Apr 12, 2018
Dr. Ken introduces Dr. Marcella Wilson. Dr. Wilson is the first woman and the youngest person ever to be selected as the Chair of the Department of Psychiatry of a local hostpital. She was also the first woman president of the San Diego Psychiatric Society.
Dr. Wilson explains what a first break means. She says it is referred to as a psychotic break. It is generally the first time a patient is recognized as having a problem. Symptoms have usually already been present. It gets to the point the symptoms are more severe and family and/or friends recognize they need professional help. She discusses delusions, which are false ideas that could be bizarre or grandiose. Hallucinations are another symptom. These are false perceptions.
When presented, the patient may talk in an unusual way. They might even make up words. One issue people see prior to the break is the person will have had a little bit of a downward spiral regarding hygene, isolation and behaviors not typical of them.
Dr. Wilson says that the San Diego County Mental Health Hospital serviced uninsured people. Now it serves the underinsured or people with Medi-Cal. It serves as a catch all hospital for those who can't pay or cannot be in a private hospital.
Dr. Ken worked at that same hospital for 15 years.
The county mental health hospital uses a team approach. This comprehensive team is dedicated to helping the patient. They try to have family meetings to gather and exchange information. Discharge planning was always a huge proiroty ofr discharging the patient. Who will help them and at what level must be decided. They try to integrate the caregivers as much as possible.
Dr. Ken brings up the 5150 detention. He says it ties into the stigma. Dr. Wilson comments on the legal aspects about 5150. She says it is a Health and Welfare Code. It is just a 72 hour hold for the 5150. At the 72 hour mark something else must happen. The initial 5150 can only be instantiated by peace officers and doctors within an institution. There are 3 reasons to detain someone. They are a threat to themselves, a threat to others or they are gravely disabled, meaning they cannot appropriately take care of themselves due to mental illness.
Dr. Wilson explains that if 72 hours isn't enough, they can initiate a Riese Hearing, which means the court is involved. The court comes to the hospital and the patients have a patient advocate. The doctor presents the case for why the person should be on medication If they are a threat to themselves or others or they are gravely disabled, the hearing will determine if the patient needs medication or not.
If the patient needs to stay longer, but refuses, they initiate a 5250, which is a 14 day hold. The court comes to the hospital to determine if the 14 day hold is proper.
Dr.Wilson says that some people become so identified with being a 5150 that perhaps it is a delusion. Paranoid delusions are about the legal system--the FBI or the police.
Dr. Ken says that even the extended period isn't enough. Dr. Wilson discusses permanent conservatorship. She says a 5270 is a 30 day hold. It can be applied as a temporary conservatorship. The same process applies, with a representative of the court coming to the hospital for a hearing and the patient can defend themselves. She mentions a 5300 which is a certification of dangerousness to others.
Dr. Wilson discusses how they get a conservatorship. She explains that they are based upon grave disability. It is usually someone who has come in and out of the hospital many times. First you get a temporary conservatorship which lasts 30 days. Next you get the permanent conservatorship which is for one year and can be renewed.
Dr. Ken points out there is a mild, moderate or severe level of schizophrenia.
Dr. Wilson says that caregivers can gain a better understanding of what is really going on. She says it can be scary to the patient and the family members. By having a better understanding, the outcome is better. Questions should be asked fo the doctor about the plan. Soemone on the team can tell the family members about the short term plan. The presence of the family members is very important. Consent is a huge issue. As long as the patient allows a family member to be in the room, that is the same as them giving consent.
Dr. Wilson has some encouragement for those family members livign with members who have schizophrenia. She says that sticking with them an da good doctor, there is definitely heope. It isn't all about medication (which is important), but you should find someone with a therapeutic touch. Therapy is just as important as medication.