Wednesday is Three-Day Day, Part I

I'm sure this varies from state to state, but here in this state, when someone signs himself into a psychiatric unit, he does so with the condition attached that if he believes he is ready to be discharged, and we do not, we have the right to hold him an additional three business days after he has notified us in writing of his desire to go. If we still don't feel the patient is ready for discharge after the time is up, and he won't retract the three day letter, we have the option at that point to file papers with a court asking for a hearing to commit the patient to our care.

Now, it often happens that patients sign these three-day letters over the weekend -- either all the word find puzzles have been filled in, so there's nothing else to look forward to but smokes, or they were brought here from some emergency room over the weekend and never throught they should have been admitted in the first place. Monday being the first full business day after the weekend, many of these three-days expire at 5pm on Wednesday. So tomorrow with be a big day for discharges, court papers, and intense negotiations with the patients. There are many strategies on both sides of this transaction, but I won't go into that now.

For now, I'll say that tomorrow I've got two three-day's expiring. What's at issue is not our opinion about whether these patients could benefit from further hospitalization, or even whether they need further hospitalization. It's whether we believe we would be putting either the patient or someone else in imminent risk of serious harm by unlocking the front door. In practice, though, what we really figure is whether a judge will likely believe us when we say that the patient is a danger to herself, or the patient when she says she's not.

Of tomorrow's two, one patient is quite paranoid, argumentative and lives in a homeless shelther for mentally ill women. She's here apparently because she's been cheeking her meds, and attacked her roommate in the middle of the night. She denies all of this. In fact, she denies having a mental illness, and states her only problem is that she needs to see a dentist, and why aren't I helping her with that?! The other is a middle-aged guy with a history of a few near-lethal suicide attempts, who has a vague and and convoluted story about some money having been stolen, resulting in his wanting to kill himself.

Anything can happen with a three-day -- despite what you've planned for and expected, at the last minute the doc can decide to discharge or file papers, the patient can retract, the patient can say she'll retract, and then not. Sometimes a patient gets a reality check from someone on the outside ("No, you can't come home until you've been back on the Zyprexa for another week, and if you promise to stop calling the FBI's field office every day.") and retracts under duress.

My prediction for tomorrow? One will retract and one will not. We won't try to commit either. One walks, one doesn't. Any guesses?

Stay tuned,

Madeline