Just Sign Here

Posted on December 22, 2005 in California Watch Mania The Orange

I’m as firm an advocate of patient rights as any, but there are times when I feel that my own kind can be their own worst enemies. For the second time in a year, one of my support groups has been haunted by persons who thought themselves competent enough to take a third individual out of a psychiatric ward. That person ended up with an injured wrist on the very day he was released. (Another received a beating from local police and worse.)

Here in California, you can have a court hearing after a week. The judge decides if you are fit enough to leave the ward on your own. All they ask is that someone sign out for you. There is no requirement that the person signing you out find you a safe place or ensure that you continue your treatment as an outpatient. They can dump you on the street or take you back to their place for a night of sexual harassment, drug use, or physical abuse.

There’s no call for competency of the signators. In this case, if the court had investigated, it would have found that the two people who agreed to accompany the third out the door were not, themselves, mentally competent. Simple interviews would have revealed that one was in a combative mood and the other believed that his depression was caused by demons. After removing the person from the hospital, they left him to engage in a little reckless activity that resulted in his spraining his arm.

The psychiatrist tried to convince the court that the patient was not yet ready, but Orange County — in its great wisdom — decided that clearing a bed in the hospital overruled what was right for the patient and turned him over to two men in mania.

This incident and an earlier one have moved me to make sure that my psychiatric advance directive precludes anyone but my wife and my cousins from removing me from care.

The law which allows this was crafted by overzealous patient rights activists who found allies in cost-cutting legislators. When they emptied the hospitals, they did not provide outpatient care as they promised. To ensure that the truly difficult cases didn’t remain on the public weal indefinitely, they crafted this bill to lance what they saw as a rising boil. It allowed anyone to go to a court and sign a patient out of the hospital. Then dump them on Skid Row.

Bipolars who help other bipolars mean well. They don’t want their friends cooped up forever. When friends have come to me, however, I prefer to leave it to their families and their psychiatrists to decide, which these two did not do. I encourage those on the inside to work through their treatment and be well when they leave. I feel there needs to be oversight over the process, requiring that those who remove the patient from the hospital be responsible for their care. Ideally I would restrict the right to patient families and to individuals specifically named in psychiatric advance directives.

Patient rights advocates have told me that they will oppose such a law. Why? Because it will make their job harder. “We have to do what the patient wants,” they tell me. I understand where the law came from. It was designed to protect patients from scheming doctors and family members who want to keep them inside forever. But the same patients are not protected from ruthless private conservatorships which can seize their assets and spend the money while taking a fee for their “services”. Or from patient rights advocates who don’t think a recent suicide attempt merits extra watchfulness. Or reactionary courts out to practice a little Social Darwinism.

That’s California for you. We throw the sick into the streets or find a way to make money from them. All without accountability.

Accountability can be a very hard concept for bipolars in mania and court officials to grasp.