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nsopergo
11-27-2018, 07:15 AM
Hi all! I've been trying to do some research to find some specifics for a story I'm working on, and have had a hard time finding reliable information. Basically, my main character's husband has suffered a severe mental break (due to magic, if it matters - though the real world doesn't know magic exists). He is completely incoherent, arguable not conscious of himself or the world, and frequently violent with phases of catatonia in between. He can't communicate or take care of himself, and requires 24-7 professional care. This much I know from the plot of my book.

What I don't know is what his treatment would look like. I would love for anyone with experience with the treatment of mental health problems (especially severe/clinical cases) to provide some advice. I want to make sure that I get some of these details right, but I also want to treat mental illness and its treatment in a real and respectful way. The main things I want to know fall into two categories:

(1) What kind of facility would he be housed at? Would it be a regular hospital room or some kind of mental health facility? What would the facility look like? I tried looking into residential mental health facilities, but they all seemed like they were designed for mostly functional people (e.g. working on a farm as part of the therapy).

(2) What kind of medical or therapy treatment would he receive? Would he be on some kind of tranquilizer to keep him calm? Would they try other kinds of drugs to sharpen his focus or something? Since he's not capable of communication, it would be hard to have traditional therapy sessions where you talk with a therapist. Would art therapy or something else be used instead? What else might be part of his treatment?

Thanks in advance!

ironmikezero
11-27-2018, 10:31 PM
I'm uncertain how you envision crafting your world; but if it's to be like our reality, there may be a significant issue to address before you pursue possible patient treatments. An incoherent, oblivious, violent, and periodically catatonic individual will likely manifest behaviors in public sufficient to be legally deemed as constituting a danger to himself and/or others. This would probably lead to an involuntary commitment to a secure facility (hospital lock-ward) for a court-ordered psychiatric evaluation. It's possible that a diagnosis and recommended treatment may become part of the report to the court; however, a conclusive diagnosis is not assured at the initial evaluation. The length of such a commitment is typically at the discretion of the court of jurisdiction, with advice from competent medical authority.

cornflake
11-27-2018, 11:15 PM
Hi all! I've been trying to do some research to find some specifics for a story I'm working on, and have had a hard time finding reliable information. Basically, my main character's husband has suffered a severe mental break (due to magic, if it matters - though the real world doesn't know magic exists). He is completely incoherent, arguable not conscious of himself or the world, and frequently violent with phases of catatonia in between. He can't communicate or take care of himself, and requires 24-7 professional care. This much I know from the plot of my book.

What I don't know is what his treatment would look like. I would love for anyone with experience with the treatment of mental health problems (especially severe/clinical cases) to provide some advice. I want to make sure that I get some of these details right, but I also want to treat mental illness and its treatment in a real and respectful way. The main things I want to know fall into two categories:

(1) What kind of facility would he be housed at? Would it be a regular hospital room or some kind of mental health facility? What would the facility look like? I tried looking into residential mental health facilities, but they all seemed like they were designed for mostly functional people (e.g. working on a farm as part of the therapy).

(2) What kind of medical or therapy treatment would he receive? Would he be on some kind of tranquilizer to keep him calm? Would they try other kinds of drugs to sharpen his focus or something? Since he's not capable of communication, it would be hard to have traditional therapy sessions where you talk with a therapist. Would art therapy or something else be used instead? What else might be part of his treatment?

Thanks in advance!

For you to have a treatment plan you need a diagnosis, in general, especially as you're talking about a long-term situation. What do you want to happen? Work backwards from there.

nsopergo
12-02-2018, 10:24 PM
An incoherent, oblivious, violent, and periodically catatonic individual will likely manifest behaviors in public sufficient to be legally deemed as constituting a danger to himself and/or others. This would probably lead to an involuntary commitment to a secure facility (hospital lock-ward) for a court-ordered psychiatric evaluation.

