"Voluntary Patient Treated as Involuntary"

I presented to the Emergency Department with acute genital pain, seeking medical help. I was calm, coherent, and able to explain my symptoms and history. I had no mental‑health concerns at the time.

I consented to the initial medical assessment. During this, the doctor learned that I have trauma‑related difficulties with genital exposure, which prevent me from tolerating certain examinations. Only after this discussion did the doctor suggest that I might benefit from speaking to a psychiatrist. This was presented as supportive, not as something that could affect my voluntary status.

Because of my history, I asked directly, “Will I be confined if I speak to someone?” The doctor replied that they didn't think so.

My refusal of a genital exam was based on trauma, not irrationality. In my late teens, when I came out of my apprenticeship, I was sexually assaulted. I escaped what had been done to others, but had mentally gone over my fate in my mind after seeing photos of them. Since then, I cannot cope with restraint of any kind. This was explained to the doctor, the psychiatrist, and documented in my notes.

Despite this, once psychiatric involvement was suggested, the situation escalated. I was asked to complete police‑style information “in case I ran.” My keys were taken. I was told I could not leave until a psychiatrist “signed me off.” None of this aligned with my reason for attending, which was solely related to a genital examination I could not undergo due to trauma.

At no point was I informed that:

• I could decline psychiatric involvement

• I could leave as a voluntary patient

• I had specific rights under voluntary status

• Speaking to psychiatric staff could result in being placed in a controlled environment

As the evening went on, I became increasingly distressed. I believed that if I were not being detained, someone would have told me. I began to fear I would be held overnight. At that point, I started planning suicide. Had I been kept any longer, I believe the outcome could have been catastrophic. This was entirely preventable with clear communication and genuine informed consent.

In the week following the incident, I experienced:

• Two blackouts

• Multiple panic attacks

• A panic episode on public transport when a nurse sat beside me

• Distress triggered by bathrooms resembling the hospital

• Hyper vigilance, fear, and avoidance

• A breakdown at work, requiring a medical clearance

These reactions stem directly from being misunderstood, escalated, and placed in an environment inconsistent with my voluntary status.

I returned to Joondalup A&E to replace damaged medication scripts that had gone through the wash. During this visit, I had another episode, and a nurse suggested I might need to return to MHOA. I felt I needed actual help. This time, I understood what that meant and, despite fear, felt in control and willing to engage. This was consent. They arranged for a doctor to see me.

However, after hours of waiting back in A&E, I felt ignored. When I politely checked whether I had missed my turn, I felt the nurse was abrupt and angry, even though it seemed others were being treated far more respectfully with similar requests. After further waiting, I took another ticket out of desperation. I felt the staff were cold and dismissive. I was handed my script and made to feel like a nuisance. I broke down crying. When asked if I still wanted to see the doctor, in what I felt was a demeaning tone, I said I would never return and left.

Outside, I sat on a bench in tears. I walked to the mall and felt overwhelmed and hopeless. I felt worthless and strangely empty, as if on autopilot. I didn’t call my spouse to pick me up; I headed for the train. I had no intention of returning home. A message from my child saying they were coming to visit pulled me back from the edge. It seemed strange timing, as I hardly ever see my child.

I have lost eight friends to suicide, and I spent more than a decade in my youth feeling suicidal. I understand how difficult psychiatric hospital work is and how vigilant staff must be. But I also know that people like me — calm, voluntary, and seeking help — can be harmed by processes that are not trauma‑informed.

Months earlier, I had been scheduled for a cystoscopy. I explained that I could not cope with the standard cleansing preparation and asked to complete it myself under supervision. I also could not tolerate additional staff during general anesthetic, so I couldn’t take what they saw as an easy option. These trauma‑related needs were not accommodated, and I was denied treatment. My body‑dissociation issues make these situations extremely difficult.

Adding to this, my discharge notes stated that I had “embarrassment concerns over the size of his genitalia.” This is incorrect. My distress has nothing to do with size. It stems from gender dysphoria and longstanding dissociation from my genitals. The issue is psychological and trauma‑related, not anatomical.

Considering that I present as male, always wanted a partner and children, and have spent my life sacrificing parts of my body, expression, and sense of self to survive, the distress I experience around unwanted maleness is significant. These difficulties have been compounded, not eased, by my interactions with the health system. I am asking for understanding, not judgment. Please stop making my life harder than it already is, and show some compassion.

For an organization with a lot of dedicated and caring people, I can’t seem to understand why this has happened.