Planning to Protect Our Rights

Depression and Bipolar Support Alliance

colorWhen an individual with a mental health condition in need of intensive psychiatric care is hospitalized, whether voluntarily or involuntarily, the individual, family, and friends may have mixed reactions. They may feel relief that the individual is safe, but they may also feel emotionally, physically, and potentially financially drained. Yesterday on CFYM, Dr. Sederer shared his expertise in navigating what can be daunting legal and medical legalities on patient psychiatric hospitalization treatment rights. DBSA believes that patient protections are important to ensuring individuals are the lead decision-makers in their own wellness. The best wellness outcomes are achieved when individuals living with mental health conditions and their family and friends are educated and prepared for crisis.

Education is Power

DBSA encourages individuals to become knowledgeable about (1) mental health laws in the states in which they reside; (2) options for treatment centers and outpatient programs other than hospitals; and (3) the rules and regulations regarding admission and release in hospitals and treatment facilities, both for voluntary and involuntary entry.

Whether hospitalized voluntarily or involuntarily, individuals have the following rights:

  1. to have treatment explained;
  2. to be informed of benefits and risks of treatment;
  3. to refuse treatment the individual feels is unsafe;
  4. to be informed about any procedures that the individual feels may be unnecessary; and
  5. to refuse to take part in research and experimental treatments, and to disallow students or observers.

DBSA supports adherence to these patient rights in all circumstances.

Planning for Crisis in Times of Wellness

Dr. Sederer is right that we need crisis solutions that are not coercive. DBSA encourages individuals to be proactive by writing a crisis management plan, creating an advance directive, and assigning a medical power of attorney to ensure that the individual’s wishes are followed leading up to, during, and after a time of crisis (which may or may not involve hospitalization). The crisis management plan is an immediate action plan that includes doctors, specific treatment regimen, signs that indicate the individual is symptomatic, first response steps that can be taken in order to avoid hospitalization, and specific preferences for alternatives to an emergency room, such as a mental health triage clinic.

(For many, alternatives to emergency rooms promise empathetic and high quality treatment, with professionals well trained in dealing specifically with mental health crises. One such alternative to the emergency room for mental health assessment, The Living Room at Turning Point, is funded by a $1.2 million grant from North Suburban Healthcare Foundation. DBSA would like to see more funding for and awareness of these types of facilities, as they may encourage more individuals to seek and receive treatment.)

While a crisis—or wellness—action plan is not a legal document, individuals can share these documents with trusted family members, friends, and doctors to alleviate the frustration and sense of helplessness that many feel during a crisis. The advance directive and medical power of attorney are legal documents. It is best to check with each state’s Protection and Advocacy for Individuals with Mental Illness (PAIMI) agency on laws regarding documentation, or to seek legal advice, and to share these legal documents with trusted family or friends.

The Role of Wellness Partners

Treatment decisions are the final right and responsibility of the individual. However, individuals do not need to act alone. Clinicians and trusted, supportive, and educated loved ones can act as valuable partners to an individual’s wellness. Fears and mystery surrounding voluntary and involuntary hospitalization may be addressed in open conversation with a clinician. Family and friends can be partners in wellness, too. They must find balance between providing support in the wake of difficult circumstances, expressing honestly their beliefs about the safety and best interests of their loved ones, and respecting the wishes and rights of the individual. Family and friends should be knowledgeable about hospitalization, should the need arise, and know what to expect and how to act.

Treatment Plans Reduce Risk for Crisis

DBSA advocates for peers to be proactive in their own treatment plan and wellness choices. Maintaining a regular therapy schedule, adhering to a treatment regimen, developing a strong support system, participating in a peer support group, and making healthy lifestyle choices are central components of an individual’s wellness lifestyle. DBSA groups support individuals’ wellness goals through authentic conversation—in which humor helps individuals push through areas that are painful; wisdom and vulnerability can be shared in a safe place with trusted people; questions and information foster informed decisions and self-advocating with clinicians; and perhaps most importantly, individuals can understand that they are not alone. A DBSA survey found that individuals who attended a DBSA support group for more than a year were less likely to have been hospitalized for their mood disorder during that year.

Bring Everyone to the Table

With a strong support system, a crisis management plan, and decision-making power in their corners, individuals living with mental health conditions can and do achieve and maintain wellness. DBSA recognizes, however, that many people fall through the cracks. Whether an individual has not yet been diagnosed or has not been exposed to the idea of crisis management planning, crises for which no plan exists will occur. In these cases, loved ones may feel at a loss as to how best to help or how to make decisions, such as calling the police or researching alternative options.

It is this situation in particular that calls for urgent and targeted conversation that brings together the individual, family, police, hospital emergency room personnel and decision makers, and mental health advocacy organizations. These groups need to speak together—placing the perspective of peers at the center of the conversation—to determine the most effective rules and regulations to address the problem of helping individuals receive the treatment they need while protecting their individual rights.

For more from DBSA on this and related issues, read our position paper, Optimal Treatment for Optimal Wellness.

4 comments
MrJoeHerman
MrJoeHerman

In 39 years of recover, no clinician has ever mentioned or suggested an advanced directive.  It was difficult to come up with a plan on my own. . .  but I made one.    Are we missing something here in the behavioral health community? BTW,  If a clinician does not even have an instrument do this, how would a peer be expected to create this own there own?

DBSA
DBSA

We also wanted to add a recommendation:

If a crisis occurs and the peer is not a danger to themselves and is not aggressive or violent, all measures should be taken to have that peer see their clinician to determine best treatment options. Often, a meeting with a clinician and adjustment of the wellness regimen is enough. If a peer is aggressive, violent, or otherwise appears in imminent danger of self-harm, outside agents such as EMTs or police may be needed. By creating an an action plan and discussing it with your designated health care advocate, hospitalization can most often be avoided and only utilized in the narrower circumstances described above. Once made, make sure you distribute the plan to appropriate members of your support network and family.

DBSA
DBSA

@MrJoeHermanCrisis-related conversations and proactive planning are all too often absent from dialogues among people with mental health conditions, their clinicians, and their families/friends/caregivers. As a community, we need to bring this message forward, so your comment—and our collective voices on Care for Your Mind—are important steps in the right direction.

In the meantime, here are some things that we as peers can do.

1.Mention advance directives and proactive planning to all of our clinicians.

2.Keep searching for doctors who are a fit for our needs and concerns, with resources like DBSA’s Find a Pro.

3.Use DBSA’s guide and templatefor advance directives.

Thank you for your contribution to Care for Your Mind.

MrJoeHerman
MrJoeHerman

@DBSA @MrJoeHerman Thank you so much for this information. I will be passing this on to our local DBSA and NAMI support groups!