Involuntary Psychiatric Care: The Part of the ‘Free Britney’ Saga That Could Happen to Anyone

Yves here. Even in the Communist state of New York, you can be committed for psychiatric care/evaluation for 72 hours against your will. A friend married a woman who turned out to be a Stage 4 alcoholic, and she’d regularly initiate screaming fights with him and then call 911. Despite her being 5’2″ and him being 6’3″, the cops quickly saw she didn’t act like an abused woman and would haul her off to the drunk tank. I don’t think they were every charged (as in asked to pay for that) but she did wind up getting so aggressive once that she was committed for a week (the standard in New York is danger to yourself or others). Again not sure what the financial arrangements were.

Aside from the similarities in backgrounds (both in tech, both art majors in college, both had dentists as fathers), they both had schizophrenic brothers. The husband had helped his brother with managing his condition (including occasionally talking him off the roof when he went off his meds; the brother became a very successful laser light show designer). Most of his friends thought the husband felt he could similarly rescue his wife, which turned out not to be the case.

When they divorced, the judge ruled she got only a desk and a chair. Her ex paid for her to have an apartment for a year, but she still wound up homeless.

The bigger point of this shaggy dog story is that I suspect the biggest abuses of institutional psychiatric occur with well off or perceived to be well off patients, particularly with a family keen to escape embarrassment, or those who can be consigned to mills, heavily medded.

By Dr. Christopher Magoon, a resident physician at the Columbia University Department of Psychiatry in New York City. Originally published at Kaiser Health News

When Britney Spears last went before a judge, in June, she bristled as she told of being forced into psychiatric care that cost her $60,000 a month. Though the pop star’s circumstances in a financial conservatorship are unusual, every year hundreds of thousands of other psychiatric patients also receive involuntary care, and many are stuck with the bill.

To the frustration of those who study the issue, data on how many people are involuntarily hospitalized and how much they pay is sparse. From what can be gathered, approximately 2 million psychiatric patients are hospitalized each year in the United States, nearly half involuntarily. One study found that a quarter of these hospitalizations are covered by private insurance, which often has high copays, and 10% were “self-pay/no charge,” where patients are often billed but cannot pay.

I am a psychiatrist in New York City, and I have cared for hundreds of involuntarily hospitalized patients. Cost is almost never discussed. Many patients with serious mental illness have low incomes, unlike Britney Spears. In an informal survey of my colleagues on the issue, the most common response is, “Yeah, that feels wrong, but what else can we do?” When patients pose an acutely high risk of harm to themselves or others, psychiatrists are obligated to hospitalize them against their will, even if it could lead to long-term financial strain.

While hospitals sometimes absorb the cost, patients can be left with ruined credit, endless collection calls and additional mistrust of the mental health care system. In cases in which a hospital chooses to sue, patients can even be incarcerated for not showing up in court.  On the hospital side, unpaid bills might further incentivize a hospital to close psych beds in favor of more lucrative medical services, such as outpatient surgeries, with better insurance reimbursement.

Rebecca Lewis, a 27-year-old Ohioan, has confronted this problem for as long as she has been a psychiatric patient. At 24, she began experiencing auditory hallucinations of people calling her name, followed by delusional beliefs about mythological creatures. While these experiences felt very real to her, she nevertheless knew something was off.

Not knowing where to turn, Lewis called a crisis line, which told her to go to an evaluation center in Columbus. When she drove herself there, she found an ambulance waiting for her. “They told me to get into the ambulance,” she said, “and they said it would be worse if I ran.”

Lewis, who was ultimately diagnosed with schizophrenia, was hospitalized for two days against her will. She refused to sign paperwork acknowledging responsibility for charges. The hospital attempted to obtain her mother’s credit card, which Lewis had been given in case of emergencies, but she refused to hand it over. She later got a $1,700 bill in the mail. She did not contact the hospital to negotiate the bill because, she said, “I did not have the emotional energy to return to that battle.”

To this day, Lewis gets debt collection calls and letters. When she picks up the calls, she explains she has no intention of paying because the services were forced on her. Her credit is damaged, but she considers herself lucky because she was able to buy a house from a family member, given how challenging it would have been to secure a mortgage.

