If you could provide me with a study of the total amount of involuntary commitments and the amount that are “abuse” and show that it does occur “often.” Make sure you exclude the “abuse” ones where the statutes and safeguards were ignored, like both the examples you provided earlier. That would be a big help.
Again, I am out of my ken (and my barbie) when you speak of incompetence. In Illinois, the standards for "involuntary commitment are HIGHER than the standards for competence. In addition, a finding of “incompetent” is one that deals with guardians and long-term inability to take care of oneself. Involuntary commitments are temporary, and are attempts to make sure a person doesn’t have to be adjudged incompetent, when they no longer pose a threat to themselves or others.
it’s not a medical decision, it’s a legal one, one with the protection of the individual and society in mind, one that is made to avoid incarceration, or death.
before you go advocating the abolishment of help for the mentally ill, you might want to meet a few people that genuinely need treatment, they exist regardless of your ignorance of them. Meet someone who is acutely suicidal some time, come back and report to us the success you had convincing them to give up his right to kill himself. If you can, tell us how his family feels about it too.
All I can tell you is that every MHP I’ve dealt with has been professional, well-educated, and sincerely trying to help people
Again, I’ve not seen anyone in this thread shrugging off, and I’ve seen one person, a nurse, who I would say fit that bill
Not ostensibly. Because of. They are held behind closed doors because they legally have to. And they legally have to to protect the confidentiality of the system. Would you want your case to be able to be seen by any schmoe off the street?
I disagree that potential for abuse should override the safety for the patient, the family of the patient, and anyone who could be harmed by the patient. For every case you cite where a person’s rights are improperly infringed by the law (and not by someone ignoring the law), I can get you three where a non-committed mentally ill person has proven himself a danger to himself or others. Now, don’t take that argument to mean I am somehow not concerned with the abuse of the system. But by getting rid of the laws because there is a potential for abuse when they aren’t followed is throwing the baby, the tub, the entire bathroom out with the bathwater.
If the bathwater drowns half the babies that get thrown into the tub, then maybe we really should throw away the tub. Or at least stop throwing babies into it.
I would rather have my case seen by any schmoe off the street than have it conducted in secret. At least if the hearing takes place in the light of day there is a chance that the judge (at least) will act out of concern that the public will consider his behavior unreasonable. Right now the only people who know what goes on in committment hearings are the people being committed and the people doing the committing, and the people who get committed are not able to influence that system because being committed takes away your right to change the system. This sort of inequity of power creates a grave risk of injustice and makes it difficult for such injustices to be corrected.
I’m pleased as punch that you’ve never seen what you consider the violation of someone’s rights. I would ask that you admit that you have not been present at every civil committment hearing and every temporary committment decision and acknowledge that the world might not be as rosy as you think. I would also suggest that you may be (deliberately or accidentially) blinded to abuses because you may have prejudged many incidents that an impartial observer might judge differently. MHPs are no more immune to human falliability, and in fact seem to be unusually prone to it (“Patient exhibits writing behavior.”).
I also think that a lot of MHPs try too hard to “help” people who don’t want or need it. Involuntary committment should be based on whether the individual is an immediate threat to public safety, not whether the individual “needs help”. My brother acts weird and has, rarely, assaulted people for no good reason. He does not need to be committed, but I am afraid that your standards might result in that – without violating any law.
By what standard? How can you demonstrate that a person who wants to kill themselves actually has something wrong with them instead of merely holding a belief you don’t agree with? Defining “wanting to kill yourself” as something wrong is circular.
What about “being agitated”? If a person is angry during a psych eval, how does the investigator determine whether that anger is appropriate to the patient’s circumstances? Who decides what reactions are appropriate?
I don’t think anyone here has any problems with the idea that mentally ill people need help.
The question at hand is this: WHAT DOES ‘MENTAL ILLNESS’ MEAN?
All thoughts, emotions, and responses are ultimately physical in nature. Can you demonstrate that anyone knows enough about the workings of the brain to distinguish between a brain who’s hardware is functioning properly but the behaviors et cetera resulting from that brain are considered inappropriate or undesirable by some and a brain that is malfunctioning?
Can you justify the judgments of individual practioners or society in general that a way of thinking is inherently wrong or incorrect? Can you provide a justification of the beliefs of “sane” individuals?
Any system is abusable if the people in it don’t follow the rules. I believe Kelly M’s problem with the mental health system is that it can be abused from within the rules.
If it gets you locked up in a place you aren’t allowed to leave, incarceration has not been avoided. If it gets you locked up in that fashion when you haven’t committed any crime, oppression has not been avoided either.
I am not attempting to abolish help for the mentally ill. Or even ‘help’ for the ‘mentally ill’, for that matter. I’m trying to abolish involuntary treatment for anyone who is capable of making their own decisions.
