Voluntary vs. Involuntary IP Psych -- Differences?

When facing a mandatory referral for Inpatient (IP) psychiatric treatment, is it better to request it voluntarily as opposed to involuntarily? Does the "involuntary" patient's record get "stigmatized" such that treatment is more aggressive, includes restraints or heavy sedation? And what if he or she refuses so forcefully as to include shouting and spit flying out of the mouth?

So the PDocs are telling her that she can go IP willingly. But if not, they said she's going regardless.

I'd try to talk her into it (somehow) if I thought it would greatly benefit her. But I'm very afraid that they will ignore her medical needs and treat her invisible complaints as manifestations of mental illness. I know that they're not equipped to meet her medical needs because it happened once before.

This is a good decade out of date, but there’s no real difference except that you can’t sign yourself out if you’re involuntary. They watch you a bit closer if your involuntary but otherwise treatment is the same. I once was give the choice and choose to go voluntarily because I figured I could sign myself out the following day. But that didn’t work, they made me involuntary and I was so mad I threw a fit. I was placed into solitary for my safety. It wasn’t being involuntary that they reacted to, it was my behavior.

As for the medical needs, yes that’s a problem. Psych units aren’t set up that way. I know here, where I live now they have a geriatric and physical unit. That is more set up for physical stuff. Can you inquire as to wether or not the have a geriatric unit? I was on one once when I was in my 30’s as they waited for an opening in a mood disorder unit. It wasn’t being involuntary much calmer and quiet.

If it's still true that she can discharge herself if she goes voluntarily, that would motivate her.

She voluntarily checked in many years ago, but they couldn't change the dressing on the open wound she had. Instead they called me in to do it.

The psychiatric unit is on the same campus as the hospital, but "wound care is closed today."

And we had to "fight" to get her out before the mandatory three-day stay.

That’s strange. I’ve had wounds before that they took care of on the psych floor. Self inflicted knife wounds that they changed. They also would bring in a hospital bed if it was needed. Did you look intro geriatric psych floors? They are much quieter than general psych wards.

It depends entirely on what the law says where you live. During my recent inpatient stay (last year) I was certified (e.g. involuntary) for most of my stay, but opted to stay as a voluntary patient a few more days. This was done because I was looking at getting into a treatment program that did not accept referrals for patients who are currently certified. Even before I was admitted to the psychiatric ward, I was treated for co-occurring medical problems in the emergency room, despite already having been certified. The only difference between involuntary and voluntary is that as an involuntary patient you can't leave.

It also seems extremely odd that they wouldn't treat wounds like you've described. If this was at a major metropolitan hospital, they should've had such care available 24/7. Even in smaller, regional hospitals, I'd have guessed such care would still be available on call.

The wound care department was on holiday because it was Veterans' Day. At least, that was the excuse they gave. And actually I asked about wound care before she signed the agreement, and they said they'd provide it.

Hmm, that gives me an idea. This hospital has its own psych ward; I'm assuming they'd commit her to it. But now that I read your reply, we should be able to choose a different facility and still comply with law.

Well, my wife was committed on Thursday. My suggestion to transfer to another hospital went nowhere. First, when I called the other hospital, I couldn't get past a clerk or operator. When I mentioned the idea to the PDocs who wanted her committed locally, they said transfers just don't happen -- most places prefer to reserve their beds for their own patients. I don't really believe that -- I have no trust in them. But I don't have the energy or resources to pursue further.

The process was made more upsetting when the security guard showed up to escort us (my wife in a wheelchair, two nurses and me) to the oldest, most dismal part of the hospital, which is reserved for IP mental health.

We are blessed to have a few wonderful nurses, C and R, who did 1:1s (along with many others) while she was getting medical care. Unfortunately, the surroundings are depressing, the bathroom is moldy, and some other patients are violent. The old guy next door whipped out his schlong and peed on poor C and he kicked another nurse in the ribs two days ago.

But the vitriol that my wife expresses toward the PDocs is intense and scary. It's as if she's turning feral. Her PDoc, "maggot head," wants to keep her IP because she "seems to blame others for her problems." It's possible she can get out by agreeing to an intensive outpatient program. But the schedule would be exhausting to her.

Meanwhile, they had the opportunity to work with her (since 3/17) but they did absolutely nothing for her except show up in her room and upset her. They could've transitioned her from KPin to something else, for example, or adjust other meds. Nope.

Statues say that the IP stay is paid for by the state, so I plan to reject any invoices they send to me.

Update:

My wife was discharged from the ward on the fifth day. She (and I) agreed to the Intensive Outpatient Plan (IOP).

