My {In}voluntary Commitment and Why You Should Care

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Photo Credit: yyellowbird via Compfight cc

Our bedroom door creaked slowly open at 6:35am this morning and my little man crawled under the covers next to me while my husband finished getting dressed for work. As I felt the chill of little toes brush my warm legs, I thought back to this same day, five years ago, when my mania had reached the breaking point.

I had begun to cross the threshold, going from highly manic to the inevitable psychosis, when my husband took matters into his own hands and called 911 for help.

What a stark comparison to today, I thought, as I reached into my sock drawer to fish out my psych ward socks. I pulled them on this morning as a way of honoring my past, while at the same time recognizing how far I’ve come and how I don’t ever want to go back.

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If your father were having a heart attack, or symptoms consistent with those of a heart attack, you would rush him to the hospital where he would receive treatment. If your child had a 104 fever and was gravely ill but refused to take any medicine, you would call your pediatrician who would tell you to rush the child to the Emergency Room where he would receive medical assistance.

But if someone you loved were experiencing a mental health crisis and needed to see a psychiatrist or be involuntarily committed to a psychiatric facility to receive treatment, you wouldn’t believe the obstacles you have to surpass in order to get them the care they need to get well.

I know, because my family and I plunged head first into these roadblocks in the U.S. mental healthcare system five years ago when I was hospitalized for postpartum psychosis after the birth of my first child in 2008. Writing about this experience was something I wanted to do in order to educate people about the policies surrounding access to mental health care in the state of Virginia. {The laws vary by state. A good resource with links to studies and comprehensive information is MentalIllnessPolicy.org.}

In researching my mental illness and the treatment I received during my hospitalization, I requested copies my medical records from the hospital. I’d like to take you back to the week of October 22nd, 2008, approximately four weeks after I had given birth to my son. Belly still swollen, breasts leaking milk, I lost touch with reality during the early hours of that cool fall morning, but remained silent about my growing sense that this would be my last day on earth.

I was terrified of being taken away from my baby even though there was a little voice in the far corner of my mind urging me to go. I just didn’t want to listen.

That morning my husband knew from my past two manic episodes that I needed to be taken to the hospital. He called his mom and sister to come over and help, as we had been through this before and he knew my erratic manic behavior would require more than one person assisting in the effort to get me ready to be transferred. His next call was to dial 911, where he explained to the dispatcher that I had a bipolar diagnosis, was off my meds because of having just had a baby, and was now rapidly deteriorating and we were in need of help to get me to the hospital. He then called my psychiatrist, leaving her a message to tell her what was going on. And lastly he called my parents in Florida to alert them as well.

I remember being on the phone with my Dad while sitting on a chair in the kitchen, talking to him on speaker phone while the two female police officers who had been dispatched to our house were standing right before me. He was pleading with me to go with them. I don’t recall much, other than being afraid. I don’t know exactly how much time passed, but eventually they were able to take me, in handcuffs, under a Temporary Detention Order (TDO), to our local hospital for an evaluation.

I was clearly manic to the point of psychotic. It was well documented in the detention order paperwork that I had reported hearing voices and seeing ghosts in the baby’s room. My husband had told the officers that I had only slept 3-4 hours a night for the four nights leading up to his call for help. His sleep estimates were correct – it had been the weekend of our son’s baptism and I was trying to prepare for out-of-town guests along with getting everything ready for the party we were hosting. On top of learning to care for our new baby and suppressing the mania that I had felt since the night he had been born, it all caught up to me.

The Temporary Detention Order allowed my husband to have me sent to the hospital for an assessment. My husband was my Petitioner – the person asking that I be involuntarily committed. We were led to an empty hospital room where I was handcuffed to the metal bars of the hospital bed. My husband stayed by my side the entire time. The nurses assessed me and it was determined that there was substantial likelihood that, as a result of my mental illness, in the near future I would suffer serious harm due to a lack of capacity to protect myself from harm. I refused all meds in the Emergency room and I met the criteria for involuntary admission to a psychiatric ward of the hospital, not to exceed a 30-day stay.

I was taken by police car, still handcuffed, to our local hospital’s geriatric psychiatric ward, the nearest facility with a bed available. By the time the bed had become available, it was late at night and I remember being terrified upon entering the facility because of the Halloween decorations festively decorating the glass doors which were pulled open for me. My throat closed and I struggled to breathe, leaning all my weight back, attempting to keep them from guiding me in. They eventually coaxed me in and a young attendant began working with me to get me through the intake process. I remember her arms, covered with tattoos. Her name was Jenny.

