the involuntary admission barrier to care

I am very far away from the news cycle, these days, but even I have not missed the horror of another terrible school shooting. As it should, the topic of America’s mental health system appears to have again come up. I want to very briefly note a serious practical barrier to appropriate care, which is the involuntary admission system.

When I reached the end of my ability to cope with my illness last August, I had a dilemma. I went to the hospital because of a long string of erratic and self-destructive behaviors. But the final event that drove me to seek emergency care was that I had accused a friend of hacking into my bank account and threatened to harm them in revenge. That they didn’t have me arrested was an act of mercy. When I got to the hospital, I knew that if I revealed that I had threatened physical harm to someone, I would be at risk of a 9.13(b), New York’s involuntary admissions policy. Most other states, I believe, have similar laws. I could not risk the disruption to my life, and the total loss of control, a 72 hour stay would entail. And since I was not willing to divulge that detail, which would have made my crisis clear, the psychiatrist who treated me would not allow me a voluntary admission and I was left to pursue outpatient care. This is the lacuna into which you may find yourself when you have a psychiatric crisis: how to receive appropriately urgent care without losing control of your life. This problem was particularly acute in years past because I was hiding my condition from family and friends and was terrified of them finding out.

This dynamic, I’m sure, would not have impacted the Florida shooting. And I recognize the need for some form of involuntary admissions. But I am convinced that many people avoid seeking care entirely out of fear of involuntary admission, and something has to change.

Miles in his dotage

Old man.

Dusty clawed, waddle-walker, tail kinked like the corner of a page in a book. Ears rimmed with white, eyes a little red, belly a little big. You can still trot, when you really want to, but mostly you amble along like a kid on his way to school, moving as if the purpose of moving was not to move. You can’t get onto the bed on your own anymore, but you can pull me right over in pursuit of a chicken bone. You look like you, in my head, and then I find old pictures of you in your prime and I’m taken aback. Memory is funny when you’ve been with somebody constantly for over a decade. I can’t remember what life was like before you and I have no intention of knowing what it’s like after you. You will not let me cut your nails. You grunt and groan like the old man you are. You are tired.

In time, after your stroke, when you had learned to walk again and the skin on your head wasn’t pulled so tight and your belly wasn’t so distended, when you went off the steroids and the hair the vet had shaved finally came back, when I was no longer carrying you around like a briefcase or holding napkins to your nose as it bled and bled and bled – afterwards, many people told me how good you looked, how you were good as new, how you seemed just the same. And it was true that you got better, in a way I never thought you would.

But I also knew and know that something has been broken in you ever since, that there is some deep quality inside of you that was changed, as if life itself insisted that your illness be written permanently on the record of your life. As an animal your body is your legacy, and the illness – and your brave recovery – are part of that legacy. And when you struggle to get up the stairs, or when your body shakes faintly in its quiet sad way, or when you lie in my arms as I scratch your belly and I can feel how you shudder inside, I feel again that feeling I felt when I picked up your contorting body and put you in the car.

A little brokenness isn’t the worst thing in someone of your age. You carry it well. You have gotten so much better; I can’t believe you were once on 9 medications. I guess the tables have turned. You have been there through more than a decade of mine – a decade of growth, a decade of experience, but mostly a decade of regret. Every mistake in a life of mistakes, a witness to my failures without judgement. When we lived in Rhode Island and I couldn’t afford to run the heat at night I’d put on two hoodies and you’d curl up in my arms on a tiny twin bed. Now you never want to sleep next to me, and it makes me a little sad. But I get it. It’s a little statement of your independence. You are, after all, your own, before you are mine.

Old man. You still hunt rabbits in your sleep. Squirrel chaser, bone chewer, baying hound of Lefferts Gardens, I know that you will never die.