[annielovesbacon]

(trigger warning for some brief eating disorder/weight related talk.)

So last summer my therapist told me if I lost any more weight, we would have to discuss going to the hospital (and she pretty clearly insinuated that I'd have to go whether I wanted to or not).

I am in a relapse right now and am wondering if she will make this same threat again. I was curious on what grounds a therapist can hospitalize a client involuntarily, so I looked up the law in my state. It pretty much just says there must be "clear and convincing evidence" that someone is a danger to herself or others to be hospitalized involuntarily.
The only evidence my T would have is what I have said to her in therapy. Can our confidential conversations really be used as evidence? And can things I say really be considered "clear and convincing evidence"?

Lots of questions about this. Would appreciate any perspectives, like personal experience or maybe someone with better legal understanding than me.

[stopdog]

It really will depend upon your state as to the procedural rules. In my state, interested parties can swear out affidavits describing how someone is a danger to themselves or others and then the sheriff will go pick them up and take them to a locked psych ward where, if the person does not agree to be admitted, paperwork for an involuntary admission will be started. In my state, they can hold a person for up to 96 hours and if the psychiatrist wishes to hold the person longer involuntarily, they must seek an additional period of several weeks by filing a motion with the court. An attorney such as myself is appointed to represent the person, and a hearing must be held where the md describes the danger. The person is entitled to a jury trial if they wish and may but cannot be compelled to testify on their own behalf.
Sometimes a therapist calls the police if the person will not agree to go. The therapist rarely testifies at this first stage - usually in my state it is just the md and possibly a family member. In my state, the md can use the notes from the hospital stay against the person, and that includes things the person says to the md, the staff, or to other people being held if the hospital staff overhears anything. They can use notes or information from other people but not for the truth of the matter asserted (hearsay rule) but to say it helped them form their diagnosis. But this procedure is state specific and each state has its own rules which can be very different from each other. The state that neighbors mine just 20 or so miles away has a completely different process.

This is not intended to be legal advice in any way. Just a description of involuntary mental health commitment in my state.

[annielovesbacon]

Originally Posted by stopdog

It really will depend upon your state as to the procedural rules. In my state, interested parties can swear out affidavits describing how someone is a danger to themselves or others and then the sheriff will go pick them up and take them to a locked psych ward where, if the person does not agree to be admitted, paperwork for an involuntary admission will be started. In my state, they can hold a person for up to 96 hours and if the psychiatrist wishes to hold the person longer involuntarily, they must seek an additional period of several weeks by filing a motion with the court. An attorney such as myself is appointed to represent the person, and a hearing must be held where the md describes the danger. The person is entitled to a jury trial if they wish and may but cannot be compelled to testify on their own behalf.
Sometimes a therapist calls the police if the person will not agree to go. The therapist rarely testifies at this first stage - usually in my state it is just the md and possibly a family member. In my state, the md can use the notes from the hospital stay against the person, and that includes things the person says to the md, the staff, or to other people being held if the hospital staff overhears anything. They can use notes or information from other people but not for the truth of the matter asserted (hearsay rule) but to say it helped them form their diagnosis. But this procedure is state specific and each state has its own rules which can be very different from each other. The state that neighbors mine just 20 or so miles away has a completely different process.

This is not intended to be legal advice in any way. Just a description of involuntary mental health commitment in my state.

I was hoping you would comment I really appreciate your explanation of the (possible) legal process. I know it's different in every state but it's helpful for me to hear about one way it could happen. Thank you!

[junkDNA]

my T used text messages to show the magistrate that I was in danger of hurting myself. in my state you have to go thru a magistrate who will then write an order for you to be picked up by the police. when my mom and I ivc'd my sister we collected evidence to show the magistrate

in my state there's a pretty huge grey area for people who are dysfunctional and need help but are not actively suicidal and homicidal... my sister was totally lost into psychosis but the magistrate refused several times to write an order... until she threatened to murder my mother. after that the police came.

you get taken to a local emergency room to be evaluated... and if the md in the er agrees to IVC then you get shipped off to the psych ward... sometimes hours away depending on availability

[nottrustin]

In my state, it is pretty much as SD described except that the they can only hold a person for 72 hours after the original paper is filled. A after that from is filled we have 10 days to hold a court hearing. We have a video conference so the judge is at the court but everybody else is at the hospital.

