How does the mental health system work?

I can’t give you any medical advice. I don’t have a doctor patient relationship with you, you are the reader only. Nonetheless much can be said about how the mental healthcare system works although it’s different from community to community and state to state.

When a person is suicidal, then they need to be kept safe. It may take days or weeks to unravel all the things involved with that desperate emotion that is a cry for help. But if you let someone be by themselves then they might take their lives, so a person who is thinking about ending their life should be brought to an emergency room.

The key aspects of this is, does a person have thoughts of wanting to end their life? Do they have any intent or plan? Do they have an incentive? Are they under the influence of substances that impair their judgment?

If you have reason to believe, there is a high likelihood of somebody, taking their life, then you should bring them to the emergency room. If they don’t want to go then you can call police. Police are hesitant to deprive someone of their rights and take them to an emergency room against their wishes. They need to have proof that there is a high risk for suicide. Often the person who really wants to commit suicide well then hide all the facts about it from police, so they can go ahead and commit suicide.

So it can be a dicey situation. It’s good to act quickly. If you think someone is suicidal, don’t let them out of your site. Call 911 and have the police come. Police nowadays are usually quite well trained about mental health issues, and so they can arrive and ask appropriate questions. It helps if you ahead of time document the facts. Then print it out and when a policeman has in his or her hands, a piece of paper, showing proof of high risk of suicide, it makes it easier for them to say OK we’re going to the emergency room, if, in fact, that’s the right thing to do.

You can record things by video of someone is saying they want to end their life, and it’s on video, then it’s hard for them to deny it later on when the police show up. Likewise, you can get other people who can corroborate your observations About a person being suicidal and get this down in writing.

Once you get to the emergency room, you want to have a mental health assessor talk with your child. This is an experienced, trained professional who knows how to ask the right questions to see if there is a high risk for suicide. if you aren’t there, then the patient can say no I’m not suicidal, and within minutes that person can be discharged, and then of course they could commit suicide. So it’s important to stay with the patient the whole time they are in the emergency room and you be involved in the decision-making. You can ask for, the latest update from the assessor, are they agreeing for an inpatient admission or not?

Normally a psychiatric assessor is quite sympathetic with the patient and those who are in the know about what’s really going on, so if someone is actually suicidal the assessor should be able to figure that out in half an hour to an hour assessment. That will then be communicated to the emergency room Doctor Who can give the order for, the patient to be transported to a psychiatric hospital. If the patient is not willing, they can be put on a 72 hour hold, which allows the medical people to transport the patient against his, or her will to a psychiatric facility, where they will be kept for at least 72 hours.

Here again it’s important that involved people stay with the patient through the whole process so they don’t slip through the cracks in the system. Once a patient is admitted to the psychiatric facility, this is often on locked ward. The doors are locked. The patient can’t get out. Often their cell phone is taken away from them so that is not a distraction.

Someone is really suicidal doesn’t want family members involved in the treatment in the psychiatric facility. They can reveal what the real issues are that are not being dealt with, and therefore their remains an incentive for a person to commit suicide. For instance, Joe isn’t getting over losing his girlfriend and he’s, not accepting relationships often come and go this way, but he’s lost in South blame and so wants to kill himself to end the pain of the break up. If that’s the issue and he doesn’t wanna deal with it, then he would want to keep friends and family away from the facility. In that case, he would not sign a release of information Form. The release of information form is in which the patient agrees to allow medical treatment people to communicate with the other person named on the form. It is against the law for medical people to share medical information with others without the patient’s permission.

That being said, if it is a life-threatening situation, then medical people can share information with friends and family, if it is necessary for protecting the life of the patient.

In that situation, without a release of information, then family members can be prevented from being informed about what’s being done for the patient, what’s the treatment plan, and what’s the discharge plan. Family members can often be quite frantic to try to communicate with the patient but the patient doesn’t have a cell phone, and the family can try to call the inpatient unit, but without a release of information form signed, the psychiatric unit often replies I can either acknowledge or deny that this person is here. If they are here then if they have signed a release of information form, then they may call you back.

All of this makes the inpatient treatment situation Cumbersome and difficult.

What many people don’t know is that the family still can share information with the treatment team. The team just can’t acknowledge that the patient even is a patient there. But if you know the patient is there, then you can share as much information as you want. I had Pat share documents, several pages about all the Issues hidden from other treatment people. These issues might be paranoia, delusions, lying, underlying motivations, etc.

Hopefully a release of information form is signed and you can be involved in care for the patient. This means you can call every day for an update from the nurse and from your son her daughter. Treatment can include individual and group therapy, issues can be identified such as learning Coping skills. Also, treatment can involve education such as mindfulness training and meditation. Treatment can also involve medication. If a family member is a medical guardian, then they need to be consulted regarding prescription of medication. With a release, signed, family members can be informed of what medicines have been changed, and what they’re helping with or not helping with. For example, sleep medicine has been started and the patient seems to be better rested.

I always recommend that a family member keep a journal of what’s going on each day. That’s helpful to be able to get feedback to the treatment team. For example, this is day three and the patient continues to not want to deal with the issue that got him there, namely paying over the break up with a girlfriend who was toxic and a drug addict Worsening his addiction issues. He hasn’t talked about it but no one is pushing him too and so we want a family meeting on that issue to try to get some progress on that issue.

Obviously, it can be very frightening for a patient to be on a locked unit in a psychiatric hospital. Their freedom has been taken away, and their surrounded by strangers. It’s very helpful, obviously, for family, too provide support in these difficult times. But that can also help the patient deal with their issues.

