Psychiatric Advance Directive (Gamma PAD) prompted by the OCHCA for Keith “Buster” Torkelson, MS, BS (2025)
Link to First Publication
Wednesday, July 28, 2021
A Real Psychiatric Advance Directive (PAD) 2021, prompted by
the Orange County Health Care Agency (OCHCA) for Keith “Buster” Torkelson, MS V
Brand New Day
https://brandnewdayhmo.blogspot.com/2021/07/a-real-psychiatric-advance-directive.html
See > Appendix
Legal_EOL_Managed_Passing_EAD_Euthanasia_25030702_Actual
Tuesday,
July 27, 2021
Psychotropic
plus Medication History for Keith “Buster” Torkelson, MS, as Associated with
OCHCA, prompted Psychiatric Advance Directive (PAD)
https://psychiatry4dummies.blogspot.com/2021/07/psychotropic-plus-medication-history.html
Keeping Records – Personal Health
Records (PHRs)
>We recommend that you keep records of your doctors,
medications, living arrangements, hospitalizations, legal issues, assessments, assessment scores, computer passwords and accounts, etc.
OCHCA: How to submit a psychiatric
advance directive?
To submit a psychiatric advance directive (PAD) in California, complete
a general Advance Health Care Directive form, sign it, and have it witnessed or
notarized. You must then give copies
to your healthcare providers, healthcare agent, and family, and you can
register it with the California Secretary of State to make it a permanent record. The Orange
County Health Care Agency (OCHCA) can also provide specific forms and guidance
on creating a PAD.
FYI - Register an AHCD and/or PAD with the California
Secretary of State
To register an Advance Health Care Directive (AHCD) with the California
Secretary of State, you must mail the completed and signed "Registration
of Written Advance Health Care Directive" form along with a $10 filing fee
to the state's registry. The AHCD
itself does not need to be included, but the registration form provides
information for the registry and indicates the location of the actual document.
Registration of Written Advance
Health Care Directive
https://ahcdr.cdn.sos.ca.gov/forms/sfl-461.pdf
Do you have to notarize your
psychiatric advance directive?
You don't have to notarize a Psychiatric Advance Directive (PAD) in
many states, like California, but you must either get it notarized or signed by two qualified witnesses to
make it legally valid; notarization is often recommended as it adds a
strong layer of proof of identity and intent, preventing future challenges. The
specific requirements (notarization or witnessing, and witness qualifications)
depend on your state's laws, so checking your state's guidelines or using a
state-specific form is crucial.
Qualified Witnesses
A qualified witness is someone with specific knowledge or experience, allowing them to testify
about facts or provide expert opinions, especially to authenticate documents (like
business records) or offer specialized insights in court, proving they
understand the record-keeping procedures or the subject matter to help the
judge/jury understand complex issues. Key types include Expert Witnesses
(specialized knowledge, e.g., doctors, engineers), Lay Witnesses/Fact Witnesses (firsthand knowledge), and
those qualifying business records (familiar with organizational procedures).
Title
Psychiatric Advance Directive
(PAD) 2025, prompted by the OCHCA, by and for Keith “Buster” Torkelson, MS, BS
72 Hour Hold
We here at Mentalation Solutions
Group (MSG) will finish proofreading this, our principal’s, Keith “Buster”
Torkelson MS’s, Psychiatric Advance Directive or PAD on or before December 13,
2025 (SA). The original (Beta) version
of our PAD was published back in 2021. What
follows is Buster’s Gamma Version
or Revised PAD. We will use some of this
material when the time comes for constructing Buster’s Final (Omega) PAD. We plan to publish this version on one or
more of our Blogs before the end of the year 2025.
FYI – AHCD Form > Metadata > 7 Pages >
https://oag.ca.gov/system/files/media/ProbateCodeAdvanceHealthCareDirectiveForm-fillable.pdf
FYI – California Psychiatric Advanced Directive Form (pdf)
UCLA Health (41 pages)
What is an Advance Directive?
An Advance Directive provides a way for people to direct
their own healthcare even when they are in a coma, have dementia, or are
mentally incapacitated or unable to communicate. A person can use an Advance
Directive to spell out her wishes regarding physical and mental healthcare and
to select someone to make health care decisions when she is unable to do
so. In California, an Advance Directive
is made of up two parts, (1) Appointment of an Agent for Healthcare and (2)
Individual Health Care Instructions. A person may choose to complete either one
or both of these parts. Either part is legally binding by itself.
Intent Taken From Be Well OC
Promotion
BeWellOC is Orange County's mental health and wellness initiative,
which supports Psychiatric Advance
Directives (PADs) as crucial tools for individuals to plan future
mental health care during a crisis, detailing treatment choices and appointing
a health proxy to ensure their voice is heard when they can't speak for
themselves, aligning with county efforts to promote self-determination in
mental health care.
Advance Directives for Mental Health Treatment
>The following is a list of Psychiatric
Advance Directive (PAD) parts that we here at Mentalation Solutions Group (MSG)
found in an online Commercial-off-the-shelf (COTS) instrument. The author(s) indicate: “Please refer to the
Psychiatric Advance Directives Toolkit for instructions
to complete this worksheet”. For
the most part, we are creating our own “Toolkit” based on Keith “Buster”
Torkelson MS’s lived experience centered on Behavioral Health. MSG’s motivation is: The Orange County Health
Care Agency (OCHCA) continues investing in PADs. There is a chance the OCHCA’s PAD project may be
abandoned. In either case, “Buster” and
Mentalation Solutions Group (MSG) are shooting to get our OCHCA-driven PAD in
the virtual record first. This report
will be paired with our PAD Project Mechanics Study (PAD-PMS). Recurrent Theme about Buster’s PAD is: Sleep is protective. Lack
of Sleep is a risk. Buster has a
psychiatrist to help him with sleep.
Back on July 29, 2021, we published our PAD Beta Version.
Work Done > Metadata >
https://brandnewdayhmo.blogspot.com/2021/07/a-real-psychiatric-advance-directive.html
OCHCA PAD
An Orange County (OC) psychiatric advance directive (PAD) is a legal document that allows a person to state their treatment preferences and appoint a healthcare agent to make decisions for them during a mental health crisis. The OC Health Care Agency (HCA) has been involved in a Multi-County Psychiatric Advance Directives (PADs) Innovation Project to help implement PADs, and a person has a legal right to complete one, according to the Orange County Health Care Agency. The document is created when the individual is well and is used only if their condition makes them unable to make or communicate their own decisi
FYI - Psychiatric Advance Directives
OC Health (112 Pages)
https://www.ochealthinfo.com/sites/hca/files/2021-05/PADS_Innovation_Project_PDF.pdf
May 12, 2021
With support from the Governor and Legislature, MHSAOC had launched several multi-county collaboratives, including the Innovations Incubator.
Psychiatric Advanced Directives
bhsoac (.gov) (85 Pages)
PDF
Mar 5, 2025 — Marketing Consultant: develops branding for the PADs project. The Multi-County PADs INN Project is funded by the Mental Health Services Act.
Commercial-off-the-shelf (COTS) Outline for a PAD
1. Symptom(s) I might experience during a period
of crisis
2. Medication instructions
3. Facility Preferences
4. Emergency Contacts in case of mental health
crisis
5. Crisis Precipitants. The following may cause me to experience a mental
health crisis
6. Protective Factors. The following may help me
avoid a mental health crisis
7. Response to Hospital. I usually respond to the hospital as follows
8. Preferences for Staff Interactions
a. Staff of the
hospital or crisis unit can help me by doing the following
b. Staff can
minimize the use of restraint and seclusion by doing the following
9. I give permission for the following people to
visit me in the hospital
10. The following are my preferences about ECT
11. Other Instructions
12. Legal documentation for
Advance Directives
FYI - Another Reference for a Template
https://www.bazelon.org/wp-content/uploads/2017/04/PAD-Template.pdf
Typical Length of a Thorough
Psychiatric Advance Directive
A thorough Psychiatric Advance Directive (PAD) generally has no typical "length" in pages; its length is determined by the detail and specificity of the user's instructions and the requirements of their state's legal forms. The time it takes to complete one is a better measure, typically requiring between 45 minutes and two hours to fully articulate one's preferences.
1. Symptom(s) I might experience during a period of crisis:
Sleep and Crises
>The key factor that repeatedly
fuels crises for Buster has been the inability to get adequate health-promoting sleep in the bed that he leases
and resides in. As of July 11, 2021, Buster
had not been in the psychiatric or physical hospital since 2012. This ended in 2024 when Buster was
hospitalized again. Currently, Buster
rents a bed in a Rent a Shared Room (RASR) facility. The facility is called Harvest Retirement and
is an Assisted Living Facility (ALF).
