Procedure for being sectioned

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Harlequin

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Cautiously, without meaning disrespect, I've been trying to read up on what happens to people who are sectioned in the states, but struggling to get the information specifics that I need.

I know the procedures in the UK (partner is psychologist) but it's different over here; everything happens through the NHS and the mental health act is very clear cut.

On the american side--can someone else (relatives) have a patient sectioned? Presumably it can also be voluntary on the patient's part, but do they sign off rights etc if so? Can the state choose to detain a patient even if no one else requests it? For example, in the case of clear attempted suicide, or danger to others.

What happens for Americans in this position with no healthcare insurance? Are patients who get sectioned kept in an ordinary hospital (like they sometimes are here)?

How easy is it to visit people who have been detained, and how long are they kept for/what needs to happen for them to get out again?
 
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JDlugosz

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I have no idea what yiu’re talking about: sectioned? As it cut into pieces?!
 

neandermagnon

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I think it's "committed" in American English? I'm not sure if I've remembered the correct word. They don't use the word "sectioned".
 

Lillian_Blaire

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I actually have some first-hand experience with this.

Short answer--yes. Yes, you can have your child committed against their will (and sometimes a spouse), if you have a physician agree with your assessment that they are a danger to themselves or others. And yes, even in voluntary situations, often a patient's rights are removed.

If you go (or are taken) to a hospital because you say you want to kill yourself, they usually admit you into the hospital immediately, for overnight observation. If, at this point, you are still thought to be a danger to yourself or to someone else, you can be committed to the "psych ward" of the hospital or transferred into a facility that specializes in mental/emotional issues. This can and is often done without the patient's consent and the patient cannot be released until the doctor signs release papers. This is an involuntary commitment.

If you are committed to one of these types of facilities, getting a visitor is very difficult. Usually the physician in charge determines when a patient is ready to see visitors. It can be several days or weeks, it just depends.

If you decide for yourself that you might hurt yourself or hurt someone else and go a private recovery facility willingly (rather than going to the public hospital), they usually have you examined/interviewed by a psychiatrist to assess your situation. And in the cases I know of, if you are accepted into their treatment program, you give up your rights. It may depend on the facility--some may have more stringent rules than others, but the ones I know of really won't let you leave until the physician clears you. Visitation is extremely limited. You are required to attend the classes they assign, required to take the medications they prescribe. The demand for a bed in these facilities is extreme, so if they don't think you absolutely need it, they will deny you admission.

Public hospitals are not allowed to turn patients away for an inability to pay, especially in the case of suicidal or homicidal tendencies. They bill your insurance companies. If you don't have insurance, you are still sent a bill (and not paying it will hurt your credit). Admission to treatment facilities is usually dependent mostly on the severity of the threat you cause, without a lot of concern for insurance, as far as I know. But the better your insurance coverage, the more willing a good facility is to take you as a patient. So if you don't have insurance but are involuntarily committed, you may end up in a less-than-ideal facility. Though there are some charity hospitals, most require you to pay any balance your insurance doesn't cover.

My knowledge is limited to my own experiences, but I can tell you that as a mother, I thought very long and hard about allowing my son to be seen by the psychiatrist in one of these facilities for an intake interview, because I was told, in no uncertain terms, that if the doctor found him a danger to himself or others, he would be admitted and I would not have any right to remove him. He would not be allowed to leave, even if he felt better. I couldn't just go pick him up and take him home. He would be there until the doctor released him.

Even before the interview, they took away both our cell phones, my purse, his wallet, belt, and shoes. This wasn't a dark and scary mental institution, either, but a prominent and well-respected treatment facility. Their procedures are fairly standard, from what I understand. So, my son quickly decided he wasn't suicidal after all, and felt we could deal with the situation on our own, with the help of a psychologist. I took him (he was 20 years old, by the way) and we left, not willing to put our trust in the doctor, worried that once my son was inside, he might be detained well beyond the amount of time he wanted to stay. He wasn't willing to give up his freedom.

I hope this information helps. Others might have different experiences.
 
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MDSchafer

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It varies a lot by state, but the basic principal is that if you admit to having suicidal ideations or a plan the hospital is obligated to hold you until you can be evaluated by pysch. The amount of time again varies by state, but the clock only includes working days. So, say in some state it's 72 hours, if you are committed after 5 p.m. on Friday your 72-hour clock doesn't start until Monday. So you can be held, not specifically in a pysch floor, for up to five days at that point. During which you will be under one-to-one supervision to make sure you don't kill yourself.

Typically once that hold runs out the hospital can extend the hold by a few more days. After that you have to go to court in order get a civil commitment. Here is a link to a pdf that explains the process in South Carolina.

http://www.pandasc.org/wp-content/u...ntal-Health-Commitments-Fact-Sheet-5-7-12.pdf
 

cornflake

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Cautiously, without meaning disrespect, I've been trying to read up on what happens to people who are sectioned in the states, but struggling to get the information specifics that I need.

I know the procedures in the UK (partner is psychologist) but it's different over here; everything happens through the NHS and the mental health act is very clear cut.