The debt looms over her psyche. “It’s not fun to know that there’s this thing out there that I don’t feel that I can ever fix. I feel like I have to be extra careful — always, forever — because there’s going to be this debt,” she said.

Lewis receives outpatient psychiatric care that has stabilized her and prevented further hospitalizations, but she still looks back on her first and only hospitalization with scorn. “They preyed on my desperation,” she said.

While it is likely that many thousands of Americans share Lewis’ experience, we lack reliable data on debt incurred for involuntary psychiatric care. According to Dr. Nathaniel Morris, an assistant professor of psychiatry at the University of California-San Francisco, we don’t know how often patients are charged for involuntary care or how much they end up paying. Even data on how often people are hospitalized against their wishes is limited.

Morris is one of the few researchers who have focused on this issue. He got interested after his patients told him about being billed after involuntary hospitalization, and he was struck by the ethical dilemma these bills represent.

“I’ve had patients ask me how much their care is going to cost, and one of the most horrible things is, as a physician, I often can’t tell them because our medical billing systems are so complex,” he said. “Then, when you add on the involuntary psychiatric factor, it just takes it to another level.”

Similarly, legal rulings on the issue are sparse. “I’ve only seen a handful of decisions over the years,” said Ira Burnim, legal director of the Bazelon Center for Mental Health Law. “I don’t know that there is a consensus.”

People who have been involuntarily hospitalized rarely seek a lawyer, Burnim said, but when they do, the debt collection agencies will often drop the case rather than face a costly legal battle.

The media will be obsessed with Britney Spears’ next day in court, expected to be Sept. 29. She will likely describe further details of her conservatorship that will highlight the plight of many forced into care.

Others won’t get that kind of attention. As Rebecca Lewis put it, reflecting on her decision not to challenge the bills she faces: “They’re Goliath and I’m little David.”

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  1. Tom Stone

    I’m hoping to have my landlord recieve a Psyh Eval through the courts.
    He is well to do and from a well to do family, he is also 85 years old, had an extreme personality change less than a year ago and his behavior since has become erratic to put it very mildly..
    He’s been on oxygen for more than a year and now only drives his carrera at night, at high speed.
    Without his hearing aids…

    1. Jeremy Grimm

      I am not a physician — so for what it is worth: I wonder whether your landlord may have suffered a stroke. Your statement that his behavior has “become erratic to put it mildly” is both cryptic and suggestive. Before you take action to compel that he receive a Psych Eval you might be wise to read up a little on the laws in your state. Depending on the nature of his erratic behaviors, I believe it would be far better to bring his condition to the attention of his closest relatives and leave matters to them.

      1. Arizona Slim

        Count me as another member of the Not A Doctor Club.

        I concur with your suggestion, and, if it was me, I would say that I had a similar experience with a couple of close relatives. A neurological consult confirmed what I suspected — both had dementia.

      2. Tom Stone

        Jeremy, I’ll still put it mildly.
        My landlord’s behavior has been unsafe, irrational and abusive in a “WTF, you have got to be shitting me” manner.
        I have retained legal counsel and will be asking for injunctive relief, for a start.
        He is a danger to himself and to others and having been hit head on by an impaired driver I am very aware of the potential consequences if he continues to drive.

        1. Jeremy Grimm

          One fine evening, my son attacked me as I sat typing on my computer causing me some bloody but non-permanent injuries. Between the two of us the hospital where I went to the E.R. and the where the police later brought my son for psychological evaluation managed to construct an amazing bill for all sorts of things including chest x-rays for me and my son — although my son was uninjured and I had head injuries. My son ended up at the state mental hospital.

          My son was charged with aggravated assault. The wheels of ‘justice’ slowly turned. After almost six months, my son’s case came to trial. He was moved to the psychiatric section of a county jail where he remained for two years while innumerable court dates and meetings with the prosecutor slowly determined that my son was mentally ill and should be held at the state hospital for treatment instead of going to state prison for eight years — the last plea bargain on offer.

