Talk to me about inpatient behavioral health...

[Barb_]

We are going through this with someone right now.  Once we have a HIPPA waiver, how much information will they give us? What are our rights?  How long does treatment typically last?  What to expect after release? If the admit was voluntary, can the patient check out at any time?  I may have more questions, but please give me any tips or advice.  This has been a long time coming and I've already been through all four stages of grief and am firmly in the acceptance stage, so don't feel like you have to speak gently. 

 

Barb

[Jyhwkmama]

I have no information for you but want you to send you hugs.

 

Dealing with mental illness in a family member is its own special kind of hell.

[Barb_]

I have no information for you but want you to send you hugs.

 

Dealing with mental illness in a family member is its own special kind of hell.

 

Yup.  Trying to avoid collateral damage is the toughest part.

[TranquilMind]

We are going through this with someone right now.  Once we have a HIPPA waiver, how much information will they give us? What are our rights?  How long does treatment typically last?  What to expect after release? If the admit was voluntary, can the patient check out at any time?  I may have more questions, but please give me any tips or advice.  This has been a long time coming and I've already been through all four stages of grief and am firmly in the acceptance stage, so don't feel like you have to speak gently. 

 

Barb

 

I'm sorry.  I pray things go better than expected.  No personal experience but I hope you get some answers. 

 

[Mosaicmind]

I posted over in high school. I've been there myself. I have Dissociative Identity Disorder, Major Depressive Disorder, Anxiety Disorder, and several other diagnosis. Now, if you believe it, my parts have other disorders also that aren't on that list. Yep! I'm a very multifaceted woman, hence my forum name.

[slackermom]

Treatment length depends on lots of things: the treatment plan, perceived danger to/from patient, insurance coverage, etc.

If the plan calls for a new medication, inpatient care may last until it appears to take effect. Some treatments such as ECT may be preferable on an inpatient basis, but can be done outpatient if patient is otherwise stable and able to get to and from the facility.

I am not sure how detailed the shared information would be with a HIPPA release.

In my understanding, despite voluntary admission, is someone wants to leave against medical advise, doctors could determine that patient needs treatment, effectively changing to involuntary status, but there are time limits on how long a person can be held.

[Katy]

Well, IME all of this greatly varies by state, so take everything posted with a grain of salt, unless they have direct experience in the same state and with the same hospital chain (IE: hospital lawyers) you're involved with.

 

Generally once there is a release you can get medical records, diagnosis, etc.  Not therapy notes.

 

Generally if someone checks themselves in they can check themselves out, unless they have made it clear that they are suicidal or otherwise would be a danger to themselves.  And then, how long they are held against their will varies greatly depending on the state.  Some states have near perfect autonomy, patients can refuse treatment even if they are a danger to themselves or others unless there is some sort of criminal charges involved.

 

In other states, you and another family member can get power of attorney very easily, be given guardianship and have them committed for as long as your finances allow assuming you have ample evidence they are a danger to themselves or to others.  IE:  they are an alcoholic and have a history of driving drunk, even if they have never been caught.

[Joker]

My dd was hospitalized for a week. It was voluntary but if she wanted to leave, we and the doctors had to agree. She's a minor though.

 

Even being a minor, we are not told everything. She mostly has to agree to what is shared. We were told about any medication they put her on.

 

They had set visiting times and a list of what was and wasn't allowed clothing wise so we were able to bring her things. She was also allowed short phone calls at set times.

 

After release, it was best for my dd to continue a strict schedule. Everything was scheduled out in her facility and we came up with one at home. We stuck to that for several months until she felt okay without it.

 

Finding a good therapist was also key. She went often after her release.

 

 

It was honestly the hardest thing I've ever been through. Leaving her each time was painful. We also started therapy for our other dd because it was very hard for her to see her sister like that.

 

I hope things get better soon for you and your family.

[Barb_]

Medication change and a better diagnosis are the primary goals.  I'm really unhappy with the lack of information I've been given.  We went to emergency (lightly occupied) and I was left alone in the waiting room with a promise to come get me after triage.  2.5 hours later I was still sitting there.  I finally found out we were going inpatient because of a text, not because anyone from the hospital ever spoke to me.  I finally dropped off the overnight bag and left.  Is this common?  I just found out from the website that this is a short term facility.  No one there gave me any ideas about length of stay.  

