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infractuspennae
11-20-2013, 04:02 AM
My MC's 24-year-old son had a psychotic episode, where she was injured. She ended up with a black eye, 1" laceration to the back of the head (with concussion), and clear finger marks around her neck. The police were called, and he was taken to a crisis center for observation.

She is now talking to the psychiatrist in charge of her son's case. I know he should not go home. But I am not really sure what the next step should be. Is the only option in this case inpatient?

Captcha
11-20-2013, 04:07 AM
You should clarify the location of your story for the most accurate answers, but I know that there are group homes for mentally ill people in my area. There might be something like that where your characters are. You might also be surprised by how pressure there is on the mom to take him back home. (Pressure from others AND from herself). If he's got his medication figured out or if she has any other reason to believe he's back on track, she might feel that he'd be at his best in familiar surroundings, and others might support her with this.

veinglory
11-20-2013, 04:16 AM
There is an terrible story in the news right now that illustrates that if a bed in an appropriate unit is not available, the son may be sent home. So you could probably have whatever best serves the story happen and have it not be implausible.

infractuspennae
11-20-2013, 04:34 AM
You should clarify the location of your story for the most accurate answers, but I know that there are group homes for mentally ill people in my area.

Location is San Francisco, Ca

infractuspennae
11-20-2013, 04:36 AM
Thank you both for the information!

jclarkdawe
11-20-2013, 05:26 AM
Starting point is that mom isn't talking to the doctor, unless junior has signed a release. Junior is a big boy, with big boy problems, and mom isn't going to be able to do much.

Second is I don't know the history of junior. It plays out a lot here.

Third is prison and jails are full of psychotics. Unless he is incredibly around the bend, unlikely he'll end up in a hospital, in which case it's going to be a lot longer before he's released.

Fourth is he'd probably be charged with attempted murder of mom. Every psychotic I represented had stacked charges, and here at a minimum I'd expect a felony level resisting arrest. Also probably destroying some property. Bail would probably be above $10,000 cash. Only reason he wouldn't be in jail is if his psychotic break was so severe that he needs to be in a secure psychiatric unit. Once they get him under control, then he goes to jail.

Fifth is how responsive to medication is he? That's what's going to drive the treatment plan, and the treatment plan will drive the bail conditions/sentencing.

So repeating what Veinglory asked you, what does the plot need?

Best of luck,

Jim Clark-Dawe

King Neptune
11-20-2013, 05:32 AM
JCD hit the main points.

At 24 the guy is an adult, and he probably should be put somewhere until he becomes stable. I won't detail about relatives who had this kind of situation, but you MC doesn't want him at home.

valerielynn
11-20-2013, 07:08 AM
Depending on where your character resides, there could be some kind of a group home or psychiatric center that he could go to.

slhuang
11-20-2013, 09:58 AM
This isn't related to your question at all, but I thought it might be helpful. You might know all this already and be taking it into account, in which case just ignore me. :)

The vast majority of mentally ill people (including people who experience psychosis) are not violent. There are indeed some mentally ill people who are violent, but it is a small minority. So please be very careful not to imply that mental illness causes violence or that psychosis causes violence. That's not the case at all, and a lot of people who live with and manage mental illnesses have to deal with the ideas people get from books/movies/television.

(It's not only a matter of responsible portrayals, though -- as a reader, I also dislike books that equate mental illness and violence because to me it shows a lack of research, and also it just feels lazy.)

Again, I apologize for addressing something other than your question. And to be clear I am not saying you are not depicting mental illness correctly, as I don't know whether you are or not. But since the question was about violence and mental illness I thought I should mention all this just in case.

infractuspennae
11-20-2013, 12:27 PM
OH I know...my father is the main idea for the MC's son. He suffered from Salience Syndrome (since I like that name better than Schizophrenia). Never once did my dad hurt anyone. He just heard voices.

Violence, typically comes because of other issues like drugs or drinking. Which is partly to blame here. But the main theme with dealing with the mental illness is that they are not monsters, but humans just like everyone else and should be treated as such.

MC son is one side of the coin (the uncontrolled illness), and another supporting character is the other side (medication controlled & socially functional).



This isn't related to your question at all, but I thought it might be helpful. You might know all this already and be taking it into account, in which case just ignore me. :)

The vast majority of mentally ill people (including people who experience psychosis) are not violent. There are indeed some mentally ill people who are violent, but it is a small minority. So please be very careful not to imply that mental illness causes violence or that psychosis causes violence. That's not the case at all, and a lot of people who live with and manage mental illnesses have to deal with the ideas people get from books/movies/television.