For 2024-2025, Buster has been able to get adequate rejuvenating
sleep. He is on the optimal psychotropic cocktail for sleep. He has been sharing with two severely
physically ill persons. One died in 2024, and the other died in 2025.
Historically, when Buster exhausts his coping efforts and behaviors, he
asks for help. He tries to avoid asking
“911” for help. When he needs to ask for
help regarding sleep and peace we here at Mentalation Solutions Group (MSG) call
it a full blown Crisis.
Crisis Intervention
>Buster learned in his Crisis
Intervention class at Cypress College (fall, 2011) that a Crisis = Danger and
Opportunity. Once a true crisis is in
effect, until its’ resolution, Busters
signs and symptoms have been: Worrying, impaired sleep, worsening of the sleep problem,
problems resting, move readiness by moving property from his room to his
storage, panic attacks, increased risk for injury, increased risk of accidental
death, lack of motivation to help out in his volunteer capacities, sleeping
outside (practicing homelessness), wanting to call “911” on the person keeping him
up, wanting to Mace the person keeping him up, etc. Buster has practiced exceptional restraint with regard to those interfering with
his sleep. Again, a crisis is punctuated
with having to ask for help, including having family members step in to help and/or calling “911”. If need be, apply
Euthanasia Advanced Directive (EAD) as outlined in the appendix.
2. Medication instructions.
A. I agree to the administration of
the following medication(s):
Psychoactive Medications (+) – Rimal
B. Bera MD (RBB) = Buster’s current psychiatrist
Brief Medication List – Mainstay
– Current December 13, 2025
Taken at Bedtime
All are current and effective
Chronobiologic Dosing of
Medication
Chronobiologic dosing, or chronotherapy, is the practice of administering medication at specific times to align with the body's natural circadian rhythms. The central principle of this approach is that the body's physiological functions—such as hormone secretion, enzyme activity, and digestion—follow predictable 24-hour cycles, which in turn affect how drugs are absorbed, metabolized, and tolerated. By timing doses to match these daily patterns, chronotherapy can enhance a drug's effectiveness and reduce side effects.
CloZAPine Contingency
Associated Document > Metadata
>
13_OS_TD_Clozapine_14102503_Contingencies V2025
Brief Medication List (s) – Others
- Recent
Improvement Desired
We are looking for something better to use in the AM that
covers the day.
Medication History > MSGBase
> Metadata >
Work Done [Ditto]
Tuesday,
July 27, 2021
Psychotropic
plus Medication History for Keith “Buster” Torkelson, MS, as Associated with
OCHCA, prompted Psychiatric Advance Directive (PAD)
https://psychiatry4dummies.blogspot.com/2021/07/psychotropic-plus-medication-history.html
Safety – CloZAPine Risks
>When Buster was first stabilized on CloZAPine circa 2006 at Westminster Therapeutic Residential Center (WTRC), he was given his whole daily dose at once by the pharm staff. Buster was finding that it made him very dizzy. When he got up to go to the bathroom at night, he would faint and fall down. Eventually, both dizziness and falling were reduced with a lower dose of CloZAPine and breaking it up into divided doses.
Neutrophils
>This is not to say that, Buster has eliminated nightly dizziness and risk of falling yet in recent years, both are more tolerable. Buster cannot drive the car after he has ½ or more of his nightly dose of CloZAPine in his system, so he takes it just before bedtime. This means he cannot help people out using his car at night. CloZAPine is associated with low white blood cell (WBC-V-PMN) counts. In particular, CloZAPine is associated with low neutrophil (PMN) counts (neutropenia). We have been working on a CloZAPine Contingency Plan (CCP) just in case Buster begins to suffer neutropenia. Buster typically has elevated PMNs which is a protective factor.
What Enables My Wellness?
>Buster is committed to the Rent a Shared Room (RASR) environment as a scar from Behavioral Health campaigns lost. Now and henceforth, Buster is overly vulnerable to harm. At the core of his treatment plan is Sleep. For all practical purposes, as of 2024, he is dependent on CloZAPine, Lorazepam, and Ambien for nightly sleep. As it used to, now having alone CloZAPine in his system at night does not completely guarantee sleep. Now more than ever, his RASR environment and roommate have to be conducive to Sleep (Sleep Able-Environment and Sleep Able-Agent). The Agent is his RASR roommate. Currently (2025), Buster is between roommates or Solo.
Neutropenia
>As we addressed above: CloZAPine
has a glitch. CloZAPine is associated
with a blood factor transformation called Neutropenia. If this happens, the doctor may respond with
cold turkey elimination of CloZAPine [SEE THE STORY OF SAM I AM - Next]. A better approach would be titrate down the CloZAPine
rather than eliminate it. For mitigation efforts, Buster addresses his CloZAPine
Contingency Plan or CCP.
Work Done
April 2019 - Brand New Day HMO –
We Called Him Sam I Am!
http://brandnewdayhmo.blogspot.com/2019/04/
Emerging Health Risks for Keith
“Buster” Torkelson
Introduction – CloZAPine
Contingency Study – Sam Revisited
If our New & Improved Behavioral Health Doctor (BHD) had been more amenable during our “Crash Appointment” he would have discovered how and why we want some tweaking about of our 3 medication “Cocktail”: CloZAPine, Lithium, and Lorazepam. We were going to tell him why we want him to consider exchanging our Lorazepam (PRN) for generic Restoril (PRN). In 2012, we were instructed by Doctor Daniel’s that she could do better for us by eliminating our mainstay CloZAPine. The medication she gave us did not help us as CloZAPine did. She broke our CloZAPine continuity. We stayed up sleepless for three nights. We went “wacko” and ended up back on the Psych Ward, where we met doctor Bum Soo Lee, MD (BSL). We are highly dependent on CloZAPine for our nightly sleep. Without it, we do not sleep. We have/had a friend at Brand New Day (BND). We call him Sam I Am! As of 2018, Sam had been “Stable” on CloZAPine for years. Last year (2018), Sam had some poor lab (CBC) results. He was taken cold Turkey off CloZAPine. One week later, he hadn’t slept. As of 2019, Sam is Missing in Action (MIA). 2012, while in the hospital, without CloZAPine, doctor BSL approved for us Restoril to sleep. Restoril was nearly as effective as CloZAPine. Lorazepam for us cannot substitute for CloZAPine for our sleep needs. The OCHCA, for whom we associate, would call delivering on our Restoril request part of our personalized Safety Net. At the “Crash Appointment” the doctor (RBB) said he would not listen to us! He said, “Tell your friends about it”.
Work Done
2018 - CloZAPine RX 4 Ecstasy- Featuring “Sam I Am”
http://clozapinerx4ecstasy.blogspot.com/2018/
Sep 28, 2018 - Keith E Torkelson, MS, is the principal of Mentalation Solutions Group
Vignette - Here Is The News! –
CloZAPine Risk & Contingency
As we write this paragraph, it is
June 26, 2018. We will carry this
paragraph through multiple publications because we find it important.
There is an issue with our primary medication, CloZAPine, for which we
have no tangible fix. Today, while at the
clinic for our routine Complete Blood
Count (CBC) work we overheard another consumer, Sam I Am, sharing in
the waiting room. Sam reports that after
being stable on Brand-name Clozaril (Generic CloZAPine) for over twenty (20)
years his CBC lab values changed for the worse.
In other words he is now suffering low numbers of White Blood Cells
(WBCs). Most likely it is his
Neutrophils in the WBC family that are low.
This is termed Neutropenia. Bad
news! Neutropenia indicates that you
cannot be prescribed Clozaril (CloZAPine) anymore. We will leave the “doctor” anonymous. In response “doctor” stops Sam I Am’s
Clozaril cold turkey while he waits
for a second lab to confirm the problem. Sam reports he has not been sleeping because
Clozaril is essential for a full restful night of sleep. When we left him about 11am we wished him
luck because the lab and his Clozaril disposition are pending. Sam is quite bright when it comes to how much
he has learned as a Behavioral Health Consumer (BHC). He said that a relative said why not reduce the Clozaril
rather than take it away cold turkey.
Further his relative advices that on a reduced dose he might get the
benefit of sleep and get his WBC number(s) up again. For us, also on CloZAPine, we have worried
quite a bit about a life without CloZAPine.
Actually in 2012 we suffered
catastrophic losses and CloZAPine was in the scenario. As Sam puts it Clozaril was a real game
changer for him. We agree, for us CloZAPine
has been a game changer. In the next
paper we will address what we call our CloZAPine Contingencies. This vignette (puzzle) should be printed and
shared with Medical students in their Pharmacology Course because good “fixes” about
CloZAPine are in need.