On the american side--can someone else (relatives) have a patient sectioned? Presumably it can also be voluntary on the patient's part, but do they sign off rights etc if so? Can the state choose to detain a patient even if no one else requests it? For example, in the case of clear attempted suicide, or danger to others.

What happens for Americans in this position with no healthcare insurance? Are patients who get sectioned kept in an ordinary hospital (like they sometimes are here)?

How easy is it to visit people who have been detained, and how long are they kept for/what needs to happen for them to get out again?

Well, yes and no. No, you absolutely cannot have a relative, or anyone else, sectioned of your own accord, as in 'my husband is bananas, here, he needs to be kept,' and they'll keep him on your word.

You can call the police and report that someone presents an imminent danger to themselves or others. The police will respond to that call and take the person to a hospital where they'll be seen by a psychiatrist or psychologist. If that person (or persons, it may require more than one for an involuntary hold) agrees that the person presents an imminent danger, the person can be held for (depending on the locality -- as, very different from the UK, these laws all vary some as they are all municipal so here mostly state-based but some more local) generally 72 hours.

If someone will go with you willingly to a hospital to say they wish to be admitted, they might be, depending on what's going on, the facility and their insurance.

If someone will go with you willingly to a hospital emergency department to say they are having suicidal or homicidal (or are floridly psychotic or something but you're able to take them), they may be admitted, based on psych evaluation, but if they're going willingly, it's usually a self-admit, unless they're way out of it in the psychotic way. If, say, they go with you and explain they're suicidal and want help, are admitted and then change their minds, they may be held on a psych hold but that'd kick in the same process as the above, and may or may not also start a court process, depending.

Once the 72 hours (or whatever, depending on locale), are up, the facility will need a court order to keep an unwilling person in the facility. These are not that simple to get. The holds are periodically reviewed and the state/the facility must repeatedly demonstrate the specific need to keep the person against his or her will.

The default assumption by the court is that someone should be able to make his or her own decisions, so a facility needs to prove each and every time why a person cannot or should not be able to. It's a high bar. It's not easy to keep someone, or to medicate them against their will (a whole other court procedure). It's done, don't get me wrong, but it's got specific legal steps that need to be followed and the court generally looks hard at removal of basic rights.
 
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Harlequin

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Many thanks, cornflake and MDSchafer. That also answers a lot of questions.

I think other the main thing I will need to look into is how it all ties in with insurance. If you don't have any they (from what I remember) can't turn people away for emergency care--but who gets charged? Do hospitals bill the state? Do you pay it back years down the line if you get a better job or something, for example?
 

auzerais

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I think other the main thing I will need to look into is how it all ties in with insurance. If you don't have any they (from what I remember) can't turn people away for emergency care--but who gets charged? Do hospitals bill the state? Do you pay it back years down the line if you get a better job or something, for example?

Medical debt is like any other debt. The hospital bills the patient. If the patient doesn't pay, they will probably be sent to collections, and the debt shows up on their credit report. You owe the debt until it's paid, and until it gets paid it's accruing interest and the debt is becoming larger. So theoretically if you get a better job down the line, you would want to pay it back, but it's probably astronomical at that point.
 

Siri Kirpal

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In Oregon, the process is much as cornflake described. When a friend of Mr. Siri's went out and brandished a cucumber at passing cars, he called the police who took her to the psych ward in a hospital. From there, she was committed to a treatment center.

Blessings,

Siri Kirpal
 

Bren McDonnall

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Just went through this with a friend, so this is what happens in Wyoming.

She went in to see a psychiatrist after a great deal of urging from family members and was immediately committed.

There were concurrent physical issues so she was held in the ER for several days until she stabilized. During the first couple of days, visitation was limited to 2 people and 1 hour. After about day 3, it was normal visitation, but she had no phone or anything, and I mean anything.

The one time I visited, I brought a canned soft drink. They had to pour the stuff into a styrofoam cup, because they couldn't leave the can in her room. During the whole time, there was a hospital staffer (or volunteer, possibly) assigned to the room to be with her. She was not left alone for a moment.

Once the physical aspects were cleared up, she had to go to court to avoid being committed to the psych ward indefinitely. The determination was that, since she'd not actively been trying to kill herself, that she could go home, but must do therapy. The key part was that she had to go through the court system to get out, she couldn't simply leave.

IF you wanted to commit someone against their will, you need 2 different doctors to agree that it's necessary and then go through the courts. (as per state social worker regarding a senior citizen just about a month ago)


ETA: Regarding billing. In the US, you cannot be turned away for inability to pay if there is no other place to send you. There are hospitals where you will be refused, but then transported to nearby facilities that will take you.

You will be billed, whether you can pay or not. After a given time, (5 years, generally) the hospital will write the charge off. The write offs are a part of the business model and are expected and factored into the books. There are also 'charitable' write offs and pro-bono care instances, also for tax purposes.

