[allison0728]

How do you get someone who has gone psychotic to get help. This person is extremely dellusional and paranoid and keeps saying they are not psychotic.

Also, do you tell them what they think is happening is not real or do you just listen ?
Help

I'm not too sure, but I'll give you my opinion for what it is worth.

I think it is one thing to agree with what they are saying...

And quite another to sympathise with how they are feeling...

If I had some delusional beliefs that were paranoid in theme I imagine I might well feel pretty afraid and anxious. I would think you could sympathise with those feelings without having to endorse the particular beliefs they have come to on the origins of those feelings.

How about if you present the situation as your being very concerned for them and for how they are feeling? Medication can be fairly effective with respect to helping people feel better. To reduce some of those experiences that tend to prompt delusional explanations.

Make sense?

[kimmydawn]

I think I would call a professional, or a professional facility, to ask what could possibly be done in this circumstance.

If the person is delusional and paranoid, he/she probably wouldn't agree to getting help, but might. have you tried talking to this person when she/he doesn't seem to be as delusional/paranoid (assuming there are those times)?

I still think that calling a local professional, hospital, community mental health organization, department of health and human services, etc., would probably be where I would start just to find out some initial options and suggestions.

good luck! please let us know?

kd

By law ff the person is an adult they have the right to refuse treatment regardless of if they believe they don't have a problem or have been officially diagnosed. There is no way anyone can FORCE the person into treatment or to follow that treatment program until they have been deamed a threat to themselves or others. So basically if the person is an adult there is very little that you can do. In fact the only thing you can do is wait until the person is a danger to themselves or others and then during the dangerous situation call the police, they will transport the person to the local ER for an evaluation. That person will have to be seen by 2 on staff psychiatrsts. Those two will decide if the person is well enough for release or should be held on the mental health unit for a 72 hour observational evaluation. At the end of the 72 hours the MHU treatment team decides if the person should be released or committed to the unit for 14 days. At the end of 14 days the treatment team decides if the person can be released or they are sent to a longer term facility until they are deamed no longer a threat to themselves and or others.

[allison0728]

My friend is now sounding normal again. But doesn't seem to know that he was dellusional for almost a week.

[Genevieve]

It really depends on a number of factors, and myself is mostly right, although different jurisdictions do not require two psychiatrists. In fact, I've never seen the requirement for more than one... (Just a note. Otherwise, the 72 hour/14 day holds are the same here.)

If this is someone already seeing a pdoc or therapist, you can try to contact them. Neither will be able to talk TO you, but they can listen to your concerns. If you go this route, be specific: "he's delusional" isn't likely to get very far, but "he believes that I am leading a conspiracy against him and is therefore holding a gun when he calls me" will.

If this individual is not in treatment of any sort, then you're in a pickle -- call the police? Or not? That's really all I can suggest, and then you have to hope that the police actually take him to the psychiatric ER, and then that the PER sees that there's a problem. Some people present so well, even in psychosis, that they won't get help that way unless they're really in bad shape.

As for you, I guess I'd think validating the feelings, without validating the beliefs? You know, "It must be very frightening to you to believe that. I don't think those beliefs are accurate, though." And I'd probably add in a few concrete reasons that they're not accurate.

Good luck.

Here in oregon it is two psychiatrists or 2 psychologists as is new york, vemont, nevada, conneticut, california, and the list goes on for a total of 42 out of 50 states. After being hospitalized 3 time involuntarily I looked into it because I was going NOT going in again. You can find out if your state is one of those that require two simply by contacting your local chapter of NAMI or your state branch or the nation wide branch of the American Psychiatric Association who can let you know what is required for commitment to your local mental health unit or your state mental health facility.

calling the persons mental health professional will not do any good. without a release of information signed by the client treating professional is not allowed to talk with anyone other than the client about treatment and needs. This is set down by the federal HIPPA Privacy Law. The treating professional cannot even acknowledge that the person is their client. In otherwords they cannot even listen to a phone call about that client without the signed release form.

[gardenergirl]

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myself said:
calling the persons mental health professional will not do any good. without a release of information signed by the client treating professional is not allowed to talk with anyone other than the client about treatment and needs. This is set down by the federal HIPPA Privacy Law. The treating professional cannot even acknowledge that the person is their client. In otherwords they cannot even listen to a phone call about that client without the signed release form.

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Actually, the HIPAA law and most confidentiality rules do not prohibit a clinician or professional from listening to someone about their client. They cannot acknowledge that the person is a client of theirs, and they cannot disclose any information about that person's treatment. But they can and do listen to someone's input while at the same time NOT acknowledging that they know the person being talked about. It's tricky, but not prohibited.