(It's not only a matter of responsible portrayals, though -- as a reader, I also dislike books that equate mental illness and violence because to me it shows a lack of research, and also it just feels lazy.)

Again, I apologize for addressing something other than your question. And to be clear I am not saying you are not depicting mental illness correctly, as I don't know whether you are or not. But since the question was about violence and mental illness I thought I should mention all this just in case.

infractuspennae
11-20-2013, 12:41 PM
Starting point is that mom isn't talking to the doctor, unless junior has signed a release. Junior is a big boy, with big boy problems, and mom isn't going to be able to do much.

I worked in health care so I completely understand the regulations there. And I have dealt with them, as far as that goes.


Second is I don't know the history of junior. It plays out a lot here.

This would not be his first time, but it is since he has been an adult.


Third is prison and jails are full of psychotics. Unless he is incredibly around the bend, unlikely he'll end up in a hospital, in which case it's going to be a lot longer before he's released.

That I will have to give some thought to.


Fourth is he'd probably be charged with attempted murder of mom. Every psychotic I represented had stacked charges, and here at a minimum I'd expect a felony level resisting arrest. Also probably destroying some property. Bail would probably be above $10,000 cash. Only reason he wouldn't be in jail is if his psychotic break was so severe that he needs to be in a secure psychiatric unit. Once they get him under control, then he goes to jail.

So I might want to look into writing in a lawyer that deals with these types of issues? That was not something I considered. But I can make it work with the characters I already have. One, is already an advocate for the mentally ill.


Fifth is how responsive to medication is he? That's what's going to drive the treatment plan, and the treatment plan will drive the bail conditions/sentencing.

Either way it's all up to a judge in other words?

cornflake
11-20-2013, 12:52 PM
My MC's 24-year-old son had a psychotic episode, where she was injured. She ended up with a black eye, 1" laceration to the back of the head (with concussion), and clear finger marks around her neck. The police were called, and he was taken to a crisis center for observation.

She is now talking to the psychiatrist in charge of her son's case. I know he should not go home. But I am not really sure what the next step should be. Is the only option in this case inpatient?

Why is he taken to a crisis center not a jail cell, a psych/hospital one if he's uncontrollable, but one nonetheless?

He apparently beat up his mother, left her with visible injuries, the cops were called; he's going to jail. Do you mean after, if she bails him out or if he's released OR or something?

jclarkdawe
11-21-2013, 12:52 AM
Originally Posted by jclarkdawe http://www.absolutewrite.com/forums/images/buttons/viewpost.gif (http://www.absolutewrite.com/forums/showthread.php?p=8543665#post8543665)
Starting point is that mom isn't talking to the doctor, unless junior has signed a release. Junior is a big boy, with big boy problems, and mom isn't going to be able to do much.
I worked in health care so I completely understand the regulations there. And I have dealt with them, as far as that goes.

But I don't know that. And it's clearly a problem starting with this. Among other issues is she's a victim to a crime he committed and this discussion could involve the potential for witness tampering, never mind the mental health laws.


Second is I don't know the history of junior. It plays out a lot here. This would not be his first time, but it is since he has been an adult.

That's very unusual. Usually psychotics with violent tendencies have an anger management problem. This results in public outbursts of anger in inappropriate fashion. Police are called, and with luck, things are quieted down without any charges.

If he's non-complaint or not under the care of a doctor, it would be very, very unusual to have a six year stretch with no police contact. This doesn't have to lead to arrests and convictions, but I don't see him be clear of incidences.


Third is prison and jails are full of psychotics. Unless he is incredibly around the bend, unlikely he'll end up in a hospital, in which case it's going to be a lot longer before he's released. That I will have to give some thought to.

I'd work around this by reducing the potential charges. Right at the moment, you have a strangling offense. Strangling is never accidental, and ends always in a homicide or an attempted homicide if the police become involved. So you've got a serious charge here that you can't explain as an accident.

Get rid of the strangling. You don't want extreme violence. You want some violence that the police can work with. If he just hits her and she falls down, although no one will believe them, they can argue it was an accident. This gives the police an opportunity to accept a 72 hour hold at a psych unit instead of jail.


Fourth is he'd probably be charged with attempted murder of mom. Every psychotic I represented had stacked charges, and here at a minimum I'd expect a felony level resisting arrest. Also probably destroying some property. Bail would probably be above $10,000 cash. Only reason he wouldn't be in jail is if his psychotic break was so severe that he needs to be in a secure psychiatric unit. Once they get him under control, then he goes to jail. So I might want to look into writing in a lawyer that deals with these types of issues? That was not something I considered. But I can make it work with the characters I already have. One, is already an advocate for the mentally ill.