At this point, (after the write off) they'll generally sell the debt to a 3rd party collector who'll purchase it for pennies on the dollar on the off chance they'll someday be able to collect it. Gigantic bills can be addressed in bankruptcy actions (although student loans cannot, for some reason)
 
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Jeneral

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On the subject of hospital bills, I'll mention that most hospitals (at least the ones I've been to) will set you up on a payment plan if you can't pay the total amount. I went to the ER once without insurance and paid it off at something like $50 a month for a year and a half. I'm on a payment plan for a surgery I had last year which should be paid off next month, and am starting payments on a recent hospital stay.
 

Bren McDonnall

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It has a lot to do with government interference in the industry quelling competition in both the medical and insurance industries. In the past ten years or so, however, at least in the medical realm, private urgent care clinics have been sprouting up all over. What once would have been a multi-thousand dollar ER visit complete wit 3 hour wait can be done in an urgent care for around $100-$150 in under 45 minutes.

Unfortunately, mental health care is still pretty costly if you go full on private. Although, even here, there are needs/means based clinics that'll treat you for as little as $5 per session.
 

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Well, heck. That sucks =S

More reasons why we won't ever move back >.>

But the difference is, you get a higher standard of care. In the UK nurses make less than a third of what US nurses do, even less when you account for cost of living, and they have higher RN to patient ratio, which leads to substandard care and a greater chance of death. So yeah, you get what you pay for.
 

rtilryarms

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Most states have mental health laws. In Florida, for instance, it is called by the common name Baker act. Start research there, you will find more info.
 

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Technically it is a psychiatrist who "has the person committed" aka admits them to a secure ward. It would make no real difference, for an adult patient, of they were brought in by family, the police, strangers, or walked in on their own. They are admitted to the secure ward because they are a serious danger to them-self and/or other people due to psychiatric illness. The main difference in the US is that they will check you have insurance first. if you don't, outcomes will vary but being refused treatment is a possibility in many locations. Maybe it isn't meant to be, but it sure happens.
 
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Harlequin

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But the difference is, you get a higher standard of care. In the UK nurses make less than a third of what US nurses do, even less when you account for cost of living, and they have higher RN to patient ratio, which leads to substandard care and a greater chance of death. So yeah, you get what you pay for.

Not to drag it into a debate, but the NHS is currently ranked the top rated health service in the world. Nurses are underpaid thanks to the current government, and I'm sure it's above to change in VERY short order, but at present the standard of care is pretty good.

It's possible to get private healthcare and health insurance in the UK, if you want. My partner does some contract counselling work with an insurance provider, for instance. Private is always an option. If you get what you pay for, then I would prefer the NHS over low-cost private in the States every time. We'd not be able to get decent health insurance there, and the charges are disproportionate to the actual cost of care.
 

Harlequin

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Technically it is a psychiatrist who "has the person committed" aka admits them to a secure ward. It would make no real difference, for an adult patient, of they were brought in by family, the police, strangers, or walked in on their own. They are admitted to the secure ward because they are a serious danger to them-self and/or other people due to psychiatric illness. The main difference in the US is that they will check you have insurance first. if you don't, outcomes will vary but being refused treatment is a possibility in many locations. Maybe it isn't meant to be, but it sure happens.

That could actually work well >.> But wouldn't they send you somewhere else?
 

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Not to drag it into a debate, but the NHS is currently ranked the top rated health service in the world. Nurses are underpaid thanks to the current government, and I'm sure it's above to change in VERY short order, but at present the standard of care is pretty good.

It's possible to get private healthcare and health insurance in the UK, if you want. My partner does some contract counselling work with an insurance provider, for instance. Private is always an option. If you get what you pay for, then I would prefer the NHS over low-cost private in the States every time. We'd not be able to get decent health insurance there, and the charges are disproportionate to the actual cost of care.

Yeah that higher death rate in UK hospitals doesn't mean there's a higher standard of care in the U.S. It could mean a metric ton of things, including that, at least in part, the NHS taking everyone and the inability of the deeply impoverished to get inpatient care for things in the U.S. that they can from the NHS that might be tipping numbers both ways (can be leading to higher inpatient death numbers and lessening them if people are dying outside of hospital in the U.S.), the way things are counted, the types of prolonging care chosen by individuals, etc.

That could actually work well >.> But wouldn't they send you somewhere else?

They're meant to, but the place you're sent to could be overrun with patients, leading to refusal for lack of space or a wait of days in the hallway, or being told to return, or being sent someplace *else* which.... like the poster said, it's not supposed to happen but it does.
 

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Not to drag it into a debate, but the NHS is currently ranked the top rated health service in the world. Nurses are underpaid thanks to the current government, and I'm sure it's above to change in VERY short order, but at present the standard of care is pretty good.

The recommended staffing ratio for med surge floors are eight patients to one nurse. The American standard is four patients to one nurse. Neither country reaches their goal, but a five or six to one ratio is far better than a nine or ten to one ratio that a lot of UK hospitals are running. The UK lags behind the US in every measurable metric of care. The only countries that hold even, and beat us in some categories are tiny European countries with a Population less than Atlanta and less land mass than Maine.
 
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