 

Was also never told about dos and don'ts, visiting hours, phone calls.  Nothing.

Edited June 23, 2016 by Barb_

[Katy]

Medication change and a better diagnosis are the primary goals.  I'm really unhappy with the lack of information I've been given.  We went to emergency (lightly occupied) and I was left alone in the waiting room with a promise to come get me after triage.  2.5 hours later I was still sitting there.  I finally found out we were going inpatient because of a text, not because anyone from the hospital ever spoke to me.  I finally dropped off the overnight bag and left.  Is this common?  I just found out from the website that this is a short term facility.  No one there gave me any ideas about length of stay.  

 

Call the department this person is in and ask to speak to the nurse for this patient.  They should be able to give you more information about what to expect, and if not, be able to refer you to a social worker or physician who can.

[purplejackmama]

Is the patient a minor?

[Barb_]

Call the department this person is in and ask to speak to the nurse for this patient.  They should be able to give you more information about what to expect, and if not, be able to refer you to a social worker or physician who can.

 

Ok, that's good to know.  I've been so frustrated because everyone is coming to me for information and I have to keep telling them I have zilch.  Nada.  

[Barb_]

Is the patient a minor?

 

No.  That complicates things.

[Barb_]

My dd was hospitalized for a week. It was voluntary but if she wanted to leave, we and the doctors had to agree. She's a minor though.

 

Even being a minor, we are not told everything. She mostly has to agree to what is shared. We were told about any medication they put her on.

 

They had set visiting times and a list of what was and wasn't allowed clothing wise so we were able to bring her things. She was also allowed short phone calls at set times.

 

After release, it was best for my dd to continue a strict schedule. Everything was scheduled out in her facility and we came up with one at home. We stuck to that for several months until she felt okay without it.

 

Finding a good therapist was also key. She went often after her release.

 

 

It was honestly the hardest thing I've ever been through. Leaving her each time was painful. We also started therapy for our other dd because it was very hard for her to see her sister like that.

 

I hope things get better soon for you and your family.

 

I have some questions.  Can I PM you later tonight?  I have to leave for a few hours.

[purplejackmama]

No. That complicates things.

Unfortunately, I agree. I only have experience with a minor. I'm sorry you are walking this stressful path.

[Joker]

I have some questions. Can I PM you later tonight? I have to leave for a few hours.

 

Of course!

[SparklyUnicorn]

This stuff varies wildly.  Hopefully you'll get to talk to someone who can give you more answers. 

[Liz CA]

I will PM you.

[zimom]

I have a family member (FM) that has been inpatient for either 30 or 60 days, short term several times (at least 5) and most recently Baker Acted.  Once FM was also taken for an evaluation and it was determined that FM could be served via intensive out-patient and then FM did not follow through, and of course, nothing was done.   I am basically the only relative left/involved. 

 

Sending hugs since I've BTDT but unfortunately not much advice.  It has been a very long road.  The one thing I've learned is if an adult does not really want the help, there is nothing you can do.  But no matter how many times I tell myself that, it is emotionally draining and you will still keep trying to 'fix' the problem.  Try to keep yourself and the rest of your family physically and emotionally safe.  

[StephanieZ]

If possible, get a Health Care Proxy and/or Health Care Power of Attorney (as well as a Durable POA if there are any financial/legal matters that might need to be handled). If it were me, I'd talk to my attorney and get *all* of the things I might need ASAP and before admission if at all possible (as you'll need the patient's signatures). If you have the right paperwork (varies by state) you can/should be able to get all the information the patient has a right to as well as act on their behalf. There are even Health Care POAs that are limited to information gathering . . . My mom gave me (and my brother) those early on in her last illness, as that fully enabled us to talk to all DRs/get all records/etc without enacting the Health Care Proxy (that is only activated when the patient's DR(s) confirm s/he is not competent). I would not rely on the medical institutions HIPPA forms (although, sure, do those too) because what if the patient is moved or gets care from another provider, etc. You want a universally accepted document that can "travel" with the patient. 

 

(((hugs)))

[chiguirre]

IME, the nurses on the ward didn't seem to know the facility's rules very well. I found those out from the security guards at the entrance, some of it by trial and error. We also didn't get an estimate of expected stay until GW had been there for a couple of days. That was after having camped out in the mental health ER for 36 hours with very minimal intervention. We weren't sure we'd get a bed for GW at all and the system was clearly overburdened and overcrowded. It was truly a crazy experience in bureaucracy and helplessness.

