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> in a crisis and had me sent to 72 hour hold Oftentimes it's not even that, or can go to the opposite extreme. It can be "or until evaluated by a psychiatrist

> in a crisis and had me sent to 72 hour hold Oftentimes it's not even that, or can go to the opposite extreme. It can be "or until evaluated by a psychiatrist or MHP". I'm a paramedic in Washington. The biggest example of this I remember was a 14yo, intentional pharma overdose. We brought her in, "invol". Four and a half hours later, call goes out, same address, 14 year old girl, overdose. We checked with dispatch, was there a glitch? Nope. Psychiatrist had spoken to her, determined she was "no threat to herself". Parents drove her home, and within fifteen minutes she'd locked herself in the bathroom again, and taken more of the same meds. Was furious. Between the psychiatrist, parents not locking up the meds, hell, the ER, she probably still had drugs in her system. "Maybe hold on to her for more than four hours this time." Also, tangentially, if EMS wants to transport you involuntarily, we actually need Law Enforcement involvement - they don't even necessarily need to talk to the patient, but they do need to complete the paperwork that takes them into custody, which they then "assign" to us. EMS generally has no power to treat you against your will (however, if you are actively a threat to yourself, we can act on that, usually restraint and sedation. Or there is 'implied consent' where if you lose the ability to effectively consent, the law assumes that a rational person would want aid to be rendered).

JohnMakin 2y ago
I’m aware of a lot of this dynamic and have written extensively about it elsewhere - in this case though, especially looking back, it was ridiculous. I was extremely stressed about finals and didnt know what to do. Was borderline homeless and struggling to support myself. I had never seen a counselor or therapist before and was mildly depressed. she asked me a few leading questions like “how would you feel if you failed your finals and dropped out?” and I said something along the lines of “I guess I’d feel suicidal.” then, “do you feel suicidal now?” and I said I wasn’t sure. Then she goes, “so you cant tell me if you go home right now, you cant guarantee me you won’t kill yourself?” now at this point I had zero ideation even, no plan, no intentions of killing myself, but being a pedantic dork studying philosophy I said I wasn’t sure about that, because I really wasn’t sure what to say. 10 minutes later a cop shows up, puts me in handcuffs, parades me off campus in them and people I knew saw it. I had absolutely no clue what was going on and had to sign papers I didn’t want to sign and when I protested the answer was basically “you can come voluntarily or with force, your choice.” It ended up doing far more harm than good for me. I know physicians personally that will often throw people into 72 hour holds in the ER “just to be safe,” either not understanding or caring the long term consequences of being put in an involuntary hold. These same physicians have told me she did the “right” thing but anyone with common sense and experience could figure out very quickly I was not a danger to anyone. I was just trying to find some help because I was overwhelmed.
- FireBeyond 2y ago
  I am very sorry for your experience - that's entirely horrible. I'm the same as you, too, and pondering the deeper, thinking answers. That whole process sounds messed up. I would say over 99% (and that's not an exaggeration, but literal) of our invol patients do not have police involved (other than to submit paperwork to the hospital), let alone cuffs. Our EMS protocols DO require soft restraints during transport, but we generally make a point of being apologetic about it, putting them on at the last moment and that we will take them off ASAP (essentially once the ambulance is in Park). Even this is only because, unfortunately, some of those patients have attempted to exit a moving ambulance, sometimes at freeway speeds. I'm curious what papers were put in front of you, though, as the whole point of the involuntary custody process is that your acknowledgement is not necessary (at that point - after the mental health hold hearing, in front of a judge - you are asked to acknowledge/sign, but not required).
  - JohnMakin 2y ago
    This is california law and I believe the code is 51-50 but this is over 20 years ago so I’m a little fuzzy. I think looking back they were just liability papers the university was having me sign, I remember having to acknowledge things (that I didnt have time to read) that I wouldnt be able to purchase a firearm for 7 years and a whole bunch of other legal gobbledegook about being detained and what my rights were. The whole time a cop is standing above me making me sign it though and no one was answering my questions. I was extraordinarily confused for most of it until the cuffs went on and I had kind of a vague understanding I had said something wrong. At no point did anyone tell me what I did other than to tell me stuff like “you’re very ill and are being looked after for your own safety, care will be provided to you and you will be ok” kind of stuff. I cannot stress enough that this assessment was based on less than a 10 minute conversation with me. They even had a followup with me I was forced to go to, because I had missed the finals (because i was gone for like 3 days) and therefore actually failed. So they then convinced me to do a medical withdrawal to save my grade which very ironically led me to actually dropping out because I lost all my scholarships and grants. I would have probably been fine had I never sought help, and I suspect although my experience was extreme and probably malfeasant, that this treatment of people undergoing difficult mental things is probably very commonplace within the system.

