Has anyone here petitioned their pwBPD for involuntary evaluation?

[maxsterling]

It's been a while since I posted here.  Since my last post it seemed like things were slowly improving (or I was improving) until about 6 months ago.  Since then, my wife has spiraled downward, having rages at nearly everyone, including health care providers, therapists, employers, friends, and family.

Last week - the rage was towards members of my family during a camping trip.  My wife wound up saying about the cruelest words I have ever heard one person say to another and raged enough that at least two other people in the campground called police.  The incident left me physically and mentally in shock, so much that I could barely walk or talk for an hour or two and a brain fog that lasted a few days.

I am shocked the deputies that came did not take her into custody or admit her to a mental health hospital.  They told me that in the state we were in, there is very little they could do.  My wife refused to call for any phycological help for herself, and when I got a crisis team to go to her, she refused to talk to them.

In the state I live in, I can fill out paperwork to have her involuntarily admitted for evaluation.  They evaluate her for 24 hours, then can hold her for up to 72 hours if they feel she may need in patient care.  After that, a judge can order her to in patient care.

Has anyone had to go this route?  I'm considering it but also considering it may hurt more than help if the resists.  She has mostly calmed since last week, and I don't think they can keep her unless they feel she is a physical danger to herself or others.  She knows well enough what not to say - my fear is that they keep her 24 hours and let her go.  I don't think they can admit her for treatment for just being extremely angry.

What she needs is DBT or intensive outpatient therapy, but she won't seek it.  I've been trying as gently as possible to point her in that direction, but it is not easy as she is continuously blaming all her problems on others. 

 

[kells76]

Can you remind me if you have a therapist for yourself?

If so, I would ask your T about the involuntary hold process. I think you and I are on the same page that it could be very damaging to your marriage. That's not to say "don't do it" or "do it" -- just a fact to keep in mind. Your T may be able to provide more guidance or insight about the logistics of the process, the pros and cons, and the emotional benefits/costs.

In his book The Gift of Fear, author Gavin De Becker describes weighing the pros and cons of getting a restraining order. Different intervention, but same mindset: it can solve some problems, but create or exacerbate others, and it's important to understand the nuances of your own unique situation before proceeding.

You can also consider consulting with multiple different local professionals in different areas: one or more lawyers (consider asking for an "initial interivew"), your local DV hotline (especially if your kids have been around their mom raging/threatening violence), and DHS/CPS (because you have minor children). If you call DHS/CPS make sure you are saying it is for a hypothetical situation. In that case, you don't have to make an official report or give your name. You can describe what's going on and ask them how they might assist in a situation like that. Sometimes the "safety plan" is that one parent lives elsewhere for a time. Could be a different path forward than a psych hold. Not saying it's a great idea or the best idea, but there are other ideas out there beyond a hold, and getting yourself really informed will be important as you decide what is healthy for your family.

[ForeverDad]

Also be aware that the legal system views poor behavior as more actionable for children than for adults.  Children, after all, are minors and not expected to have the ability to withstand rants, rages and other abuse.

Also be aware that poor behavior often goes hand in hand with other BPD traits such as Denial, Blame Shifting, etc.  Of course, people in general may do that as well, but the persons with BPD traits have them to an extreme level.  So consider if you do report this.  What if she at that time denies it, maybe even blaming you as the bad guy?  What proof would you have or would it be he-said versus she-said and as unsupported hearsay possibly ignored on a legal level.?

[Pook075]

Has anyone had to go this route?  I'm considering it but also considering it may hurt more than help if the resists. 

I almost went that route with my ex wife while she was having a psychotic episode during our initial breakup.  But once she realized that it was a possibility, she removed me from all her medical charts and sought a restraining order against me.  She also trashed me to our adult kids and all her relatives and said that I was trying to put her in a psych ward against her will.  It was so ugly that I decided not to pursue it, even though our primary physician told me it was necessary.