I'll admit that I hadn't thought of the legal implications of the man's condition. I did expect he would be committed to some kind of facility - in fact, his wife (my main character) specifically brought him in to be committed so he can get help. (And because he's in such a condition that no one could take care of him at home alone, even if that was their full time job). I don't know a lot about hospital lock-wards. Can you tell me anything more about them?

cornflake
12-02-2018, 10:59 PM
I'll admit that I hadn't thought of the legal implications of the man's condition. I did expect he would be committed to some kind of facility - in fact, his wife (my main character) specifically brought him in to be committed so he can get help. (And because he's in such a condition that no one could take care of him at home alone, even if that was their full time job). I don't know a lot about hospital lock-wards. Can you tell me anything more about them?

That's not a thing.

Family members can't bring people in to be committed. Nor will an inability to take care of someone at home lead to inpatient care -- unless the state is in some way involved, like CPS, APS, etc., are involved or, as ironmike said, unless the cops are involved because the person presents an immediate danger to himself or others.

If you call the cops and say someone is imminently likely to self harm or to harm someone else (not like, gee, he's thrashing about, cops would say to call your own psychological professional), and the cops respond and believe this to be the case, they'll bring them to the ER for a psychiatrist (or two, depending on the local laws) to determine whether the person can be held, usually for 72 hours. Past that, it involves the psych professionals believing there is no option but inpatient incarceration to prevent imminent harm and they have to go to court to prove it. It's not an easy bar. It certainly does happen, but that's what you need for an involuntary commitment. For a voluntary commitment, the person has to be of sound enough mind to sign themselves in to a facility (and btw, who is paying for that, and what kind of facility, and for how long? Because insurance will give you like... 10 days? Maybe?)

A family member can't sign in an adult unless they have a working, signed power of atty.

You also, see above, need some kind of diagnosis.

ironmikezero
12-03-2018, 10:25 PM
Re: hospital lock wards . . . In the simplest terms, these would be secure wards wherein designated patients are housed, monitored, and treated pursuant to a court order (make no mistake, this is typically involuntary incarceration). Not all hospitals have such secure facilities; whereas, most longer-term detention facilities have secure infirmaries. Bedspace in a (commercial) hospital lock ward or a long-term detention facility is usually available to the court via a contract with that facility (state facilities may be exceptions to the contract rule).

As cornflake pointed out, a court must be involved.

cornflake
12-03-2018, 10:39 PM
All the above said, if someone has a psych professional they've been working with and they, or their spouse or family member, call that professional and say, 'help, X is doing Y, the professional involved will do something, which might involve inpatient treatment if necessary, but that's usually after there's a diagnosis, treatment of some sort, etc., and dependent on the person's willingness to go along, or see above my previous post.

Like if someone had schizophrenia and was on a medication protocol and etc., and suddenly started displaying worrying behaviours like neglecting hygiene, not sleeping, responding to voices only they could hear (for random instance of obvious-to-others stuff), and that person's family called the person's psychologist, the psychologist might, depending on insurance, previous behaviours, etc., try to get the person into a hospital's psych ward for assessment and to possibly recalibrate meds or check if meds were being taken and try and convince the person to get back on the meds.... however, if the person involved is lucid enough to say they do not want to go to hospital, and do not appear to present an imminent danger to themselves or others, too bad.

This is where the family can't commit someone comes in. You can't hospitalize, medicate, treat, an adult who does not wish to be treated without a court order (or power of atty, etc.), and it's NOT easy to get. Possible, but not easy.

abdall
12-04-2018, 02:57 AM
I don't know about modern medicine all that well, but if this is set back in the day, like between 1920 and 1950, then the 'help' he would have gotten wouldn't have been very helpful at all. I'd recommend doing some research on Nellie Bly or reading The Bell Jar by Sylvia Plath and One Flew Over The Cuckoo's Nest if you're looking for more...dated practices. For modern and more humane methods I'm not really a lot of help, I'm sorry.