          My son’s public defender — who was replaced as soon as I was able to find and retain a defense attorney who specialized in felony level criminal cases, something much more difficult than I expected — advised my son to take the plea offer. The original prosecutor for this case was adamant about charging my son with attempted murder and pressing for 30 years in state prison. After reading my victim impact statement this prosecutor issued a subpoena dragging me into his office early in morning, on the day the grand jury met to consider my son’s charges. He threatened to have me charged with perjury if I changed my testimony from that captured by the police who surrounded my hospital bed as the doctors stapled numerous ‘dings’ on my head. I forgot the cardinal rule — DO NOT TALK TO THE POLICE UNDER ANY CIRCUMSTANCE. I had been hoping this incident would help me obtain treatment for my son. The prosecutor released me and relied entirely on the testimony of the police officer who had been in charge of the case. During the two years my son’s case was ground under the wheels of justice, a succession of five different prosecutors pressed the state’s case against my son. [The original prosecutor had moved on to practice defense law.] Finally after two years and considerable expense the state determined that my son was mentally ill and belonged in the state mental hospital for treatment — something I thought had been determined at the time my son was first incarcerated. To make matters more appalling — the only reason my son’s attorney was able to argue for having my son’s mental illness treated at the state mental hospital instead of landing him in state prison was an obscure piece of criminal case law decided some years earlier.

          The legal system is a dangerous labyrinth full of dungeons and dragons.

    1. Maritimer

      How many psychiatrists/psychologists are captured by Big Pharma and Industrial Treatment Systems? Once you are put on the drug treadmill, you may never get off. Kaaaaaaaaaachingggggggggggg.

      Works for viruses too!

  2. ambrit

    I do know from second hand experience that the “Privatized” Psychiatric Clinic system is predatory at base. A friend was taken to a hospital Emergency Room after a “cry for help” suicide attempt. His Mom says that a “representative” of a psychiatric clinic, licensed by the State, (he showed his placard of identification,) was on the scene within an hour to “gently” steer her towards committing her son for a week in said clinic for “evaluation and care.” The Hospital backed up the “representative’s” claims of the need for this “service.” No State run alternatives were offered. This ‘Privatzed’ clinic was it. Take it or leave it.
    The bill came later. Roughly $1,500 USD per day for seven days. We helped him and his Mom with a little bit of cash to hire an attorney to fight this bill. The attorney took a thousand dollars and got the bill lowered to $2,500 USD. Sometimes, good deeds are not punished.
    As above, the moral of the story is that, when you are being forced to do something, sign nothing.
    The Mom in the above tale of woe did sign something. Fortunately, the attorney argued that his clients were the victims of deceptive sales practices. It never went to trial. The clinic settled quickly.
    My takeaway from this is that any and all medical related issues, procedures, and the like, should be non-profit. (I cannot think of a more persuasive sales pitch than; “The alternative is Death.”)

  3. Star116

    In 2011, I was involuntarily committed in Texas for four nights. Not only was I responsible for the out-of-network hospital bill, but also the ambulance (friend called 911), the ER doctors, the psychiatrist, the hospital doctors, and the county court fees (for stuff including the court appointed lawyer to represent me). At the time, I didn’t even consider disputing the bills or refusing care. I simply wanted to pay the bills and make it all go away. So I ended up setting up payment plans so I could afford the bills. Fortunately, my job was secure enough that my employer let me take vacation pay and non-paid leave (didn’t qualify for PTO because I was short of one year employment by one day when the time off started).

    Also note, that involuntary commitment caused a lot of anxiety on top of the depression and anxiety that already existed.

    1. Star116

      Also, the police in the ER room initiated the involuntary commitment for my “best interest and protection”. I didn’t see a psychiatrist or therapist until two days later. I find this inadequate.

