Will the therapist say I am crazy and lock me up?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Psychiatric hospital.
Photo courtesy of pixabay.

Being locked up is a fear of some people coming to therapy.

The chances of this happening are very close to zero. The fact that you came in on your own means this is highly unlikely for many reasons.

This idea of the upset person who gets “put away” in a mental hospital, usually called an insane asylum, makes for great T. V or a good novel, but in real life that does not happen, at least not very much and particularly not here in the United States.

Here are the reasons why you are not going to get locked up just for going to see a counselor.

Professionals just do not think of mental illness that way anymore.

The old notion was that there were two kinds of people, normal and crazy. If that were true we would need to lock everyone up because I do not see any normal people in my world. Some people may be more normal or less normal than others, normal being a statistical concept. Being different does not make you crazy.

Mental illness is not the same thing as being crazy.

Mental illness is on a continuum, people get unwell, then they get sick, then they move back in the other direction as they recover. Most people have times in their life when they are anxious or depressed. If someone is shooting at you please get anxious. If a family member dies, I hope you get sad. Do not let that anxiety or depression control you for the rest of your life.

People we call mentally ill get stuck at that “too sad” or “too anxious” and do not seem to get back to a better place without help.

There is a big argument about why. Watch for an upcoming post on the causes of mental illness as I see them.

The therapist expects you to have some problems, so no they are not likely to think you are over the edge just because you came for a little emotional help.

There are only three special reasons you can be confined to a psychiatric hospital against your will.

Holds for involuntary psychiatric hospitalization in this area are only written if the client is a danger to themselves, a danger to others or they are so disabled they can’t feed themselves or clothe themselves. Being poor, or homeless, does not count. I hand you a cookie and you eat it, I offer you a sweater and you put it on, you pass this test.

If you say you are planning to kill yourself then you may be detained until those thoughts pass and you recant that thought. Professionals are suspicious if you were saying you would kill yourself to the police just a few minutes ago and now you are saying that you won’t.

Saying you have thoughts, usually will not get it. You need to also have a plan for when and how you will do it or a history of attempts or some other reason for the official placing you on an involuntary hold to believe this is something you might do.

Being under the influence of drugs or alcohol is a risk factor. People who binge drink or are drunk are 55 times more likely to attempt suicide than sober people. So if when drunk you say you are going to kill yourself and the police are called you may end up in a psychiatric hospital for a very short stay.

Say you are planning to kill someone else, say you also have a gun and you may end up in a hospital or a jail for a while longer. Even then the law just does not let the police or the psych hospital keep people who might someday hurt someone else all that long.

Once the person sobers up or changes their mind, the chances are that they will have to be released even if the police still think that this person may in the future hurt someone.

While this lets some people out who may harm others it also keeps a lot of people from being locked up just because they scare someone else.

The psych hospitals are pretty full and they charge a lot of money.

The hospitals do not want to keep anyone there one minute longer than they have too. The days of years in an asylum are over and gone. Most stays now are a week or less. Stays beyond 30 days are rare.

In crisis units, the stay around here is most often less than a day.

Yes, I know the involuntary hold says 72 hours, but in practice, not many people stay that long. That 72 hours or 3 days is a maximum, not a for-sure.

Most of the complaints I hear are that people were discharged from the hospital before they felt ready, not that they were kept too long.

As soon as someone appears able to cope with life they get let out even if they will need meds or therapy to be able to cope in the future.

Counselors, in most places, are not authorized to write involuntary holds.

Even if a counselor works for the government and writes holds in their day job, they are not able to write them in their private practice. So unless your treating professional is a psychiatrist with treating privileges at the hospital there is a low chance they have that little card that lets them write holds, especially one that would let them write the hold in their private office.

What could happen is if you said you were going to kill yourself or others and you convinced the therapist that you were serious about this, he or she might call the police and get you detained until you change your mind.

There you have it. The things that bring most people to counseling are miles away from the things that might get you locked up in a psych hospital. Stop worrying about this and go get the help you need before you have to live your life in the place of unhappiness.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Does a drunk suicidal person go to jail?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Does a drunk suicidal person go to jail?
Picture courtesy of pixabay

When the law, medicine, and mental health intersect.

Sometimes people have more than one problem.

What happens when someone has a medical problem, a psychiatric problem and they break the law? When something interacts with the law the law usually wins. How these cases at the intersection of disciplines are resolved depends on the laws in your jurisdiction. Most places in the United States have similar statutes often based on uniform law statutes. More and more places on earth are recognizing that mental illness is not a choice and that the mentally ill need special consideration in their encounters with the law. Here are some of the possible outcomes of a drunken suicidal person based on what happens here in my jurisdiction.

