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righthere
06-17-2010, 07:05 AM
I'm writing a young adult paranormal book. My character starts seeing ghosts. When he tells his mom, she gets him an eye exam and schedules an appointment with a psychiatrist. During his appointment, the psychiatrist is possessed and attacks him. The main character has to fight back and ends up holding a letter opener to the throat of the psychiatrist when she returns to herself.

Now, I want him to be committed -- well, not committed, but held for a 72 hour psychiatric evaluation. I think the situation I've put him in serves as proper grounds for this as he does pose a danger to others -- at least from the view of the psychiatrist.

My question is, what exactly happens during the evaluation? I know that the evaluation usually takes place at a local or county mental facility. But other than that I'm not sure what happens. Is the person locked in a padded room? Are they free to wander around the ward? Are they medicated? What meetings does the person have? Do they have to meet with a psychiatrist during the 72 hours or are they merely observed?

Any help on this would be appreciated.

GeorgeK
06-17-2010, 08:06 AM
I was one of the few surgeons willing to see consults on the psych ward and used to work in a hospital before med school as one of the lowly guys in white who had to report to the "assistence alerts" where we'd do the mattress tackle and pull out a limb for a nurse to inject with something. It depended a lot on the patient and whoever was taking care of them and how recently the facility had been updated. Everything I've seen sice the mid 90's had closed circuit monitoring of the entire floor. A patient might once in a while make it to a phone and dial out just long enough to say a few words. If they seem calm they might be allowed to wander the halls inside the locked unit. The calm ones sometimes would accompany staff outside to the smoking area. If they are stark raving, screaming, disturbing other patients, then they used to be strapped down in 5 point leathers and drugged. Now, I think they just get put in an isolation room which is still monitored with cameras. I'm sure someone with more recent experience will wander by.

righthere
06-17-2010, 08:54 AM
Thanks for the reply.

My character will be calm during the evaluation. He's not actually crazy and has nothing wrong with him. Obviously he's not going to want to be there, but he doesn't want to be diagnosed with anything so that he's kept longer.

After he realizes that the psychiatrist is no longer possessed, he's going to drop the letter opener and back away. He'll also appologize.
I was thinking of having him saying that he doesn't know what happened, that he hasn't been getting a lot of sleep and that he's stressed. I'm hoping that with this he could kind of get the psychatrist to think that insomnia is the problem and during the evaluation that's kind of what they're looking for.

He's going to have a ghost advising him on what to do and say so that he can get out of it after the evaluation is over. But I'm not really sure what the ghost should tell him or what happens during the 72 hours.

veinglory
06-17-2010, 02:43 PM
So how does the psychiatrist remember the event. But even if you are in a very threatened posture, if a psychiatrist emerges from an unexplained blackout they will have trouble being certain that the person should be committed.

shaldna
06-17-2010, 03:41 PM
I know that here you have to be refered by your doc for a psyche evaluation.

veinglory
06-17-2010, 04:20 PM
Where is "here"? Any begavioral health care center I know of in the US will allow self-referal in a crisis situation.

righthere
06-17-2010, 05:33 PM
The psychiatrist will not remember what happened while she is possessed, but when she "comes to" the main character will be pinning her to the ground with a letter opener to her throat.
While I agree that she'll have difficulty because of her "blackout," she's not exactly having him committed. Combined with what the character's mother has already said and will say (when they talk after the fact), she's reccommending that he be held for evaluation. Even with her own uncertainty of the event, she was still in harm's way at the main character's hands.

jclarkdawe
06-17-2010, 05:52 PM
This is going to be a question of how credible do you want to be.

So the doctor is possessed, and comes out of it to find the kid holding a letter opener at his throat. The doctor does not remember how he got to that point. Now more so than most people, a doctor is going to notice that memory lapse and the how did I get here state. He's going to have to put together some level of statement to get a committal proceeding started. How does he explain this?

Now the kid has a rational and consistent story that isn't believable. He's not going to be displaying any signs of any mental disease. Doctor examining him is going to have to decide why he is inventing this story. My guess, especially with a kid, is the doctor will decide the kid is inventing the story to get out of trouble. At that point, the kid walks on the civil commitment and goes to jail. Or they drop the whole thing.

The committing doctor knows he's going to have to explain this to a judge if he issues a committal order. And as the kid's attorney, I'm going to want to be in criminal court than dealing with a civil commitment, especially since my guess is the kid doesn't want a commitment.


I was thinking of having him saying that he doesn't know what happened, that he hasn't been getting a lot of sleep and that he's stressed. I'm hoping that with this he could kind of get the psychatrist to think that insomnia is the problem and during the evaluation that's kind of what they're looking for.This is not enough for a committal. Send the kid home with some sleeping pills. To be committed against your will, you have to be a PRESENT danger to yourself or others. Unless he is a continuing danger, you get sent home. Your kid has identified his problem, and pills can deal with it.

Evaluations in New Hampshire take place at a hospital in exam rooms. A security guard would be placed outside, and the doctor talks to the patient. If the patient is violent, the patient may be restrained on a bed. Medication is given to get the patient under some level of control. (But since your kid isn't out of control, how is the doctor going to help him?)

Patient is then transferred to a mental health ward, either the state hospital or one of the few psychiatric wards in hospitals. Realize there aren't that many beds available in this type of situation. As long as the patient doesn't cause trouble, he or she will be allowed to wander in the ward to their heart's content. Group meetings are fairly constant (every couple of hours). If he's not actively presenting symptoms, he'd meet with a doctor once a day.