Believe me, I’ve met many many people who were miserable and in genuine need of treatment. Just not the kind of treatment that is meted out by psychiatric institutions. If you were rock-solid unflappably confident, courageous, patient, resourceful, resilient, and stoic, you’d be well-equipped for surviving the incredible assault on self that pyschiatric incarceration imposes. On the other hand, if you were all of these things, what the fuck would you need with treatment aimed at treatment?
This board has many participants who currently or previously sought out the benefits of psychiatric treatment on a voluntary basis, with a therapist of their own choosing, and many of them believe the treatment thus provided saved their lives, or at least made it possible for them to function. I happen to have beliefs about the efficacy of modern psychopharmacology that probably differs from theirs, but I wouldn’t dream of making it difficult for them to obtain the help that works for them.
As long as I retain the right to say “no” to the same treatment, or any other.
And Hamlet, you’re missing the point. I’ve been to multiple conventions in halls the size of NY’s Javitz Center, crammed with survivors of involuntary psychiatric treatment. I’ve told my story and listened to those of the others. I don’t have access to statistics on rates of involuntary incarceration and the portion of them that involved bypassing or making a travesty of existing safeguards – how could I? * – but it’s beyond the “acceptable risk” level.
We’re talking about the right to be free from deliberate modification of our thinking and feeling processes by another party without our consent. The “acceptable risk” for that kind of thing would have to be akin, percentage-wise, to the rate at which surgeons remove healthy limbs by accident in hospitals. If you could fill a convention center with angry ex-patients who were missing arms and legs because safeguards for ensuring that the operation was only performed on the consenting or those who were incapable of consenting + needed the operation were bent or bypassed, would you need to know what percent of annual amputation surgeries they represented before you figured out that something was wrong?
For every case you can cite where a violent person has been charged with a crime and locked up for the protection of society, I can get you three where a non-incarcerated individual has been violent. What’s your point? Should so-called “mentally ill” people be locked up more easily if stats show we’re more violent on average? Males are more violent on average than females but we don’t lock men up. Oh, but the “mentally ill” are a minority. So are black males, and if we don’t control for any additional variables our stats may show that they are more inclined to violence than people outside that category, but we at least do them the dignity of arresting them and charging them for something that we say they actually did before incarcerating them, yes?
I can’t give you stats right at the moment, but I’ll talk with the people in the NY group who have been doing courtwatch and ask if they have a figure.
My point was simply to show that there is a definite need for involuntary commitment laws, and because of that need, we should not do away with them. I would not disagree that the decision whether somebody is a “danger to himself or others” is a very difficult one to make, but it is one that needs to be made to protect people at risk and the patient themself.
I would greatly appreciate any help you could be. If it is indeed the case that the system is fraught with abuse, which in my experience and in my albeit limited research, I’d be much more likely to agree with you that there is a need for some serious reforms. I don’t know what reforms we could do, but I’m open to any suggestions. And Thank you in advance for your help.
TVAA: my issues with mental health care are multiple.
First, it is my belief that the system can be abused while following the “letter” of the rules.
Second, it is my belief that the system can be abused in ways such that the abuse will only be known to the people involved in the abuse and the people being abused. The only “outside party” involved is the judge, who quite frequently becomes so closely allied with the MHPs doing the committing that he is, for all practical purposes, complicit in the abuse.
Third, it is my belief that the de facto, if not de jure, definition of what is sufficient cause for both temporary and extended committments is too lax and far too much in the hands of MHPs without adequate oversight.
Fourth, it is my belief that the mental health industry actively seeks to avoid both judicial and public oversight.
Fifth, it is my belief that a lot of MHPs are too quick to find mental illness and too quick to try to force help on people who they have concluded are mentally ill without sufficient reflection of whether the treatment they seek to force on them will actually improve their quality of life. They seem to have a magical belief that committment will help these people even though it often harms them in the short and long term – and then use this iatrogenic injury as further proof of mental illness.
Sixth, it is my belief that the mental health industry has no solid, objective understanding of what mental health is, but routinely claims to have objective standards by which it makes these decisions.
re: dangerous, I should have as much right as a schizophrenic to be violent and still refuse unwanted psychiatric treatment as a violent nonschizophrenic would have, as long as I’m competent. Charge me with assault or whatever other charge is appropriate, but if I know which way is up, can make change for a $20, can tell you who the President is, can answer a few logical puzzles, and can explain back to you the meaning of the law against assaulting people that I’ve just violated by smacking you upside the head, my schizophrenia is not relevant and forced treatment should not be imposed.
Hamlet, I’ve posted the following to the NY list and will return with the results:
I have been asked to provide stats and cites for alleging insufficient protections against commitment (forced psych hospitalization). Specifically, the percent of commitment hearings in which the procedure has deviated from:
• The hospital’s pyschiatrist has to make the case that the subject of the hearings is a danger to self or others and is in need of treatment.