Partly this depends on the order in which things happen. Do they go to the hospital for a heart attack and then we discover they are drunk and suicidal? Or have they been arrested for driving under the influence first? What if they killed someone while drunk and now are thinking of killing themselves. All very different scenarios.

While I separate medical, psychiatric, and correction issues, some places may have facilities for several of these issues. Hospitals may have psychiatric units, in custody units, and so on.

Crisis issues should always get the first look.

If someone is having a heart attack or bleeding to death they need immediate medical attention. They go to the hospital. If medical problems show up while they are in jail or the psychiatric facility they should be transferred to a medical hospital unless where they are also offered that second service.

Alcohol is one of the most life-threatening of all the drugs from which to detox. People can and do die from alcohol withdrawal. If someone has ever had the Delirium tremens (DTs) they are at risk to die while sobering up. This needs to be supervised by a medical doctor.

If someone is suicidal they need psychiatric care.

We have a procedure here in California for placing someone on a psychiatric hold (technically a request for evaluation) and getting them sent for an evaluation. That first hold is only good for 72 hours. After that, a psychiatrist needs to say they need to stay or they get discharged. If they committed a crime they might get discharged from the psychiatric facility and still face legal charges.

Once at a psychiatric hospital and under the care of a psychiatrist, they will be evaluated and kept until the crisis resolved. The laws have lots of safeguards to keep people from putting other people they don’t like away and keeping them locked up for long periods of time.

Once upon a time – people stayed in psychiatric hospitals for a long time. Stays of several years or even forever commitments were common. Not anymore. Since the advent of effective medications, stays at psychiatric hospitals are getting shorter and shorter.

Stays of a week or less are now common. A long-term stay in the psychiatric facilities I have worked in would now run two weeks to a month.

Killing yourself or attempting to is illegal in most places, only the most rabid law and order types would even consider chasing someone down and arresting them because they had thought about suicide while drunk.

With the intoxicated person, they are likely to change their mind about suicide once they sober up. Studies show that people who are binge drinkers, when they drink they get drunk, are 55 times more likely to attempt suicide than people with no alcohol in their system.

So generally speaking a drunken suicidal person will not be sent to jail. If nothing else the jail does not want people killing themselves while in jail. Having clients die in your facility is bad for a business even if you run a jail or prison.

No jail for the drunken suicidal person – unless –

If the drunken person has committed a serious crime while intoxicated they are still held liable. Being drunken is not an excuse for bad or illegal behavior. Being mentally ill does not, and should not, get you a pass either.

You may not go to prison, but you will have consequences, like time in a hospital for the criminally insane, until we are sure you understand what you did and are capable of not doing that again.

Jails do have psychiatric units and they do have to put people who were arrested for serious crimes on a suicide watch from time to time. But no, most times, they have no interest in arresting and detaining someone who is suicidal.

For the record – people who are placed on a psychiatric hold are not under arrest. This does not result in a police record or mean you will have to say yes to having been convicted of a misdemeanor or felony on a job application. Your psychiatric treatment record is supposed to be confidential just like your medical treatment record. Do not let the fear of legal consequences stop you from calling for psychiatric help if someone is suicidal. Dead people do not worry about having a record.

One consequence of being in the psychiatric hospital will likely be a form you sign at discharge that tells you that you cannot buy or own a firearm for five years after being in a psychiatric hospital. If you want to get a gun, then you will need to appear before a judge and convince him you have a good reason to own one.

But if you are the sort of person who gets drunk and then thinks about killing yourself and others, you are not the kind of person that I would like running around my neighborhood with a weapon.

If someone is medically sick they need to be in a hospital, someone who is suicidal needs psychiatric care, and someone who breaks the law gets arrested. When someone has more than one of these issues we may have trouble figuring out what to do.

Hope that answers the question a reader sent in “Does a drunk suicidal person go to jail?” If you have more questions or comments on the issues of suicide, intoxication, and our society’s response to people with multiple problems please leave a comment.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Dangers of Binge Drinking

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drinking

Binge drinking.
Photo courtesy of Pixabay.com

Binge drinking may be more dangerous than we thought.

One drink per day for thirty days, for many people this is no big problem. No drinks for thirty days and then binge drink thirty drinks in one day, that would be a huge, maybe fatal, problem.

