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I have committed myself twice, once for being suicidal and once for life-ruining anxiety. It did not help in the way I expected. You are essentially not allowed to express confidence in your own health because your caretakers will assume you’re overeager and take it as evidence you need more time in the hospital. Don’t get it twisted, though, your stay length is entirely determined by convincing health insurance companies that any time there will reduce recidivism.

The smart people “play” healthy, not admitting ongoing doubts and concerns. Why? Because you go to the hospital to make rapid medication changes. The therapy offered is often insufficient, both in terms of one-one-one therapy and simply what you can cover during your stay. Overstaying is enough to make anyone clinically depressed. It can also cost a lot; while it is illegal to fire for mental health leaves, it is not uncommon to get let go for “unrelated reasons”, to prevent paying for future stays, or simply because they’re uncomfortable supporting their employees to this extent.

Mental health hospitals are aimed at maximizing the number of beds in use, ensuring everyone is at least as medicated as the doctor thinks they can handle, and pumping insurance companies for money. If you are considering one, use it to prevent crises, not to expect any kind of therapy suited for long-term help. The simply do not have the available attention, funding, or even reliable pharmaceutical research to make a dent in the latter.

To be honest, I have high hopes for psychedelics to make fruitful, therapeutic use in a short stay. As it is I’ve lost faith in the pharmaceutical industry to demonstrate the pills they make are effective, let alone not harmful to the general population. 3/5ths of the mental health prescriptions I’ve been given have been pulled from the market, linked to high suicide rates, or linked to other serious medical issues (no shit, Risperdal made me lactate as a male.)

...and of course, the absolute worst part is seeing people you know will never function in society, many rimes without family. I suppose better the asylum than the street, but we will likely always need long-term mental health care in publicly funded facilities.

Ironically, a great way to get out of psychiatric commitment is to cancel or threaten to cancel your health insurance.

Can you elaborate? I have my guesses what you mean but want to be sure I'm inferring correctly.

I lifted it from this: https://twitter.com/twitkeels/status/860158814900953089

Agreed on all points. The system demands that you learn to play the game quickly, lie about certain things, etc.

My brother also had a psychotic episode last year, was on injections of risperidone for some months, now only zyprexa, back to univsersity, almost normal, except for bipolar/borderline behaviors and a tendency towards creating drama. People don't understand that when someone is in a psychotic state, they don't live in the same reality. It's not a question of free will or choice, or control. People see distorted faces, visions, hear things and the worst part are not these hallucinations, but delusions, strong beliefs (he thought the family conspired against him, that he was raped as a child and even that he was transgender) and anosognosia, which means they aren't aware of it. At the same time my father also started "traveling in time", not sleeping, convinced that there was some cosmic truth behind these events. He also ended up in a psych ward, but now it seems he might be having some kind of atrophy. But seeing your father restrained to a bed in front of you is not pleasant, hardest thing I had to do in my life. And now I don't even know if we made the right choice, those drugs, haldol and leponex, I mean, even after months of not taking them, he still walks like a zombie, shuffling gate, jaw dropped, open mouth, no affect whatsoever. He's not the same man and I don't know if he will ever recover.

There is a lot to parse.

Thoses drugs are dangerous and do not cure a patient usually leaving them in a worse state mentally. When you are the one forced to make these decisions its tough because there are no easy answers.

I find the traveling through time reference interesting. I remember the line from slaughter house 5. What cosmic truth was he approaching?

I forget the details, but my brother filled his head with ideas about non-linear time, spiritual plane, lacrimosa (?), and some other nonsense he had discovered in his crazy state of mind, very philosophical new-age stuff. My father is also that type who believes in esotericism, things like pendulums, bioenergy and radiesthesia. So this really affected him. And I guess he had had some internal conflicts about his marriage and life for some time (also treating depression for twenty years) and then started decompensating. Poor man would spin around, trying to turn back time, or convince us of some powers, or how my brother was almost son of god. Nothing he and my brother were saying made sense, but to them it was like they really uncovered some deeper meaning.

(Somewhat OT)

> People see distorted faces, visions, hear things and the worst part are not these hallucinations, but delusions, strong beliefs

> but to them it was like they really uncovered some deeper meaning.