Tapering Falsehood
Based on medical literature, the statement that gradual tapering of cloZAPine
is a "better approach" than abrupt discontinuation for neutropenia is
inaccurate. In cases of cloZAPine-induced neutropenia, the drug must be
discontinued immediately. The potential harm from severe infection due to
neutropenia is a more acute danger
than the risks associated with abrupt withdrawal.
Work Done
CloZAPine Determination (Long One)
https://clozapinerx4ecstasy.blogspot.com/2018/03/medimpact-healthcare-systems-inc.html
CloZAPine Practical
https://clozapinerx4ecstasy.blogspot.com/2017/06/clozapine-practical-03-inspiration-by.html
CloZAPine Post
https://clozapinerx4ecstasy.blogspot.com/2017/06/clozapine-blog-practical-02-charter.html
CloZAPine Maintenance (Long One)
https://brandnewdayhmo.blogspot.com/2022/07/medication-problems-with-brand-new-day.html
MSGBase > Metadata >
15_CloZAPine_Publications_Work_Done_21072704_Notes
V2025
Health Related Engagements -
Phlebotomy
>We here at Mentalation Solutions Group (MSG) have defined the incidents where Buster gets out of the house for health-related ventures as Health Related Engagements (HREs). His insurers, such as Brand New Day and Cal Optima, even compensate (d) him for some of his appointments. Since 2012, Buster has very near-perfect attendance for in-network and out-of-network appointments. Buster attends to and coordinates his HREs both in-network and out-of-network. One of his high-priority HREs was his monthly CloZAPine associated Complete Blood Count (CBC) blood draws. Earlier in 2025, the CBC registry requirement by the CloZAPine Registry was removed. This saves money, time, and makes CloZAPine more available to those in need. We had suggested fewer CBC’s years ago.
Coordination
>Buster coordinates his
medication each month. He was touchy
when it came to his required monthly CBC’s (phlebotomy). It is a relief as of 2025 to not have them so
often now. Buster’s doctor, Ravinder P. Singh, started her CloZAPine experiment
on Buster back in 2006. Since 2006, Buster has had no less than 168 blood draws for CloZAPine driven CBC testing. Buster’s left arm is his preferred arm to draw
from. This keeps his good arm, his right
arm, in reserve for the future.
Incidentally, now that Buster is 66 years old, the future is now.
What works? What doesn’t and Why?
Doesn’t work
>During the years since the initial psychotropic experiment (1989), treatment with Haldol (neuroleptic), Buster has agreed to more than twenty experiments using psychotropic drugs. With the major tranquilizer class of medications Buster has been treated with more than six. CloZAPine appears to be the medication of choice for his anxiety and sleep disorder. We would entertain something that works better during the day.
Sustained release injectable(s)
>Since Buster needs minimal interference (adverse effects) during the day to carry out his activities like driving the car, he prefers no CloZAPine, Ativan, or Ambien in his system during the day. Buster requires CloZAPine, Lorazepam and Ambien to sleep. He consulted a few doctors that indicate he would probably not be able to sleep as he ages without medication. Mistaken Belief: If a consumer cannot clear the medication from their system every 24 hours, then they are at risk for toxicity. It may take a week or even a year, yet they more often than not become toxic.
Sleeplessness with increasing age
Sleeplessness increases with age due to natural shifts in our internal clock, lighter/fragmented sleep, and more frequent awakenings (like needing to use the bathroom), leading to less deep sleep. Common age-related causes include hormonal changes (less melatonin, more cortisol), chronic pain, medical conditions (sleep apnea, arthritis), medications, and mental health issues like depression, with insomnia and nocturia (nighttime urination) becoming more prevalent, affecting sleep quality even if total time is similar.
Dr. Daniel’s Experiment
>Dr. Deutsch, a doctor in the past, had managed toxicities that originated in the hospital at the core of his practice. In other words, he specialized in detoxification. CloZAPine has some annoying side effects. Yet, after ironing out some shortfalls, Buster’s CloZAPine benefits outweigh its’ shortcomings. In 2012, Buster had been on CloZAPine for about 5 years. In 2012, Buster was treated by Dr. Daniels at the Anaheim Lighthouse. She told Buster that with Invega, she could “put you in a place that you have never been before”. Her sell worked, and Buster agreed to her experiment. Dr. Daniels proceeded to cold-turkey Buster off CloZAPine and began loading Buster with her Invega SR Injectable. The experiment ultimately put Buster in the hospital.
Bum Soo Lee, MD
>For three days, Dr. Daniel’s
augmented Invega with a Barbiturate
to help with sleep. After she
removed the Barbiturate Buster was sleepless for three nights. To repeat, next due to inadequate sleep, Buster
ended up in the psych ward at
Western Med Anaheim. That is where he
met Dr. Bum Soo Lee, MD (BSL). Doctor Lee
had the choice: Maintain Buster of Invega which doesn’t work for him or resume
CloZAPine which has a history of helping.
BSL chose CloZAPine. At this moment, we knew Dr. Daniels' experiment
had failed, Buster and incurred losses such as hospital time and associated
costs.
Other Treatments and Assists
> Because Buster holds out as long as possible before he calls “911” he is very sick when he is admitted to the psych ward. More often than not, the attending physician concludes that it is a medication issue. Circumstantially, this is the case because out of more than 10 primary psychotropic medications applied over time only three or so were a good fit. The only time a medication change really made a change for the better is when Dr. Ravinder P Singh started Buster on CloZAPine (2006). It took three trips to the Psych Ward before doctor Singh finally got it right. She started Buster on CloZAPine and asked him to submit to Conservatorship (LPS). She released him to a long-term semi-lockdown therapeutic residential treatment facility: Westminster Therapeutic Residential Center (WTRC).
Time Spent
>When Buster goes to the psych ward, it is nearly always related to sleep issues, and he is in need of a bed move. Quite often, his immediate family (natural supports) steps up and helps him with his belongings and other episodic challenges. The assist that Buster needs most is finding a Good Bed on the way for stepping down care. Other assists would be a sustainable treatment and services plan focused on Buster’s unmet Sleep needs. In 2015, Buster’s sleep needs were met. This holds true for 2025 also. Aside: In the hospital, it would be nice to bring back “Smoke Break”. In 2024, there were no smoke breaks. While in the psych ward, when he needs it, Buster likes access to the time-out-room formally called the tie-down or restraint room. In Buster’s history, he only brought the muscle (staff) down on himself on one occasion. He would prefer for managing problematic persons on the ward: That staff come up with a better approach than tackle and mangle. On any given day, Dr. Ravinder P Singh would spend a minute or two with each in-patient consumer on her caseload. Buster would prefer the psych ward doctors to spend more time with their charges. We would also like our outside doctor to treat us on the inside or vice versa, as did Bum Soo Lee, MD. In the context of Psychiatric Advance Directives (PADs), it might be a promising practice to spend five minutes each day with the treating physician discussing germane features contained in a PAD.
Assessment
>A factor that helps in making Buster different than those in his Rent a Shared Room (RASR) cohort(s) is self-assessment. Another factor that makes Buster unusual is literacy and the skills to support literacy such as: Computing, writing, and publishing. He is also superior in problem solving than most of his contemporaries. In addition, Buster is Mental Health Services Act (MHSA) aware. Now, as of March 2024, the MHSA is called the Behavioral Health Services Act (BHSA). It is the MHSA language that we here at Mentalation Solutions Group (MSG) fondly call the Steinberg Programming Language (SPL) that helps Buster in keeping the faith. Yet once again, and most importantly he places as a very high priority nightly sleep. Back in 2006-2007, while sleeping at Westminster Therapeutic Residential Center (WTRC), his LPS Conservatorship presented problems.
End LPS Conservatorship
>Buster asked the WTRC treating physician, Dr. Belman (2006-2007): What is the average stay? He said two years! Buster had a family business on the outside to help run. So to sort things out, Buster did four things: Determined his issue was anxiety, gained approval from the service chief and staff to pursue Cognitive Behavioral (CBT) bibliotherapy for anxiety, created a behavior assessment, and created an anxiety management assessment. After about three and a half months of working on his program for setting things Right, Buster presented his materials to a visiting forensic psychologist, Dr. Sue Beck. She represented Buster in his case with the Probate Court. Conservatorship was ended on a Friday, and Buster was out the door by Sunday. He was directed to place himself. The duration of care at WTRC had been 4 months. In sum, his WTRC worker Roxanne indicated that Buster’s resilience was impressive.