Best of luck,

Jim Clark-Dawe

shadowwalker
06-17-2010, 05:57 PM
The "danger to others" would be sufficient in most states to have him put in a 72-hour hold. Restraints are not allowed, nor are drugs (in most states) for control purposes. Depending on the unit, the client would be allowed to walk around if they weren't 'excited'; if they were, they would be locked in a monitored padded room.

During the 72 hours, they would most definitely speak to a psychiatrist and/or psychologist, probably several times. No drugs would be administered until the psychiatrist was sure of a preliminary diagnosis. At the end of the 72 hours, if it were determined that the client was no longer a threat, they would be released (although may be sent directly to jail if, in this case, the doctor pressed charges). If the threat was still viable, then the docs would go for a commitment order.

righthere
06-17-2010, 07:00 PM
Thanks for the advice.

Going off what jclarkdawe said, yes the kid does know what his problem is, but the kid's not a doctor. Is it credible that, even with memory lapse, a doctor will accept a 16 year old's self-diagnosis and send him home with nothing but sleeping pills after this happens?

I just want to clarify that I'm not having the psychiarist get the boy committed. She's merely reccommending that he be held for 72 hours for evaluation. She will not be pressing charges. At the end of the 72 hours, he will be released with the sleeping pills. He will not be telling any doctors about the possession or what really happened.

I may need to actually consult a psychiatrist to see how this situation would be handled.

shadowwalker
06-17-2010, 07:10 PM
Thanks for the advice.

Going off what jclarkdawe said, yes the kid does know what his problem is, but the kid's not a doctor. Is it credible that, even with memory lapse, a doctor will accept a 16 year old's self-diagnosis and send him home with nothing but sleeping pills after this happens?

I just want to clarify that I'm not having the psychiarist get the boy committed. She's merely reccommending that he be held for 72 hours for evaluation. She will not be pressing charges. At the end of the 72 hours, he will be released with the sleeping pills. He will not be telling any doctors about the possession or what really happened.

I may need to actually consult a psychiatrist to see how this situation would be handled.

She definitely wouldn't accept the self-diagnosis. Now, if he were to stay awake for the 72 hours, that might 'prove' his statements - but no way they would give him sleeping pills. His parents would have to be notified of the hold immediately, and any prescription medication would have to be okayed by them, and they would have to get it for him. But they would recommend all kinds of other relaxation methods first. Psychs don't like sleeping pills - for obvious reasons ;)

As to the commitment - the original psychiatrist wouldn't have the final say. Once he's put in hold, it's then up to the doctors (and it would be a team) evaluating him. She would have input, but that's all.

righthere
06-17-2010, 08:12 PM
I just wanted to clarify ... of course I meant that the prescription, if any, would be give to the parents to be filled, not given directly to the boy.

jclarkdawe
06-17-2010, 09:14 PM
I was being a bit simplistic.

Kid starts talking with second doctor. (Obviously the original doctor can't commit and I have no doubts that the OP knew that from the get-go.) Second doctor asks kid, "What happened?"

"I don't know. I guess I snapped or something. (He sure can't explain what happened.) I've been up for the past few days, not getting any sleep."

Doctor doesn't nod to himself, declare the case solved, and moves on. He investigates. He asks further questions, he looks for physical signs, he might check with the parents. If further determination makes it look like the kid is right, then the doctor looks for a solution to the problem. The doctor should prefer medication to a hold. It's less restrictive. But if the kid can use some relaxation approaches to get some sleep, then the doctor would choose that. Doctors should always choose the smallest solution to a problem.

Based upon what's been presented, if the kid was committed, I'd have the doctor's ass at the hearing. It's not enough.

However, here's a way to make this into something better. Especially since he's getting some "help." First doctor comes out of his possessed state, to see letter opener waving in his face. When asked, the kid says nothing. Says nothing to nobody. When asked about the weather, he says nothing.

When examined by the second doctor, he says nothing. Not a thing.

Now the second doctor is going to be suspicious of the non-responsiveness, and not terribly convinced. But he's not getting any help at letting the kid go. The doctor has a kid saying nothing and a dangerous episode. Doctor has no clue what happened. Kid could very definitely be gaming the system. If the parents agreed, I could see a doctor in that situation committing the kid. It's not a good answer from the doctor's point of view, but the options are worse.

Best of luck,

Jim Clark-Dawe

Wayne K
06-17-2010, 09:26 PM
My eyes hurt so I didn't read anyone's post, but I've been held a few times on 15 day psyche evaluations, so I can tell you what really happens.

If they want to keep someone, they'll find a reason to keep them. There are ways to challenge that decision, but no one ever really does. You behave and get out in a few days.

They evaluate you over a few days, and if you seem okay they let ya go. If they want. Remember, there's no judge and jury in there. I went in front of five dioctors who said I was without a doubt sane and not a threat to myself or anyone else, and then they kept me anyway.

You can even be denied counsul if the doctor says so.

They're God in there. Everything is as they say it is, simple

shadowwalker
06-17-2010, 10:44 PM
You can even be denied counsul if the doctor says so.

If that's what you were told, they lied. You absolutely have a right to legal representation. I know of no state that can legally deny you that - in fact, if you're judged ill enough, an attorney will be appointed to represent you because you're mentally unable to yourself.

Wayne K
06-17-2010, 10:47 PM
It's all in how they do it. I could go on for hours, but believe me, they can delay it for a long time.

backslashbaby
06-18-2010, 03:06 AM
Maybe the psychiatrist could tell the kid he's going to press charges or try to have him committed if he doesn't voluntarily go in for a sleep study, or for a 72-hour evaluation?

I've known folks where it's been 'highly recommended' (hint, hint) that they commit themselves... "it looks much better if you do it."

eta: sorry I keep calling it committed. Evaluation, yes. You can go in of your own accord, on advice of your doc, is my point :)