  4. PlutoniumKun

    In the suburb I grew up in there was a small private psychiatric ‘home’ for women run by the CoI (episcopalian) church. I don’t think they had accepted any patients for years as all the residents were elderly – it full closed by the 1990’s. Most were ok to walk around or go to the shops and my mother, being a kindly soul, would often invite some in for tea and a biscuit and a chat. It was obvious many were very lonely and so grateful for this.
    I was too young to understand much at the time, but it was clear that much of their problems came from institutionalisation, not mental illness, and they were in the homes as they were an embarrassment to their wealthy families for one reason or another. Many had gotten pregnant as teenagers, which presumably was considered evidence enough back in the 1940’s or 50’s that they needed to be locked up. I guess it is progress as a society that we don’t do this so much anymore, although maybe we have other ways of getting rid of those who are embarrassing.

    1. norm de plume

      Removal of an embarrassing relation is one of main drivers for the institutionalisation of perfectly sane people; another is an inconvenient wife.

      Been listening to a podcast on Cary Grant and it turns out his philandering drunk of a father committed Cary’s mother (a delicate soul who today would be recognised as having OCD) when Cary was 9 or 10, in order to install his lover. It was intimated vaguely that she had gone to relatives in the country, and then later that she had died. Cary only found out when he had just started his big Hollywood run at about age 35, that she was still alive. He flew over to see her, bought her a house, begged her to come to the US (she said no) and kept in regular touch.

      So a happy ending I suppose, but still a family tragedy that in one move his scheming father could, like any husband of the time, delete an obsolete wife for a new model, as easy as you please. A childhood and a motherhood stolen.

  5. Jeremy Grimm

    My son, who has demonstrated danger to himself and others, has been involuntarily committed to my State’s Mental Health System — a system I believe to be better, and better funded than most. They have had at best mixed success in treating him. I believe the conditions in the Mental Health System work to aggravate my son’s problems. There are too few psychiatrists, too few social workers, too few psychiatric nurses, and too little money to support them. The situation tends to drive pharmaceutical ‘solutions’ and a tendency to control patients rather than their mental conditions. Most [all?] of the available anti-psychotic drugs have serious side effects and provide some but inconsistent improvement to my son’s condition. When I have visited my son I sense a profound boredom in the patients and in their situation.

    One curious feature of my State’s Mental Health System is the disproportionate number of minority patients. The Caucasian inmates, like the minority patients, appear to originate from less than sumptuous backgrounds. I believe many of the patients were involuntarily committed for detox coupled with their mental illness. The staff consists almost entirely of minority employees and all the psychiatrists I have met or spoken with on the telephone were immigrant Filipino or Indian women. I am quite certain mental illness is no less common among the Caucasian population and the more well-off minorities, although I believe precarity increasingly burdens those outside the 1%, and disproportionately burdens the poor. This post suggests an answer to my unspoken question of where everyone else ended up … other than on our streets. From the post, I am led to suppose they are nicely sheared before they end up on our streets.

  6. Sam Adams

    Nothing says scam like the conservatorship courts of New York and specifically Suffolk County where the favored players are regularly assigned lucrative cases that provide the Lawyers an annuity. There have been numerous investigations fo NYS conservatorship parts and attorneys with little change over the years.

  7. Drake

    Quoting the Bazelon Center? That was funded by profits from selling stolen Japanese American’s property after WWII.

    “How a Young Syndicate Lawyer from Chicago Earned a Fortune Looting the Property of the Japanese-Americans, then Lived Happily Ever After as America’s Most Respected Civil Libertarian Federal Appellate Court Judge”

  8. jr

    As a card-carrying bipolar individual, I have had some real wild rides with my treatment. I do not say “sufferer” because I have found my condition to have benefits as well as disadvantages. You haven’t seen a sunset until you are manic, it’s like the sky is singing to you in colors. A beautiful song will make you literally weep with joy. Sex can be, erm, explosive.

    I’m classified as a 2, or “bipolar lite” in my terminology as opposed to a 1 which is pedal to the metal, but as a Meet-up group of bipolar folks I attended years ago attested being assigned a “1” or “2” status is highly variable. It can depend on the meds one is taking. For example, I was on a drug schedule that kept me in bed around 14 hours a day for almost a year and a half. A shuffling zombie who barely kept his job due to calling out on average four to five days a month. Lose your job, lose you home, and you lose your mind.