• The subject of the hearings gets to provide evidence to the contrary in his/her own behalf, including alternative psychiatric opinions.
• The subject of the hearings is provided with an attorney or gets the opportunity to retain one privately, and the attorney is allowed to and does take a position adversarial to the one taken by the hospital’s psychiatrist, i.e., argues that the subject of the hearings is not dangerous (or at least is not dangerous as a byproduct of being incompetent as well as inclined towards violence) and therefore does not need psychiatric treatment.
• The judge is open to arguments on both sides and exhibits, if not necessarily pure impartiality in every situation, then at least the absence of a distinct bias towards approving commitment whenever it is asked of the court by the psychiatric institution.
• The default assumption is an assumption of competence, as would be the case in a standard civil competency hearing, and the burden of proof lies with the parties alleging incompetence.
I know from my own observations and from many anecdotal tales told by all of you that each and every one of these just ain’t the way it is. In search of stats though…I know there have been some “courtwatch” projects. I remember the Duberstein courtwatch thing in particular. Do we have anything akin to a random-sampling “courtwatch” findings from several different courtrooms? Can those who have done courtwatch give their best estimates of percents on these bullet points?
(It’s not like they have access to statistics saying otherwise; I’m not falling into the trap of agreeing that I need hard numbers in order to have the authority to make these statements).
Here is the first courtwatch report to which I’ve been provided access by the NY group. It isn’t “statistics” precisely, since the data analysis is qualitative. (The relevant variables are rather difficult to quantify without raising serious questions about how they were operationalized, so this is more honest anyway).
Hamlet (and anyone else wishing to argue from firsthand experience that the procedures are fair and the protections honored): After reading the materials at the above link, perhaps you would care to comment on how your observations have differered from what is described here?
Explanatory note re: the link: A Rivers hearing is specifically required in New York State in order to impose forced treatment. The standard is higher than the standard for commitment – you need only be “mentally ill” and dangerous to self and/or others in order to be committed involuntarily, but you still retain the right to refuse treatment as an incarcerated mental patient in NYS subsequent to the court case Rivers v Katz until and unless it can be demonstrated in a hearing that you are also incapable of understanding the risks and benefits and/or are not able to reach a reasoned decision through a coherent and explicable thinking process. In other words, effectively a competency hearing. (I’ve been saying throughout this thread that involuntary commitment should be scrapped and that incarceration should be dependent on violation of law or demonstration of incompetency, period). The “bifurcated” hearing occasionally referred to on the linked site is one where the issue of retention (keeping you against your will, i.e., commitment) is being considered as well as the issue of the right to refuse treatment (the Rivers hearing).
After suffering from several attacks of mania, I decided I might need proffessional help. When I went to the hospital they had me sign papers to basically allow them to do what they must to treat me, without telling me that what they would do was keep me overnight for observation. I was absolutely shocked when they wouldn’t let me leave. I don’t think I have to explain the horror you can see in a psychiatric observation unit. They attempted to force antipsychotics on me because I wouldn’t stop crying. They said the same thing, “they’re just to help you sleep.”
Now being recovered from a long period of mental illness, I have to say in general mental health proffessionals are out to prescribe medication. They’ll even go as far as to prescribe a drug to counteract the side effects of another drug. And you can see them tense up when you say you’d like to try life without them. But there are some truly genuine people who care in the proffession too. Everyone I encountered in a partial day hospitalization program were wonderful. It’s just sad that it took some hard searching to find them.
It fascinates me, AHunter3, that a judge sitting in cases such as those described would prohibit observers from taking written notes. Do you or your sources have any insight as to what the reasons for that restriction may have been (either stated or otherwise)?
I’ve been to traffic court, waiting for them to call my name, and been told that we were not allowed to read or write because it was disrespectful to the judge. It might be that kind of thing, or, more charitably, the judge could be concerned about the privacy rights of people attending these hearings and was afraid people might be writing down names. Or, less charitably, the judge might be aware of the possibility of criticism of mental hygiene law as practiced in that courtroom, and didn’t want it documented.
I would be disturbed at a judge so vain as to require that everyone in the courtroom give him his undivided attention at all times. The judges I’ve known have been of the opinion that as long as you don’t snore, they don’t care if you sleep in their courtroom. Just respond promptly when your name is called.
** Now, if you’d called them on the lie (and it was a lie… there are plenty of other sedating agents that are commonly used to induce sleep, there’s no reason to use antipsychotics), I wonder if they would have considered you “uncooperative”, perhaps even “paranoid”.
How they expect people to trust them to do anything when they have no scruples against lying to their patients’ faces is beyond me.