We covered this in another thread, and **Jodi **touched on some of it, but cops cannot make a medical diagnosis for someone they pick up. They’re not doctors.
Anyone experiencing a mental health crisis will be taken to a hospital ER for a medical clearance first. Lots of things can masquerade as a psychotic episode or break. Med interaction, infection, dehydration; things like that.
Once the patient is medically cleared, they will meet with a psychiatrist for a consult. Usually a social worker will be involved. After it’s determined what the best course of treatment will be, the patient will be transferred to the approproiate place. Some larger hospitals have psych wings in them, other times a patient will be transferred to a dedicated psych facility.
I will try to find a cite for you. I have read from several sources (including the APA) that psychiatrists are very poor at predicting future violence. They’re wrong something like 2 out of 3 times.
Even if you had a cite, that would be a meaningless statistic without comparative data. IOW, if psychiatrists could predict violent behaviors 33% of the time and everyone else could only predict it 10% of the time, they would be considered comparatively very good at predicting. Furthermore, it does not take into account that it is not merely an overt act of future violence that makes the threat of future violence credible and concerning. IOW, even if only, say, 1 in 10 persons threatening a violent act actually accomplishes it (completely made up statistic), we might still decide that proportion is not societally acceptable if we cannot dependably predict which of the ten it will be. And violence or the chance of violence is not the be-all end-all of a civil commitment inquiry anyway; there is also the question of whether the person is able to care for him or herself. A person who is heedless of his or her own personal safety due to acute mental illness might be deemed gravely disabled and subject to commitment, even if the chance of violence is nil.
Not meaningless at all. Sure, obviously 33% is better than 10% but it’s still nowhere near accurate enough to use to revoke civil liberties. There are certain factors that make violence more likely but we cannot predict future violence in individuals.
Not sure what you’re alluding to here.
Not sure what you mean by “societally acceptable.” The trouble is we have differing levels of restrictions based on arbitrary psychiatric labels.
Agreed but unfortunately being unwilling to take psychoactive drugs is interpreted to fall into the category of being “unable to care for one’s self.”
Actually, I think it mostly has to do with the fact that once you’re caught in the net you’re pretty well screwed. It’s very difficult to prove yourself sane once it’s been decided you’re crazy. Rosenhan experiment - Wikipedia
No, thankfully we’ve moved away from long-term institutionalization as it was getting too expensive. The trend today is towards assertive community treatment where they’re allowed to live in the community so long as they’re willing to be drugged and do what they’re told. If they screw up, though, it’s back to the bin.
Yes they did get out but the experiment shows that psychiatric labels are arbitrary and unscientific. They still are. There is absolutely no objective test for any mental illness.
Scary. It’s better than forced institutionalization, I suppose, but still. Are you ok with that?
I don’t know about any, but certainly a lot of them. My question is: What’s the better solution? Even without a clearly-identifiable, objectively-measurable cause, many people suffer the symptoms of what we call mental illness; these symptoms sometimes add up and negatively affect these people’s day-to-day functioning. If not psychiatry and psychology, how can these people be treated (for their own sake) and dealt with / sequestered (for everyone else’'s sake)?
I guess it depends on which people you’re talking about. The drunk driver is definitely a danger to himself and to others. That’s why we have laws against drinking and driving.
No it’s not. I can be a schizophrenic in the opinion of the psychiatrist. That’s a medical opinion. It’s not indicative of my capacity or tendency to be dangerous. The latter are the official grounds for institutionalizing me against my will. The former is considered by some (not by me) to be a “disease”, although it’s sort of stretching the definition a bit and begs a question or two to get there.
If I’m there in court, I’m disagreeing with some or all of the above:
• that the diagnosis is wrong? unfortunately, there’s no test for schizophrenia; but as I said before it’s not really germane; it should not be admissible in court. I’m either dangerous or I’m not; whether I"m schizophrenic should be irrelevant.
• history: I may disagree with the version that’s in the chart
• current condition: here I am, before you now. with regards to dangerousness my current condition is quite relevant. I expect you to pay some attention to my current behavior, certainly.
• level of insight: similarly, I expect you to listen to my testimony. feel free to ask questions of your own. keep in mind that you should not assume that failure to agree with the psychiatrist about my condition and/or need for treatment constitues “lack of insight”! That would be begging the question in a really nasty way, now wouldn’t it?
• compliance with treatment: and once again, if I disagree with the psychiatrist’s opinion I may be and most probably am refusing treatment. if I disgreed with the psychiatrist’s recommendations and yet did NOT refuse treatment, that might be cause for concern about my level of insight, but to refuse treatment that I don’t agree with is consistent and logical. wouldn’t you agree?
Less weight than the opinion of the patient, certainly. Admittedly that’s assuming I can trust the patient to be telling the truth.