    It can depend on the doctor as well. I was over-medicated for the first few years because my well-intentioned doctors were trying to find the right mix for me and each of them had a different idea what that could be. I was nearly put on Lithium, the nuclear bomb of psychiatric drugs, by a lazy practitioner I was being treated by. She told me Lamotrigine and Risperidone were just “stand in” drugs for Lithium. I refused that diagnosis. Talk about a path to suicide.

    It’s also dependent on life circumstances. Stress from work, relationship troubles, a few too many lines of chola at a party, or a long night making love to a bottle of McCallan and you can find yourself somewhere you don’t want to be. Mentally and then physically.

    The point of all this is that at anytime during my “bad” period I could have gone off my rocker so much so that I would have ended up involuntarily locked up. In fact, my first shrink was amazed when I told her my story and said I should take great pride in my survival instincts. Most people in my position, she said, are homeless, jailed, or committed at some point. I’ve been the first two but I’ve never seen the inside of a “rubber room”, thanks be to Father. I also have the best partner in the world who saw through the craziness, if it had been up to the majority of my family I would have died on the streets.

    A side note: anyone equating my condition with my spiritual practice will perhaps be disappointed to hear that they don’t track at all. I have only been able to practice when I became clear-minded and stable. The visions and related phenomena I have experienced have all occurred when I am mentally comfortable and in control. Admittedly, a touch of mania does add a little spice to my more enflamed prayer sessions but in general the two aren’t compatible.

  9. LawnDart

    I am agast at the many ways profit is sought from human suffering. Saddling mentally ill with unpayable debt that may push them onto the streets, how is this good for society?

    Oh, silly me: “There is no such thing as society.”

  10. Utah

    I’ve been involuntarily and voluntarily committed a few times. Somehow I didn’t receive a bill for two of them. One voluntary and one involuntary. Maybe because I’m poor. Back before the ACA I only got something like 12 days per year, but they figured out how to use previous years for some of the time. The ACA really did make mental health care better. But I’ve only ever been in hospitals that were state run and funded or a private place that was not a publicly traded company. Friend’s have been in places that are owned by big corporations and they stay longer than I ever did.

    Psych care is a mess. Even outpatient services are difficult when you have to meet your deductible before your copay kicks in. Luckily my insurance plan doesn’t have that, but that’s because I did my did diligence working through the available plans that let me see my therapist and psychiatrist without meeting a copay. Otherwise I wouldn’t have been able to afford it. I also work out every year how much it’ll cost me to have a breakdown and have to be hospitalized. Mental health is tricky.

    1. Angie Neer

      Utah, thanks for sharing your experience. Do you think your involuntary commitment was appropriate and helpful? I have heard from someone I respect that his involuntary commitment, due to severe depression, saved his life. But obviously it is a high-stakes event that is tragically easy to abuse. It sounds like you have experiences of your own and of friends that would be very informative for us NCers.

  11. schmoe

    This is another perspective. There was a situation with a family member who had a very bad case of schizophrenia and a history of violent attacks on others and suicide attempts. There were several commitments and medication effectively put the person into a foggy state, but one where there would not be violent outbursts. Nothing cured her delusions. She often refused medication due to side effects (cotton mouth), and had social workers telling her not to take her medication – viewing this is something of a civil rights issue despite this person being profoundly mentally ill.

    After several suicide attempts, we recognized a certain pattern and would try to have the police intervene when we knew a violent outburst or suicide attempt was coming (it wasn’t hard to see). The police would ask “has she actually said she will commit a violent act against herself or others?”, even though the police never doubted she was seriously mentally ill and it was apparent to anyone around her during a psychotic episode. Often the answer was no, because the patient knew that if she said so, she would be taken away. Nonetheless, when the police went away, the expected incident would often come to pass.

    This story did not end well.

    Not everyone knows what is best for themselves, and when these stories go horribly awry, someone gets severely injured, or worse.

    1. Jeremy Grimm

      In many state acts of violence against persons can land someone in a state courtroom and could land them in a state prison. The laws and penalties for assault, and aggravated assault in many states are very harsh. Psychiatric hospitals are bad. Prison for the mentally ill could be a death sentence.

