Tuesday was terrifying, Wednesday was hectic, and Thursday? Hoo boy. The client from Tuesday was being released from the hospital and I was having another client picked up by the probate court, so I spent the day fielding calls from social workers, probate court, and the sheriff trying to locate the client who was being picked up, all the while taking care of my usual busy Thursdays, as all of my standing appointments have gravitated to Thursdays. I felt bad, I kept having to ask my clients to go back to the lobby while I fielded yet another urgent call- I only take calls from other professionals while I have a client in my office, so most of my clients have never been asked to wait in the lobby for a moment. I had to ask one of my sweetest clients to go to the lobby three times, the poor dear. He was so confused and quite frankly, scared, so I had to sit down and explain probate to him so he wouldn’t be so scared.
I’m not sure if I’ve ever covered the topic of probate. Probate isn’t probation, where a client has to check in due to committing a crime. Probate is where the mental health court steps in and court orders a client into treatment, because the client will not accept treatment and is an active risk to themselves or others. Treatment includes taking medication (but more on that later), and seeing their case manager and doctor. The client and I have to write a treatment plan that the court then enforces, in that if the client violates that plan, there will be a motion filed to have the client taken to the hospital for assessment. This plan hits all of the domains a regular service plan covers, including physical health, mental health, risk, school, home, housing, money, etc.
Probate sounds big and impressive and scary but if a client knows the system, it’s completely worthless. It doesn’t really have any teeth and honestly it only really works on clients who don’t know how weak it can be, as filing a motion to have someone picked up is rather difficult. I have to demonstrate that the client is of significant, active risk to themselves or others, so simply skipping medication or appointments will not get them picked up. Knowing that I *can* tell the court tends to keep clients compliant, and the hope is that once they are engaged in their treatment, they will develop the insight to want to remain compliant with treatment even when they are off probate. (This… is not how it usually works out in reality. Shock, I know.)
There are two kinds of probate: outpatient and inpatient. If a client is taken to the hospital on a psychiatric hold, such as what happened earlier this week, a hold only lasts for a maximum of 72 hours. If the treatment team agrees that 72 hours is not enough time to be able to reduce the risk the person is at, they can file a motion for inpatient probate, which means the client has to remain at the hospital until the doctor feels they are no longer an active risk to themselves or others. This can be motioned into outpatient probate from there, if the treatment team feels the client needs ongoing monitoring to remain safe.
On the other hand, if someone is in the community, I (or a family member) can go to the Probate Court downtown and file a motion, giving examples of the client’s behavior within the last 30 days, and the Magistrate decides if that person should be picked up for hospitalization. The client is picked up by the sheriffs and taken to the hospital, where they are assessed, and a few days later there is a formal probate hearing in which the assessing doctor, and whomever filed the motion, are put on the stand to explain their concerns. The client is always allowed to comment at their own hearings, as well, and they are represented by an attorney.
Another thing to note: forced medications are not a part of this. The only medications which can be “forced” are injectible medications, and a forced medication order can only be put through by a hospital, and usually the state mental hospital. That issue has its own court hearing outside of a normal probate hearing, and it’s a tough fight. My agency cannot force medications on anyone, so we don’t even touch on it. Only when one of my clients is in the state hospital does it even hit my radar.
One thing of note, as I and one of the MDs I work with discovered last fall, is a client can actually strong-arm the court to be released from probate. My client refused to agree to the treatment plan and demanded that if she was not hospitalized for one year, she got to sign a voluntary, which is a form that the client and MD complete that states the client will continue treatment independently- which is something she has no intention of doing, mind. She has always stated that she has no intention of continuing treatment and frequently states that she’s going to disappear again to get “out from under your control.” I’ve been dreading that one-year mark, because this client is extremely sick and this is the first time she’s been relatively stable in years. Probate made the difference between chronic homelessness and no benefits, and her having an apartment of her own and receiving SSDI and Medicare, because she (very reluctantly and with much kicking and screaming) worked with me to get her benefits set up. She complained about it the whole way and still does, but she’s got a roof over her head and is no longer sleeping in her car, so I’ll take it.
Not many of my clients are on probate, because I work with them to help them understand about their illness. They might not *like* their medication, but they understand that it’s important to control their symptoms, and most of them are disturbed enough by their symptoms that they’re willing to take their medication to help with it.
Some of my clients, however, don’t believe there’s anything wrong with them, and it’s everyone else who needs medicine. Honestly, so long as you’re not a threat to yourself or anyone else, I’ll do my usual medication schpeil, but go ahead and get on with your bad self. I have no problem with discharging clients that have no desire for treatment, because so long as they’re not on probate, it’s their choice, and I would rather someone who wants the treatment to be utilizing it, than someone who refuses to taking up space on my caseload that someone else needs. I am all about personal choice because it could be me sitting there as a client- it almost was. It could be in the future. I want to be given the choice and autonomy to run my life as I see fit, and I hate having to probate clients and will do everything in my power to keep them autonomous and independent. However, once they become an active risk to themselves or others, I have a legal obligation to make sure they and the community are safe. Probate is one of the touchiest parts of my job, because it is scary for my clients and mostly pisses them off, but it is a necessary evil.
I’m just not looking forward to the phone calls I’ll be getting from her tomorrow.