> ome internal conflicts ... and then started decompensating

If anyone is interested in a taste of what that might be like, the recent game "Hellblade: Senua's Sacrifice" is very impressive. It's basically a psychosis simulator, developed under heavy consultation from a group of patients that suffer from psychosis/delusions.

Similar to how you mentioned it's not just the hallucinations, the game does things like using "find the perspective that makes those logs look like a rune/glyph" to prime/encourage the plater to see potential "deeper meanings". Headphones are required, because binaural recording techniques are used very heavily to e.g. place voices in specific locations "in" and around your head.

Warning: this recommendation includes a very strong trigger warning re: grief, mental and physical abuse, and (obviously) the very graphic realities of severe psychosis and other mental health issues.

http://www.hellblade.com/

Commentary by the devs and some of the consulted patients about making the psychosis simulator: (some mostly-minor spoilers) https://www.youtube.com/watch?v=0jF3rr6t2Hg

Development diaries: https://www.youtube.com/playlist?list=PLbpkF8TRYizaT6GfMcKBG...

If you prefer watching as LP, I recommend (Yogscast) Hannah's: https://www.youtube.com/playlist?list=PLK9CD9s2JfIeoub7dINHI...

Agreed. Years ago, my wife made a suicide attempt that I stopped. We agreed together to go to the psych hospital after for evaluation. It was a mistake. They forcibly kept her for 3 days. She has a huge anxiety about being trapped places since she was neglected and abandoned as a kid. It didn't prevent her from hurting herself any more than she would have, and made things much worse afterwords because it was traumatic. You have absolutely no control or agency once you're inside. I would never bring her back under any circumstances.

I believe the law, varies by State, usually mandates a minimal of 72 hours of observation in a psychiatric facility when there has been an attempt, or credible threat, reported.

Additionally, some classes of people are mandated reporters. If they fail to report the threat, or attempt, they will lose their license and, I think, can face both civil and criminal charges. Again, some variation depending on jurisdiction.

Teachers, health care professionals, day care workers, police, etc. are all mandated reporters. They must, by law, report an attempt or threat. An attempt, by law, means a minimum of 72 hours of involuntary commitment. After which, a judge can be called in to extend the stay.

I had a sister who was mentally ill. For my last two years in the Marines, I was a transportation officer at a detention facility (brig), where I was a mandated reporter and sometimes had to work with people who had developed their mental illness during their enlistment or had somehow managed to pass the psych eval and managed to enlist. There were a suprisingly large number of them.

So, I've had some exposure to the system and the missus used to work in the field. For a while, I volunteered to help some of them out. I used to take some fishing, hiking, and to do things like archery practice. I was a mandated reporter during that, and had to take a number of classes on mental health.

If you're curious, I stopped because I don't have the heart for it. It isn't that I don't have a heart for the mentally ill, it's that I don't have the heart for the system in which they are stuck. I don't like being powerless and I was unable to effect change.

Yeah, I got the impression it was because of some rules or fear of lawsuits. The result is the same though - I would never recommend checking in unless you have no other choice. If you do talk to a psychologist, know when to lie.

As bad as it is, or as bad as it can be - as not everyone has bad experiences, I'm not sure I can recommend being dishonest with a mental health care provider during a time of crisis.

Unfortunately, the system is designed to deal with a broad spectrum of people with myriad complexities. They do tend to take a very hard line approach and to assume the worst. They also have reason to not always trust the patient.

It's tricky with mental health. In many ways, it's a damned if you do and damned if you don't situation. This is more true during the initial observation period and one of the reasons many facilities do isolation for the first 24 hours, even for voluntary commitments.

It should be noted that voluntary commitments can rapidly and more easily become involuntary commitments. After all, the patient has already admitted that they are unwell.

Nope, I have no idea how to fix this mess.

They are invested in finding an illness. It is how the system functions and the point of treatment is to keep you in treatment because when you are in treatment you are safe. The drugs they give in turn cause many of the problems they treat.

I think for the majority of cases committing themselves usually makes the situation worse.

Precisely what the Rosenhan experiment revealed

https://en.wikipedia.org/wiki/Rosenhan_experiment

> a mental health care provider during a time of crisis.

whose mental health care provider? Yours, or the one who is legally bound to be an agent of the state? you wouldn't talk to a lawyer who was obligated to report your confidences to the police, so why a doctor?