      You indicate “medication effectively put your family member into a foggy state” and then note that “nothing cured her delusions”. Perhaps curing her was not the intention.

  12. Dave in Austin

    The deinstitutionalization of the 1960s was done with the best of intentions and righted some terrible wrongs. If you’ve never seen it, get a copy of Titicut Follies by Ferederick Weisman to understand the challenges of running an institution where people are often involuntarily held. I worked at one while I was in college. I lasted three days.

    But shutting the institutions was the wrong answer. We’ve all seen the homeless “off their meds” on the streets and the old bag ladies with their shopping carts. I have no good answer but I have two examples of wht happens:

    I know two people sent to “rehab nursing homes”. Medicare pays for a short time. One of the people in DC has been there for more than a decade as a private pay- $120,000/year- and my admittedly limited efforts to get him relocated to a better rural facility have been stonewalled by the institution; they are understaffed because of Covid; they will not let an outside physician in to evanuate him so they say “Sorry, he can’t be moved”; they see him as a cash cow- for a few years more- and then, according to friends in the biz, when he is out of money he will be transfered to a regular nursing home. The second is a relative- 78, diabetic overweight- who took a fall lost muscle mass during his five days in the hospital and has been in the rebab under Medicare- which pays for rehab for only 30 (?) days. When I announced we would not pay the $185/day private charge for more than a week, suddenly the home got serious about his hehab because they were afraid they might be stuck with him with no Medicare reimbursement. I expect to have him out in a week.

    As I say, I have no easy sollution. But I never though that Brittany Spears would become the poster child for private pay involuntary commitment. Free Brittany!

  13. Brunches with Cats

    Taking a deep breath to share a closely guarded personal experience related to this post and a link in yesterday’s Water Cooler …

    Not quite three years ago, I woke up in the ICU after a near-successful suicide attempt. No idea where I was, what day it was, how I got there, or how I survived what I was reasonably sure would be “enough to do the job.” I’d been unconscious for 72 hours, almost to the minute.

    Turned out I was at the regional hospital closest to my home. I was transported there the day before by the village emergency squad following a call to the local police initiated by my VA psychiatrist, who sent instructions that I might be “dangerous” and that under no circumstances should I be allowed to leave the ER. She also signed the order to have me involuntarily committed. That would scare the hell out of anyone, and yet what really freaked me out was, “OMG, how am I going to pay for this?” It was enough to make me regret not planning more thoroughly (as it was, it took me 10 days to plan and arrange for a permanent exit).

    The “good news,” if you could call it that, was that the VA would cover the entire bill, as I’m a U.S. Army veteran eligible for VA healthcare. The bad news is that they had complete control over when I would be released. The even-worse news wouldn’t become apparent for another 3-4 weeks, but that’s a whole different story. The nutshell version is below. Meanwhile, I want to address yesterday’s 2PMWC link, “The Malleability of Memory,” which got several comments. Why I wanted to die is complicated, but the memory aspect was a key factor.

    Psychotherapy often demands that we dive into repressed traumatic memories. Not only is this difficult, as yesterday’s comments reaffirmed, but it can be dangerous for the patient. At this time three years ago, I was descending into that deep dive after months of building the necessary trust with a new VA therapist. Those who have done it know that it requires prying open your psyche like the metaphorical sardine can, and you can’t just open it at will for an hour a week (more like 45 mins these days) and lock it back up when the clock runs out. You’re in a raw, vulnerable state, shaken and in varying levels of dysfunction, depending on where you are in the process and what you’re accessing — and you may not even know what it is until you get there. Because the process takes its own time, you may hit the bottom of the subterranean pit in the middle of the night, on a weekend, or during the therapist’s vacation, and then what? If you have a safety net of family and friends to support you, you might make it to the next appointment. I didn’t. The deep dive was aborted.

