Friday, July 4, 2014

Talk to Me (Or, Tie Me Up and Beat Me)

Last Monday I had occasion to spend some time (quite a lot, actually) in the emergency room of our local hospital. I'm fine now, thanks, but on Monday I had a bellyache, and my doctor sent me to the ER for a bunch of tests.

They put me in a fairly comfortable room with my own loo and a good view of people's passing feet. As I languished on my gurney people came in from time to time to take vital signs, information, and bodily fluids. One of them asked whether I had an advance directive. No, I said.

So he brought me one, only it was from the wrong pile of papers. He brought me a mental health advance directive. I had no idea that such things existed, never in all my years having fallen into the hands of the mental health establishment, for which God be thanked. I knew at once it was a mistake. Surely they weren't expecting me to go mad in there.

So, a mental health advance directive. This is how one wishes to be treated when one goes completely bonkers. I didn't sign it, but rather brought it home to share with dinner guests, since a good laugh promotes digestion. Now I will share one of the best parts with you. "Seclusion," I guess, means a padded cell, and "restraint" means a strait jacket.

Preferences about emergency interventions

I would like the interventions below to be tried before use of seclusion or restraint is considered (check all that apply)

  • "Talk me down" one-on-one
  • More medication
  • Time out/privacy
  • Show of authority/force
  • Shift my attention to something else
  • Set firm limits on my behavior
  • Help me to discuss/vent feelings
  • Decrease stimulation
  • Other_____________

"Chain me to a hot radiator," an alternative suggested by a dinner guest, was not on the list, nor were "leave me the hell alone" or "tie me up and spank me." Personally I would prefer "Shift my attention to something else." (Oh, look! A submarine!)

Someone pointed out that Paragraph Eight essentially nullifies the whole document: "You should be aware that there are some circumstances where your provider may not have to follow your directive."

The Advance Directive for Mental Health Care bears the marks of having been uttered by the New Jersey State Legislature, as it mentions particular statutes. Long live the State.

Kate Gallison


  1. Terrifying to think this can happen in the USA today! tjs

  2. Absurdist literature has never been one of my favorites, Kate, but as described by you I find it very diverting and entertaining. Looks to me like the the denizens of the loony bin have written their own application for admission.

  3. So, Kate, you shouldn't have gotten this; you didn't need it.

    Believe it or not mental health advance directives are meant to be helpful. Just as people who are seriously physically ill are not always a position to make their needs known, so mentally ill people can find themselves in the same situation. We need to treat the most vulnerable people in the most humane way possible and so anything that can be done to avoid four point restraints and strait jackets is to be encouraged. I agree the treatment modalities sound odd, but any move toward giving people say in their medical or mental health care is to be lauded.
    Steph (Licensed Clinical Social Worker in the State of New Jersey)

  4. Steph, I quite agree, and the treatment modalities seem perfectly reasonable to me, though easy to make fun of. It's just that this particular document had such an air of futility about it, beginning with paragraph eight and ending with the bit where you were supposed to file it with some bureaucrat in Trenton, where it would be password-protected. In the throes of having an episode you were supposed to remember a) that it existed and b) what the password was. Absurdist literature about describes it. I can just see the legislators working on this thing in committee, where many of the public are invited to speak and none are listened to.

    Maybe I have the wrong take on it. Anyway, here it is:

  5. Oh, no! A PDF file. Well, that insures it will never be looked at. I think (though I'll admit I don't know for sure) that it's sufficient to have your own copy so that you can give it to the hospital. . It's all very new. It's only in the last few years that I've had to ask psychiatric hospitals if patients had a mental health advance directive.Most peple don't Many people (including some mh professionals) have no idea there is such a thing.You're right. If the New Jersey legislature has any say in this futility will be the word of the day.