Thirty drinks, if consumed rapidly enough and kept down would result in a “theoretical” blood alcohol level of .60 which is enough alcohol in one person to have made seven and a half people legally drunk. At that blood alcohol level, the person would probably not need treatment. They would already be dead.

Blood alcohol levels of .50 to .60 are likely to be fatal. But even lower levels can kill or permanently injure a person. Alcohol kills more people in the United States every year than ALL DRUGS, legal or illegal combined (not counting nicotine.) Even when people die from other drugs, they typically have alcohol in their bloodstream.

To be fair, not everyone who drinks, binge drinks, and gets drunk. About half of all Americans old enough to drink have not had a drink in the last thirty days. Those who drink a lot, damage themselves and others a lot.

The twenty percent of Americans who consume the most alcohol, the frequent binge drinkers, consume 80% of all the alcohol sold. The majority of all the people in prison around here were drunk or high in the 24 hours before they committed the crime that sent them to prison.

People who drink rapidly and reach high blood alcohol levels are likely to have blackouts.

Even at much lower levels, we find that “binge drinkers,” those who consume larger than typical amounts of alcohol on one occasion, are 55 times more likely to attempt suicide.

The damage alcohol does to the body depends on the level of alcohol in the bloodstream. Our way of assessing risk, based on the number of drinks during a single “drinking episode” is biased towards underestimating the extent of binge drinking. Not everyone who drinks gets the same result.

The blood alcohol level is dependent on a number of factors and the number of drinks is only one of those factors.

Body weight influences blood alcohol levels. If a one hundred pound person and a two hundred pound person have the same number of “standard drinks” the one hundred pound person will have a significantly higher blood alcohol level.

Alcohol is soluble in water, the more water in the system the lower the blood alcohol level. Men have more water per pound of weight than women. This means that if a man and a woman of the same weight drink the same amount of alcohol the woman ends up with a higher blood alcohol level.

Liver function also affects the body’s ability to process alcohol. A damaged liver and the drink will stay in your system longer.

Age is a factor. You can put color on your hair but you can’t pretty up your liver. As you age the liver gets old and tired. It won’t process as much alcohol per hour. An old liver will result in higher blood alcohol levels. Studies tell us that the “safe” level of alcohol consumption for an “older person” is maybe half what it was for a younger person.

If one glass of wine a day is good for you at age 30, three glasses a week will be your max at age 80 or so. I know there are exceptions, don’t email about your grandparent who still drinks a tall one every day and is in good health. Studies say that for the elderly, most of them, 3 drinks a week would be all that is safe.

Binge drinking is defined as 4 drinks on one drinking occasion for a woman and five drinks for a man. We have already underscored that for people of low body weight or the elderly or woman these numbers are way too high.

Who is at the highest risk for medical problems from binge drinking? Four groups are at highest risk, the young, the old, the pregnant, and the alcoholic.

The young have more drinking problems.

They don’t know the risks and the results. They can get drunk, hurt someone, be in trouble and there goes the life. Almost all people with a substance use disorder become alcoholics or addicts before the end of their twenties.

The elderly have lots of substance use problems.

These folks are not exempt. In more than half of all hospital emergency room admissions of senior citizens, the elderly person is drunk or high when the accident occurs. One reason seniors are falling down and breaking hips is they are stoned.

Seniors may become depressed when they retire or end up living alone. They may drink; take prescription drugs and even illicit drugs. Put that all together and it is easy to have substance abuse get out of control in the elderly.

The pregnant should not drink.

Any alcohol is bad for the developing fetus, the more alcohol the worse the damage. We can’t always see the damage as it can hide in lower IQs, retardation, and learning disabilities. Alcohol induces “Fetal Alcohol Spectrum Disorder” which is the largest source of preventable birth defects.

The alcoholic will not be able to safely drink.

As many an alcoholic will tell you “one is too many and a thousand is never enough.” The hallmark of alcoholism is the loss of control. An alcoholic has lost control of how much they will drink once they get started. The only “safe amount” for someone with a history of alcoholism to drink is – none.

Many drug addicts get into recovery and then fool themselves by thinking “I never had a problem with alcohol so I can drink safely.” Scratch a drug addict and you will find an alcoholic. The same seems to hold true for anyone who has had any other form of impulse control problem.

Consider for a moment. If you drink multiple drinks, most days or end up drunk when you drink you may have a drinking problem. If you binge drink, drink with the intent to get drunk or buzzed, you are in the highest risk group.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel