Daily. It’s a rare day when we don’t. In OH, medics can’t involuntary commit. Cops can. The County Mental health place is in my city. We get calls from them to assist w an involuntary commit on a regular basis. It’s a revolving door. The mental health system is broke. We take the same people over and over because there are no or few permanent facilities anymore. It’s much worse than when I started. We even have to involuntary commit kids on a regular basis because shitty parents.
Formerly known as xpd54.
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In the ER it's literally almost every patient, depending on how loosely you define the term; from substance abuse to florid psychosis. Most often brought by you guys (LE/EMS/Fire). Behavioral problems beget medical problems and then you end up with schizophrenic diabetic homeless patients who lose pieces of their toes when you pull off their socks. We also of course get them when they're just an extra spicy flavor of crazy and/or intoxicated that day and need an acute resolution to their episode.
The state of America's psychiatric services is extremely concerning. Nationwide we have a massive shortage of mental health providers - particularly of inpatient mental health facilities. This shortage hurts people in the middle-ish-class the most; often from families too "wealthy" to receive state funded inpatient treatment, but not nearly wealthy enough to afford the many for-profit private facilities across the US. It is sadly not uncommon to see this end in the death of a young person from a good home, which is absolutely devastates their family.
I am not in LE, but I can't imagine this shortage going unnoticed by those who are. The lack of beds means that it is harder and harder to get M1 holds (or whatever you call your state's 72 hour involuntary medical hold). If their service is full, psych can't take them (or will be less likely to take them), and if psych doesn't take them, they go literally right back out to the streets.
edit: here is an article that touches on this topic. Worth the read if you have 5 minutes.
Last edited by Nephrology; 10-17-2017 at 03:21 PM.
Most of our involuntary commitments are out within 4-6 hours.
Formerly known as xpd54.
The opinions expressed in this post are my own and do not reflect the opinions or policies of my employer.
www.gunsnobbery.wordpress.com
Colorado Springs has a dedicated crisis response team that deals with mental health issues. The team consists of 2 cops, a Paramedic and a crisis evaluator. The cops have specialized training on dealing with mental health issues and the evaluator is always with them but again, they kept bringing the same people in for evaluations over and over.
The worst part of all this was the kids. They'd bring these kids in, label them "mentally whatever" put them on disability and Medicaid and start milking the system.
The place I worked frequently would put people on an M1 hold then find out there were no beds available. I saw people sit in intake for 24hours plus waiting for placementOriginally Posted by Nephrology
Last edited by Cypher; 10-17-2017 at 03:36 PM.
When they know how to play the doctors and "play" sane for a few hours they are out easily.
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It doesn't help that sometimes the 911 call is literally "I saw someone sleeping outside." Yes, you probably did. That's probably because they're homeless.
But out of an abundance of caution, EMS is sent to check them out, who out of an abundance of caution, brings them to us, who out of an abundance of caution, have psych check them out...
They need a place to actually go from the ER, and until psychiatrists (willing to take a paycut to work for the state) start growing from trees, there isn't one. It's really bad.
Not even necessarily. Sometimes psych literally can't take them, and sometimes psych has a different (in their defense, arguably better informed) understanding of the term "gravely disabled." Being crazy isn't a crime, and doesn't necessarily qualify as grave disability - even if the things they did to bring them to the ER (drinking listerine, screaming at passerbys, smashing car windows with a hammer...) would sound to every normal human being like the very definition of the term.
It's even more complicated if they are intoxicated - especially sympathomimetics like meth. I was one told someone's behavioral problems were 99% meth, 1% mental illness, even though they were clinically sober at the time and definitely not sane. Out the door they went.
That said, I definitely wouldn't worry about a patient "tricking" psychiatry... after all, talking to crazy people is literally all they do for a living, and they get LOTS of practice.
Sounds about right. This happens very often to people getting dispo'd to medical/surgical units, too... fun times in American healthcare
Last edited by Nephrology; 10-17-2017 at 04:01 PM.
That’s not who we commit. We only commit people we PERSONALLY observe to be either suicidal or a danger to others. As in, “I’m going to kill myself.......” Or so far gone that they can’t take care of themselves. Homeless people need not apply. Nor do we commit people who are just crazy. Lotsa those around.
Last edited by Lon; 10-17-2017 at 03:54 PM.
Formerly known as xpd54.
The opinions expressed in this post are my own and do not reflect the opinions or policies of my employer.
www.gunsnobbery.wordpress.com
If most states were like the one I worked in, they pretty much abrogated MH to LE and the Penal System 20 years ago.
The path of least resistance will seldom get you where you need to be.
I work in the world's biggest outpatient clinic so.....only on those days when I go to work.
Didn't mean to imply that you'd commit folks who don't meet HI/SI/Grave disability criteria; it was a comment on the overwhelming volume of demand for psych services (which often includes the homeless brought in for evaluation) that does not help to free up space for those who qualify for a hold.
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