If your wife is doing better, then perhaps there is less of a benefit from trying to do anything now.  The time to take action would have been when she was in crisis, and it doesn't sound like she's there any longer.

[Notwendy]

Hi Max, I remember you. I am glad you had some time of relative "better". What I observed is that BPD mother's behaviors were less at times than others. She continued to have BPD but some times were relatively better for her maybe.

I don't have experience with a spouse in a form of residential care, but maybe sharing my experience with BPD mother will help. I agree with the recommendation to ask your therapist about options for signing someone in. What I found in my situation that one can have someone held temporarily for emergency situations but not for long term treatment if they are lucid and legally competent. If your wish is for your wife to receive DBT- that requires her  being motivated to do it and a longer term commitment. You may think she needs it- and you may be correct- but this is her decision.

I don't know about what was done for BPD mother when we were children as we were too young to be aware of that. Her behavior- the rages, the dissociations- were mostly kept in the family. She blamed others for any issues and was not motivated to seek therapy like DBT. Her perspective was as if she was the victim.

One aspect of her personality that made it difficult to get her to seek help is that she needed to feel in control and in any kind of residential setting, she would have less control.

Another one- is her ability to "pull it together" when there was the possibility of being placed in a more controlled setting and then she'd not qualify. I think one can only hold someone for 24-48 hours if they are a danger to themselves or others. DBT is long term outpatient therapy. You can't commit someone to that. So while she may have qualified in the moment, once the dissociation was over, she was lucid again.

One incident that I know of is when her physician had her go to inpatient care for medication abuse. She did not cooperate with the plan and signed herself out after 2 days, and refused to follow up with outpatient treatment.

Later, in her elder years, I had power of attorney (she remained legally competent, this was for emergencies). BPD mother was in a skilled nursing facility for medical care. The staff felt she needed to stay there long term (it met her needs). The social worker encouraged me to use the POA to get her to stay if she wasn't mentally able to sign for herself and called a staff meeting. During the meeting, she was lucid, blamed her family for "dumping her" there and insisted on leaving.

If your wife is being a danger to herself or others- then don't hesitate to call for emergency help. Although you may think it's not helpful if they don't admit her- it is helpful in that- they make the decision if she's a danger to herself and others, not you, and we aren't qualified to make that decision. I did call 911 on BPD mother when she didn't want to go. When she was in the emergency room, she did not want to be admitted. They could not force her if she was lucid. But this placed the decision between her and the medical staff.

If your wife is similar to my mother, the dissociative episodes are temporary. Once the feelings have been projected, she's more lucid. If a person is lucid and legally competent- you can not force them to have treatment.

I think it's valuable to call for emergency if needed so we feel we did the best we could- even if they make their own decision later and are angry about it. The intervention may be limited or not-but once we've sent them to the hospital- we have done all we can on our part and I think it is important to know that.

If you feel you need to get your wife to help- then there's a value to you and possibly her in doing that, even if she reacts.

[ForeverDad]

If your wish is for your wife to receive DBT- that requires her  being motivated to do it and a longer term commitment. You may think she needs it- and you may be correct- but this is her decision.

If your wife is being a danger to herself or others- then don't hesitate to call for emergency help. Although you may think it's not helpful if they don't admit her- it is helpful in that- they make the decision if she's a danger to herself and others, not you, and we aren't qualified to make that decision. I did call 911 on BPD mother when she didn't want to go. When she was in the emergency room, she did not want to be admitted. They could not force her if she was lucid. But this placed the decision between her and the medical staff.

About that "we aren't qualified to make that decision" aspect.  I faced that unspoken response from the professionals for two years during my divorce and the next six years post-divorce until the court finally made a parenting order that worked.  They were "the professionals".  By contrast, although I had lived with my ex-spouse for well over a decade, I didn't have professional education and training for them to listen to me.  My voice just wasn't enough, not even to make much impact on my own lawyer.  The system has a process that has evolved over time and my experience and input just weren't invited.

