Tag Archives: Danger

I – #AtoZChallenge on Mental Health

Welcome to the letter I post of my #AtoZChallenge on mental health. This was a hard letter again, but I stil have a few words for you. Here goes.

Intramuscular Injections

Antipsychotics can be taken by mouth, but many can also be injected in a patient’s muscle. That way, they need to be administered only once every week or two rather than taken daily, because in a muscle, they’re absorbed slowly and steadily. Intramuscular injections, also caled “depot medication”, are often used on patients who refuse oral medication.

Involuntary commitment

Like I said in my letter D post when discussing danger, patients who are a danger to themselves or others can be committed to a psychiatric hopsital involuntarily. In the Netherlands, there are several ways a patient can be committed involuntarily. In acute situations when a patient is a grave danger to themselves or others, they can be taken into care with the mayor’s approva. Usually, this takes the form of a simple phone call by a psychiatrist to the mayor (or their substitute), who will almost automatically give the go-ahead. A judge will see the patient committed this way within a few days and approve or deny the involuntary commitment. An acute section lasts three weeks and can be prolonged with another three weeks once.

If a situation is less of an acute problem or after at most six weeks on an acute section, a patient can be brought to a judge for a longer section. A patient does not need to be an immediate and grave danger to themselves or others; merely being a danger suffices.

There are two newer forms of commitment too. First, there’s the observation section, which lasts three weeks and is meant for people who haven’t yet been diagnosed with a mental illness and aren’t a grave, acute danger either. A patient on an observation section can’t be subjected to force. A patient who realizes they might become a danger at some point, can file for self-commitment, indicating they will be admitted to a hospital and treated if certain criteria have been met, whether they want to at this time or not.

A patient can’t at this point be forced into outpatient treatment unless through a provesional section, threatening involuntary inpatient treatment if they don’t comply with their treatment plan while in the community. The government is trying to change the law so that patients can in fact be forced into any form of mental health treatment.

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D – #AtoZChallenge on Mental Health

Welcome to my letter D post in the #AtoZChallenge on mental health. Today, I have quite a few words to share with you again.

Danger

In the Dutch mental health act, people can be involuntarly committed to a mental hospital if they’re a danger to themselves or others. Danger can refer to many things, including self-harm or aggression, but also to “social disintegration” or “eliciting other people’s aggression with one’s behavior”. In other words, if you’re plain irritating, you’re a “danger” to yourself.

Dependence

With the current rehabilitation model of psychiatric care, we’re not supposed to become dependent anymore. That is, we can clean our rooms and do other household chores, but often only when told to. I have often experienced the same sense of dependence no matter whether practical independence was encouraged or not.

Depression

One of the more common mental illnesses within the general population. It is not as common among long-term mental hospital inpatients, although some will claim they feel “depressed”. That usually refers to minor, everday depression. I was once screened for depression because a mental nurse insisted I get screened after teling him how low I felt. Being borderline, I often feel slightly depressed but my emotions also shift rapidly.

Diagnosis

What the mental health professionals say is wrong with you. You need a primary diagnosis, which dictates practically everything about your treatment. If you happen to have more than one mental disorder, too bad.

Discharge

When you’re let out of the mental hospital or, in outpatient treatment, when treatment is discontinued. Discharge is usually a mutual agreement between the patient and their treatment provider. An exception is involuntary commitment, when someone can be discharged when their section runs out. People can also be forcibly discharged if they have improved so much that they no longer need the mental hospital, have broken the hospital rules multiple times, or refuse every treatment offered.

Drugs

This can refer to either the drugs handed out like smarties by mental health professionals or to the street drugs patients get in the hospital parking lot. Seriously, drug dealers wait right outside of a mental hospital and patients with privileges will get their (and other people’s) drugs. Outside of my unit is a billboard that says drug use is prohibited, but I’ve smelled people smoke marijuana and who knows what else right next to the billboard.

Autism and Elopement

As a teenager, I ran off quite frequently. Sometiems, I started off with a purpose, such as going to the mall, but I ended up lost and then wandered off in a meltdown. Sometimes, I ran away because of an argument with my parents, because I was overwhelmed, or for no apparent reason at all. Running off is pretty common in young children and teens, but when you have disabilities, it complicates the matter. For example, I would not as easily have gotten lost on my way to the mall had I not been blind. Parents of autistic children often talk about elopement as if it is somethig unique to autistic children. This is of course not true – neurotypical children elope too -, but, when a child has social and communicativve difficulties, elopement does become a more dangerous thing.

In The Everything Parent’s Guide to Children wiht Autism, 2nd edition, by Adelle Dameson-Tilton and Charlotte E. Thompson (2012), there’s a specific section on elopement. Strategies advised to prevent it include the usual: put extra locks on doors to the outside, install an alarm system, etc. However, the authors also advise parents to establish a routine whereby the child knows when they can and can’t leave the home. For example, for a young child, they can’t leave the home unsupervised. Evene as an adult, I need to have a routine that says I can’t leave the ward unsupervised unless I have a specific goal and know the way there. Most autistic children outgrow elopement, but some do not. I feel that, especially with older children, explaining elopement and why it is dangerous, is vital. Social stories or pictures may help with this. The reality is, even on locked institution wards, people elope, and there are no places in the care system where your autistic (adult) child will get the one-on-one supervision you might provide them at home.

Jameson-Tilton and Thompson advise always informing trusted people in your neighborhood and the local police of your child’s risk of elopement. When I lived indpenednetly, I didn’t inform the police, but they got to know me soon enough. As Jameson-Tilton and Thompson suggest, a MedicAlert identification bracelet may be useful. In the Netherlands and I believe many other countries too, autism cards are sold which have a few key points about autism on them and on which you can write your name and an emergency contact number. For non-verbal autistics, an identification bracelet is still needed, because reaching in your pocket wihtout warnign may be interpreted as dangerous by the police, so you will need to be able to say that you have a card which explains your disability.