Also, it turns out that the PDocs cut her dose of KPin in half, and introduced melatonin, which helped my wife sleep through the night. So there was some slight benefit to the experience.

Overall they provided better care for her than I expected.

As well, the doctor who referred her to psych reduced the dose of prednisone about 20%, which we've wanted to do for a long time.

Right now I'm overwhelmed with the additional meds, which I spent over $62 for (with insurance). Our situation is almost the same as before except:

1. My wife's pain is greatly reduced (a good thing).

2. We don't have enough KPin to last until the next PDoc appointment.

IT sounds similar to being given the option of voluntary or involuntary once you have been TDO'd. I don't believe it makes any difference. Under Virginia law, once you have been TDO'd you will lose your 2nd amendment rights regardless of how you are committed. I went through it all and recently had my 2nd amendment rights restored by a court. The VA has seen the last of me.

in ky yu can sign in voluntarily but they can still put you on ahold if you try to leave and a judge will decide how long you stay (even up to 60 days) in state hospital. you can also be put on an MIW where a judge involuntarily admits you and th judge and dr make the decisions

Here it depends where you end up. Some hospitals here do not accept IEAs (NH’s commitment term: involuntary emergency admission), some accept both, and the state hospital does almost explicitly 99% involuntary admissions. The cool thing about IEAs is they can only keep you 10 business days (which really means 14 days plus holidays since hospitals are always open). The cool thing about voluntary is you can technically leave when you say you want to go (+the time for the doctor to approve it and do the paperwork) as long as they don’t believe you’re going to hurt yourself as soon as you leave.

The state hospital everyone is on the same level no one is treated worse or better (the food is crap, I think recently an employee got killed, but other than that when I was there staff wasn’t evil, other patients were too drugged to do anything too crazy other than, I don’t know, try to flush the TV down the toilet). Same with strictly voluntary hospitals which are a little more focused on recovery through groups and less “hold until looks like they’d be okay a day in society and discharge” laser eyes.

The mixed places are interesting. I’ve only been to two in the state (I don’t remember any of my stays in Mass which suck but whatever), one voluntary the other on an IEA. I was treated like garbage at both. The voluntary one, we’ll call ‘P’ I was in for psychotic mania. The hospital just sucked, they had a system error so I was taken off my meds—two anticonvulsants at a decent dosage(!), an antipsychotic, and some stuff for my stomach—cold turkey because it wasn’t anywhere to be found even though they knew I was on them. They never fixed it or anything and I asked if I could leave they said yes and put on my paper I left ‘AMA.’

Second one, we’ll call ‘E’ I was struggling with my eating disorder, SH, and SI. E is mostly a medical hospital with a psych floor, with no psych specific nurses they just get rotated out around the building (a lot of them openly complaining about being on the psych floor). I was accused of faking seizures when I had a panic attack (I shake a lot). I never claimed it was a seizure or anything and they just… ugh. I kept asking the nurses if they were doing this dumb shyt to “reality check” and they’d just respond “you’re safe.” Like, I don’t care if I’m safe, I want to know if Eric’s back there talking shyt! That kinda points to a yes when you don’t say no…I could NOT have been happier when my 10 days weee up because if I was voluntary there that stay I would’ve gotten worse (I was not psychotic before going, but that place was so stressful I was by the end of it) and could only have left AMA.

When is the next appointment? Can you move it up? Or call and see if you can get something just enough sent over to fill the gap (they might not because it’s a controlled substance, but it’s worth a shot you do have a good reason)?

Glad some good came out of it.

Yes she never ran out of the Kpin. Unbeknownst to me, the IP Pdoc's office scheduled a special appointment with the regular pysch APRN, who claims that no one ever spoke with her about the incident. Plus, she got a 2-week Rx from the IP Pdoc.

Re: IOP, we got no referral. My T runs a clinic in our town. He says they are booked solid. He fact, he had to start working nights to accommodate the increased workload. So no room for DW, and she's glad because she didn't want to do it to begin with.

Meanwhile, her pysch APRN and my T are saying that my wife slipped through the cracks and I've got to reach out to fix things. But if I do that, I'd really piss off my wife, so I'd rather not.

So while my wife was involuntary, her roommate was voluntary. "Jenny" had such severe anxiety and panic attacks that she needed some sort of refuge. But Jenny also was advised to do IOP therapy. She declined because there would be no one to look after her grandchildren for that extended time.

How much say do you have in her treatment right now (both legally and through her say)? Have you signed an ROI with her providers and you guys can talk? Is pissing off your wife temporarily worth helping her mental health right now?