[Notwendy]

I don't know about the divorce setting but in the medical realm, the law preserves personal autonomy. As family members we can't label someone, or place them in a medical setting, or even access their medical information as long as they are legally competent to make their own decisions.

To prove someone is not legally competent is a medical and legal process. Since BPD mother was able to "pull it together" in front of medical providers, she did not meet criteria for legal incompetence.

Even though I had power of attorney- my BPD mother, if she was able to make her wishes known could override any decision I might make. I don't know about the divorce setting but in the medical realm, I could not make any decisions for my mother about treatment, mental or physical, as long as she was able to decide for herself.

I think there are two different situations here. If anyone- regardless of qualifications- believes a person is a danger to themselves and others- they can request an emergency evaluation. Once the person is in the care of qualified providers- the providers decide on what to do next but outside of the immediate danger situation, they can't force a person to stay without the person's consent.

[Notwendy]

About that "we aren't qualified to make that decision" aspect.  I faced that unspoken response from the professionals for two years during my divorce and the next six years post-divorce until the court finally made a parenting order that worked.  They were "the professionals".  By contrast, although I had lived with my ex-spouse for well over a decade, I didn't have professional education and training for them to listen to me.  My voice just wasn't enough, not even to make much impact on my own lawyer.  The system has a process that has evolved over time and my experience and input just weren't invited.

I can understand how frustrating this is, especially when children are involved. The law, if it is going to err- errs on the side of protecting autonomy.

Without these safeguards, a spouse or adult child could make false claims against a person and take away their autonomy. I was concerned about my mother making poor financial decision but if I had taken her to court- the court would be focused on protecting her rights, not her childrens' opinions, even if they were accurate.

It's frustrating to have the knowlege that the person is disordered and needs help but we have little power over someone who is legally competent- which they can retain even with some mental disorders.

[maxsterling]

Really good discussion, thanks everyone.

I went to talk to the people at the emergency psych hospital and learned a few things:

1) Somone submits a petition, and it is reviewed for merit.  If the review determines the person is facing an emergency threat to him/herself or others, that person is taken in for a 24 hour evaluation.
2) An "emergency" only includes events from the previous 72 hours.
3) During the 24 hour evaluation, professionals assess the person and determine if an additional 2 days are needed. 
4)  During the initial 24 hour and subsequent 48 hour periods, witnesses can provide evidence that the person needs to be admitted to a psychiatric hospital.  A judge then rules on whether the person is admitted or released. 
5)  The person at the hospital told me the threshold is high, and the judge wants all I's dotted and T's crossed.

Based on that, it seems the system is set up to address emergency situations where someone is in immediate danger.  Once the danger is passed, the person is released.  During last week's crisis, the possibility was there, but even then my wife was not making physical threats to myself, herself, or others, and the kids were not in her presence. 

So really this route is probably only helpful if physical harm is imminent. 

This is really between a rock and a hard place here, and I think the best option for the short term is to maintain the status quo.  I'm doing my best ATM to minimize the time the kids are with my W alone or initiate things that could result in trauma to them.  There is no immediate emergency.

I have talked to a lawyer in the past but can't remember if it was before the kids were born.  I was told regarding visitation/legal custody of kids that initially it is hard for anything other than 50/50 until there is a recent, serious threat.  That means for the short term, the most likely scenario if we split is that the kids would split time with her and while I know that is potentially dangerous to the kids emotionally, it kinda boils down to he said/she said.  Knowing my W, she would probably be on her best behavior for a little while until someone else witnesses something. 

[Notwendy]

Based on that, it seems the system is set up to address emergency situations

What they told you with the process is similar to my experiences with elderly BPD mother. There'd be a crisis situation, and then plans to address it. But once the crisis was over- she'd be back to baseline. There wasn't a way to have her in long term therapy unless she chose it.