Considerations when Considering
>Buster finds meaning in his
life through performance. It is largely
due to performance that Buster has participated in so many experiments with
psychiatrists. [MEDICATION LIST LINK
BELOW]. Buster had a most significant other ever
(MSOE) from 1998-2018, or twenty years. When a medication change was made, such
as to Paxil or Zoloft, what mattered to Buster's MSOE was that Buster could be
intimate. Paxil and Zoloft caused overt
impotence. CloZAPine for Buster is not
associated with diminished performance.
Some side effects of medication have directly influenced Buster's performance. Wellbutrin enhanced
Busters’ performance yet aggravated his anxiety. Lithium’s associated tremors can be
stigmatizing. In Vet School, Buster was
on Lithium for a term, and the tremors interfered with his team’s surgery on a
rabbit in Liver Physiology. The tremors
also make it hard to write and draw. As of 2025, Buster accepts his diminished
sex drive. Below is an example
of how well Buster could draw before psychotropic medications.
Performance
>More factors that make Buster a bit different: He knows and shares his history of serious and persistent behavioral illness (SPBI). In addition, he is literate, completed college, driven to perform, applies measurements, volunteers, and for the most part knows what he needs. Whether well or not, Buster pushes himself hard. These factors enumerated above are some of Mentalation Solutions Group’s (MSG’s) qualities for a Professional Consumer (ProSumer).
Autonomy
When Buster is healthier, as measured by his Activities of Daily Living (Extended) he is for the most part, autonomous. Buster works hard to set things right after a hospitalization. As of July 17, 2021, Buster had not been in the hospital since 2012. He credits this partially with making sleep a priority. In 2024, Buster was hospitalized after more than 10 years of coping and managing crises.
Side Effects
>Unfortunately, this is not the place and time to discuss the costs of side effects since Buster signed on for Behavioral Health Doctor (BHD) driven psychotropic experimentation back in 1989. CloZAPine had a different sensation profile every night. Some nights it could be miserable, whereas other nights it is quite unremarkable. After Buster ingests by mouth ½ or more of his daily dose of CloZAPine he can get irritable. He does not prefer to do any complex business after starting his nightly divided dose of CloZAPine. He takes his Lithium during the day so as not to interfere with his perception of CloZAPine. This is part of what we call Minded Medication. Lithium’s costs have nearly always outweighed its’ benefits. Yet Buster takes it because his current (2025) doctor prescribes it as an indirect indicator of Buster’s adherence.
CloZAPine and Sleep
>Buster’s Ativan (Lorazepam) is
prescribed as needed (PRN). Buster is
lucky because other patients who see the same Behavioral Health Doctor (BHD)
indicate that the doctor prefers to not
prescribe Ativan. When indicated,
Buster only takes Ativan in the evening or at night. Restoril is not only a good alternative to
Ativan it is part of our CloZAPine Contingency Plan (CCP) for Buster. Buster was tried on Seroquel, yet it can
interfere with his life, both by causing bizarre nightmares and restless leg syndrome. Seroquel is not an alternative to CloZAPine. CloZAPine has helped with Buster’s anxiety, yet it is the side-effect “May cause drowsiness” that Buster leverages. Buster suffers from an intractable sleep
disorder. CloZAPine overtly made Buster
sleep. Now it takes CloZAPine, Ambien, and Lorazepam to sleep. As we saw with
the Dr. Daniel’s experiment, without CloZAPine, Buster does not sleep. After about 48-72 hours without sleep, Buster deteriorates so much that he is a
candidate for the psych ward.
B. I do not agree to administration of the following medication(s):
Slow-release injectable and non-generics
Tuesday,
July 27, 2021 [DITTO]
Psychotropic
plus Medication History for Keith “Buster” Torkelson, MS as Associated with
OCHCA prompted Psychiatric Advance Directive (PAD)
https://psychiatry4dummies.blogspot.com/2021/07/psychotropic-plus-medication-history.html
C. Other information about medications (Allergies, side effects)
Medication Management
>After 36 years (1989-2025) of near-perfect compliance (adherence), it is unlikely Buster will come to the hospital for not being adherent to his medications. There are very few medications on his experimental ledger that he would prefer to try again. Some practitioners consider Buster allergic to some psychotropic medications. If the doctor on-call in the hospital or the med staff including the med nurse runs Buster’s nightly CloZAPine titration protocol his chances for injury and other discomforts increases. Buster is best left to take his medicine as he seems fit. In other words all of his medicines would best be “As needed” or PRN. When one commits to the hospital fix the outcomes are quite variable.
Alternatives
>We will finish revising our CloZAPine Contingency Plan (CCP) in the near future. Back in 2012 when Buster served time in the Orange County Jail System (OCJS) someone most likely the intake nurse only approved ½ his usual dose of CloZAPine and cold turkey took away his Ativan. For about 30 days Buster didn’t sleep well so Buster coped by depressing his brain and in due time reduced his functioning. On release he had a functioning level far less than when he was admitted. Qualitatively he had the functioning of a Sea Slug or Turnip. His global assessment of functioning (GAF) was reported at 40 out of 100 with high scores being favorable.
Effects – Featuring CloZAPine
Side Effects – CloZAPine – High Impact
Effects – Featuring CloZAPine
Side Effects – CloZAPine - Lower Impact &
Resolved
Medication Management - Problem
Fixes
Argument for CloZAPine
>All of the above effects of CloZAPine may sound like a good argument to find something better. It is not. After some fixes here and there: Such as reducing the daily dose, divided dosing 4 times over 2 hours, and dosing only at night many of the risky effects have been mitigated. CloZAPine is a good if not the best psychotropic medication that Buster has been experimented with. For various reasons Mentalation Solutions Group (MSG) is not a proponent of fixing a side effect by adding another drug such as Cogentin. In 2021 Buster took five medications. If he had to keep two they are: CloZAPine and Atorvastatin. As compared to others that are disabled and living in a rent a shared room (RASR) only being on 5 medications is a huge achievement. Make note that when a consumer is admitted to Orange County Jail (OCJ) you are unlikely to get your medications as prescribed by your doctor: Both in variety and dosage. This may have changed because the OCHCA the health provider has become more aware and accountable.
Require adequate CloZAPine to
sleep
>Whether it is a bed in jail, residential therapeutic center or the psych ward Buster needs his sleep. In order to get sleep he has been highly dependent on nightly CloZAPine since 2007 or more than fifteen years. Interruptions or inadequate doses of CloZAPine have been associated with decline in behavioral health and / or going into the hospital.
Aside – PAD Motivation
>On one occasion Buster sought out seclusion on his own because he was having a panic attack. While in the hospital Buster has been restrained a few times. Someone in one of the (PAD) information sessions indicated the PADs are a means to: “Have your voice heard”. This is one our motivations to release Buster’s PAD to a broad public.
Minded Medication - Brief
>Buster practices something we call Minded Medication. In general minded medication is designed to sustain the flow and efficacy of CloZAPine and other lesser medications. It prevents the accumulation of containers and medications not prescribed anymore. Have you ever heard the following message associated with an appointment: “Please bring all of your medicines with you to go over with your doctor?” Buster does not bring all his medications to appointments nor do his doctors ask to see them. This prevents losing all of your medications by not having them with you. Depending on the medication you lose it can be a hassle getting re-prescribed.
In a given month Buster didn’t
use all of his Ativan
During the monthly minded
medication turn-over Buster flushes
the remaining Ativan. Every
fourth month he brings the un-used Ativan to his BHD to turn it in. His BHD has yet to take the extra Ativan from
Buster for appropriate disposal. If
Buster were to go in the hospital it may be helpful to bring his containers
with some meds in each with him. Buster
has experienced some discontinuity with his meds upon release from the hospital. Therefore, Buster prefers to leave some emergency meds with someone he
trusts such as the landlord. As of 2024
Buster is living in a retirement home and his medication is managed by staff.
Photo
>Considering this is our
Psychiatric Advance Directive (PAD) for Buster we tried to reserve photos for
our other PAD related studies such and our PAD
mechanics report. Below is a
photo Buster DBA Keith took while living in a Rent a Shared Room (RASR)
environment. There are some odd ten
prescribed medications that his roommate was dependent on. Busters’ doctor past, Arnold P Deutsch MD,
called these mixes cocktails. The photo
shows Buster’s roommate Doug’s (Dug’s) cocktail back around 2009. Again, we count some odd ten (10)
prescriptions. Doug has long since died and
Doug died too young (DTY).