    Back to this article, I know exactly what Rebecca Lewis means about not having the emotional energy following hospitalization. In a nutshell, the “even worse” of above is that my VA mental health “team,” instead of helping me get back on my feet after ten days in the psych ward, accused me of deliberately traumatizing the therapist, and they abruptly pulled him off the case without an immediate replacement. He told me to contact him in the interim if I needed anything, but after I left him a phone message, the team leader threatened me with a restraining order for harassment. When I protested, they started treating me like a whistleblower. I had to search for my own therapist outside the VA and somehow summon the strength to fight them tooth and nail to pay for it.

    After 2-1/2 years of working with a very good therapist, we’re at a place where we can consider resuming the aborted deep dive. And resume, it must, as much as I dread it. The memories are still there, a leviathan in an underwater cave whose presence might be denied indefinitely but for the tidal waves on the surface whenever it’s disturbed.

    P.S. In the time it took to write this comment, several others were brave enough to share their experiences. Thank you. It helps me feel less anxious about sharing mine.

    1. Jen

      Thank you for sharing your story. I’m thankful that I found an excellent therapist at the time when I needed it. In my case the deep dive was more like hurling myself of a cliff after suppressing the causes of my trauma for so long. She connected me with a very good neuropsychiatrist who found the right medication (and the right dose) to get me through the roughest patch. There was a period of time when the only thing that kept me from slamming my car into a guardrail at 140 MPH was knowing I had two dogs at home who needed me and wouldn’t understand where I went. My rescue in particular.

      It was hard, but the hard won peace of mind has been worth it.

      1. Brunches with Cats

        Thanks, Jen. Reading of your success is encouraging.

        A good therapist and the right medication/dose are critical, and not just in therapy for repressed/suppressed memories (there’s a difference). In fact, the spiral downward began when the VA psychiatrist assigned to me before the above-mentioned agreed to switch me to a medication that I’d asked to try, but did it in a way that caused withdrawal symptoms, including suicidal behavior. When I complained, he told me to go find another doctor, so for a short time, I had no medication at all. The therapist had been on my side throughout and went the extra mile to make sure I stayed safe, but then got strangely squeamish when we started doing the real work. It’s like if you hurled yourself off that cliff trusting that your therapist had a firm grip on the bungie cord, only to find in mid-air that she’d let go of it and walked away. That betrayal of trust, plus the trauma added by the VA post-discharge, made it impossible to dive right back in. My current therapist, fortunately, has understood this very well.

        Earlier this year, I asked to do another trial with the medication that had been interrupted. It has been a whole different experience with a competent psychiatrist who understands this drug and knows how to prescribe it. It did take a few months to adjust the timing of the dose, but once we got it right, a lot of other things started falling into place.

        And definitely yes to the effect of pets. My cat is the best friend I’ve ever had and one of the reasons it took ten days to get my affairs in order. I had to know he would be loved and cared for. He was looked after very well while I was in the hospital, but when I came home, he leapt into my arms and all but glued himself to my legs for the next week.

        The one other thing that has saved my life is gardening.

  14. Questa Nota

    A relative worked in a field that you might call Concierge Mental Health. Clientele, not patients, regularly pay out $50,000 to $90,000 per month, in cash for treatment(s). Those treatments may address various substance abuses or related vices, and are administered in a very upscale environment with chefs and other amenities.

    That type of program isn’t some Wild West anything-goes situation. There are regulations and controls for strict handling and dispensation of meds, for example, and they do get psych and other help.

    Typical clients are sent to the facility, of which there are a shockingly large number, by their board of directors, senior partners, family office reps, attorneys or others in some position of responsibility. Some are in desperate need of discreet, confidential, out-of-view treatment and benefit greatly from the focused approach. Others are shuffled off for a month or longer on a type of mental health holiday, either to help curb various vices, avoid further embarrassing episodes, or just get someone out of the way for a while to allow others to return to running whatever business. There are a few frequent flyers, which could be called recidivists in a different setting, but are instead welcomed back to help with some flare-ups or other issues. Some get fired by the facility due to egregious behaviors.

    Insurance is rarely a factor in paying for the above. No names are ever to be mentioned outside the facility.

  15. swampopossum

    I would highly recommended the Devil in Silver by Victor LaValle. He was compelled to write it after a friend experienced involuntary commitment to a psychiatric hospital.

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