They tried to give me drugs to force me to sleep, but my mania was so rampant and I continued to refuse oral medication, so I was given an injection to tranquilize me and my body succumbed to the rest it so desperately needed. I woke groggy, and still very ill.

The Temporary Detention Order meant I could be held involuntarily for one to five days, until a commitment hearing could be held. I was admitted the night of October 22nd, and my commitment hearing was scheduled for 9am on the 24th.

After only thirty-six hours of psychiatric care, I was still extremely sick and my mania was apparent to everyone close to me. But the chemical imbalance that was still working itself back to balanced with the help of the meds and forced rest, wasn’t severe enough to present me as a threat to myself or others during the trial, and despite my family’s strong arguments that I was not well enough to go home and care for myself, let alone a newborn, the judge still deemed me well enough to not be held against my will.

I was free to go home. Case dismissed.

My father spoke with the judge immediately following the trial’s conclusion. He was shocked and couldn’t believe the judge was going to send me home in the condition I was in. My father then asked if they (my family) were able to convince me to stay in the hospital, voluntarily, would I be able to stay?

The judge informed him that yes, I would of course be able to stay on a voluntary basis, but on the same token, I’d be able to sign myself out at any time.

This news was plenty good enough for my family and they immediately began encouraging me to stay and rest, so that I’d be able to return to my newborn baby in a much clearer state of mind. They knew that with just a few more days of treatment and solid sleep, I’d be in a significantly better place to where I could continue to see my outside psychiatrist and work on making a full recovery.

Fortunately, I was well enough to rationalize their concern for me and that was all it took to convince me to sign myself in. I stayed for three more days. My husband and dad came to visit me every day to check on my progress. They used my somewhat still disoriented state to their advantage as they were able to remind me each day that “we all needed to be in agreement that it was the right time for me to go home,” and I was too fragile mentally to process what had happened in the hearing so I followed their lead. I had signed myself in to stay and could leave when I was ready, but I didn’t really comprehend it all at the time.

I called home daily to check on my baby and asked them to bring pictures to the hospital. He changed so much in that week that I missed. His wispy brown hair on top fell out, so he had a bald head with only hair on the sides and around to the back. I cried at a picture they brought me of him smiling on his back laying on a blue and green striped baby blanket. Desperate to get back to my son, I eagerly took my meds each day and night, and did my best to be a model patient.

I signed myself out of the hospital on the 27th, after a 5-day stay, and walked into the kitchen of my house where my mom was stirring a pot of homemade chicken noodle soup cooking on the stove. I made my son a bottle of formula and sat on the couch to learn the art of bottle feeding him after having spent a month perfecting breastfeeding. I will never forget that moment. While feeding him and gazing into his eyes I silently vowed that I would do everything in my power to stay healthy for him. I never wanted to be taken away from him again.

Some people might say that involuntary commitment laws take away a person’s constitutional right to freedom. I completely disagree.

My family sought help for me because they knew I was so severely ill. The system initially determined I was a threat to myself, but the judge at the commitment hearing determined that was no longer the case. Situations like this happen all the time due to the current state of our mental health system and unfortunately, these holes in the system are what contribute to tragedies like Virginia Tech, Sandy Hook or the Navy Yard shootings. It’s the subjective “threat to themselves or others” which is determined by someone who has never met the mentally ill person, which is what needs to change.

People who are aware of family or friends who have mental health issues (and we all know someone given the statistic of 1 in 4 Americans living with a mental illness) need to be more proactive when they sense a change in someone’s behavior. By paying attention to the fragile mental states of people within our own environments, we will be able to push for help before it’s too late. The mental health laws need to be reviewed and modified to permit family and friends to have the ability to have people in trouble involuntarily committed for longer periods of time, so they are better able to make bigger strides towards recovery during the time in which they are under the hospital’s psychiatric care. Until this done, we will continue to see more tragedies.