The therapists information may get you initially brought into the hospital, once there the doctors make their own assessment. A person is first brought in our psych ED unit. Where eith a psychiatrist or psych NP evaluated to see if one meets involuntary criteria. If they do the person is brought to the inpatient psych unit. In the 10 years I have been preparing all the court documents and recording thd . Hearings I have me had outpatient providers testify. Only family members who are often concerned for the safety of the patient is released from the hospital without further trearment, the inpatient doctor and occasionally the patient.

[Ididitmyway]

In my state it works similarly to what's been previously described. Only MDs though have the authority to hospitalize someone involuntary for an evaluation. A non-medical therapist may call PET (a psych emergency team) for a patient evaluation if they believe the person is in danger to themselves or others or they may call the police who'd determine if the person needs to be hospitalized. But it's an MD who prepares the documentation for involuntary hospital hold. In my state it's 72 hrs. If it's determined that the patient has to be held there longer, the decision goes through the court and they may be held for additional 14 days and then the same process goes up to 21 days.

It's not easy to hospitalize someone against their will in my state. Your mental conditions have to be really deteriorated for the court to believe that you are a danger to yourself and/or others.

[MobiusPsyche]

I believe you see your T through your University clinic, correct? If you're attending the university and see someone at the clinic... the T at the clinic can share things with student affairs or the Dean of students or whatever and they can essentially decide that now is not the time for you to be in college. They can't force you to go to the hospital but they can force you to do therapy and groups and see an MD to get cleared as healthy and that sort of thing to stay enrolled.

When I was IVC my pdoc wanted to hospitalize me, but I refused to do so voluntarily. So a social worker from the local MHMR came and did an "independent" evaluation. This evaluation indicated that due to my impulsivity and ideations, I was a danger to myself. Had I not then chosen to commit myself voluntarily, I would have had a court hearing within 72 hours to determine whether the IVC would hold.

Similarly to ididitmyway, when my LCSW was contemplating having me committed back in February because I was a danger to myself, he contacted the county emergency services team to determine whether or not I needed to be hospitalized. What they said was that should I continue to refuse to safety plan, he would need to contact the police.

[SparkySmart]

Well, for me the issue is this: You admit that you're in relapse, and that this causes your therapist justifiable concern. Wouldn't you want to be admitted for help? Going voluntarily would avoid police, possible handcuffs, court hearings, judges, violation of privacy, possible expulsion from school, restrictions on your freedom, etc., and may result in a better outcome. You're worth it.

[stopdog]

In my jurisdiction -it is relatively easy to involuntarily commit someone from the legal side. As long as the md is not a complete idiot - they can usually come up with something that sounds like enough to get the first statutory hold period. But although I get a lot of notices of involuntary holds (the hospital sends a notice to the attorney who is next on their list)- most people don't get to the court stage. If the hospital can get rid of a person without fear of being liable for something, they will. Depending upon your side of things (and I represent the client so not me) it is considered by those who want to force drugs/treatment on others - hard to get some people medicated/involuntarily treated because of cutbacks and insurance woes.

[BizzyBee]

Originally Posted by stopdog

In my jurisdiction -it is relatively easy to involuntarily commit someone from the legal side. As long as the md is not a complete idiot - they can usually come up with something that sounds like enough to get the first statutory hold period. But although I get a lot of notices of involuntary holds (the hospital sends a notice to the attorney who is next on their list)- most people don't get to the court stage. If the hospital can get rid of a person without fear of being liable for something, they will. Depending upon your side of things (and I represent the client so not me) it is considered by those who want to force drugs/treatment on others - hard to get some people medicated/involuntarily treated because of cutbacks and insurance woes.

And your experience, have you found that those with better insurance are more likely to be held by hospitals? Sometimes i wonder if it has more to do with money for those making the evaluation to have someone committed.

Canada here but I think it pretty much universal that if you are deemed a danger to yourself, you can be committed. I would consider a severe eating disorder as such.

