Welcome to #SchizoChat, the biweekly forum where I ask questions about your mental health experiences, spout fun (?) facts about schizo-related topics, and answer the questions you send over comment/DM. Today we are talking about consent to treatment!
If you’ve missed some of our previous #SchizoChats about schizo symptoms, antipsychotics, asylums and more please check out my pinned tweet—I have them all linked there!
I'm hoping to add fun facts to this thread every 5 minutes or so, so stay tuned! #SchizoChat
I'm also running a big statistical analysis in the background, so if I suddenly drop out it is because my computer crashed. It's been happening a lot frequently.
I'm also running a big statistical analysis in the background, so if I suddenly drop out it is because my computer crashed. It's been happening a lot frequently.
Remember that everyone has the right to share their own experiences—please be respectful of others! You don’t know what they’ve been through. #SchizoChat
So what do I mean by “consent to treatment?” #SchizoChat
Many patients suffering from mental illness are given psychiatric treatment against their will/consent. How common is it, you ask? Check out this poll! At the time of tweeting 50% of respondents say they've been forced into care.
#SchizoChat
#SchizoChat
This could be forcing patients into hospitals/institutions against their will and/or forcing them to take medication #SchizoChat
How is this allowed and what impact can it have on mentally ill patients? #SchizoChat
If you have been treated against your will and you don't mind sharing your experiences please let me know! I'm curious to see what everyone's responses are. #SchizoChat
Forced institutionalization, or involuntary commitment, is a legal process. Individuals deemed severely mentally ill may be confined for treatment in a psychiatric hospital or forced to undergo outpatient treatment. #SchizoChat
This process generally starts with a short hospital stint—generally 72 hours, during which patients are evaluated to determine if inpatient or outpatient services are required. #SchizoChat
If psychiatric doctors determine that the patient requires involuntary commitment to an inpatient facility this claim is evaluated in a formal court hearing. Patients are entitled to legal counsel during this hearing. #SchizoChat
In many countries, including the U.S. Canada, Russia, and Israel, patients can only be committed if they are considered a danger to themselves or others. #SchizoChat
CW: suicide
Being a danger to oneself includes imminent suicide risk, which of course could be the result of depression but in schizo-type patients it can also sometimes be the result of psychotic delusions and hallucinations. #SchizoChat
Being a danger to oneself includes imminent suicide risk, which of course could be the result of depression but in schizo-type patients it can also sometimes be the result of psychotic delusions and hallucinations. #SchizoChat
CW: suicide
Every time I see a knife a voice tells me to slit my wrists. Every time I see a bridge a voice tells me to jump.
I keep myself safe by avoid triggers and through a careful combination of treatments but trust me-- suicide risk and hallucinations can go hand-in-hand.
Every time I see a knife a voice tells me to slit my wrists. Every time I see a bridge a voice tells me to jump.
I keep myself safe by avoid triggers and through a careful combination of treatments but trust me-- suicide risk and hallucinations can go hand-in-hand.
As you might imagine, the ability to forcibly institutionalize citizens has been abused to persecute political adversaries, which was especially common in the Soviet Union but also happened in the U.S. during the anti-communism hysteria. #SchizoChat
But the vast, vast majority of the time folks are institutionalized to keep them or others safe #SchizoChat
Inpatient treatment can be quite expensive. If you have been institutionalized, how much did you end up paying? #SchizoChat
In addition to inpatient treatment in psychiatric hospitals, at-risk patients may be forced to prepare a program for outpatient care. This “outpatient commitment” may also be a formal court proceeding. #SchizoChat
As the name suggests, patients undergoing outpatient commitment still live in the community (rather than in a facility) but they are forced to adhere to strict orders to take medications, have appointments with professionals, and sometimes even stop abusing substances #SchizoChat
Outpatient treatment is generally much less expensive and less restrictive than inpatient treatment, but it can be less safe for at-risk patients. #SchizoChat
Oh, I forgot to mention at the start: I study bird development, not schizo-related topics, so if you see that my tweets contain an error/incorrect fact please let me know and I will fix it! #SchizoChat
Patients may also undergo less formal procedures, such as guidelines to follow to avoid hospitalization signed voluntarily rather than under court order. It depends on the local jurisdiction. #SchizoChat
CW: suicide
This has happened to me in the past. I went to university counseling services to seek help for suicidal voices and was told I was going to the hospital. As I cannot afford a hospital stay I was able to beg my way out of it by signing a non-legally-binding contract.
This has happened to me in the past. I went to university counseling services to seek help for suicidal voices and was told I was going to the hospital. As I cannot afford a hospital stay I was able to beg my way out of it by signing a non-legally-binding contract.