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On this fifth anniversary of my TDO and subsequent voluntary psychiatric commitment, I’m able to smile at my son’s insistence on dressing up as a ghost for Halloween. Five years ago I was not taking my medication and therefore went through hell, reportedly saw ghosts, and thought the world was coming to an end. But today I’m cutting eye holes out of a white sheet to dress my little man up on the last day of this month. A costume which serves as a gentle reminder of my past, while allowing me to appreciate the invisible challenges which inevitably lie ahead.

Comments

  1. Such a great post here. Thank you for sharing this moving story. I’m so glad that you and your family were brave and persistent in getting you help so you could have a stronger foundation in moving forward. Very proud of how far you’ve come.

    • bipolarmomlife says:

      Thank you so much, Katy. I’m glad too.

      • I found this post while researching what options my family and I have to get my bipolar mother the help she needs right now. It’s the first time we’ve all come together and openly talked about her problems. I’ve been struggling not only with the reality of the limited options but the decision itself and what impact it will have on her and our relationship. Reading this meant a lot. Thank you.

  2. What an emotional read for me. I can feel each moment as I see the words. I can understand the terror of the sight of Halloween decorations. Bless you and thanks for sharing.

  3. So proud of you Jenn. Thanks for sharing your story

  4. Great post. Thank you so much for sharing about this.

  5. Wow! My heart hurts for your that you went through this. Thank you for sharing it. I feel like I learned a lot from this post.

  6. I am so glad your family advocated for you! You are such a beautiful person and wonderful loving mother Jenn. Mental illness deserves the same quality of care as physical illness. There’s such a difference in the systems and it’s so sad.

    • bipolarmomlife says:

      I’m so glad, too. And thankful. Thank you so much for your kind words, Cristi. I completely agree with you – it should all be equal – and I believe that in time, it will.

  7. Your kids are so lucky to have such a brave mom who loves them so much. Such an amazing story – you are going to help soany people by sharing.

    • bipolarmomlife says:

      Thank you so much for reading, Aimee. It’s my hope that it will help people. It’s helped me by being able to write it out.

  8. thank you for your candor.

  9. What a great and emotional post, Jenn. Thank you for sharing. I learn so much about mental illness after reading your posts. You are an amazing person and doing such amazing things. Keep up the great work and God bless you and your family.

    • bipolarmomlife says:

      Thank you so much for reading, Savy! I hope all is well with you and your family and hope to catch up with you in the near future.

  10. Hi Jennifer – Great post. Powerful. Yes, the civil rights laws regarding ..persons with mental illness are absurd. As you say, “Some people might say that involuntary commitment laws take away a person’s constitutional right to freedom. I completely disagree.”
    Me, too. I just read Kathy Brandt & Max Maddox book about their family struggle with bipolar disorder. They bring up the same point. I talk about this issue in my review of it.. You are a very strong person and thank goodness you were lucid enough to agree with your family’s entreaties to get to the hospital. 30 days is a reckless restriction, often people with BiP1 need several months to stabilize and get functioning again. That’s the level of care that is needed, in spite of what insurance companies say.

    • bipolarmomlife says:

      Thank you, Kathy. I think about that a lot – what would have happened if they wouldn’t have been able to convince me to stay in the hospital. I probably would not have been able to make as smooth a recovery as I did. I’m one of the lucky ones. Thank you so much for reading and sharing.

  11. you’re an inspiration.
    thank you for saying the hard things.
    for fighting the fight.
    for speaking up.

    when so many of the rest of us are in chains, being silenced by others, made to feel ashamed for something that requires meds/medical treatment, just like so many other things.

    • bipolarmomlife says:

      Thank you for speaking up, too. You’ve been brave in so many ways – most recently in talking openly about your struggles in writing and in video. I’m so proud of you. We should never feel ashamed of taking meds that help us. It took me a long time to realize that.

  12. Thank you for sharing your strength and will to be healthier… and that sometimes we have to do things involuntarily until we can do them voluntarily.

    • bipolarmomlife says:

      Thank you for reading, Amy! And you are so right – we do have to do things involuntarily sometimes until we can be set free. I appreciate this so much having been through it.

  13. Thank you for your honest post. Congratulations on your recovery and hard work! Your post helped me understand ppp. Even though it is a scary condition, your story proves that it is treatable if managed well. Thanks for this important blog!

    • bipolarmomlife says:

      Thank you so much, Ana! I’m glad it helped you to understand ppp a little better. I appreciate your support.