 

On the plus side, the billing department was the most competent I've ever dealt with. They told us our copay and that was it, no slow trickle of bills for months afterward. I was very pleasantly surprised after all the admission red tape.

 

I hope you can figure out the bureaucracy and your FM gets the help they need.

[MrsBasil]

For my state, in the situation I was in with an adult who was not my child.  HIPAA waivers can be revoked by the patient at any time.  You may also need to get a separate waiver through the insurance company to get detailed billing or claims information or find out specifics of coverage. Mental health(and addiction issues which is what I was dealing with) is information that is heavily protected.  Even with a Durable POA getting information on claims paid was next to impossible because it would be admitting what care had been provided.

 

You have to get a HIPAA waiver for every place they may go, so hospital, respite, halfway house, actual inpatient.  Most places seem to encourage and expect the information to go from the patient to the family, even with waivers you get the basics. 

 

If at all possible, I would suggest a Medical POA and a regular POA if the patient is agreeable.  I realize my situation was different than what yours sounds like, but it was explained to me that mental health information is even more heavily protected than regular health information.  I would do I could to get reliable and true information from providers if at all possible.

 

(((hugs)))

[Joanne]

Medication change and a better diagnosis are the primary goals.  I'm really unhappy with the lack of information I've been given.  We went to emergency (lightly occupied) and I was left alone in the waiting room with a promise to come get me after triage.  2.5 hours later I was still sitting there.  I finally found out we were going inpatient because of a text, not because anyone from the hospital ever spoke to me.  I finally dropped off the overnight bag and left.  Is this common?  I just found out from the website that this is a short term facility.  No one there gave me any ideas about length of stay.  

 

Was also never told about dos and don'ts, visiting hours, phone calls.  Nothing.

 

It's pretty common. Typically the professionals are mostly occupied with their case load, and it can be very difficult to include family. I can't speak for your setting, but if a patient signs a release in my psych ER, it is "good" for a year unless revoked. Typically, we share info such as med compliance, sleep, hygiene, level of participation. A good inpatient program will have a family component of some kind.

 

Sometimes confidentiality prohibits family members from being near not because of the patient, but the OTHER patients.

 

Length of stay is determined (often) a bit after the first assessment, when a patient is typically most acute. In my case, we send them to the pysch hospital (we are "just" the ER) and the Psychiatrist, RN, and Therapist there make the length of stay determination at that point, often a day or two after the first event.

 

Voluntary means they can leave. If the professionals feel they are not "safe" to leave, they can file paperwork to make the patient involuntary.

[MrsBasil]

Oh, PS.  Everything the ER told us about the facilities my family member went to was wrong.  I would try to speak with an admin in the inpatient facility.  Leave messages.  I think it took us 4 days to get an initial call back.

 

IME, my family member was told at every step they were there voluntarily and could leave at anytime.  Which meant that they could check themselves out as long they weren't considered in danger or dangerous to others.  The bar for that seems to be pretty low.  Again, only my experience. 

[Joanne]

Please be very careful, and conservative and guarded about pursuing a POA for a young adult with mental illness. It is not "where" I would go for a first, second, or third choice.

[Katy]

Please be very careful, and conservative and guarded about pursuing a POA for a young adult with mental illness. It is not "where" I would go for a first, second, or third choice.

 

This is interesting Joanne.  Can you elaborate on the how's & why's?

[Joanne]

This is interesting Joanne. Can you elaborate on the how's & why's?

POA is a strong power and document. Young adults need their autonomy and to not have their recently earned rights of confidentiality, medical autonomy, and self determination taken from them. And families should not easily risk the disconnect; that young adult needs you as support. Acute mental illness symtoms are not typically enough to strip a young adult of their rights.

[MrsBasil]

I'm going to defer to Joanne on this.  My suggestion to obtain POA was based on my experiences with a family member who expected that I would handle all of their affairs anyway, has willingly set up a durable POA and signs HIPPA waivers at all medical offices prior to the addiction issues that came up.  This person expects that I'll manage their finances and give them an allowance of their own money until their death. 

 

POA did make things easier in obtaining medical information, but it wasn't done with a young adult and I was not in a parent position with my family member.  If that's potentially damaging I would listen to Joanne and not me.  Sounds like we have vastly different situations.