And if someone is a danger to themselves or others, HIPAA and most state laws allow for breaking confidentiality in order to keep them safe.

gg

Sorrpy to correct you but I am not taling about HIPAA that is different than the federal HIPPA law. And I do know what the HIPPA law states because I just went through an investigation process against a DHS case worker named Cynthia Garnero. The result was that she was taken off my case, placed on administrative leave and her other cases were investigated and she was fired, lost her social workers license and can no longer work in the state of Oregon as a social worker. The investigation and results remain a part of her permanent work record. And the civil rights office for my jurisdiction is keeping all information pertaining to this complaint available in case Cynthia Garnero (and or Oregon Department of Human Services) should choose to break this law again.

Even if the person is a danger The treating professional cannot talk to or acknowledge the situation if it comes to them from anyone that is not on a signed release form from the cleint themselves. In the case of a client being a danger to themselves the treating professional must tell the person calling "I'm sorry I can not talk to you but if this person (no matter who the person is) really is a danger to themselves or others anyone involved with that person should call 911 or the police" and then the treating professional must hang up the phone or otherwise walk away from the person making contact.

[gardenergirl]

Well, it sure sounds like you went through a difficult experience. That stinks.

I'm not sure what distinction you are making about HIPAA and federal law. HIPAA is a federal law. There are also state laws about privacy, and if they are stricter than HIPAA, they supercede HIPAA.

But I also know that a professional is not prohibited from listening to another person speak. Again, they cannot acknowledge who their clients are, but just listening to someone talk about their concerns to you is not a breach of privacy.

gg

Yes by this law they ARE prohibitted. See added info to my above post. I put it there so that the info would be together. My best friend felt I was a danger at one point because while in a memory piece I was making threats to her and threats to kill myself. The only way my therapist could help was to first have me sign a release form in case it happens again. She could not because of this law listen to my friend or do anything about the situation except tell my friend no matter who the person was that person should be taken to the ER by 911 or the police.

HIPPA was passed into law just a few years ago. They also have a website and you can also get info about this by contacting The Civil Rights Department. The one for Washington, Alaska, parts of california, Oregon, Idaho is in Seattle Washington.

[gardenergirl]

We'll have to just agree to disagree, then.

gg

[Genevieve]

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myself said:
Here in oregon it is two psychiatrists or 2 psychologists as is new york, vemont, nevada, conneticut, california, and the list goes on for a total of 42 out of 50 states.

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Actually, I have been involuntarily hospitalized after an interview with only one doctor. In California. More than once. And, more times than not, been released after assessment by only one doctor. (Frankly, a couple of times that I really should have been held for 72 hours. Once I was released less than 24 hours before a suicide attempt.)

</font><blockquote><div id="quote"><font class="small">Quote:</font>
calling the persons mental health professional will not do any good. without a release of information signed by the client treating professional is not allowed to talk with anyone other than the client about treatment and needs. This is set down by the federal HIPPA Privacy Law. The treating professional cannot even acknowledge that the person is their client. In otherwords they cannot even listen to a phone call about that client without the signed release form.

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Actually, I just did call a friend's therapist to express concern, with no release. Professionals can listen, and they can act on information given -- they just can't say anything to anyone without a release.

It's kind of a reverse of the reporting rule where they have to tell you if there's a threat against you from a client.

[JustBen]

Hmmm. I guess it's kind of like reading a letter that someone sent you about a client? One-way commnuication?

Your experience is rare thing. I can tell you that according to the APA, federal HIPPA law and all united state boards of clinical certified and licensed social workers boards all state in their rules and ethics codes that medical and mental health treatment personnel are NOT supposed to even acknowledge such phone calls WITHOUT a signed release of information on file from the client. The American Psychiatric Association and your states board of clinical certified and licensed Social workers can send you the information on request Just tell them you need information regarding their confidentiality rules and ethics codes. That is how I got my information when a social worker violated my confidentiality which led to her being fired from the agency and losing her license.

Also though the intake papers with a therapy agency states they are allowed to break confidentiality in the event of suicidal or homicidal situations they are allowed to do so only if they are contacting the police, 911 those type of emergency services. or suppeniaed for court purposes. They cannot call just anyone and say I saw so and so and they made a threat against you. If they could do that I would be sitting in jail many times over. when a person makes a threat against another first the therapist assesses how serious it is, then calls the supervisor and the supervisor contacts the police and the polce pick up the person making the threat and the person is immediately hospitalized involluntarily or placed under arrest depending on the type of threat of harm. How do I know this - while in a memory piece (alter) during a therapy session I threw a table at my therapist. It was decided between the supervisor and therapist that they would try to help me gain control of this without police intervention and hospitalization first. But I was informed of the law, agency protocal and possible ramifications should we not be able to take care of this situation within the agency.

As for hospitalization again your experience is rare. I was hospitalized in california in Lancaster to be exact and I WAS required to speak to TWO professionals. This was about 15 years ago.

