Navigating Postpartum Depression: Hospitalization and Family Dilemmas

After being involuntarily admitted to the hospital, the patient was successfully hospitalized?

The patient had a dispute with her mother on December 10, 2018, and was forcibly sent to the hospital.
In a state of mental confusion, she signed a consent for hospitalization.
The attending physician stated that she is a severely ill patient, and her sister has been appointed as her guardian.
Most communications and assistance have been handled by the guardian and the specialist.
Recently, the patient has expressed a desire to be discharged and has inquired about her improved condition.
Currently, there is a divergence of opinions between the family and the guardian; the guardian and the maternal side wish for her to continue hospitalization or be transferred to a nursing facility, but they are unwilling to pay for the expenses and the patient does not agree to go.
We are her children, but the patient has long neglected us and has previously harmed us.
As young adults currently studying and without income, we are concerned that the maternal side will shift all medical expenses onto us.
The attending physician hopes that our family can reach a consensus.
According to Article 38 of the Mental Health Act, when a hospitalized patient’s condition stabilizes or improves, and there is no need for continued hospitalization, the mental health institution should notify the patient or the guardian to arrange for discharge and cannot detain the patient without cause.
Before the patient is discharged, the mental health institution should assist the patient and their guardian in formulating a specific and feasible rehabilitation, referral, placement, and follow-up plan.
The competent authority of the municipality or county (city) should establish a 24-hour emergency mental health care mechanism to assist in escorting patients for medical treatment and emergency placement.
1.
If the guardian wishes, how much longer can the hospital keep the patient?
2.
The attending physician said the patient can be discharged at any time, but someone must assist the patient with the discharge process.
Does the person assisting have to bear the hospitalization costs and subsequent care responsibilities?
3.
If the hospital notifies the guardian or family members who are unwilling to assist with the discharge, can the patient discharge herself? What would be the consequences?
4.
Will the doctor use the reason that the mental health institution should assist the patient and their guardian in formulating a specific and feasible rehabilitation, referral, placement, and follow-up plan to justify keeping her hospitalized?
We were raised by our father, who, due to the divorce, has already paid off a significant amount of her credit card debt and provided her with alimony, while also raising us with considerable debt.
We truly lack the ability and willingness to take on her responsibilities, but we are also worried about the accumulating costs of her long-term hospitalization.
We hope that while she is still young and in a condition to support herself, she can be discharged.
Thank you.

Chen Ruixiang, 20~29 year old female. Ask Date: 2019/02/27

Dr. Zhang Nairong reply Postpartum Depression

1.
If the guardian wishes, how long can the hospital keep the patient? Answer: After inpatient treatment, if the acute psychiatric symptoms have alleviated, the patient may meet the discharge criteria for the acute ward.
The attending physician will usually negotiate with the patient and the guardian to determine the discharge date.
This case describes a situation where the guardian unilaterally requests the patient to remain hospitalized; however, the patient's right to autonomy regarding discharge must be respected.
Furthermore, resources in the acute ward are limited and regulated by the National Health Insurance Administration, so indefinite delays in discharge are not possible.
The specific timeframe for discharge negotiations needs to be discussed with the attending physician.
2.
The attending physician says the patient can be discharged at any time, but someone must assist the patient with the discharge process.
Does that person have to take on the responsibility for the hospital fees and subsequent care? Answer: The discharge should ideally be handled by the guardian, who is responsible for managing the hospital fees and subsequent care arrangements.
If the guardian is unwilling to assist, but other family members are willing to help, they effectively take on the guardian's responsibilities in managing the hospital fees and subsequent care.
3.
If the hospital notifies the guardian or family members, and they are unwilling to assist with the discharge, can the patient discharge themselves? What are the potential consequences? Answer: The spirit of the Mental Health Act is to respect the patient's autonomy.
If neither the guardian nor family members are willing to assist with the discharge, the hospital cannot unjustly detain the patient.
The patient has the right to discharge themselves.
However, if the patient is severely ill, the hospital will typically notify local health or social services to assist with community follow-up.
4.
Will the doctor keep the patient hospitalized because the psychiatric facility is required to assist the patient and their guardian in formulating a concrete and feasible rehabilitation, referral, placement, and follow-up plan before discharge? Answer: The key point of Article 38 of the Mental Health Act is that if the patient's condition is stable or has improved, and there is no necessity for continued inpatient treatment, the patient cannot be unjustly detained.
Therefore, once the patient meets the discharge criteria for the acute ward, the hospital has no authority to restrict the patient's freedom and prevent discharge.

Reply Date: 2019/02/27

More Info

Navigating the complexities of postpartum depression (PPD) and the associated family dilemmas can be incredibly challenging, especially when hospitalization is involved. In your situation, it appears that there are multiple layers of emotional and logistical difficulties that need to be addressed. Let's break down your questions and concerns systematically.

1. Duration of Hospitalization: The length of time a patient can remain hospitalized is typically determined by their clinical condition and the judgment of the treating physician. If the patient has stabilized and no longer exhibits acute symptoms, the hospital may recommend discharge. However, if the guardian (in this case, the sister) insists on continued hospitalization, it may be a matter of negotiation with the healthcare team. The hospital cannot keep a patient indefinitely without a valid medical reason, as per mental health laws.

2. Discharge Process and Financial Responsibility: The treating physician has indicated that the patient can be discharged at any time, but a responsible party must facilitate this process. This does not necessarily mean that the person assisting with the discharge must bear the financial burden alone. If the guardian is unwilling to take on this responsibility, other family members may step in, but this should be discussed openly to avoid misunderstandings about financial obligations.

3. Patient's Right to Discharge: If the hospital informs the guardian or family members that they are unwilling to assist with the discharge, the patient has the right to leave the hospital, provided they are deemed stable enough to do so. However, it is crucial to understand that discharging oneself against medical advice can have consequences, including a potential lack of follow-up care and support, which could jeopardize the patient's recovery.

4. Continuing Hospitalization and Treatment Plans: The stipulation that a hospital must assist in creating a rehabilitation and follow-up plan before discharge is designed to ensure that the patient has adequate support upon leaving. If the patient is stable, the hospital cannot justify continued hospitalization solely based on the need for a discharge plan. However, if the patient is still experiencing significant symptoms or if there is a risk of harm, the physician may recommend further treatment.

Given the financial and emotional strain on your family, it is essential to communicate openly about these concerns. It may be beneficial to involve a social worker or a mental health advocate who can help mediate discussions between family members and the healthcare team. They can also assist in exploring options for financial assistance or community resources that may alleviate some of the burdens.

Additionally, it is crucial to consider the long-term implications of the patient's mental health. While the immediate goal may be to facilitate discharge, it is equally important to ensure that the patient has access to ongoing support, whether through outpatient therapy, community resources, or support groups. This can significantly impact their recovery trajectory and help prevent future crises.

In conclusion, navigating the complexities of postpartum depression and hospitalization requires a collaborative approach. Open communication among family members, the healthcare team, and possibly a mental health advocate can help ensure that the patient receives the care they need while also addressing the family's concerns about financial and emotional well-being. It is a challenging journey, but with the right support and resources, it is possible to find a path forward that prioritizes the health and recovery of the patient while also considering the family's needs.

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