On 2004-07-11 18:26:00, Nihilanthic wrote:
"Tell me, why is a locked-in 'residential treatment' EVER necessary?
Being in a hospital for a sickness or a closed ward to physically prevent you from killing yourself or hurting someone aside, what REQUIRES it?"
That *is* what requires a locked ward. A patient that is an imminent danger to himself or others who either needs to be stabilized or *cannot* be stabilized.
Being psychotic tends to vastly increase a patient's risk for violence to others. Some kinds of depression vastly increase a patient's risk for violence towards himself.
Some of these patients are "good medication responders," which means if you can get them on the right dose of the right medications, you can handle their problems through outpatient care and following their condition on a maintenance dose of their meds. (I fall in that category.)
Of the good medication responders, some accept that they have a major mental illness and want to be sane and have few enough side-effects that they follow doctor's orders and take their medications (I fall in that category.)
Then you have people who, as a result of their illness and their side effects and the stigma associated with mental illness don't accept or believe that they're mentally ill, when they are, and won't take their medication.
Those folks tend to get rehospitalized over and over again, stabilized on their medication, and released. Some states now have something called "outpatient commitment" which means that if they go off their meds their family and police don't have to wait for the danger to become imminent to take them back to the hospital and get them back on their meds. The choice (and they do have a choice) is take the meds or stay in the hospital.
The folks who aren't medication responders don't have a choice. As long as they're dangerous, they have to stay hospitalized.
Then you have people whose danger to themselves or others is from severe cognitive impairment rather than mental illness. Everything from severe autism to severe mental retardation.
Frequently those folks can stay home, if their families have the resources, or be placed in an unlocked group home.
Sometimes, the patient is so not-competent and so prone to wander, and prone to sudden outbursts of anger and violence, that they have to be kept in a locked ward for their own or others' safety.
Some Alzheimers patients are so prone to wander and so far gone that they have to be kept in a locked ward too keep them from wandering off and getting hurt.
*Some* drug abuse problems have such an immediate, high risk of death or injury to self or others (heroine addiction, huffing, PCP, alcoholism at the DT stage), that in the *very short term* a locked ward is justified, but *only* if the danger is imminent and *only* until the patient is stabilized. More than three weeks or so at the absolute outside would be excessive---I'm just talking the immediate stabilization of the patient, not the whole course of substance abuse treatment.
And, of course, actual criminal behavior justifies locking someone up----but only after a fair trial with full due process of law.
And, of course, parents are no more qualified to decide if a particular teen patient needs a locked ward than they are to diagnose the kid and prescribe medication and dosages. Nobody of any age should be involuntarily committed just on the say-so of a relative. There's just too much room for incompetence and unconscionable conflicts of interest.
Timoclea