Figure – Another of Dug K’s Prescription Cocktails
3. Facility Preferences.
A. I agree to admission to the following
hospital(s):
>We here at Mentalation Solutions Group (MSG) ask ourselves: Why suffer at a lower level of care? At some point a consumer such as Buster might receive high quality of care. This includes placement. Buster is gradually becoming aware of many standards for excellence about medication management and housing including good beds. We here at MSG focus a good deal with “The Bed”. An example of increased awareness resulted when Buster stayed for a term in two Great Beds at Westminster Therapeutic Residential Center (WTRC).
Stay out of the Hospital
>After his 2007 release he placed himself in a substandard Bed. An indicator of a substandard bed is when the consumer is in short-order right back in the hospital, has to move or chooses homelessness. Buster had to move because the facility closed circa 2008. We here at MSG want as a minimum for our Buster that changes are in order and if when needed that his new Bed is a humane one and will meet his unique needs. We here at MSG would really prefer Buster never need the psych ward again. It has been since 2012 or nine (9) years in 2021 since he was last on the psych ward. We attribute this in part that Buster keeps sleep as a daily priority. In 2024 Buster required the hospital again. Sleep was involved.
|
Facility |
Note |
Detail |
|
Western Med Anaheim |
Frequent Flyer |
Fast track releases that put Buster at greater risk Needed to agree to LPS in order to get treatment and
essential respite at WTRC |
|
College Hosp Cerritos |
Nightmare on Eden Street |
Released to LA county |
|
Royale |
First TRC Experience |
Good food Doesn’t know where he would have gone if dad had not had
him released |
|
Westminster Therapeutic Residential WTRC |
Standard of Excellence |
Policies and programs were rather good Inmates expected to sleep at night |
|
John Henry Foundation |
Hope for future |
Bed portfolio consideration Rimal Bera foundation Medical Director |
Preferences for
Emergency Treatment
|
Quite variable
|
Prefer to avoid
|
Hospitals
Psych Ward
|
Set Back
|
Not enough like real
life to prepare consumer for community living
|
|
SMH |
Reality Check |
Came close to referral to Napa State Mental Hospital
(1989) |
Jails
|
Set Back
|
Consumer getting monthly
check issue
Reduction in medications as prescribed by doctor on the
outside expected |
Metropolitan SH
|
Asked RPS
|
Ravinder P Singh to
place us there
|
Aliso Ridge
|
Great
|
Facility, program and
food
|
Global
|
Music therapy
|
Kristina rocks
|
Last Reviewed: 20251226-F:
As Related to Facilities
What will help? What will make
things worse?
>After all his hospitalizations Buster believes he has worked out the basis about a successful hospitalization, this includes planning in advance using tools such as PADs and avoid going to the hospital in the first place. By making sleep a very high priority Buster has not been to or in the hospital since 2012. This ended in 2024 when Buster went into the hospital twice. What makes things worse is quick release to a Bad Bed. Buster cannot live alone anymore. Permanent Supportive Housing (PSH) indicates they can get consumers such as Buster into a home of their own. Due to too many episodes of panic, Buster is dependent on the Rent a Shared Room (RASR) environment. If one of more of his roommates does not sleep well or maintain 830pm – 830am quiet time this can acerbate Buster’s anxiety. Dr. Ravinder P Singh (RPS-2006) was very helpful when she tried the CloZAPine Experiment with Buster. RPS got the medicine side down yet did not pursue the long term housing problems that Buster faced/faces. She sent him to Westminster Therapeutic Residential Center (WTRC) and that was unrealistically helpful. WTRC staff listened better to Buster than RPS. Buster’s roommates at WTRC slept rather well.
B. I do not agree to admission to the
following hospital(s):
>At one time Buster was released to LA County. The facility Eden Manor in South Gate was dog-eat-dog with: Drinking, drugs, prostitution, fist fights, etc. At and near Eden Manor Buster was way out of his league being away from family and his Most Significant Other Ever. We call environments such as these “Traps”. At Eden Manor, Buster was definitely out of his comfort zone or CZ. Buster appealed to his family and they helped relocate him to Orange County his County of origin. Even though in this incidence his “911” call came from “The OC” he was transported to College Hospital Cerritos in Los Angeles County. The placement people never asked him his housing preferences. They failed to help him with their uninformed placement to South Gate. Another time he was transported to South Laguna from Anaheim. After they treated him they released him to the streets. Currently, as Buster’s Orange County connectedness decreases he entertains other hospital options yet it is probably best to stay with hospitals in central Orange County. Buster’s insurer is Cal Optima in Orange County.
FYI – In short – Objective
EDEN MANOR - CLOSED - 8921
California Ave, South Gate, CA
https://m.yelp.com/biz/eden-manor-south-gate
[20251226-F LINK BROKEN]
Assisted Living Facilities
1 review of Eden Manor – “This
place is horrible! I have lived near Eden Manor for over a decade and it is…” We find this was the case.
C. Other information about
hospitalization:
Take first hospitalization in an
episode seriously
>Buster needs: Rest and tranquility when he surrenders to the hospital. He also needs assurance that he will be treated humanely. Buster has been released to some nightmarish situations. We already addressed Eden Manor in South Gate. In the episode of 2012 his first hospitalization was to South Laguna now Providence Mission Hospital Laguna Beach. He was released to the streets some thirty miles from his home (bed). We here at Mentalation Solutions Group have the impression that if the first hospitalization were managed better he very likely would not have ended up in Orange County Jail (March 2012). He went from a good bed in the hospital to a Bad Bed in the community, to a worse bed in Orange County Jail. It would have been better if he was placed in a new good bed.
4. Emergency Contacts in case of mental health crisis:
Guarded Disclosure – Version to Disclose
>Due to the evolving nature of
emergency contact information we suggest that the consumer carry their contact
including emergency contact
information on a wallet card. We
left out personal contact information because we don’t want to rile up Buster’s
family. The professional contacts are
current as of July 21, 2021 (W). This
part of the PAD could be very dynamic over time thus needs to be considered
differently. Buster has had more than 10
Behavioral Health Doctors (Psychiatrists).
He graduated from his
last one Bum Soo Lee MD because BSL retired. BSL was replaced by Rimal B Bera
MD (RBB). One of the reasons we chose RBB was doctor’s age parity. Both RBB and CDM (PCP) at the present time
are co-located. We include updated
information below as of November 4, 2025 (TU).
Amendments
>This is a good place to
discuss amending the Psychiatric Advance Directives (PADs). For the typical consumer we project 3 PADs in
order to get things right. The first two
(Beta and Gamma) can be amended by whatever means works. This is the Gamma Version of Buster’s PAD. The
third or mature and notarized PAD (Omega) that will be digitized and kept in
digital cloud (silo) format is best amended by appending and condensation.
Personal Contacts
Name: LAK: Address: Home Phone #:
Work Phone #
Relationship to Me: (Oldest
sister and primary family helper)
Name: EAK: Address: Home Phone #:
Work Phone #
Relationship to Me: Nephew and
successor family helper
Name: ASK: Address: Home Phone #:
Work Phone #
Relationship to Me: Niece and
successor family helper
Professional Contacts
Psychiatrist: Rimal B Bera MD
> Work Phone # 714-741-0116
For coordination purposes
Primary Care Physician: Min A Cen
> Work Phone # 714-643-7176
Care Manager (Cal Optima): Amy >
Work Phone # 714-246-8480
Insert image of insurance card
>It is likely we will not
share Buster’s insurance, Medicare, and Medi-Cal information.
5. Crisis Precipitants.
The following may cause me to experience a Mental Health Crisis (MHC):
>Any of the items in the Crisis
Factor Summary (CFS) list below may cause an MHC crisis. There are additional factors we chose not to address
at this time. We prefer to use
Behavioral Health Crisis (BHC) rather than MHC.
BHC implies that there are corrective
behaviors.
Crisis Factor Summary (CFS)
Crisis Intervention Management - Crisis Factors
Too traumatic and complicated to do it justice here
6. Protective Factors. The
following may help me avoid a mental health crisis:
Recurring Theme = Sleep is
Protective.
Precipitation & Critical
Control Points
>Buster doesn’t deteriorate very fast. At times, from the initial overburden that triggers a series of negative effects till hospitalization crisis growth may take more than 1 year. One of the negative effects and serious indicators for Buster is when Law Enforcement and/or Crisis Personnel become involved. Buster has never really been a problem for them. He goes away quietly. All Buster really wants is to be safe while he sorts things out and sets things right. Setting things right includes finding a better bed. For Buster, the most important Critical Control Points are centered on his sleeping and anything that interferes with his sleep. He needs to be heavily sedated upon admission. Currently, we are considering medical assistance in Dying (MAiD) for Buster. See appendix for Euthanasia Advance Directive (EAD).