> It should be noted that voluntary commitments can rapidly and more easily become involuntary commitments. After all, the patient has already admitted that they are unwell.

Yes. Once admitted you have something no matter how convincing you are. Never talked to someone who walked out having not be diagnosed with something.

I'm not sure this is really on-topic, but I'll share it anyhow. I think it adds to your statement with personal experience.

Warning: This may be a bit long and hastily written.

For reasons, I once doubted my sanity. To make a long story short, I used to use an obscene amount of drugs. I'm an addict in recovery, sort of - I take prescribed Suboxone.

I didn't use because I didn't feel well, I used because I wanted to feel even better. I was never a stereotypical addict, I was a functioning addict. I had no major trauma, no abuse history, or any history of mental illness.

I used because I liked being high. I wasn't escaping anything. My life was fine. I just liked getting high. My drug of choice was opiates, they helped me sleep and not think all the time. In fact, I have a Ph.D. in Applied Mathematics - from MIT. I have plenty of money, healthy relationships, and no real criminal record, or at least convictions.

So, after rehab, I doubted my sanity. I doubted whether or not I was sane. I mean, what sort of sane person wants to shut their brain down and get high? What sane person knows the risks of addiction but still chooses to inject themselves with untested drugs purchased from shady people?

So, I went to the shrink and we had a few sessions. I did my best to be absolutely honest with them. Even during the peak of my drug use, I was completely honest with my physicians. They are tasked with saving my life, I shouldn't lie to them. I did the same thing with the head doctor.

Finally, he sets me up for advanced and expensive training. It was three eight hour days, one of which was spent taking this giant test called something like the MMPI. It is one of those tests where you fill in the ovals and it's thousands of questions long.

Two of the days were spent talking to people and doing some writing. They didn't feel obligated to hook me up to any of the machines.

It took a bit for the results to come back and it turns out, I'm not even remotely insane. I kind of hoped I was, because then I'd have a reason for some of my choices. Nope... I'm probably more close to clinically sane than the people who administered the tests.

Except, and this is the important part, they won't tell you that you're sane. This isn't verbatime, but it went something like this, "You show no signs of your life being negatively impacted by any diagnosable mental illness. You exhibit no significant traits of any clinically diagnosable disability as defined in the DSM-V." It was something like that.

So, even after all those tests, and apparently being pretty damned sane, they still wouldn't call me sane - only that I wasn't able to be diagnosed with anything on the list and that my life wasn't being harmed by any uncontrolable brain functions.

That's as close to sane as they appear to admit. The initial head doc hadn't done the tests, but had sent me out for them. We both got a good chuckle at the responses.

He then recommended I visit a therapist once a week and offered me some sleeping pills.

At the very least, they do seem inclined to keep you in their care. They won't say you're sane, either. Even when they couldn't pinpoint an issue, they still wouldn't say I was sane. The closest they came was saying that I'd no signs of my life being harmed because of a mental process I couldn't control.

Go figure?

Because you can't prove someone is sane, yet you can check (with varying accuracy) for "insanity". That's exactly the content and meaning of their answer. That's why you never got the sentence you waited for.

Also, you have an interesting life story :)

It has been a fun ride. It's nearing the end and I have no complaints. I'd not go around again, make some room for the next set of riders.

Interesting. This is very similar to my story, I use heroin for much the same reasons as you describe, but I've only started on the recovery phase. Now I'm a little worried about what might happen once I finally move onto methadone for good ;(

Weird how focused you are about being labeled 'sane' by people who don't use that label.

My frustration with "mental health" is that many things like bipolar, schizophrenia and depression(even ADHD sometimes) are often viewed as incurable while also having no true litmus test. This talks about some of the issues https://www.youtube.com/watch?v=wuhJ-GkRRQc Not to mention the fact homosexuality used to be a mental illness. Prisoners are definitely no better considering then you have a criminal record for a while typically.

Hi Thomas. Thank you for sharing your story. I'm sorry about your brother. I'm going through a similar situation with someone very dear to me, and I'm wondering what will happen to them. Would you have time for a quick chat or phone call? My email is in my profile; please email me if you see this.

NAMI (National Alliance on Mental Illness) has free classes and support groups for friends or family members of people suffering with mental illness.

It helped my Mom and me immensely when our family member had a psychotic break. I highly recommend them if you can make the time.