A patient does deal with their issues. That’s their ticket to get out of the hospital. Dealing with issues means excepting relationships. Don’t always work out the way you want them. Or it could be accepting some someone has control issues or anger issues or addiction issues. Then they come up with a plan to deal with them that’s written out and then start doing some of that work and getting some good results as well as good feedback from support people.

Then comes outpatient help.

If there are still many intense issues, a person may benefit from intensive outpatient care. This may mean 2 to 5 times a week a person meets at a facility next to the hospital. There they get individual and group therapy, as well as or two times a week, or more often, seeing a psychiatrist so medication can be changed as needed.

This kind of intense care doesn’t happen so much anymore due to insurance issues. Often insurance won’t pay for it. Or, they pay so poorly that hospitals don’t offer it.

Still you can get intense outpatient care just by working much more frequently with an individual counselor and a psychiatrist. I will sometimes see patients on my lunch hour so I can be able to see them two or three times a week, allowing for more frequent medication, changes, or counseling or both.

It can be a challenge to coordinate between the Dr and Therapist. I often ask my secretary to email a copy of my notes to the patient so patient can share that note with family members and the therapist and whoever else wants to know.

Intensive outpatient work means you’re seeing a doctor or therapist or both 2 to 5 times a week. This is often needed to deal with crisis issues. Crisis issues can include withdrawal from street drugs with greater temptations to relapse. It might be patient persevere in self claim, and self hatred over things he couldn’t control, such as Losing, losing a car or job or house.

Education can play a big role and intensive outpatient work. Upon concepts such as radical acceptance are discussed, but it takes a while for a person to really digest that determent understand it, and it’s ramifications. To help with this there are offered workbooks. Common example is the dialectic behavior skills workbook. Also the cognitive behavioral workbook for depression. It’s helpful if family members are also getting copies of these books and reading them, reading the same chapters that the patient is reading and then they can talk about what they’re learning. Family Support this week can be very helpful.

Sometimes it’s hard to gauge how much better a person is getting. To help with this there are rating scales for depression, anxiety, PTSD and other issues. These can be filled out every week or two and the numbers often tell the truth of if the counseling and medicine is working or not working.

This sounds like a simple thing to see but quite often. The problem is the medicine isn’t working, but the provider doesn’t know it and so keeps at the same dose which is too low.

A common problem in all of this is the issues are not defined. Issues can be not accepting losses, dwelling on the past, obsessions, manic symptoms, among others. Issues should be defined and written down on paper, and explain, so everybody’s on the same page. The treatment plan, for the issues should be likewise written down and explained so everybody’s on the same page. I do this in my, Dr notes which can be emailed to everybody so everybody’s on the same page. While this sounds simple, it often isn’t done and then issues slip between the cracks of the treatment system.

People are busy and so often it’s hard to coordinate care with parents who are often both working. The patient and adolescent has limited time to see the doctor, after school. So it’s important to look ahead and coordinate Times for the doctor visits that work with everybody scheduled. Often phone calls can be done with several different people talking to the doctor at the same time. If that is possible, friends and family can leave notes with the doctors office, with the understanding, it will be uploaded to the patient’s electronic chart. Then the secretary should alert the doctor to the fact that note is there so he looks for it.

Some issues come up suddenly. It might be a relapse with substance abuse or a patient suddenly stops their medication and gets side effects. Family and friends should have access to the doctors phone number so they can call him. For non-urgent issues, friends and family should Have the doctors office number in their contacts on their phone. That should also include the email address for the doctor.

With good communication this way, informing providers along the way, from inpatient to outpatient, the patient often does well. Issues have been clearly identified. Medications have been prescribed with clearly defined goals, such as improving sleep, or calming anxiety. Psychotherapy goals also have been clearly defined, such as learning to reject self blame and replace it with excepting the big picture, such as relationships often don’t last and that’s OK that’s just normal.

There should be a clear understanding of what the patient is supposed to do in terms of homework and counseling, and what the doctor is supposed to do and if necessary, what family members are supposed to do.

If there is a breakdown in any of this kind of communication, then the doctor should be informed

Typically, little issues to crop up, the doctor is informed, and the problems are dealt with. This assures progress in the overall treatment of a person so they can recover from their severe depression.

If there is a stalemate in this process, you can ask for psychological testing. This is done by a doctorate level psychologist. An issue is defined, such as does the patient have a personality disorder, or autistic traits, and then the psychologist can give the appropriate survey questions the psychologist, then review the answers and writes up a report on the issues defined. For example, one psychologist evaluated a patient for dementia and found high levels of depression. That probably explained the memory issues. Another testing showed that the anxiety and depression a patient felt, mostly in social situation, was related to autistic traits. In that situation, the psychologist also did the counseling so the person could be accepting that they just don’t have a good understanding of people and their psychology, and that’s OK.

Sometimes can be halted by addictions. In that case, there can be your drug screens or other drug tests to catch an addiction. Other times a patient isn’t taking the medication and blood levels can be checked for by the doctor. Or parents can, make sure the patient is taking the medicine, and sometimes they will dissolve the medication and then give it in a milkshake to the patient, making sure they’re actually getting it. Some patients keep the pill between their cheek and gum, and then spit it out later. But doesn’t happen very often.

I’ve reviewed a common use of the mental health system as it is in the United States. Starting from the emergency room visit. I’ve reviewed how Karen progress to inpatient care and then outpatient care. I’ve reviewed how Family can coordinate their insights with the treatment team, contributing to the overall good outcome for the patient. I hope this is been helpful!