7. Response to Hospital. I usually respond to the hospital as follows:
|
Domain |
Note |
Detail |
|
Activation |
Calming Medication |
More often than not Buster is anxious when he gets to the
psych ward – He responds to calming medications |
|
Contraband |
Most of the standard list is still sound |
Smartphone should be permitted so the consumer may call
coordinating treatment & working with a housing specialist |
|
Bed Covers |
Two versions |
Big one is not warm enough Small one is too small |
|
Dangerous roommates and people |
Ask for help |
Most dangerous was at the Royale |
|
Eating |
Best Part |
Less wasted food when Buster is on the ward because Buster
redistributes the leftovers |
|
Exercise |
Weak program if any |
Intense like standard gym yoga is better |
|
Hygiene |
Shower every other day |
Buster prefers hot baths - Like as offered at Woodland
Memorial |
|
Medications PRN |
Example is / are the sleeper(s) |
You have to ask for it between 11pm and midnight |
|
Networking |
Bonding with a female |
Only happened once (Robin T.) |
|
Phone |
Technology and Recovery |
Old school pay V new school smartphone |
|
Pillows |
Crunchy pillows |
On admit Buster is activated yet prefers to lay down
immediately First off he modifies the crunchy pillow |
|
Privacy |
Give it up |
Will prepare you for the Rent a Shared Room (RASR)
environment |
|
Release |
Re-hospitalization - Huge problem |
After pampering if they cannot find you a good bed >
Then you tend to revolve back again |
|
Smoking |
Second best part |
“SMOKE Break” |
|
Temperature |
A bit cool |
WMA - Buster spent about a day shutting down the majority
of the AC ducts |
|
Visitors |
When they bring you goodies |
Cigarettes and approved health food |
Last Reviewed: 20251102-SU:
8. Preferences for Staff Interactions.
a. Staff of the hospital or
crisis unit can help me by doing the following:
>For the most part psych ward staff have been gracious to Buster. What we ask for Buster is provide for him a great bed, sleep, peace, safely, medicate immediately to stop the anxiety including panic, give him a snack, and bring back smoking: “Smoke Break!”. We would also like more time with the Behavioral Health Doctor that was linked with him. When Buster’s PAD becomes effective we would like his “doctor” to take time for discussing sections that apply.
b. Staff can minimize use of restraint and seclusion by doing the following:
History of restraint
>Buster has been tied down or cuffed to the bed a few times. First at Yolo General Hospital (YGH, 1989) he was observing other patients getting to have smoke break. He didn’t get to have smoke break. So in short order he escaped to have himself a cigarette. It took about 8 hours and ten miles to catch up to him. When returned to the psych ward they 5-point restrained him to one of the “scary” beds in a “scary” room: “To teach him to behave”. Almost immediately he had to go pee. When he was in a Bakersfield hospital (1993) for a physical health condition (dislocated neck) they tied him down because he unplugged the noisy IV machine twice. Since then manufacturers have made IV machines nearly silent.
Discipline
>Buster unplugged it because it was too noisy to get rest. He asked to be restrained in the ambulance once because he feared the rear door flying open on the freeway and he might fly out. If he did he wanted the gurney to take the brunt of the fall and or collision. Ambulance staff complied and strapped Buster to the gurney. While being serviced at Huntington Beach Hospital he had a panic attach and made a break for the door. They told him he could not leave. Hospital staff used padded handcuffs to restrain Buster to the bed. They wouldn’t let him get up to go pee. Buster has never been secluded by psych ward staff. On one occasion he asked to use the time out room to get peace and help him with his panic.
9. I give permission for the following people to visit me in the hospital:
>Only once was there a problematic visitor. This was Buster’s 1st cousin who showed up at College Hospital Cerritos to have Buster sign a Proxy. She wanted Buster to sign away his 25% voting rights for the family business. Hit a guy when he is down alright. This was only one element in a huge family fiasco with consequences that still affect Buster’s family to this very day. Buster is open to all visitors.
Inventory of Visitors – Psych Ward
History - Brief
>To keep it short Buster would enjoy it if his Behavioral Health Doctor (BHD) Dr. Rimal B. Bera will visit. Buster has one sister living in Orange County. It would be nice if she and or her husband would visit if he were in the hospital. Her husband has visited Buster in the hospital (2024). In 2024 Buster’s oldest sister and husband visited Buster when he was in Skilled Nursing, Buster’s niece ASK is his advocate.
10. The following are my
preferences about ECT:
>At some point Buster’s mom apparently had lived experience during the 1940s and 1950s with associates that were treated for Behavioral Health issues with Lobotomy and Electroconvulsive Therapy (ECT). Apparently ECT has been in use since the 1930s. Buster’s mom was a bit traumatized with the treatment outcomes she had and was witnessing. That is why when Dr. Deutsch prescribed pharmacologic intervention she bought into it. When Buster was in Woodland Memorial Hospital circa 1990 he met Robin T. They spent time together on the psych ward watching TV and holding hands. He was surprised to learn from her that she checked herself in periodically for her routine ECT designed to relieve her major depression.
First Two Medications
>When Buster met Robin after the hospital she could drive a car and engage intimately. Buster’s treatment interfered with intimacy. By this time Buster had been taken Haldol, the first drug, and he agreed to experimentation with Navane. If Buster were to become so anxious, suffering panic, with an elevated risk of becoming road kill like his friend Mark then he might consider ECT, induced coma or euthanasia. This section will definitely be revised. Some say that over-medication is a chemical lobotomy. Once while looking into ECT Buster discovered Transcranial Magnetic Stimulation (TMS) as an alternative to ECT. He is still undecided with ECT or TMS.
ECT - Well Undecided
FYI “ECT works for many people when drugs or psychotherapy are ineffective. There are typically fewer side effects than with medications. ECT works quickly to relieve psychiatric symptoms. Depression or mania may resolve after only one or two treatments.”
Additional Sections (Long term helper relationship)
MSGBase > Metadata >
Brief Housing History
02_Housing_History_18012801_Table CASAS LA SOS V2021
Housing
>During one of the Psychiatric Advance Directives (PAD) training sessions a consumer talked about her nightmares associated with housing and how the underlying problem(s) need to be solved. For her the presenting problem was environmental problems that impaired her sleeping. She gave as her example: She lived on the first floor and the people up-stairs walked around all night long. We likened it to when you get a crumby hotel room where the floor above you is just too active to get a good night sleep. The PAD is supposed to help with improved and integrated care. We put housing high on the list of integrative elements that needs solving. The consumer also talked about not feeling safe in her home due to many unwanted outsiders coming into her apartment. For this we really do not have a good analogy yet we feel for her.
Employment & Education
>The Psychiatric Advance Directives (PADs) can be associated with mitigating adverse impacts of a psychiatric hospitalization. Buster has fallen and gotten back up several times as measured by: Employment, volunteering, income and education. Back around 2009 Buster partnered up with the OCHCA as a consumer on track for employment. Yet, he knew his personal needs and needs in the community were not quite met. Even so he volunteered for non-monetary compensation for the OCHCA MHSA Technological Needs Committee (TAC)). To meet more of his needs Buster returned to college fall semester 2011 and came out with a 4.0 semester. As of 2025 Buster still associates with the OCHCA as a housing advocate.
Satisfied
>Ironically, in college one of
his courses was Crisis Intervention Management (HHS-CIM). Then during 2012 a year of catastrophic
losses hit. Since that time Buster has
decided to do the best with what he has.
Buster is satisfied
that he earned his BS degree, MS degree, made grades in Vet School, has an
Orange County multi-campus GPA of 4.0 and finished the MHSA WET funded Consumer Training Program. With graduation from his county volunteer
role around 2015 his county supervisor was hooking him up with either Quality
Assurance or Operations.
Trauma Triggers
>The form asks about trauma, yet, we are not positioned at this time to discuss how trauma plays into Buster’s Behavioral Health. We do know that Buster likely suffers Post Traumatic Stress Disorder (PTSD) and that he has made substantial progress with moving forward and passed trauma in his life.
FYI > TRCBase > Metadata
>
SCR_Trauma_11120503_PTSD_Assess V2021
Safety Plan
>Safety might be defined as “the condition of being protected from or unlikely to cause danger, risk, or injury”. The most injurious condition that Buster has suffered with respect to a hospitalization is being: Placed in a harmful bed and experimented on with an ineffective medication. Particularly in the early days, losses due to medication may often exceed the gains. Buster has only been roughed up by staff, enough to leave marks on his body, in the hospital once. That is another story.