This is definitely not the rule—many patients don’t have the privilege of arguing their way out of expensive hospital stays! Plus, remember, commitment is used to help patients. Saving their life is more important than their ability to pay. #SchizoChat
Instead of going to the hospital I was told that I needed to fill out a plan for everyday activities—what tasks I was going to do to stay healthy (like art or eating certain foods), who I was going to check in with, things like that. #SchizoChat
It was definitely preferable to a hospital stay for me but it still felt super humiliating to sign a contract promising I’d eat feel-good foods. Although it was a great excuse to buy all of my favorite snacks. Doctor’s orders, after all. #SchizoChat
Why are psychiatric doctors allowed to force patients to do anything against their will? After all, we are rarely forced to treat other illnesses, why are mental illnesses different? #SchizoChat
Involuntary treatment falls under two legal categories. First, officials have the right to remove someone to protect the public from harm. This is what we refer to as “police powers.” This is also why you can be arrested and incarcerated for breaking laws. #SchizoChat
Second, officials have the right to remove someone from a situation to protect that person from harm. We refer to this as “parens patriae.” This is also why abused children can be removed from bad situations. #SchizoChat
How do we decide if someone is a danger to themselves? Is it only when a person is doing something that could harm themselves or can it also mean someone who is at risk of doing something to harm themselves? It’s a complicated gray area. #SchizoChat
CW: suicide
For example, it seems pretty clear that someone holding a gun to their head is a danger to themselves. But should we also institutionalize someone who has thoughts of putting a gun to their head even if they aren’t acting on those thoughts? #SchizoChat
For example, it seems pretty clear that someone holding a gun to their head is a danger to themselves. But should we also institutionalize someone who has thoughts of putting a gun to their head even if they aren’t acting on those thoughts? #SchizoChat
Have you ever felt like a threat to yourself or others? Let me know or answer this anonymous poll! I'm guessing I'm not the only one who has. #SchizoChat
CW: suicide
For many schizo-type patients, these involuntary thoughts are ordinary if not common. I frequently hear voices telling me to kill myself. Am I a threat to myself, or can I just brush those voices away as a hallucination? #SchizoChat
For many schizo-type patients, these involuntary thoughts are ordinary if not common. I frequently hear voices telling me to kill myself. Am I a threat to myself, or can I just brush those voices away as a hallucination? #SchizoChat
Or what about patients whose mental health keeps them from eating frequently enough? Are they in danger of starving? Should they be committed? #SchizoChat
CW: eating disorder
Just in the last few months I have gone weeks where I cannot eat more than 500 calories a day. I was functioning normally otherwise (or normal enough to go to work, take care of pets, etc.) I just couldn’t eat. Should I be institutionalized? #SchizoChat
Just in the last few months I have gone weeks where I cannot eat more than 500 calories a day. I was functioning normally otherwise (or normal enough to go to work, take care of pets, etc.) I just couldn’t eat. Should I be institutionalized? #SchizoChat
Honestly, if I was committed at some point in the last few years I think it would probably have been warranted. I'm pretty bad at taking care of myself at times.
If you've been committed, do you think it was warranted? #SchizoChat
If you've been committed, do you think it was warranted? #SchizoChat
There is a complicated legal basis for forced psychiatric care. If you want to learn more about the laws please check out Rael Jean Isaac and Virginia Armat’s book Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill #SchizoChat
Getting patients treatment can be lifesaving, even if they don’t appreciate it in the moment. That doesn’t make the prospect of involuntary commitment any less terrifying for patients (including me!). #SchizoChat
At least I can understand that I have a mental illness and I’ve come to terms with the idea that I may at times be forced to seek inpatient and outpatient care. But what about individuals who do not believe they have a mental illness? #SchizoChat
You may recall (from our first #SchizoChat) the idea of anosognosia, or the lack of awareness of an illness. As many as 50% of schizo patients suffer from this: they legitimately believe that nothing is wrong.
Anosognosia isn’t stubbornness or the result of patients lying to themselves. Remember—these are illnesses of the brain. An inability to recognize illness likely results from the illness itself. #SchizoChat
I am so so grateful that I currently do not suffer from anosognosia. I understand that I am ill, I understand I need treatment and I follow doctors orders even though the medications often suck. I hope I stay this way! Fingers crossed. #SchizoChat
How do you treat someone who insists nothing is wrong with them? As you can imagine, it’s complicated. #SchizoChat
In 1973 psychologist David Rosenhan tasked students with going to a psychiatric institution and faking symptoms of schizophrenia. They were committed and forced to receive treatment even though they acted normally as soon as they were inside. #SchizoChat
This “Rosenhan experiment” shook the field of psychiatry—were psychiatrists wrong in many of their diagnoses? You may recall from past #SchizoChat-s that psychiatric treatment can be rough. Are some patients undergoing it for nothing?
