Archives for April 29, 2007

New car update

43.4 MPG.  A little disappointing given the 60/51 EPA estimate, but still a lot better than my old drive.  All done with the AC on, I might add, so that’s probably hurting the average.

And, it’s a fun little car so far.  We’ll see how it wears.

Why the VT shootings can happen again

The shooter was identified as being way more than two bubbles off level, was actually sent for a psych eval; the rest is history.

I have no illusions this couldn’t happen here in Texas.

In California, there are pretty liberal “5150” laws (the section of the Mental Health code that applies to emergency detention of psychiatric patients), and as one Officer eloquently explained “It’s an easy form to fill out”.  Apparently peace officers in California have some immunity for action based on a 5150 complaint, because I saw a lot of them.  My residency training program saw and ‘medically cleared’ at least 20 every night, then they went to an up to 72 hour hold, during which they’d be seen by a psychiatrist or two, and if felt to need more stabilization, a Judge was asked to act to hold them involuntarily for treatment.  I saw more than a couple of patients with 5150 tattoos (one on his knuckles), and they were pretty easy to clear.  Also, geographically defined, if you catch my drift.

That’s the way it worked optimally.  Occasionally we’d get a guy who said “this is what my girlfriend does every time she’s mad at me: she calls the cops, says I’ve taken an OD, and then tells them I’ll deny everything, so they bring me in here on a 5150”; his story would eventually check out, and he’d go home from the ED.  The vast majority were modestly to deeply disturbed patients who really needed the help.  I would have cared more, but I was a resident, and behavioral health evals could suck the life right out of you.  And the less said about the psych residents the better.


Here in Texas, there’s a great emphasis on personal liberty (“It’s not against the law to be crazy”), and that’s good the vast majority of the time.  There is indeed an emergency mental health code for the psychotic, deranged and suicidal, and it’s not easy to utilize.  There is no simple form, but a multipage affidavit that has to be signed by a judge prior to holding a patient for involuntary psychiatric evaluation, and that’s assuming you can get an officer to initiate the form in the first place (mere physicians cannot).  For a police officer to begin the paperwork, the patient must be in imminent danger of harm to self or others due to mental illness.

And, there’s the rub.  As the patient is in an ED, the cops tell us ‘they’re not in imminent danger, as they’re here in the ED’, and they refuse to initiate a hold.  It doesn’t matter to them that we have no psych facilities, that the patient refuses to agree to go voluntarily to a psych facility, they’re just not going to even try.  This puts the ED doc in a tough position (understatement), and there are some work arounds, but it can take hours and hours, and usually doesn’t result in the patient getting the help they need. 


Mental health laws are one of the things I’d like to see addressed in the country well before we try to change anything else.  I’m not going to hold my breath.