Champion of Protection including
Safety
“I protect those that cannot protect themselves”
(LAW1 Judge Judy)
Protective Factors
>Years ago now (2017) while Buster
was taking a health respite in Fallbrook/Temecula Buster heard Judge Judy on
the Television say: “I protect those that cannot protect themselves”. Buster tries his best yet quite often he cannot protect himself. In other words he has been injured (Tort) by
other meanie people. As Buster’s signs
and symptoms of anxiety exceed his skills to cope with them he becomes more
susceptible for harm by others.
FYI - Tort
A tort, in common law jurisdiction, is a civil wrong that causes a
claimant to suffer loss or harm, resulting in legal liability for the person
who commits the tortious act. It can include intentional infliction of emotional distress, negligence,
financial losses, injuries, invasion of privacy, and many other things.
Brief Including Torts
Starting to struggle – Recurrent
Theme - Moving
At what point does a struggle begin?
>Struggle might be defined as: “To do something with difficulty”. Another definition for struggle is: “to try very hard to do, achieve, or deal with something that is difficult or that causes problems”. Moving to a new bed has been wrought with difficulty for Buster. He has a history while moving of exhausting himself before he asks for help. At times the help he is given can make things worse. Here we focus on the Rent a Shared Room (RASR) environment. Historically sometimes moving from one bed to another is easier than others. It is often simpler for peoples with few needs and little property or belongings to move. From experience people with learned helplessness do not have many housing demands.
History of Difficult Times –
1982-2006
Beginning as a Transitional Aged
Youth (TAY Age 23)
History of Difficult Times –
2007-2021
RASR = Rent a Shared Room
FAQ - How has the last week been
difficult?
July 11, 2021 – July 17, 2021
>For the first time in quite a
while Buster can honestly say for one week nothing
impaired his sleep. With ten (10)
being perfect sleep, Buster has Sleep Value Scores (SVSs) of 9.8 or greater on
a scale of 0-10 for the whole week.
Buster recently switched rooms in the same Rent a Shared Room (RASR) establishment. A Bed incumbent died on June 27, 2021
(SUN). So far his new bed seems to be a
Better Bed. As of 2025 what could
quickly change things is: Three consecutive nights of impaired sleep caused by
either outside forces or an interruption in his medication(s) including CloZAPine,
Lorazepam or Ambien.
11. Other Instructions.
a. If I am hospitalized, I want the following to be taken care of at my home:
Housing Needs – Move necessary
Interventions to prevent
homelessness
Loss mitigation efforts
Move away from bed of origin
Move to bed in same house or
facility
Pay rent on office at storage
Preventing Lose(s)
Remaining in same bed (Ill
advised)
Assuming the hospitalization period(s) are lengthy exceeding one month and we are retaining the housing we have the following needs taking care of:
Adjustments to insurance PRN
Avoid paying for two or more beds
Bills Paid
Food eaten
Moving Property
Oversee person(s) still back a
home
Parking the Car to prevent
impound
Pet(s) Cared For
Rent Paid
Responding to notifications PRN
Solving legal such as
un-impounding the car
History - Resilience
>For Buster, ever since the inception of severe Behavioral Health issues back in 1989 he has been in the hospital several times. His best release was back in 1989 when his parents (natural supports) took him in. He took his medication as prescribed, received great nutrition, landed a full-time job at a clinical diagnostic laboratory, and got plenty of sleep. Within a year he bounced back resilient enough for his doctor to approve his return to UC Davis School of Veterinary Medicine. Many of his other releases often involved him being placed in unrestful environments.
Supporter & Designate agents
>For quite some time now Buster’s designated agent has been his oldest sister LAK. Very slowly LAK, Buster, LAK’s son EAK and LAK’s daughter ASK are working on succession. We hope ASK to assume the formal role as Buster’s designated agent in the near future. It would be a promising practice if ASK would review Buster’s PAD with him. We hope to get that done during winter quarter of 2026. Everyone in Buster’s immediate family has supported Buster in one way or another. Yet, for the most part we are working around what we call Family Burnout. Buster’s siblings are all in their seventies. Again, Buster has been working on a successor to his siblings to help him out as needed (PRN). His niece LAK’s daughter ASK has now become more engaged.
Hospital Preferences
>We went through and gave Quick Stars Scores (Q*S) to many of the hospitals and institutions caring for or cared for Buster’s Behavioral Health needs. We found that in Buster’s case it is not so much the hospital that matters rather the treating physician, medication and where they release you to. Just because one stay in a given hospital went well as measured by housing stability and time out of the hospital doesn’t mean the next stay will be equal or better. Buster would prefer a hospital close to home.
Continuity of Care (COC)
>Most consumers don’t know early on in their treatment about Continuity of Care (CoC) issues. The client frequently presents in the hospital setting. There the new consumer hooks up with their first in-patient Behavioral Health Doctor (BHD). While in the hospital some consumers work hard establishing rapport with their first BHD. Next the medication trials begin. Then they are released and get referred to or find a BHD on the outside. In a chain of events from doctor to doctor crazy things often occur. The only doctor that took a super good history such as the one included in this report for Buster was Kaiser’s Aliso Viejo Dr. David Dobos. In 2012 Buster was matched as an in-patient with Dr. Bum Soo Lee MD (BSL). On release and pulling a few strings Buster was matched with BSL on the outside. They enjoyed a productive partnership until BSL Retired. On BSL’s watch Buster never went to the hospital. This BHD centered transition is a good example of CoC as measured by continuity of medication.
Big Picture Dilemma - Advocacy
>Once again this Psychiatric Advance Directive (PAD) assignment was encouraged by the Orange County Health Care Agency (OCHCA). Buster has attended several Zoom presentations by the OCHCA selling their Mental Health Services Act (MHSA) funded PAD initiative. During the presentations, various consumers and providers have spoken up. They the hosts hope their PADs will help consumers get individualized, appropriate and needed: Treatment as measured by better outcomes. About the OCHCA’s PAD notion they ask many including community members and stakeholders to advocate. We promote the PAD process.
Transparency
>This document is part of Buster’s call to advocate. It looks very likely that we will meet the deadline that Buster has set for us: Draft and publish his PAD (Alpha-Beta) by the end of July 2021. PAD’s are both medical records and legal documents. We hope to address stigma about Behavioral Health vis-à-vis transparently sharing Buster’s PAD and PAD related materials via one of our Blogs to the general public. We are updating things and hope to share this Gamma Version PAD online before the new year 2026.
Work Done – PAD (Alpha-Beta)
https://brandnewdayhmo.blogspot.com/2021/07/a-real-psychiatric-advance-directive.html
Comments – Reference Documents
>The majority of our comments and suggestions we share with our Psychiatric Advance Directive (PAD) are content and mechanics reports. The following four areas about PADs we found compelling: Comparing a PAD to the Advance Health Care Directive (AHCD), PAD utilization, the training of dedicated PAD Specialists and PADs related Coordination of Care (CoC). At its’ very core a PAD is a coordination tool. In our preliminary (since April 1, 2021) sharing phase most of the people to which we talk about PADs think we are talking about Advance Health Care Directives (AHCDs). PAD’s are part of an AHCD.
AHCD V PAD
>A bit of extra effort is needed to help stakeholders and potential stakeholders differentiate PADs from AHCDs. We found that in practice PADs are far more complex than AHCDs. In addition, many providers prefer that a consumer only submit one AHCD. This usually occurs somewhere around intake. Also it will be wise to address how Wellness Recovery Action Plans (WRAPs) and Personal Health Records (PHRs) fit in the bigger picture of PADs. PADs are a PHR. We feel that it will take the average consumer via an iterative approach three attempts on the journey to generating the best PAD possible: Pre-educated PAD (Alpha-Beta), educated PAD (Gamma) and a final high performance PAD (Omega). This is our Gamma educated PAD.
Summary
>Just this year (2021) we here at Mentalation Solutions Group (MSG) became aware of Psychiatric Advance Directives (PADs) in their current incarnation with the Orange County Health Care Agency (OCHCA). The county hopes to fund its’ PAD initiative using Mental Health Services Act (MHSA) Innovations Component monies. After a few PAD information sessions we here at MSG decided to take the time to deliver an Alpha-Beta-PAD about our principal Keith “Buster” Torkelson MS. We have followed through with quite a bit of work. We hope that what we share here can save others time and money. It looks like it may take some time before PADs in Orange County become streamlined, routine and available from data silos. Thank you for your time and consideration (MSG-Avey). The remainder of the report is Commercial-of-the-shelf (COTs) Legalese. For the most part we have retained the legalese in its’ original format. Legalese = the formal and technical language of legal documents that is often hard to understand.
b. I understand that the information in this document may be shared by my mental health treatment provider with any other mental health treatment provider who may serve me when necessary to provide treatment in accordance with this advance instruction. Other instructions about sharing of information are as follows:
12. Legal documentation for
Advance Directives:
Note: Considering our local PAD stakeholders have yet to release their choices for valid PAD formats our PAD here is for instructional purposes only.
a.
