Mental health holds for those unable to care for themselves

[LucidResq]

Although statues and procedures vary by jurisdiction and agency, from my understanding most mental health holds are placed when a patient is an a) imminent threat to themselves (suicidal) or b) an imminent threat to others (homicidal).

I recently learned that there is a third qualification for such a hold in our state: "grave disability" - meaning they are failing to maintain basic human needs such as such as food and shelter. Examples I've heard include folks who have no food in their fridge (among other red flags) or are living in piles of feces.

Have any of you here transported someone involuntarily under such conditions? Meaning the person made no suicidal or homicidal statements/gestures/etc... but was placed on a mental health hold either by yourself, a LEO or physician due to their inability to take care of themselves?

 

[sir.shocksalot]

Absolutely. Most of those that get placed on these holds are done outside of the realm of EMS, but I have transported many that were placed on holds by myself or a doc.

Most of the time it's for an elderly or mentally ill individual who just can't take care of themselves anymore. One individual was mentally ill and catatonic and was found covered in feces and urine and pretty emaciated. While he was not suicidal or homicidal it was very evident that he lacked any ability to take care of himself. Typically with the elderly they are found in a similar state either from dementia or being physically unable to get up and care for themselves or have others care for them.

These are the homes that you walk into with the view of "wipe your feet on the way out the door." Every time I watch the TV show hoarders I think they all need to get placed on M1s.

 

[DesertMedic66]

Yeah. We had one yesterday. It's was LEO who placed him on the 5250 (gravely disabled adult/minor)

 

[Tigger]

A fair amount of our non-IFT psych holds are a result of this. Truthfully, I am not entirely sure of how this process works in Boston. I do know that when a hold is issued that the person must be transported to hospital from which the hold was issued from by ambulance, possibly with LEO escort. 100% of these calls are handled by the private companies, Boston EMS does not do these sort of transports.

Usually dispatch will ask for police to meet us on scene and depending on the conversation with the caller, we will stage and wait for police. Often times people are more apt to listen to an officer than me, and will voluntarily enter the ambulance.

Our last patient was around 50 and had been defecating in buckets placed around what was otherwise a very clean apartment.

 

[Meursault]

In MA, I see a fair number of patients without SI/HI who fit the third criteria for our mental health holds:

Very substantial risk of physical impairment or injury to the person himself/herself as manifested by evidence that such person’s judgment is so affected that he/she is unable to protect himself/herself in the community and the reasonable provision of his/her protection is not available in the community.

Often, they're chronically noncompliant with meds or generally neglecting themselves due to a previously diagnosed mental disorder. The wording is broad enough, though, that it could cover a great variety of cases.

Thankfully, I don't often have to surprise people with lovely pink copies of Form AA-4.