 

 

[gaillardia]

You know this helps people who may be having issues, they don't know who to turn to, where to turn, and especially what questions to ask.

Many good points being brought up.

[Pawz4me]

A POA (durable or health care) doesn't take rights away from anyone. Rather it allows someone to assume those rights IF the situation warrants. DH has had my POAs (and I his) since we were first married. It doesn't mean either of us has the right to act for the other unless the other one is incapacitated in some manner.

 

I think everyone over the age of 18 needs to have both durable and health care POAs in place. Now . . does that mean in the midst of a crisis (and especially a mental health crisis) is a good time to do that? Maybe (probably) not. I think that would depend on the individual situation -- what is going on with the patient, the family relationship, etc.

 

:grouphug:  :grouphug:  :grouphug:

[mynameis26]

I have no information for you but want you to send you hugs.

 

Dealing with mental illness in a family member is its own special kind of hell.

 

Yeah, dealing with mental illness in a family member is a disgusting thing. I don't have personal experience with this, but I think such patients need much care and family support. It is hard to handle such patients, but with our patience and love, we can overcome that difficulty. Recently I read an article which is related to dealing with an addictive personality ( http://www.canadadrugrehab.ca/blog/family-support/family-members-in-addiction/ ), I think, the points which were discussed in that article is relevant to deal with people who are suffering from mental health problems. I don't know whether you are searching for this kind of information. Hope this will help. All the best. 

 

Edited June 24, 2016 by mynameis26

[kwg]

Did you get a chance to talk to your person yet?  :grouphug: I had to call a lot the first time. I just went with the assumption that he was not getting my messages and kept calling until he talked to me since no one could confirm or deny anything. I was frantic inside but calm and polite and all.  I am sure the people were like "dude seriously this woman has called like a hundred times, please just talk to her. please."  :lol:  My family member can be paranoid and psychotic so you can not take much personally.  Also, I was frantic. Also, every minute felt like an hour. 

 

I guess it depends but at this place, once we talked, he gave me a code so I could just call straight through to him and if he was not busy he could talk whenever.  He was on the adult locked floor.  They did not have specific phone times but they were very strict about when to visit. Like an hour a day and because it was a locked floor you could not bring anything in that was not first approved. Also, you can not overwhelm the patients with too much support so only 2 people could go back at a time.   We had to switch out.  

 

He signed a release so I could talk to his treatment team - it was just hard to figure out if the man who is telling me  about the four horsemen nad how electronics have the devil in them is right when he says he has been there for this long and still not seen a psychiatrist or therapist or just confused about his timeline.  But I was not trying to get in his business or anything.  

 

So sorry op  :grouphug:

[J-rap]

I have found that POA is the strongest document we can have.  Other types of releases are usually temporary and frustratingly always seem to expire when I really need to step in.  POA's are permanent;  hospitals add it to their records.  You sometimes have to tell them to look it up in their records, but they'll find it.  It certainly doesn't take away the individual's rights, but it allows someone else to legally step in, get all the information, and help.

 

[Joanne]

I have found that POA is the strongest document we can have. Other types of releases are usually temporary and frustratingly always seem to expire when I really need to step in. POA's are permanent; hospitals add it to their records. You sometimes have to tell them to look it up in their records, but they'll find it. It certainly doesn't take away the individual's rights, but it allows someone else to legally step in, get all the information, and help.

And in chronic cases of ongoing medical/mental challenges in which the person is unable to sled-advocate, they are needed.

 

As a go-to after one acute episode and used as a way to "get information" for an adult child? I can't support that. I believe strongly in developmentally appropriate autonomy and privacy and in the patient determining who accesses their info.

 

That is why in THIS case, I don't think a POA is an appropriate go-to.

 

I ask patients all day, every day, if they will sign consent so I can speak with family members.

[TechWife]

If possible, get a Health Care Proxy and/or Health Care Power of Attorney (as well as a Durable POA if there are any financial/legal matters that might need to be handled). If it were me, I'd talk to my attorney and get *all* of the things I might need ASAP and before admission if at all possible (as you'll need the patient's signatures). If you have the right paperwork (varies by state) you can/should be able to get all the information the patient has a right to as well as act on their behalf. There are even Health Care POAs that are limited to information gathering . . . My mom gave me (and my brother) those early on in her last illness, as that fully enabled us to talk to all DRs/get all records/etc without enacting the Health Care Proxy (that is only activated when the patient's DR(s) confirm s/he is not competent). I would not rely on the medical institutions HIPPA forms (although, sure, do those too) because what if the patient is moved or gets care from another provider, etc. You want a universally accepted document that can "travel" with the patient. 