Signature of Principal
By signing here, I indicate that I am mentally alert and competent,
fully informed as to the contents of this document, and understand the full
impact of having made this advance instruction for mental health treatment.
Nature of Witnesses
I hereby state that the principal is personally known to me, that the
principal signed or acknowledged the principal’s signature on this advance
instruction for mental health treatment in my presence, that the principal
appears to be of sound mind and not under duress, fraud, or undue influence,
and that I am not:
- The attending
physician or mental health service provider or an employee of the
physician or mental health treatment provider;
- An owner,
operator, or employee of an owner or operator of a health care facility in
which the principal is a patient or resident; or
- Related within the third degree to the principal or to the principal’s spouse.
[Continued Legalese]
b. Affirmation of
Witnesses
We affirm that the principal is personally
known to us, that the principal signed or acknowledged the principal’s signature
on this advance instruction for mental health treatment in our presence, that
the principal appears to be of sound mind and not under duress, fraud, or undue
influence, and that neither of us is: A person appointed as an attorney-in-fact
by this document; The principal’s attending physician or mental health service
provider or a relative of the physician or provider; The owner, operator, or
relative of an owner or operator of a facility in which the principal is a
patient or resident; or A person related to the principal by blood, marriage,
or adoption.
Witnessed by:
Witness: ____________________________________
Date: _______________
Witness: ____________________________________
Date: _______________
From - STATE OF
NORTH CAROLINA, COUNTY OF ORANGE
Modified for:
STATE OF CALIFORNIA, COUNTY OF ORANGE
Not Valid
for: STATE OF CALIFORNIA
[Continued Legalese]
c. Certification of Notary
Public
[STATE OF
CALIFORNIA, COUNTY OF ORANGE]
I, ________________________, a Notary Public
for the County cited above in the State of [CALIFORNIA], hereby certify that
______________________________ appeared before me and swore or affirmed to me
and to the witnesses in my presence that this instrument is an advance
instruction for mental health treatment, and that he/she willingly and
voluntarily made and executed it as his/her free act and deed for the purposes
expressed in it.
I further certify that
__________________________ and ___________________________ ,
witnesses, appeared before me and swore or
affirmed that they witnessed _____________________________ sign the attached
advance instruction for mental health treatment, believing him/her to be of
sound mind; and also swore that at the time they witnessed the signing they
were not (i) the attending physician or mental health treatment provider or an
employee of the physician or mental health treatment provider and (ii) they
were not an owner, operator, or employee of an owner or operator of a health
care facility in which the principal is a patient or resident, and (iii) they
were not related within the third degree to the principal or to the principal's
spouse. I further certify that I am satisfied as to the genuineness and due
execution of the instrument.
This is the ____________ day of
_________________, 20___.
Notary Public
My Commission
expires:
[Continued
Legalese]
d. Statutory
Notices
Notice to Person Making an Instruction For
Mental Health Treatment. This is an
important legal document. It creates an instruction for mental health
treatment. Before signing this document you should know these important facts:
This document allows you to make decisions in advance about certain types of
mental health treatment. The instructions you include in this declaration will
be followed if a physician or eligible psychologist determines that you are
incapable of making and communicating treatment decisions. Otherwise you will
be considered capable to give or withhold consent for the treatments. Your
instructions may be overridden if you are being held in accordance with civil
commitment law.
Power of
Attorney
Under the Health Care Power of Attorney you
may also appoint a person as your health care agent to make treatment decisions
for you if you become incapable. You have the right to revoke this document at
any time you have not been determined to be incapable.
YOU MAY NOT REVOKE THIS ADVANCE INSTRUCTION
WHEN YOU ARE FOUND INCAPABLE BY A PHYSICIAN OR OTHER AUTHORIZED MENTAL HEALTH
TREATMENT PROVIDER.
Revocation &
Notary Public
A revocation is effective when it is communicated
to your attending physician or other provider. The physician or other provider
shall note the revocation in your medical record. To be valid, this advance
instruction must be signed by two qualified witnesses, personally known to you,
who are present when you sign or acknowledge your signature. It must also be
acknowledged before a notary public.
[Continued Legalese]
“Incapable”
Notice to Physician or Other Mental Health
Treatment Provider. Under law, a person
may use this advance instruction to provide consent for future mental health
treatment if the person later becomes incapable of making those decisions.
Under the Health Care Power of Attorney the person may also appoint a health
care agent to make mental health treatment decisions for the person when
incapable. A person is "incapable" when in the opinion of a physician
or eligible psychologist the person currently lacks sufficient understanding or
capacity to make and communicate mental health treatment decisions.
Medical Record
This document becomes effective upon its
proper execution and remains valid unless revoked. Upon being presented with
this advance instruction, the physician or other provider must make it a part
of the person's medical record. The attending physician or other mental health
treatment provider must act in accordance with the statements expressed in the
advance instruction when the person is determined to be incapable, unless
compliance is not consistent with G.S. 122C-74(g). The physician or other
mental health treatment provider shall promptly notify the principal and, if
applicable, the health care agent, and document noncompliance with any part of
an advance instruction in the principal's medical record.
Authority
The physician or other mental health treatment provider may rely upon the authority of a signed, witnessed, dated, and notarized advance instruction, as provided in G.S. 122C-75. (1997-442, s. 2; 1998-198, s. 2; 1998-217, s. 53(a)(5).)
Appendix – Euthanasia Advance Directive (EAD)
Legal_EOL_Managed_Passing_EAD_Euthanasia_25030702_Actual
Lack of sleep
propagates > Intense suffering
Name Keith
Edward “Buster” Torkelson, MS
20241028-M-Submit
to Death with Dignity – Did not garner the support we were requesting.
Disease Controls
How I Live
My current diagnosis
is Bi-polar 1 disorder. Bi-polar
disorder controls how I live. In
combination with a Sleep Disorder my suffering can rapidly become too great. For me bipolar is a crippling illness. Bi-polar is indirectly terminal via accident
or suicide. All of my friends and family
if they haven’t passed away live with a greater freedom than I do. I am dependent on others for the first time
as an outpatient for my medication. Most
importantly for my nightly sleep medication.
There is always a chance for medication gaps.
Without
Medication
Without the medication I go without sleep. My Sleep Disorder is indirectly fatal. I would like to be empowered particularly if I am bedridden by being Euthanized before more than 24 hours of SLEEPLESS suffering. The four stages of Fatal Insomnia happen in one night leading to misery. Within 24 hours of going without sleep I wish to be Euthanized. I would like to control how I die. I would like to die Peacefully. Last time I was let to go without my sleep medication I went sleepless for some odd 40 hours and suffered brain damage as measured by cognitive functionality. As of October 15 2025 my doctor reported functionality is 78 of 100 with high scores being better. I want to go on file via “Death with dignity” and my personal blogs as wishing for my own scenario of Death with Dignity. I am pursuing End of Life Choices California (EOLCCA) to help me with advance planning.
Promotions at the End
Psychiatric Advance Directive
A Psychiatric Advance Directive (PAD) is a legal document where you state your mental health treatment preferences (like preferred meds, refusal of treatments, hospital choices) and appoint a trusted agent to make decisions for you if a future mental health crisis makes you unable to communicate, ensuring your autonomy and care align with your wishes, with state laws varying, so checking your state's specific requirements is crucial.
Euthanasia Advance Directive
An Euthanasia Advance Directive (or Living Will) is a legal document
where you specify your wishes for end-of-life medical care, including requests
for euthanasia or physician-assisted dying (Medical Aid in Dying - MAID) if you
become terminally ill and unable to communicate, but these directives are
complex and not universally recognized for euthanasia; only a few U.S. states
permit MAID under strict conditions, requiring in-person requests, not just
written instructions, for lethal medication. While standard advance directives
(like Durable Power of Attorney for Healthcare or Living Wills) guide
treatment, MAID laws, like California's, demand direct, repeated verbal requests from a mentally capable patient for
a doctor to prescribe the drug, preventing a proxy from acting on a past
directive for this specific act.
End-of-life Choices California
https://endoflifechoicesca.org/
Need help?
If you need help with this process, please call us at 760-636-8009,
complete a request a volunteer form or email info@endoflifechoicesca.org.
20210722-TH: Readability Statistics
20251227-SA: Readability Statistics
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