Active Minds “Send Silence Packing” Tour raises awareness about Suicide. Each backpack symbolizes a person impacted by suicide. Active Minds, Inc. Courtesy
Active Minds “Send Silence Packing” Tour raises awareness about Suicide. Each backpack symbolizes a person impacted by suicide. Active Minds, Inc. Courtesy

Other Voices

Doctors need more than 48 hours to prevent suicide

By Sara Pintilie

December 12, 2017 06:36 PM

Late one evening, almost a decade ago, I got a call. My mom just tried to die by suicide.

I was 20, and this was her third suicide attempt.

In Texas, if law enforcement officials detain someone with an emergency order — because of mental health issues and being an immediate threat to themselves or others — hospitals can hold the person for only 48 hours before a doctor can determine if the patient needs to be involuntarily committed.

My mom was taken to the hospital around midnight on a Tuesday. She was responsive but inebriated. According to state law, the moment she crossed the threshold of the hospital, her 48 hours started, regardless of her ability to fill out paperwork, give an accurate medical history or remain conscious.

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And that 48 hours isn’t really 48 hours.

The amount of time medical staff actually spends time with a patient is severely truncated.

Because of paperwork, patient responsiveness, other patients, government office hours, weekends and fear of not submitting paperwork by deadline, Thursday morning, a doctor called me with a decision — only about 34 hours after my mother entered the hospital.

The doctor told me they were releasing my mother, citing it as an isolated incident, and that I could pick her up later that day.

It felt like a gut punch, so much so I pulled my car over to process this information. My mom had a history of mental health issues and substance abuse. Growing up, I felt helpless and frustrated because no one would help and she didn’t want to get help. And between the societal stigmatization and my mom’s homebody nature, not many people knew about her issues.

I felt like I was alone, watching someone I love destroy herself, and finally, finally, she was getting the help she needed.

And this doctor had just told me they were discharging her.

So I did something I’d never done before — I yelled at a complete stranger. I lost it, ranting at this poor doctor for a good 10 minutes, unleashing 20 years of frustration and pain. Then I begged him, through snotty tears, to keep her for longer, to see how much she needed the help.

He finally relented and kept my mom under observation for an extra day. But she was promptly discharged Friday afternoon.

My mom left the state about two years later and I have not seen her since.

My mom’s story isn’t abnormal. In fact, that 48-hour window makes it difficult for doctors to assess any patient and confidently recommend involuntary commitment. Not only that, but state law prohibits physicians from involuntarily holding a patient.

That doctor wouldn’t have been able to hold my mom, who believed the whole ordeal was a giant misunderstanding, even if he had wanted to.

Marvina Robinson, chief of Mental Health & Protective Orders for the Tarrant County District Attorney’s Office, says that medical staff needs more time.

Increasing the emergency detention period from 48 to 72 hours would be “the most workable and most reasonable solution.”

Having 72 hours would give patients two mornings to have a semblance of a normal routine, would allow the medication to take effect and give doctors more one-on-one time.

“It would make all the difference in the world,” she said.

Robinson’s office handles the process of involuntary commitment. Once a doctor determines a patient needs to be involuntarily committed, Robinson’s staff works to put together an order of protective custody, probable cause hearing and commitment hearing for the patient.

The process can take anywhere between 10-14 days, but almost 83 percent of these cases get dismissed during the process.

Why such an incredibly high dismissal rate?

It’s because the minute a patient says, “I’m not a threat to myself or others,” the hospital has to discharge the patient, and the order of protective custody has to be dismissed. State law prohibits physicians from involuntarily holding a patient. Only a judge can issue that order.

With a “mountainous” amount of protective orders filings — Robinson says anywhere from 30 to 50 a day — that’s a lot of wasted government clerk hours and taxpayer money.

Dismissed cases also cause chaos for the family.

Having 72 hours for an assessment could help lower the number of involuntary commitments. It could also help create an ability for medical staff to establish a long-term outpatient plan for these individuals.

Doctors have to make the call based on today, Robinson said. They are looking at the current threat.

Maybe that can change with a longer detention hold period. It would be at least be a start, as we work toward a less-antiquated mental healthcare system.

We should strive toward having a system in which, if a 20-year-old has to deal with a parent who tried to die by suicide, that young adult and their parent would have a better outcome than I did.

Sara Pintilie is a Star-Telegram editorial writer.