I've increased M's haldol to the point that he's doing pretty well now (for him). 

So, until about a week ago, I would have thought that worrying about a 72 hour hold was an unreasonable fear... except that very thing just happened to a good friend of mine. 

Her daughter had been struggling for a long time with an increase in psychiatric symptoms. M's pdoc has been this girl's pdoc for many years, and said she wasn't sure what to do next (the same thing she tells me about M) and suggested an inpatient stay. The girl and her mom refused. Two days later, when the girl still wasn't any better the pdoc said the mom needed to take the girl to the ER or she'd order a 72 hour hold. (the girl was NOT a danger to herself or others.) They agreed to go to the ER but then the pdoc wanted the 72 hour hold anyway. The nurse said the girl didn't meet criteria for a 72 hour hold, and initially refused to do it, but then told my friend that she "didn't want to lose her job" so the hold was placed on the child anyway. The girl was transported to a substandard psych facility 20  miles away (all the decent facilities were full), and during the 6 days she was there she saw a therapist once, a pdoc once, and spent the rest of the time listening to the other teens on the unit talk about sex and drugs. (Yes, she spent more than 72 hours there because each time my friend tried to push them to discharge her daughter, they said she needed a "few more days" and threatened to put a 30 day hold on her if the mother tried to take her out too soon.) She was even there on Thanksgiving... her family was allowed only a one hour visit for the holiday... an hour spent in a dingy cafeteria with the other patients and their visitors. No food, or other holiday treats were allowed in or served.

I can't believe they still treat people (children!) with mental illness in much the same way they treat criminals.