A friend of mine just got out of the hospital in Los Angelas. She had to speak to TWO staff psychiatrists in the ER because she refused to go in on her own.

I have another friend that was hospitalized in Marina Del Rey last March, she had to talk to TWO psychiatrists AND they had to agree commitment was needed.

I have a relative in Palmdale who is a frequent "inmate" as we joke of three different hospitals all of which required her to talk to TWO psychiatrists. The only time she did not was when her therapist went with her or called ahead.

I have another relative in Edwards and she was required to talk to TWO psychaitrists when transported to the hospital.

I have a friend who is a Psychiatric Nurse in Hesperia who told me last night their hospital protocal follows the state rule of talking to TWO psychiatrists.

(as you can tell California is one place I personally know about. for I lived there for 6 years in many places. If you get a chance visit Bouquet Canyon in March for me so beautiful in the spring)

California does require TWO psychiatrists. by your post you DID talk to two - one in the ER and one on the unit and then they released you after their assessment. You weren't officially committed involuntarily. Its considered involuntarily committed AFTER the two assessments are done.

For future referance - At any point BEFORE that second assessment you could have walked out the door and there was nothing they could have done about it.

Knowing what my california friends go through and what I experienced there Im guessing that The first assessment in the ER probably raised a couple flags for the psychatrist on call (otherwise you would have been released) and instead of making you wait in the crowded and noisy ER for the second psychiatrist who was most likely not presently in the hospital and able to see you right away so the first one probably ASKED you if you would mind going up on the unit until the second one could talik to you. OR you changed your mind and agreed to go on the unit over night which makes getting a second assessment in the ER basically not necessary. Both of these situations has happened to my friends along with another one and that was when one of them grabbed a bedpan and started swinging at the staff with it. obviously there was no need for the second assessment when gail did that.

Im assuming since you did not mention it you were not showing such "extreme violent actions" at the time they decided to do the second one on the unit instead of in the ER which is the protcal for such things.

When in the ER if the first psychiatrist sees no "red flags" then the second one is not necessasary.

One of my friends there was actively TRYING to be hospitalized and they wouldnt. when she got copies of her files it states "patient came into ER wanting to be hospitalized though she claimed to be suicidal her tone of voice was calm, her thought patterns showed no marked incoherence, in fact she was able to laugh and show appropieate emotions during a detailed conversation which lasted 15 minutes. There was no visable self mutilation or suicidal actions present. The only time this patient expressed any agitation was when told she does not fit the criteria for immediate hospitalization." (LOL so much for trying Meg guess you need to hit them over the head with a bedpan)

Anyway all I can do is tell the people my experience and what I know about the law and how to find the information for what they need. Since there are many people on this message board there are going to be many versions of their experiences since we are not clones of each other. So sorry you werent hospitalized when you felt you needed to to all those who werent hospitalized and sorry you were to all those who were. and good luck to all in finding what you need to help you.

[gardenergirl]

I admit I do not know the American Psychiatric Association's code of ethics; however, I'm very familiar with the the American Psychological Association's as I am bound by their code of ethics and my state laws. There is nothing in the American Psychological Association's code of ethics that states a psychologist cannot listen to another person talk about one of their clients. One-way communication, as JustBen characterized it, is not prohibited by APA's code of ethics. In my state (and many others, but not all, as state laws vary and are in no way uniform), there is a duty to report credible threats of self-harm and/or harm to others. This is based on the Tarasoff precendent. http://biotech.law.lsu.edu/cases/privacy/tarasoff.htm

In such cases, the psychologist can inform the police or inform the threatened person directly without a signed release. HIPAA would require that the psychologist disclose this break in confidentiality to the client, but does not prevent it. In the case of someone with credible and imminent danger of suicide, the psychologist can inform a family member, the police, ER workers, an identified friend, etc. without a signed release if it's in the bounds of keeping the client safe. Again, this break from confidentiality must be disclosed under HIPAA, but it's not disallowed.

In my state there are two other situations when a psychologist can break confidentiality without a signed or verbal consent for release of information. The first is if a client is a child, elderly person, or person with a disability and is being abused. The psychologist has a duty to report abuse in these populations. The other is if a court subpoena's a client's records. The psychologist must respond to the subpoena, although they do not need to break privilege unless so ordered by the court. In these cases, again, HIPAA requires disclosure, but does not prevent.

The ethics code and state laws for social workers may be different and may indeed prohibit one-way communication, although I would be very surprised.

And my intent in clarifying this is also because there likely are others reading, and I want to make sure accurate information is presented.

gg

I sure hope that you get some help out of all of this and can assist your friend with their illness. good luck, pat

[gardenergirl]

You're right, this did stray from the original topic. Sorry Allison.

gg