks ladies. Unfortunately, the family in this case in not getting involved. This individuals friends have shown the doctors text messages where the individual made reference to killing themself and there have been several attempts using different methods. Each time the individual has been taken to the hospital by ambulance. I get the feeling this person truly does not want to kill themself, but rather is seeking attention from people. I'm just worried that one time this person is going to attempt to seek attention but actually succeed in killing themself. It seems like no one is stepping up to help the individual. I don't understand how they are just able to walk out of the hospital after this, but I guess everyone has "rights".

Thanks again for your help.

Re: Anyone in the Psych field? I have a question

Re: Anyone in the Psych field? I have a question

There's a law in NYS too, Kendra's law, that I think if they have had at least 3 psych admissions or psych ER visits in one year, they can be taken to court and mandated to outpatient treatment as well as ongoing follow up from either an Intensive Case Manager or Assertive Community Treatment (ACT) team. Usually someone has to make the referral though and put pressure on the inpatient staff to follow through. And it takes time (they are usually d/ced back to the community before the court hearing takes place because the AOT team needs to get records of all their hospitalizations, do a concrete history, etc.).

This law came about back in the 90's when a schizophrenic man who was in and out of treatment, pushed a tourist, Kendra Webdale, in front of a subway train and she died.

There's pros and con's to this plan of action as well.

Message edited 1/15/2008 5:28:40 AM.

Re: Anyone in the Psych field? I have a question

Oh yeah, there is a limited amount of time someone can be held in the inpatient unit involunatarily. I think it's 14 days (we just recently went through this with a client). It's also been my experience that my clients know what to say to get out of the hospital, and due to insurance issues as well as a hospital setting just not being an appropriate "long-term" solution, they will d/c them back to the community.

Re: Anyone in the Psych field? I have a question

Message edited 1/15/2008 5:40:16 AM.

Re: Anyone in the Psych field? I have a question

Re: Anyone in the Psych field? I have a question

Thanks for clarifying Rose!!! I haven't been involved directly with the mental health population since 2004, so I am sure things have changed a lot since then.

I agree with the outpatient recommendation and surrounding him/her with as many supports as possible who are willing to advocate for his/her needs. Many times people just don't have family to rely on.

I have seen people get services and the help that they need without family involvement. Often for obvious reasons, these are the people who are most vulnerable and at-risk. Families can also be destructive and sabotage treatment plans.

I know it's frustrating but the key is to not give up. Keep advocating for this person until they get the help that they need. Remember that many social workers and especially doctors are overwhelmed with in many instances what are considered "more serious" cases. Let your voices be heard and usually that works. Keep checking in from time to time to let us know how things are going!!

Message edited 1/15/2008 7:27:59 AM.