I think you really want to avoid jail, unless you want to do a whole lot of research.


Fifth is how responsive to medication is he? That's what's going to drive the treatment plan, and the treatment plan will drive the bail conditions/sentencing. Either way it's all up to a judge in other words?

No. As his defense attorney, to make this fly, I start with his doctor and we develop a plan of treatment. Then I talk to the prosecutor and see what the prosecutor thinks of the plan. If the prosecutor likes the plan, then I talk to the victim and the police involved. If I can get them to go along, I talk to probation and see if they can make this all work. Then, if I've got everybody on board, I go to the judge and try to sell him/her. Any of the people in this objects and the judge is nearly always going to come back with a "no." Judges will go along with plans, but not if everybody isn't happy.

Best of luck,

Jim Clark-Dawe

shakeysix
11-21-2013, 01:33 AM
Small town Kansas is a bit different. The last two incidents were in an er but the first was at a private residence. One was on a WalMart parking lot. I didn't get called until she was in a holding room at the hospital but they let me in. The violence has only been against me twice. The only other time she was violent was against a boyfriend who had talked her into going off her meds. He told her that she was NOT sick but a slacker. She damn near killed him when he tried to push her while she was manic. Good thing I wasn't there. I'd have helped her!

The last time was a little scary. She was psychotic and thought I was breaking into her room when I went in to check on her. She wrestled me to the ground and pulled my hair but I managed to fight her off ad talk her calm. She is really a very intelligent adult, caring person with an illness that blots out the real world from time to time. This time I managed to talk her to the hospital.

Things go better when the patient keeps up with his/her mental health center or doctor. They can be incredibly difficult if there is not a plan in place. You will have to decide which way you want to write that.

I have to watch as they put on the jacket to transport to the hospital but I can offer advice. I can follow the police car that carries my daughter and talk to the staff at the mental hospital as she is being admitted. I can't talk to her--usually she is psychotic or sedated.

Once the meds start working again we can start the release procedure. If we need a lawyer this is the time to get one. We haven't needed one for years. Last time--two years ago-- it was only a matter of 2 days.: Sunday p.m. admission, Tuesday a.m. release. We have been through this enough times that we know the ropes. At first there was a lot of attitude on the part of the police and on my part. Not any more. Years ago we had some paper work done that makes me the responsible party. If you have any questions p.m. me--s6

WeaselFire
11-21-2013, 01:57 AM
My MC's 24-year-old son had a psychotic episode, where she was injured.
Does he live at home? If so, domestic violence and a free ride to jail. Mentally ill or not, he's going to be treated as an adult criminal, likely some serious felonies. He'll need a lawyer long before he gets to see a doctor.

San Fran PD probably sees 100 of these guys a week. He'll be tossed in a cell with all the rest of the night's roundup. A doctor won't get any say in his release or charges.

Jeff

infractuspennae
11-22-2013, 04:50 AM
Apparently, California has a Welfare and Institutions code that covers just this thing. Code 5150. Thank you to those who offered ideas, and what not, without them I would not have found this out.

Nivarion
11-22-2013, 09:08 AM
I was a missionary in the Bay Area, and got to know the streets there pretty well. There are tons and tons of homes for those with mental issues. Some of them for those who are violent from time to time. I got to know a good bit about a few of those homes if you decide to go that route.

cornflake
11-22-2013, 09:53 AM
Apparently, California has a Welfare and Institutions code that covers just this thing. Code 5150. Thank you to those who offered ideas, and what not, without them I would not have found this out.

Whether a 5150 hold would come into play will likely depend on how 'crazy' your MC is acting. If he's uncontrollable, unresponsive, unaware of person, place, time, that sort of thing, it may, but it'd seem more likely he'd just be booked and then sent to a facility by that means; I don't see the point of it if he's already in custody, but I dunno. Otherwise, he's likely just in a jail cell.

As I understand the way Ca. uses it, 5150 is generally the way to hold someone who clearly needs evaluating/holding and won't get it any other way.

Just btw, see Britney Spears and Amanda Bynes for well-covered examples of 5150s.

jclarkdawe
11-22-2013, 07:01 PM
California's 5150 exists in just about every state, if not every state. Problem for the police is a 5150 procedure is a big pain in the butt compared to an arrest. 5150 works well when the person is very around the bend, when you have a lot of family/friend support at the time of police intervention, police knowledge of the offender, the press at the scene, and stuff like that. Normally it's cuff 'em and stuff 'em.

Best of luck,

Jim Clark-Dawe