So if a patient claims they aren’t sick, should doctors take them at their word? Or assume, like the doctors in the Rosenhan experiment, that the patients were actually ill when the patients are not? #SchizoChat
Interesting side-note: new research suggests that the results of the Rosenhan experiment were fabricated. If you are interested you can read more here: nature.com/articles/d4158… #SchizoChat
Involuntary commitment can be terrifying, heartbreaking, and financially burdensome on people who understand that they have an illness. You can imagine then how they must impact people who cannot understand that they are ill. #SchizoChat
Once committed, patients may also be involuntarily restrained. Some patients say it makes them feel safer, others find it horrible. For more information on restraints check out our #SchizoChat about the history of asylums!
What happens in an inpatient facility? I have never (yet) been in an inpatient facility so I cannot tell you as well as others can but I can at least provide you with others’ accounts. Add yours! #SchizoChat
CW: self harm
Patients are denied access to anything they could use to harm themselves, like belts, shoestrings, and sharp eating utensils. #SchizoChat
Patients are denied access to anything they could use to harm themselves, like belts, shoestrings, and sharp eating utensils. #SchizoChat
Most facilities provide very structure schedules: consistent meals, quite time, physical activity, recreation time, group therapy, and individual therapy. #SchizoChat
An important part of this schedule is often medications. Just as patients can be involuntarily committed they may be also involuntarily forced to take medications. #SchizoChat
Have you been forced to take a psychiatric medication? How was your experience? I'm lucky that the only medications I've ever had to take were ones that I sought out. #SchizoChat
You may recall from our previous #SchizoChat that psychiatric medications are quite problematic. Medications may not work for every patient, they are expensive, and they often come with awful side effects. #SchizoChat
My medications are pretty good at the moment side-effect-wise but I still spend almost all day trying to keep myself from throwing up or fainting from dizzy spells. And these are the good ones! Oh well, I’m not psychotic currently so it’s a win. #SchizoChat
As we discussed in that #SchizoChat there are many reasons why patients would refuse medications! You can imagine this is especially true for patients who do not believe that they are ill.
A recent study (Robinson 2010) showed that 82% of the schizophrenic patients studied had a major relapse within five years. The most frequent cause of that relapse? Failure to take medication. #SchizoChat
So how do you force an unwilling patient to take medication? Some antipsychotic medications are given as shots. Other times patients are forced to prove that they swallowed the pills (rather than holding them in their cheeks or under their tongues). #SchizoChat
Forcing patients to take medication can be especially traumatic, especially if the patient experiences major side effects. You may recall from our previous #SchizoChat that some of these side effects may be permanent!
Patients may have very little say in their psychiatric treatment if they are involuntary committed or even if they are involuntarily participating in an outpatient program. And remember—refusing medication can be grounds for commitment itself! #SchizoChat
To sum it up, patients who do not believe they are ill may be involuntarily committed, forced to take medications they do not believe they need, and may ultimately suffer serious side-effects even if the meds ultimately keep them from harm. #SchizoChat
But also remember the flip side: patients may be involuntarily committed, receive the help that saves them, and may be released with a plan to keep themselves healthy for the rest of their lives. #SchizoChat
Would you work to have an at-risk friend or family member committed? Why or why not? Let me know!
How do we make involuntary commitment less traumatic for patients? #SchizoChat
First and foremost, we need to provide accessible and affordable treatment options for the mentally ill. If we can keep folks from reaching the point where they are a danger to themselves or others we wouldn't need involuntary commitment laws. #SchizoChat
There are many many advocates who work to make sure that patients are treated well within facilities and that their basic human rights are observed. Know of one such individual or organization? Tag them below! #SchizoChat
We must also work to #EndTheStigma about mental illness and institutions. There is absolutely nothing wrong with seeking inpatient and outpatient care! It can save your life and help you get back on track. #SchizoChat
Yet I must admit one reason I am terrified of being involuntarily committed is the stigma. I wouldn’t want my friends, family, or employer to know that I am *that* mentally ill. #SchizoChat
But again, there is nothing wrong with being mentally ill. Schizo doesn’t make me a bad person, or less of a friend or scientist. We shouldn’t be made to feel ashamed of seeking help, no matter what that help looks like. #SchizoChat
To conclude, involuntary commitment is a legal practice that can be traumatic but could ultimately benefit patients. Every patients’ experience is different and should be respected! #SchizoChat
If you are comfortable sharing your experiences with involuntary (or voluntary) commitment please do! I am curious and I’d love to be more comfortable with it if I end up being committed at some point (always a possibility). #SchizoChat
That concludes our #SchizoChat for this week. Tune back in two weeks from now! I haven’t picked a topic yet so please send me your ideas! And, as always, please share to get the conversation going and help to #EndTheStigma!
Hey @threadreaderapp can you unroll this thread please?
@threadreaderapp Here's the html version if you would prefer to read it this way: threadreaderapp.com/thread/1197303…