JohnMakin 2y ago

I’m aware of a lot of this dynamic and have written extensively about it elsewhere - in this case though, especially looking back, it was ridiculous. I was extremely stressed about finals and didnt know what to do. Was borderline homeless and struggling to support myself. I had never seen a counselor or therapist before and was mildly depressed. she asked me a few leading questions like “how would you feel if you failed your finals and dropped out?” and I said something along the lines of “I guess I’d feel suicidal.” then, “do you feel suicidal now?” and I said I wasn’t sure. Then she goes, “so you cant tell me if you go home right now, you cant guarantee me you won’t kill yourself?” now at this point I had zero ideation even, no plan, no intentions of killing myself, but being a pedantic dork studying philosophy I said I wasn’t sure about that, because I really wasn’t sure what to say. 10 minutes later a cop shows up, puts me in handcuffs, parades me off campus in them and people I knew saw it. I had absolutely no clue what was going on and had to sign papers I didn’t want to sign and when I protested the answer was basically “you can come voluntarily or with force, your choice.” It ended up doing far more harm than good for me. I know physicians personally that will often throw people into 72 hour holds in the ER “just to be safe,” either not understanding or caring the long term consequences of being put in an involuntary hold. These same physicians have told me she did the “right” thing but anyone with common sense and experience could figure out very quickly I was not a danger to anyone. I was just trying to find some help because I was overwhelmed.

FireBeyond 2y ago
I am very sorry for your experience - that's entirely horrible. I'm the same as you, too, and pondering the deeper, thinking answers. That whole process sounds messed up. I would say over 99% (and that's not an exaggeration, but literal) of our invol patients do not have police involved (other than to submit paperwork to the hospital), let alone cuffs. Our EMS protocols DO require soft restraints during transport, but we generally make a point of being apologetic about it, putting them on at the last moment and that we will take them off ASAP (essentially once the ambulance is in Park). Even this is only because, unfortunately, some of those patients have attempted to exit a moving ambulance, sometimes at freeway speeds. I'm curious what papers were put in front of you, though, as the whole point of the involuntary custody process is that your acknowledgement is not necessary (at that point - after the mental health hold hearing, in front of a judge - you are asked to acknowledge/sign, but not required).
- JohnMakin 2y ago
  This is california law and I believe the code is 51-50 but this is over 20 years ago so I’m a little fuzzy. I think looking back they were just liability papers the university was having me sign, I remember having to acknowledge things (that I didnt have time to read) that I wouldnt be able to purchase a firearm for 7 years and a whole bunch of other legal gobbledegook about being detained and what my rights were. The whole time a cop is standing above me making me sign it though and no one was answering my questions. I was extraordinarily confused for most of it until the cuffs went on and I had kind of a vague understanding I had said something wrong. At no point did anyone tell me what I did other than to tell me stuff like “you’re very ill and are being looked after for your own safety, care will be provided to you and you will be ok” kind of stuff. I cannot stress enough that this assessment was based on less than a 10 minute conversation with me. They even had a followup with me I was forced to go to, because I had missed the finals (because i was gone for like 3 days) and therefore actually failed. So they then convinced me to do a medical withdrawal to save my grade which very ironically led me to actually dropping out because I lost all my scholarships and grants. I would have probably been fine had I never sought help, and I suspect although my experience was extreme and probably malfeasant, that this treatment of people undergoing difficult mental things is probably very commonplace within the system.