 

(((hugs)))

 

If someone is not mentally competent, they cannot assign these roles and the adult caregiver will need to go to court. How easy/difficult this is will depend upon the condition of the patient, the nature of the relationship and state laws. 

[StephanieZ]

If someone is not mentally competent, they cannot assign these roles and the adult caregiver will need to go to court. How easy/difficult this is will depend upon the condition of the patient, the nature of the relationship and state laws. 

 

Well, FWIW, my mom was a lawyer, and I was her proxy/POA/etc/etc as she was mentally declining (dementia). Her lawyers (several) assisted us in updating her documents well into the illness . . . and so far as I could tell, those documents would have been very easy to use no matter how far gone she'd been when signing them . . . All you need is to get them notarized. In my case, our friendly lawyers, who all knew mom and knew her wishes and best interests, were more than happy to comply and help us do what we needed. If you don't have a friendly lawyer, then just getting the documents prepared and then having them notarized by any notary would work. 

 

Yes, if the person is not 100% competent, someone *could* argue in court that the documents are not valid. But, if there is no one who will fight you on it (say another family member), then you have no problem. In most cases, then, it's not a problem. . . And, so, I'd recommend doing the documents as early as possible, but late +/- arguably invalid, is better than not at all, IMHO.

 

Legal competency for this sort of thing extends WELL past what any ordinary person would think makes sense. My mom was legally competent WAY past when she should have been making decisions about medical care, driving, her safety, etc. WELL PAST. I know this because I has lots of consultations with several attorneys who were each very well familiar with mom and who were "advocating" for both Mom and me (as her caregiver) and also her medical doctors . . . who were similarly very familiar with Mom and I . . . 

 

So, FWIW, Mom's lawyers and doctors advised me that she was still legally competent WELL into Alzheimer's! Shocking, isn't it! The legal definitions of competency are very lenient, if you ask me. That is actually a very scary thing, because theoretically, a person who is (very) mentally compromised could be manipulated by a not-good person into signing new POAs and replacing the originally well-chosen ones . . . To me, this was one of the most scary things about caring for Mom in her mid-dementia stages . . . I was afraid that if I pushed her too hard to stop driving and/or get more care/assistance . . . that she could just sign new POAs taking away my ability to control/care for her . . . and making her vulnerable to someone else and/or, of course, enabling her to make dangerous choices. Fortunately, Mom was surrounded by lawyers and family and other people who were ethical and loved her, and also who knew I (and my brother) were there for her and would surely fight anyone to the death before we let them take advantage of or endanger her . . . (so not a very tempting target, lol) . . . But, it is really a scary thing IMHO. Legal competency is very, very forgiving, IME. 

 

To sum up, I advise you get needed documents done as soon as possible, but even if it might be legally past the legal competency place, that doesn't mean the documents can't be useful to you until/unless someone challenges you. (Who would? Why would they?) So, I'd get them done even if I personally felt the person was not competent. If someone fights you on it later, fine, deal with it. Meanwhile, you'd be enabled to protect and care for your loved one. Just do the best you can. To me, it is well worth any small risk if you're talking about enabling yourself to properly care for a vulnerable loved one.

[zimom]

RE:  POA   I would love to have a POA for my FM but reality is I know it is something that is not possible.   If I ask for it during a stable time, FM MAY agree to it, but at the same time, it may be the thing that sets FM off and then FM has no one advocating for him/her.   FM regularly calls me during episodes wanting to update wills cutting out one person or another.    For some reason this is something that is he/she fixates on during swings.   A POA would be the first thing FM would go after and cause alienation during an episode.  Since so far, I am the only family member that has somehow managed to stay on somewhat decent terms, it is something I just have to let go, which means when FM is hospitalized I am just in the dark.  

 

 

[Barb_]

Hi guys, just a quick hi. Things are cautiously optimistic right now. I'll update Monday once my little one is in gym camp. She is an energy vampire lol. Thank you for the opinions. I'm reading them all.