When Your Adult Child Breaks Your Heart

Coping with mental illness, substance abuse, and the problems that tear families apart

What to Expect During Psychiatric Hospitalization

Your rights and your child's rights

Psychiatric hospitalization can be the first step toward healing for a mentally ill child, and may be the only way to keep your child safe if she's threatened to harm herself. But almost everyone has heard a horror story about psychiatric hospitals, with fictional accounts from television and books frequently portraying hospitals as little more than abusive torture chambers. This mystery and fear surrounding psychiatric hospitalization makes many parents hesitant to pursue this option. Even if your child is extremely ill, though, she has certain rights in a psychiatric hospital, and the burden of ensuring these rights are guarded may fall to you.

Informed Consent

Informed consent is a fundamental component of a democratic society, and courts have repeatedly ruled that patients can decline treatment, even if doing so endangers the patient's life. With psychiatric hospitalization, however, the picture is more unclear. All psychiatric patients have the right to ask for and receive information about their treatment and its potential risks and benefits. They also have the right to request alternative treatments such as a different medication. However, if a court rules that a patient is incompetent, then your child could be forced to undergo treatment against her will. Moreover, if your child declines a specific treatment, the hospital may hold her longer, because declining treatment can delay the time it takes for your child to get better.

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If your child is deemed incompetent to make medical decisions, you can protect her rights by petitioning to become her guardian or asking your child to give you power of attorney. In most states, this will give you the right to participate in treatment decisions, and may give you the right to decline treatments you deem inappropriate. All psychiatric patients have the right to a second opinion, and if you are concerned that inappropriate treatments are being forced upon your child, you may want to request a hearing and hire an attorney who specializes in mental health law.

Safety and Dignity

Psychiatric hospitals can't place patients in a more restrictive environment than is necessary to keep them safe. For example, restraining a depressed patient for a day would be inappropriate if sadness or grief were the patient's only symptom. Hospitals can't experiment on psychiatric patients or physically harm them in any way. Most states establish specific standards designed to protect patients' dignity. While these rights can vary significantly from state to state, they include:

• The right to access medical care. A psychiatric patient with a tooth infection, for example, can't be denied an appointment with a dentist.

• The right to appropriate personal hygiene supplies

• Safe, reasonably-sized sleeping quarters

• Adequate personal clothing

• The right to appeal a treatment facility's decisions and the right to lodge a grievance against a hospital

• The right to an attorney

• The right to a hearing determining whether involuntary psychiatric hospitalization is appropriate.

Psychiatric patients in all states are entitled to basic democratic rights such as the freedom to vote and the freedom from unlawful searches and seizures by police. States are explicitly prohibited from using a person's status as a psychiatric patient to deny her basic constitutional rights.

Confidentiality

Psychiatric patients have a right to privacy, which means your child's treatment team can't discuss her treatment with you without her consent. This right can actually prove problematic if you're concerned about the way your child is being treated in a mental health facility, because you won't be able to gain access to information about what's happening to your child. Consequently, it's a wise idea to get your child to sign a confidentiality waiver or power of attorney giving you access to her treatment records before she is hospitalized.

Communication With Loved Ones

Psychiatric patients have a right to communicate with friends and family via letters, phone calls, and visits. However, a facility can deny this right if it believes such communication poses a danger to your child or to others. For example, if your child has threatened a sibling and continues to threaten her while in the hospital, the hospital could prohibit communication with that sibling. Your child also has the right to decline any and all communication, and is not obligated to invite anyone to family counseling sessions or to keep her family apprised of developments in her treatment.

Very rarely, a psychiatric facility will deny a patient's right to communication even when there's no valid reason to do so. If this occurs, you may want to file a grievance against the hospital, request a hearing, and hire an attorney.

Family Rights

Unfortunately, family members have few direct rights when a loved one is hospitalized. Your rights flow from your child's consent, and you won't have any rights if your child does not list you as an authorized visitor or does not give you a power of attorney. This does not, however, mean you have no way to advocate on your child's behalf. If you're concerned about the quality of treatment your child is receiving, you have several options:

• Contacting the hospital directly and speaking to a patient advocate or social worker

• Hiring an attorney and petitioning for guardianship of your child

• Notifying the media of potential abuses occurring in a psychiatric hospital

• Requesting that your child be moved to a different hospital; for this to be effective, your child will typically have to make the same request

While psychiatric hospitals can seem highly restrictive, the people who work there are professionals who specialize in treating a wide variety of conditions. They're not there to abuse or otherwise harm your child. Instead, the purpose of the rules is to keep all patients – not just your child – safe.

References:

Rights of persons in Maryland's psychiatric facilities [PDF]. (2002). Baltimore: Maryland Department of Health and Mental Hygiene.

Your rights: Psychiatric patients. (n.d.). Riverside. Retrieved from http://www.riversideonline.com/patients_guests/psychiatric-patien...

Your rights in a psychiatric facility. (n.d.). State of Connecticut Office of Advocacy and Protection for Persons With Disabilities. Retrieved from http://www.ct.gov/opapd/cwp/view.asp?a=1756&q=277272

Joel Young, M.D., who teaches psychiatry at Wayne State University, is the Medical Director of the Rochester Center for Behavioral Medicine, near Detroit.

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