Voluntary vs. Involuntary IP Psych -- Differences?

When facing a mandatory referral for Inpatient (IP) psychiatric treatment, is it better to request it voluntarily as opposed to involuntarily? Does the "involuntary" patient's record get "stigmatized" such that treatment is more aggressive, includes restraints or heavy sedation? And what if he or she refuses so forcefully as to include shouting and spit flying out of the mouth?

So the PDocs are telling her that she can go IP willingly. But if not, they said she's going regardless.

I'd try to talk her into it (somehow) if I thought it would greatly benefit her. But I'm very afraid that they will ignore her medical needs and treat her invisible complaints as manifestations of mental illness. I know that they're not equipped to meet her medical needs because it happened once before.

This is a good decade out of date, but there’s no real difference except that you can’t sign yourself out if you’re involuntary. They watch you a bit closer if your involuntary but otherwise treatment is the same. I once was give the choice and choose to go voluntarily because I figured I could sign myself out the following day. But that didn’t work, they made me involuntary and I was so mad I threw a fit. I was placed into solitary for my safety. It wasn’t being involuntary that they reacted to, it was my behavior.

As for the medical needs, yes that’s a problem. Psych units aren’t set up that way. I know here, where I live now they have a geriatric and physical unit. That is more set up for physical stuff. Can you inquire as to wether or not the have a geriatric unit? I was on one once when I was in my 30’s as they waited for an opening in a mood disorder unit. It wasn’t being involuntary much calmer and quiet.

If it's still true that she can discharge herself if she goes voluntarily, that would motivate her.

She voluntarily checked in many years ago, but they couldn't change the dressing on the open wound she had. Instead they called me in to do it.

The psychiatric unit is on the same campus as the hospital, but "wound care is closed today."

And we had to "fight" to get her out before the mandatory three-day stay.

That’s strange. I’ve had wounds before that they took care of on the psych floor. Self inflicted knife wounds that they changed. They also would bring in a hospital bed if it was needed. Did you look intro geriatric psych floors? They are much quieter than general psych wards.

It depends entirely on what the law says where you live. During my recent inpatient stay (last year) I was certified (e.g. involuntary) for most of my stay, but opted to stay as a voluntary patient a few more days. This was done because I was looking at getting into a treatment program that did not accept referrals for patients who are currently certified. Even before I was admitted to the psychiatric ward, I was treated for co-occurring medical problems in the emergency room, despite already having been certified. The only difference between involuntary and voluntary is that as an involuntary patient you can't leave.

It also seems extremely odd that they wouldn't treat wounds like you've described. If this was at a major metropolitan hospital, they should've had such care available 24/7. Even in smaller, regional hospitals, I'd have guessed such care would still be available on call.

The wound care department was on holiday because it was Veterans' Day. At least, that was the excuse they gave. And actually I asked about wound care before she signed the agreement, and they said they'd provide it.

Hmm, that gives me an idea. This hospital has its own psych ward; I'm assuming they'd commit her to it. But now that I read your reply, we should be able to choose a different facility and still comply with law.

Well, my wife was committed on Thursday. My suggestion to transfer to another hospital went nowhere. First, when I called the other hospital, I couldn't get past a clerk or operator. When I mentioned the idea to the PDocs who wanted her committed locally, they said transfers just don't happen -- most places prefer to reserve their beds for their own patients. I don't really believe that -- I have no trust in them. But I don't have the energy or resources to pursue further.

The process was made more upsetting when the security guard showed up to escort us (my wife in a wheelchair, two nurses and me) to the oldest, most dismal part of the hospital, which is reserved for IP mental health.

We are blessed to have a few wonderful nurses, C and R, who did 1:1s (along with many others) while she was getting medical care. Unfortunately, the surroundings are depressing, the bathroom is moldy, and some other patients are violent. The old guy next door whipped out his schlong and peed on poor C and he kicked another nurse in the ribs two days ago.

But the vitriol that my wife expresses toward the PDocs is intense and scary. It's as if she's turning feral. Her PDoc, "maggot head," wants to keep her IP because she "seems to blame others for her problems." It's possible she can get out by agreeing to an intensive outpatient program. But the schedule would be exhausting to her.

Meanwhile, they had the opportunity to work with her (since 3/17) but they did absolutely nothing for her except show up in her room and upset her. They could've transitioned her from KPin to something else, for example, or adjust other meds. Nope.

Statues say that the IP stay is paid for by the state, so I plan to reject any invoices they send to me.

Update:

My wife was discharged from the ward on the fifth day. She (and I) agreed to the Intensive Outpatient Plan (IOP).

Also, it turns out that the PDocs cut her dose of KPin in half, and introduced melatonin, which helped my wife sleep through the night. So there was some slight benefit to the experience.

Overall they provided better care for her than I expected.

As well, the doctor who referred her to psych reduced the dose of prednisone about 20%, which we've wanted to do for a long time.

Right now I'm overwhelmed with the additional meds, which I spent over $62 for (with insurance). Our situation is almost the same as before except:

1. My wife's pain is greatly reduced (a good thing).

2. We don't have enough KPin to last until the next PDoc appointment.

IT sounds similar to being given the option of voluntary or involuntary once you have been TDO'd. I don't believe it makes any difference. Under Virginia law, once you have been TDO'd you will lose your 2nd amendment rights regardless of how you are committed. I went through it all and recently had my 2nd amendment rights restored by a court. The VA has seen the last of me.