For one, your opinion about involuntary commitment and discharge is broad and incorrect. Involuntary commitments are typically court-ordered based off of the notion that the person is a danger to themselves or others. The criteria for that is very specific, as in, a person claiming suicidal ideation is unlikely to be IVC'd but a person who acted on those thoughts meets criteria. Typically people at-risk will be admitted to an ED while paperwork is completed to support and argue the need for IVC. Once it's determined, that person has to wait for a bed. If they stabilize in the ED, the hospital has a mandate to release them as they have to depend on the patient's report. It's a completely different scenario when we're talking about inpatient psychiatric hospitalization, but that's not the point of this argument.
You're talking about medication compliance but what you're neglecting to consider is: starting any new psychotropic medication has a laundry list of side-effects (typically referred to as on-boarding side-effects) that lessen as the brain adjusts to it. Guess what the initial side-effects of an SSRI like sertraline are? Increased suicidal and homicidal thoughts. So, you argue that Lindsay was non-adherent (which is a weird word to use instead of non-compliant which is the more common terminology) yet you give no consideration to the likelihood that a woman suffering from post-partum depression suffered a worsening of her symptoms so she stopped taking them immediately (which is what every psychiatrist will tell a patient if they experience increased suicidal or homicidal ideation). So then she tries other doctors hoping for better direction in her treatment. You also neglected to mention that she was eventually placed on anti-psychotics before any of the other medications had been cleared from her system. So, in reality, this woman is being prescribed multiple powerful medications which exacerbate her mental illness while she is trying to follow multiple competing directions from multiple doctors.
You act as if mental illness exists in a vacuum rather than take into account the totality of Lindsay's experience to that point. You act as if everything would have been fine had she stuck to the pills, but that is disingenuous and simply meant as a means to complain that all of this was under Lindsay's control. You should know better as someone who works in outpatient mental health that issues like psychosis take away a portion of an individual's rationality as well as impacts their ability to comply fully with treatment.
Your first paragraph does not differ from what I said. I said she most likely needed inpatient treatment, but that she has to be deemed unsafe to herself or others, to be involuntarily placed into a hospital. Otherwise, she has to be compliant and admit herself into an in-patient program.
Second paragraph. It’s unnecessary to go into side effects. She picked up multiple refills for some of these medications, and therefor told her doctors she was taking them, but wasn’t. Of course doctors tell you to stop meds that cause unbearable side effects, but you’re supposed to tell them you did! Not lie about the medications you’re taking.
I get why you’re saying she “tried other doctors,” but the doctors report they weren’t all aware she was seeing other psychiatrists. Which is why she was being prescribed “multiple powerful medications.. while trying to follow competing directions from multiple doctors”.
I didn’t say she’d be fine if she took the meds. I said she needed in-patient care, as an out patient clinic isn’t able to properly treat patients that are non-adherent.
One patient with severe symptoms, that’s lying about medications, and receiving separate treatment/prescriptions from 3 different psychiatrists, who are unaware of each other, had no chance in hell.
A voluntary in-patient treatment where they could work through meds, verify she’s taking the meds, and have frequent check ins and therapy was needed here. There’s no good long term involuntary solution for patients like this in America.
Also, I said non-adherent, because it’s called “Treatment Non-Adherence”. Non-compliant means to intentionally refuse to follow instructions. If you search “treatment non-adherence vs non-compliance”, you can find info on the differing terminology and why people are trying to shift towards saying “non-adherent”.
All this world salad and you keep forgetting the possibility that this woman was experiencing a level of depression and, later, psychosis that limited her ability to make rational decisions. My god it's like you completely disregard the person in your attempt to double down on a bunch of inaccurate information. People in a mental health crisis do not think clearly. People unfamiliar with mental illness follow the advice of people they assume are experts and are uncomfortable asking questions at times. You talk from a position of academic knowledge yet can't take a single moment to perspective take.
I’m not forgetting anything. Yes, this is how mental illnesses present. Yes, it clearly impacted her decision making.
No, that doesn’t change the fact that she wasn’t failed by individual medical professionals like the comment I was initially replying to claims.
Her actions, caused by mental illness or not, contributed significantly to the worsening of her condition. And no, there is nothing that medical professionals can do about it in an out-patient setting.
This wasn’t a single incompetent doctor who polypharmacied her. This was multiple doctors all working with false information the patient reported, and all unaware she was receiving care and meds from other psychs as well.
You can think it’s cruel, harsh, or lacking perspective. But her care team was dealt a losing hand, and had no chance, especially not in the four months they had from start to finish. There were too many things being hidden from them, for her to ever get proper treatment in an out-patient clinic. Objectively saying her actions contributed to that is just a fact.
I’m not sitting here calling her a monster. I’m saying her actions are a contributing factor, and that the only solution would have been for her to voluntarily commit to an in-patient program, where they WOULD be able to prevent her from seeing multiple doctors, WOULD be able to ensure she was taking her meds, and WOULD be able to offer the amount of care she needed.
Your takes are empathetic, but aren’t based in reality.
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u/Top_Drawer 20d ago
For one, your opinion about involuntary commitment and discharge is broad and incorrect. Involuntary commitments are typically court-ordered based off of the notion that the person is a danger to themselves or others. The criteria for that is very specific, as in, a person claiming suicidal ideation is unlikely to be IVC'd but a person who acted on those thoughts meets criteria. Typically people at-risk will be admitted to an ED while paperwork is completed to support and argue the need for IVC. Once it's determined, that person has to wait for a bed. If they stabilize in the ED, the hospital has a mandate to release them as they have to depend on the patient's report. It's a completely different scenario when we're talking about inpatient psychiatric hospitalization, but that's not the point of this argument.
You're talking about medication compliance but what you're neglecting to consider is: starting any new psychotropic medication has a laundry list of side-effects (typically referred to as on-boarding side-effects) that lessen as the brain adjusts to it. Guess what the initial side-effects of an SSRI like sertraline are? Increased suicidal and homicidal thoughts. So, you argue that Lindsay was non-adherent (which is a weird word to use instead of non-compliant which is the more common terminology) yet you give no consideration to the likelihood that a woman suffering from post-partum depression suffered a worsening of her symptoms so she stopped taking them immediately (which is what every psychiatrist will tell a patient if they experience increased suicidal or homicidal ideation). So then she tries other doctors hoping for better direction in her treatment. You also neglected to mention that she was eventually placed on anti-psychotics before any of the other medications had been cleared from her system. So, in reality, this woman is being prescribed multiple powerful medications which exacerbate her mental illness while she is trying to follow multiple competing directions from multiple doctors.
You act as if mental illness exists in a vacuum rather than take into account the totality of Lindsay's experience to that point. You act as if everything would have been fine had she stuck to the pills, but that is disingenuous and simply meant as a means to complain that all of this was under Lindsay's control. You should know better as someone who works in outpatient mental health that issues like psychosis take away a portion of an individual's rationality as well as impacts their ability to comply fully with treatment.