[SparkySmart]

I think you're saying that the only evidence your therapist has to justify admitting you involuntarily would be to disclose the contents of your confidential conversations. It occurs to me, though, that "clear and convincing evidence" could simply involve having you step on a scale to demonstrate a loss of weight significant enough to jeopardize your life. Why would you put her in an adversarial position of having to pursue involuntary hospitalization if you understand what's at stake? It seems to me that she cares about you!

[stopdog]

Why is the therapist putting the client in an adversarial position? Letting people take control of you because someone else sees it as caring is a terrible idea.

[stopdog]

Originally Posted by BizzyBee

And your experience, have you found that those with better insurance are more likely to be held by hospitals? Sometimes i wonder if it has more to do with money for those making the evaluation to have someone committed.

Not that directly. There are a lot of things in play and insurance is just one of them. People with good insurance often in my experience have better resources in general and better access to health care - which in this sort of situation can cut both ways - if one has only community resources, then it is easier up to a point to slip through the cracks and not end up in a locked setting until things are really super bad and because things have gotten so bad, it can take longer to get stabilized enough that the md/hospital is willing to take the risk (of being sued if one is cynical - because they care so very much if one is not) of releasing them.

[missbella]

I don't know if the Rosenhan experiment is relevant today.
https://en.wikipedia.org/wiki/Rosenhan_experiment

[annielovesbacon]

Originally Posted by MobiusPsyche

I believe you see your T through your University clinic, correct? If you're attending the university and see someone at the clinic... the T at the clinic can share things with student affairs or the Dean of students or whatever and they can essentially decide that now is not the time for you to be in college. They can't force you to go to the hospital but they can force you to do therapy and groups and see an MD to get cleared as healthy and that sort of thing to stay enrolled.

Is that really true? I admit I did not read any of the paperwork I signed when I started therapy 2.5 years ago (or maybe I did and I just don't remember) but I've always assumed that my therapist could talk about her clients with her supervisor(s) but I didn't know she could share things with the dean of students. Although given my university's apparent disregard for mental health services they probably wouldn't do anything anyway.

[annielovesbacon]

Originally Posted by SparkySmart

Well, for me the issue is this: You admit that you're in relapse, and that this causes your therapist justifiable concern. Wouldn't you want to be admitted for help? Going voluntarily would avoid police, possible handcuffs, court hearings, judges, violation of privacy, possible expulsion from school, restrictions on your freedom, etc., and may result in a better outcome. You're worth it.

Yeah in theory you're totally right, if I told my therapist I was relapsing then I would have to expect further treatment such as hospitalization right? But part of me doesn't want help. I just want to be able to talk about it, but not change my behaviors. But I know that's dumb, and I know it is unethical for my therapist to know that I am engaging in unhealthy/dangerous behaviors and do nothing to help except talk about it.
So it's a catch 22 I guess. I want to talk about it but I don't want help (especially hospitalization).

[MobiusPsyche]

It is different at each university so I can't speak to your situation specifically. You'd have to read that paperwork, or ask your T, to really know for sure.

I don't intend to be giving you more reasons NOT to see your T. I read your post in another thread this morning and I don't think you can wait until school starts to get some kind of help.

Originally Posted by annielovesbacon

Is that really true? I admit I did not read any of the paperwork I signed when I started therapy 2.5 years ago (or maybe I did and I just don't remember) but I've always assumed that my therapist could talk about her clients with her supervisor(s) but I didn't know she could share things with the dean of students. Although given my university's apparent disregard for mental health services they probably wouldn't do anything anyway.

[Anne2.0]

Originally Posted by annielovesbacon

Yeah in theory you're totally right, if I told my therapist I was relapsing then I would have to expect further treatment such as hospitalization right? But part of me doesn't want help. I just want to be able to talk about it, but not change my behaviors. But I know that's dumb, and I know it is unethical for my therapist to know that I am engaging in unhealthy/dangerous behaviors and do nothing to help except talk about it.
So it's a catch 22 I guess. I want to talk about it but I don't want help (especially hospitalization).

