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Comment by ismarc | Hacker News Reader

You've obviously never had any real interaction with someone in the grip of a mental health emergency. She was put on suicide watch and evaluation, not because it's just fun. She cut the shit out of her leg, to where it bleed through, had repeated, documented thoughts of suicide and then tried to just pretend everything was OK. The first night was emergency care, i.e., make sure she didn't die. The next days were mental health evaluation while making sure she didn't die. You cannot be forcibly admitted in the U.S. she admitted herself. She did not have to stay after the first night, but they will make you think you do because they want you alive and to help you get better. It's not some giant conspiracy to do harm to people.

Does mental health services suck pretty much everywhere? Yes. But nothing she went through was inhumane (I've been through similar scenarios in less pleasant medical facilities) and all of it is geared to try and help.

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There is plenty to moralize in your post, but I'll refrain; I'd like to factualize instead.

In many parts of the the U.S., it is possible to be forcibly admitted to a mental unit. In California, for instance, this process is called a 5150 (named for the law that allows it), and authorizes a 72-hour hold for psychiatric care. (It is also possible to authorize a 14 day hold, called a 5250.) This is not unique to California. She almost certainly did have to stay after the first night.

I want to address as well your comment as to "thoughts of suicide". The terminology for this that's used in the literature is called a "suicidal ideation", and they run the gamut from thinking about it for a moment all the way up to making plans. A suicidal ideation is (obviously) a risk factor for suicide, but is not at all a guarantee that a patient will make an attempt on their life. (To hammer the point home, there are plenty of other risk factors that we do not hospitalize for; many patients with personality disorders will try to take their own life at some point, but we obviously cannot hospitalize them all at all times, nor should we!)

Neither I, you, nor anyone outside of this person's care network will have access to her files, so it's not reasonable for me to make a judgement call on whether she should have been placed on suicide watch or not. Given only the data provided, though, it is certainly not a slam dunk that she needed to be admitted.

I appreciate the agony you must have witnessed in someone who needed urgent psychiatric care ... but the experience that you witnessed is not universal.

I've had extensive experience caring for someone with severe and enduring mental illness. That person had several stays at MH hospital, some as an informal patient and some as a patient detained under various sections of the mental health act. In about 6 years that person's DSH was severe enough to require surgical treatment and inpatient admission to general hospitals or hospitals with specialist services. (Eg burns and plastics wards). I have personal experience of accessing specialist mental health services. All of this is in the UK.

I can confidantly say that you are wrong when you say I have no experience of people in acute psycjiatric distress.

Locked rooms is very unusual. Locked wards are not normal. A person might need supervision to leave the ward but they are not prisoners and are not treated like prisoners - risk is managed by closer supervision (I know a person who had 2 members of staff within arms reach at all times) not by locking them in a room. There are rare exceptions to this with special soft rooms - all blue with heavy crash mats. In gloucestershire this room is in the low secure forensic unit, which is in the grounds of but seperate from the main adult mental health hospital for the county.

A person at severe risk of self harm or suicide will be able to do so in a very bare room - smashing their head on the walls or floor, using their clothing as a ligature.

Strip searching patients is inhumane. Intimate searches of patients is just bizarre. Especially when we remember the overlap between people who have a mental health problem and peole who have been sexually abused. Being stripped and intimately searched is distressing for most people, but could be especially so for victims of sexual abuse.

The UK charity Mind recently did a report about restraint for aggressive patients and for patients who needed rapid tranquelisation. This is something that should be used as a last resort in very clear situations. That report talked about the need to protect people from unneccessary restraint. I mention this because even this clearly protective measure (even most service users recognise a need for appropriate restraint) is looked at carefully to see if there are safer kinder alternatives.

We can't tell from her post how severe her wound was. She doesn't mention any drips, so we don't know if they needed to give her fluids or not. We don't know if they used sutures to close the wounds or if they ised steri-strips. They didn't admit her for surgery.

If her story is true it is shocking.

You say that you've experienced similar or worse. I am very sorry you went through that, and I am angry other people who should have been caring for you put you through that.

(I've noticed a couple of people mentioning my tone so I am trying to work on that. Sorry ifthis post sounds aggressive or grumpy, it isn't meant to. That's just my poor use of English).

Thanks for setting the record straight on this. It makes me really sad to read all the comments here that have no clue how treatment of psychiatric emergencies should be done. If this is representative for the United States, I'm sure as hell glad I don't live there. Never been admitted to a psychiatric hospital myself, but I have enough friends who have (serious self-harm, attempted suicide by overdose or firearms). Their stories are like yours. I have never heard of anything resembling the stuff portrayed in this story. Seems to me that the US conflates violent criminals and mental patients, with some very bizarre and ethically horrendous results.

Psychiatric wards in the U.S. are for very short term stays by people who have extreme problems. They take people who are at major risk of causing harm, and patch them up just enough so that they can be thrown out. And even that is being scaled down and sped up.

The inpatient mental health system is like a mental ICU: designed for prevention of death, not for anyone's convenience.

My point is that this approach causes harm. It's like treating heavy bleeding by applying a tourniquet and sending the patient out the door. It's medically unsafe, unsustainable patient care. This is not simply a question of budgets, it is a question of how society views mental health. This kind of treatment indicates an "us and them" mentality where mental patients are viewed as second-class citizens. Your wording, "extreme problems" also hints at such a dichtomy, although I'm sure you didn't do it on purpose. There are other ways to say this: Basket cases, crazy, insane, psycho, major issues, etc. A neutral term would be "very ill" or something like that.

My examples of attempted suicide by overdose or "self-influcted gunshot wounds" definitely qualify as "extreme problems", so it is clear that there is a different way to do this.

I am aware that your comment probably just meant to say that the system is set up in an unfortunate way, and that you probably don't represent the views I describe here. But from my perspective it appears to be much worse than just an underfunded system.

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