# What's Considered a Break in Contract?



## Twilight_Zephyr (Feb 10, 2007)

I'm a bit worried.

I've been taking place in a medical study for an experimental drug for MDD. And at my last appointment on monday...I brought up my increased thoughts of suicide. I had to agree not to harm myself until our next appoinment which is this Monday.

I've actually been feeling a lot better this week, but I had 1 really bad day. I made a plan...but told myself to sleep on it. And was not even tempted to consider the plan the next day. But on that bad day I cut myself. 

I'm afraid to go to the appointment on Monday...because I hurt myself...and am scared that they will put me in a hospital because I broke the contract.

But does that count...I'm scared. I think being put in a hospital would be detrimental to my healing. I've never been hospitilized for any reason before...not even to an ER.

I can be considered chronically suicidal. I have 1 attempt and 2 aborted attempts in my history. I have also been diagnosed with C-PTSD as well as MDD and Dysthymia...and most likely am BPD.

I've been doing really well...and think that being hospitalized would ruin how I feel about myself.

Last week I had suicidal thoughts for most of the week...this week it's only been 1 day....but I'm scared because I think that day could add up to all of the others from last week...but I am still in control.


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## Daniel (Feb 10, 2007)

> ...and am scared that they will put me in a hospital because I broke the contract



Around here (in the United States), that is not, in itself, enough to justify a non-voluntary hospitalization.  For example, a legal case in Oregon:



> Here [in this case], no evidence links anything about appellant's temperament or situation at the time of the possible prior acts of self-harm to her current condition...Apprehensions, speculations and conjecture are not sufficient to prove a need for mental commitment.
> 
> http://www.publications.ojd.state.or.us/A125915.htm


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## Twilight_Zephyr (Feb 10, 2007)

Thank You for replying Daniel.

I'm sorry I don't really have the concentration or patience to read through that all.

So you don't think the fact that I actually self-harmed, when I said I wouldn't, does not make me a threat to myself?

I would probably be considered moderate to high risk for suicide to myself right now. But my intent is very low and very fleeting...but I have been really impulsive lately.

I was thinking that the fact that I could not control my self harm would be proof enough for them to not trust me to not kill myself...maybe not, not sure.

I have mentioned high lethality, easily accessible means to them last week. And I'm feeling ashamed for saying anything and now more worried about commitment.

my self-harm is my form of coping with the suicidal thoughts.


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## Halo (Feb 10, 2007)

Twilight,

Just a thought, but do you think that you could write out what has happened and give it to your doctor and give it to him/her at the beginning of the appointment so that they know what has happened. Maybe if you can explain it to them through writing they will understand that your self harming was not an intent on suicide but more of being overwhelmed with feelings and thoughts and a way to release those. You could take parts of what you wrote here to explain it....maybe if you say that you had have been feeling better this past week but that you had one bad day which resulted in you harming yourself as a way to cope with your suicidal thoughts but decided to sleep on it and the next day that you were not even tempted to consider the plan.

Anyway, again it is just a thought?
Take care


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## Twilight_Zephyr (Feb 10, 2007)

I could tell them, just as well as write it.

Problem is I don't know if I want to tell them...cause I'm scared of what the consequences could be. But the said they were going to spend more time questioning me this next appointment about suicidal thoughts.

And the reality is...that I have now selected an easily accessible lethal method...whereas last week I wasn't sure on a method. I can't seem to stop my thoughts from drifting to bad things.

I'm also afraid they may take me out of the study and I think the meds are actually starting to work.


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## Daniel (Feb 10, 2007)

It may help to just relax for now and see how you are feeling on Sunday/Monday.


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## Twilight_Zephyr (Feb 10, 2007)

I was just thinking that Daniel...after that last post.

I'm just getting myself worked up.


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## Halo (Feb 10, 2007)

Twilight,

If at your last appt. they specifically asked you not to self harm until the next appt. then you can almost be guaranteed that they are going to ask you about it and that is going to have to be a personal decision as to whether you tell them the truth or you don't.  I can only tell you what I would do in your situation and that would be to tell the truth.  I say that for two reasons...

First, because how are they suppose to help you if you are not honest with them about what is happening and what you are experiencing and feeling; and

Second, you agreed to be in a medical study for an experimental medication and without you being honest with them how are they suppose to know whether their results are accurate and their drug really works.

So with all that said, it really does come down to your decision and although you are scared of the consequences, I can tell you that I have had both psychiatrists and psychologists know about my self harming and none of them have ever looked at it as my intent to committ suicide. They understand that most of the time that I self-harm it is because I am overwhelmed with feelings and thoughts and need a release or an escape from them.  It is not that I want to necessarily die but that I want the pain to stop.

Take care


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## David Baxter PhD (Feb 10, 2007)

TZ, what you said originally was this:



> I brought up my increased thoughts of suicide. I had to agree not to harm myself until our next appointment which is this Monday.



There is a very big difference between self-injury and a suicide attempt. Any trained therapist will understand that. I don't doubt that your therapist would prefer that you don't self-injure as well, but in this case I would suggest that, at least at some levels, you didn't break your promise.


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## Daniel (Feb 10, 2007)

BTW, a typical regulation for involuntary placement or involuntary examination is from Florida's Baker Act:



> There is *substantial likelihood* that in the *near future* he or she will inflict *serious bodily harm* on himself or herself or another person, as evidenced by recent behavior causing, attempting, or threatening such harm.
> 
> A patient may not be held in a receiving facility for involuntary examination longer than 72 hours.
> 
> http://www.psychlaws.org/LegalResources/StateLaws/Floridastatute.htm


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## David Baxter PhD (Feb 10, 2007)

And in most jurisdictions, you will find that "serious bodily harm" will be interpreted as "life-threatening bodily harm".



> A patient may not be held in a receiving facility for involuntary examination longer than 72 hours.



Just to clarify, what this means is that there must be a review after 72 hours to see whether the patient meets the criteria for an additional 72 hours (the times may vary in different jurisdictions). If the patient continues to meet the criteria for involuntary committal, s/he may be held on a new "form" (with recurrent reviews until s/he no longer meets those criteria).


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