I'm not sure if your assumption that any relapse would lead to hospitalization is correct. In my reading of what your T said (which I think is ambiguous as the future always is), I don't see that it's a foregone conclusion that you will be involuntarily committed to the hospital. I think at a minimum she would want to have a more specific safety plan and then she might suggest more intensive outpatient and then voluntary admission. I don't think it would be straight to a 911 call to pick you up for transport for involuntary admission to a hospital. Even if she did, you could hightail it out of there before the police come. Not sure that they would put it as their first priority to go out and find someone who's just lost weight.

Why not say just what you said, which is the real problem, and discuss it-- you just want to talk about it, not change your behaviors. Perhaps this isn't a forever desire, in the sense that maybe you won't always feel this way. Perhaps you haven't had the conversation that moves you towards self care, even a tiny step.

[maybeblue]

I also don't think it's too likely that she would try to hospitalize you involuntarily. A three day commitment isn't going to do much good for an eating disorder. Mostly it would just make you not trust your therapist. I guess I don't know how bad it's gotten...like are you in danger of a heart attack or something. And really your therapist might not know either. You might really need a medical evaluation.

I guess if it were me I'd probably risk it, even if I wasn't willing to change my behaviors yet. And then maybe see if I could negotiate some other treatment like intensive outpatient or even just more frequent therapy sessions. I think if you don't tell her, you have the risk of it getting bad enough that you pass out, end up in an ER and then you will have less control of the treatment you get.

[velcro003]

I’m in agreeance as well. I talk often about SUI and even how I scared myself bc i thought i might actually do it, but she has not said that I should be hospitalized. Though we are working on a plan to do something else.

I haven’t talked to her about my eating less, but she has noticed the lost weight, but hasn’t pushed me to talk about it.

[SummerTime12]

I’m in the US and also have an eating disorder. For what it’s worth, none of my therapists ever hospitalized me for my ED even when they wished I would go. The only time I’ve been involuntarily committed to the eating disorder unit was when I was already attending a PHP ED program and they didn’t let me go home when my electrolytes were off.

[annielovesbacon]

Originally Posted by Anne2.0

I'm not sure if your assumption that any relapse would lead to hospitalization is correct. In my reading of what your T said (which I think is ambiguous as the future always is), I don't see that it's a foregone conclusion that you will be involuntarily committed to the hospital. I think at a minimum she would want to have a more specific safety plan and then she might suggest more intensive outpatient and then voluntary admission. I don't think it would be straight to a 911 call to pick you up for transport for involuntary admission to a hospital. Even if she did, you could hightail it out of there before the police come. Not sure that they would put it as their first priority to go out and find someone who's just lost weight.

Why not say just what you said, which is the real problem, and discuss it-- you just want to talk about it, not change your behaviors. Perhaps this isn't a forever desire, in the sense that maybe you won't always feel this way. Perhaps you haven't had the conversation that moves you towards self care, even a tiny step.

Originally Posted by maybeblue

I also don't think it's too likely that she would try to hospitalize you involuntarily. A three day commitment isn't going to do much good for an eating disorder. Mostly it would just make you not trust your therapist. I guess I don't know how bad it's gotten...like are you in danger of a heart attack or something. And really your therapist might not know either. You might really need a medical evaluation.

I guess if it were me I'd probably risk it, even if I wasn't willing to change my behaviors yet. And then maybe see if I could negotiate some other treatment like intensive outpatient or even just more frequent therapy sessions. I think if you don't tell her, you have the risk of it getting bad enough that you pass out, end up in an ER and then you will have less control of the treatment you get.

Thanks for bringing up that involuntary commitment probably wouldn't work for an ED... I hadn't thought about that at all, I am just so terrified of the hospital haha.

[annielovesbacon]

Originally Posted by MobiusPsyche

It is different at each university so I can't speak to your situation specifically. You'd have to read that paperwork, or ask your T, to really know for sure.

I don't intend to be giving you more reasons NOT to see your T. I read your post in another thread this morning and I don't think you can wait until school starts to get some kind of help.

I wish I could be seeing a therapist right now but sadly it's just not possible. I am working an internship in another state and my insurance won't cover anything, and I just can't afford to pay out of pocket