Getting discharged is the major question asked by our patients from the first day of admission. It is hard to tell someone that, although they walked in and admitted themselves voluntarily, they cannot simply leave when they want to.
I’ve had this conversation more times than I like and so I wrote the article to put this information out on the internet for families and patients to read in times of lower stress.
– It Does Not Happen the Way You Think
By Shirley K Williams
This article is not an attempt to dissuade you from admitting to a psychiatric facility if you feel that you need the care, but rather an attempt to educate you on the legal aspects of release. This is a frustrating and confusing point for patients to grasp and frequently causes undo stress and anxiety. The process is in place for the protection of the patients, the public, and the hospitals. But like any process, it is slow and requires patience. When you are deemed ready for discharge, you will be allowed to leave as soon as the paperwork has been completed.
Once you have been admitted to a psychiatric hospital, you may regret being there and wish to make your escape. This is a very common reaction by all patients, whether they are admitted voluntarily or against their will. Finding yourself on a psychiatric unit with numerous people who have various afflictions can be quite unnerving at best and usually this is a crisis moment for you, so it is doubly unnerving. You will then find out just how different it is to be a patient in a psychiatric facility.
In a medical hospital, if you want to leave against medical advice, you are free to go after signing waivers. You just get your clothes on and leave. End of story. However, if you want to leave from a psychiatric facility, there is a lengthy process that you have to observe and you cannot simply walk out.
To understand this process, we first have to explore the reason for any admission to a psychiatric facility.
In today’s insurance driven, government controlled healthcare environment, the law is very clear that to be admitted, either voluntarily or involuntarily, you need to exhibit behavior that can be deemed dangerous to self or others by a mental health officer. Danger to self can be seen as not being able to take proper care of yourself, making suicidal gestures, or having no contact with reality. Danger to others can be seen as making very bad choices that ultimately can involve others, making gestures towards others that can be seen as aggressive, verbal aggression toward others, or physical aggression against another. You have to meet this restrictive criteria to be eligible for admission to any psychiatric hospital.
So you can see that getting out involves having been assessed by the mental health staff to see if you continue to show any of the signs and symptoms that got you admitted. The psychiatrist has an ethical duty to you and to others to be sure that once released, you will no longer be any danger. It really doesn’t matter that you say you are sorry and it will never happen again. The psychiatrist needs time to evaluate your mental status and to determine the probability of relapse into these behaviors again. There is a law that requires mental health professionals to warn others if you have made statements of intent to harm and are about to be released from the hospital.
Psychiatric services are provided by a team that includes the doctor, the nurse, the social worker, the therapists, and the unit staff. All of these people come together to discuss your behavior since admission and to determine suitability for discharge. You may even be included in this treatment team meeting, as your participation gives another piece of the puzzle.
The bottom line is that in order to be released from a psychiatric facility, you must be seen as someone who no longer presents a danger to self or others. This is something that is difficult for patients to understand but the law is very clear. So, unfortunately, getting released will take up to 72 hours or more to give staff time to observe and assess your mental status. This can be extremely uncomfortable for you, the patient, but it is absolutely necessary that the hospital and the staff feel sure that you will not longer exhibit any behaviors that can cause you or any other person any harm. I hope you can see the process for what it is and understand that everyone in the facility is actively working towards your discharge.
- EDs seeing more children for psychiatric care (nursingtrends.wordpress.com)
- Mentally ill behind bars (skwillms.wordpress.com)
- Father upset with psychiatric hospital (cbc.ca)
- Pediatric emergency department visits for psychiatric care on the rise (scienceblog.com)