  14. Thank you for so clearly explaining the process of getting an adult emergency mental health assistance in Virginia.

    We had a scary experience earlier this year with our 20-year-old son who had a mental health emergency. He was refusing treatment and because he’s considered an adult under the law, the only way to “help” him was to call our county Community Services Board (CSB) emergency service to have them come to our home to make an assessment of his condition. Because he’d made comments about harming himself, they were able to issue a TDO and he was taken to the hospital and treated.

    Note that in Fairfax County, CSB services are not free. There is a sliding scale but in our case we ended up paying more than $600 in order to get the CSB to come to our home and make the assessment.

    As a result of this incident, we contacted a lawyer and over the ensuing months we became the legal guardian for our son. The legal order specifically gives us the right to hospitalize him without his permission should he have another episode in which he is unable to make the correct decision for himself.

    • bipolarmomlife says:

      Thank you for sharing your experience with the system, Robert. I’m glad to hear you were able to gain legal guardianship over your son’s mental healthcare. It’s so important that family members be appointed these rights since the person has the potential to find themselves in such a state of psychiatric crisis that they’re unable to realize how sick they actually are.

  15. Thank you for sharing your story, Jenn. So glad you are still here. You are an inspiration to me as a fierce advocate for mental illness. I had no idea how different the laws are. It breaks my heart that people might be released prematurely without receiving the care they so desperately need. We need a safety net.

    • bipolarmomlife says:

      Thank you so much for reading, Jenny. You inspire me, too!! We do need a safety net and my hope is that we’ll get there soon.

  16. Oh Jenn. This made me cry. Like, ugly cry. Beautifully written. Why the eff would they decorate the inpatient doors with Halloween crap anyway?! Bless your sweet heart on that day. You have an awesome support team.

    • bipolarmomlife says:

      I do. I’m so lucky because they were my net. Thank you so much for reading and sorry for the ugly cry. Hugs. Xoxo

  17. I just saw this… it’s absolutely beautiful. Thanks to you for sharing it.

  18. Wow! Crying as I read. Glad I’m not alone!

  19. Therapy will empower the client to live with spontaneity, intimacy with self and others and to be autonomous. Being able to make his or her own choices without the influence of the emotional pain from past experiences.

  20. Oh Jenn. This story made me cry. It touched me so deeply – especially the moment where you sat down to bottle feed your baby boy after having to give up breastfeeding. That really resonates with me. But I also relate so well to the conviction you felt at taking the medications to get well for yourself and for your family. Both my sister and I talk often about how having small children was both a challenge and a blessing while we were sick. It was being well for them that kept us so compliant with our medications and still keeps us compliant to this day. My children deserve the very best parts of me and so I work hard to stay well for them.

    Thanks for this beautiful post. I so enjoy reading your writing.

    Sarah

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  22. Ashleyelizabeth says:

    Thank u so much! I have been going through a lot and I feel the hospitalization coming even though I take my meds religiously. you reminded me today that sometimes you just need that push from your family to do what’s right. Sometimes we don’t like it but it must be done. Thank you for helping me feel not so alone.

  23. Okay, but on the other token, almost anybody can have somebody else involuntarily detained by use of police form for merely suggesting the person is suicidal. I don’t know if you went to a private facility, but if you’ve visited a public facility, it’s no more cozy than a prison. i sat in a small room, in a reclining chair for nearly 24 hours with dozens of other people, and with nothing to occupy myself and only a ham sandwich and three thousand dollar hospital bill to look forward to. the nurses treated patients with open disdain at most and indifference at best and leave many patients worse off than when they entered. the laws already infringe people’s personal liberties so deeply, it’s absurd to suggest we need to advocate for more lax commitment laws.

  24. Good mental health isn’t just the absence of mental health problems. Being mentally or emotionally healthy is much more than being free of depression, anxiety, or other psychological issues. Rather than the absence of mental illness, mental and emotional health refers to the presence of positive characteristics. Similarly, not feeling bad is not the same as feeling good. While some people may not have negative feelings, they still need to do things that make them feel positive in order to achieve mental and emotional health.

    • Anxiety doesn’t come out of the blue. When you have anxiety attacks, it’s often because your mind has a tendency to spiral into negative thoughts often without your control. Sometimes you can control this anxiety by keeping these thoughts at bay, and learning to dismiss triggers that cause you anxiety.

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