What mental ilnness is, or is not, when it is alleged to be present, is also something the court should not assume to be established. As I said above, it should not be relevant. Ultimately there should be a single standard for determining that someone should be held against their will; that standard should be used against people who are allegedly mentally ill only if the exact same standard is used against allegedly dangerous poeple who are not alleged to be mentally ill. Our dangerousness is not a more dangerous dangerousness than anyone else’s, after all. And, if anything, we’re less predictable, so predictions of our dangerousness are less reliable.
Not everywhere, and it should not be. “Grave disability” is already adequately covered by statutes concerned with fundamental competency. People who can no longer take care of themselves or make rational decisions can be given a guardian. People who are able to make rational decisions have as much right to make decisions you (or a shrink) think are bad decisions as any other damn fool citizen.
Or disturbs the peace trying to kill himself or something, yeah. I dont really see that my suicide (were I to decide to implement one) is any of your business.
Horseshit. This hearing is inherently adversarial and should be treated as such. The psychiatrist wishes to have me held against my will. I am contesting that. It is therefore adversarial. Were either of us to have a different opinion this hearing would not be taking place.
Ultimately the psychiatric commitment hearing should be done away with, period. One standard fits all: if I am not competent, appoint a guardian. (And the law, which would apply to you were anyone to allege that you are no longer competent, should have a high bar set. If the allegedly incompetent person shows up and appears to be lucid and can answer some fundamental questions about how he or she would handle various ordinary problems, and is oriented to time and place and person, that’s a competent person who gets to retain the right to make personal decisions.
Meanwhile, if as a competent person I commit a crime, arrest me and charge me with it. For the most part no one else gets locked up for things someone thinks they MIGHT do. If we’re going to go that route, it should apply to everyone, not just schizzies. (And you seem a bit vehement, actually. Should we worry?)
No, I’m not and, in a sense, it’s even more insidious because people are coerced into community treatment who would not meet the standard for hospitalization.
Seriously, there is no objective test for ANY mental illness. There is no blood test, no brain scan, nothing.
I’m not Thomas Szasz: I don’t deny the existence of mental illness. Certainly mental disorders exist and people who suffer from them can be helped immensely. Assistance with housing and appropriate supports are critical.
I don’t know why they need to be “dealt with” at all. Why can’t they just be treated decently and allowed to live their lives? If you’re not breaking the law, why should you be hassled?
I am curious what you mean by “screw up”? Are you referring to a patient forgetting (or refusing) to take psych medications as a screw up? Decompensating or having a mental health crisis isn’t a screw up, it’s biochemical. Are you worried that once someone is labeled as a mental health patient that non-pathological but eccentric behavior may land them back in the psych hospital?
Missed this the first time. Jodi answered most of it, but I’ll add a little more.
In that book I mentioned earlier, one of the facilities the author visited had a fully-stocked kitchen with microwaves, utensils (yes, knives too) and such that could potentially be dangerous. Obviously, it wasn’t a very high-security facility. She was also allowed day passes to venture out and the security check when she went back in grew more and more lax over time; she was routinely smuggling cigarettes and such in.
Another facility was a quasi-outpatient gig where patients lived in apartments they rented for the purpose and had full access to the outside world. People without their own laptops could use the communal desktop provided in every apartment.
Earlier in the book, when she was in a high-security facility, they weren’t even allowed pencils and pens (though the rule was haphazardly enforced) and were typically given crayons to write or even sign documents with.
And from personal experience, I’ve been to one where everything was stripped from you (clothing, belts, shoelaces, belongings) and you were given a smock, a blanket, and little else. They’d provide you a little strip of toothpaste or a little paper cup of soap/shampoo if you wanted to clean up. I’d assume those things would be confiscated as well if you were truly dangerous.
Another low-security facility I’ve been in took away everything at first, but gradually granted you varying privileges depending on your behavior. When I first got in, I was tranquilized, straightjacketed, tied to a gurney and put in a padded room empty except for me and some urine from previous patients.
I was moved to the general population the next day and got my clothes and shoes back, but they took those away once I started misbehaving and trying to hang myself with shoelaces and cut myself with broken light bulbs.
As my behavior changed, so did my privileges. Eventually I was allowed to have a CD player, with which I became the facility’s DJ and started having music parties with the patients dancing around (or stumbling, thanks to the drugs) and singing (moaning like zombies). The few weeks right before I left, I was even allowed to have a laptop… until I threw a fit and smashed it into itty bitty pieces. Yeah. Good times…
That’s one possibility. Another is not being home when the team shows up. Exhibiting behaviour they don’t approve of. Expressing your intention to move. Spending money irresponsibly. There’s any number of things that could flag your file.
Except that there’s no way of measuring the biochemicals. We don’t know what a balance or an imbalance even looks like. Mental illness is just presumed to be neurological but there’s actually no evidence for it. There’s a gulf between physical and mental illness. And if, in the future, there really is a neurological basis discovered for any mental illness then all that will happen is it will turn into a real illness.
Definitely. A psychiatric label is a huge burden to bear. Once you’re called bipolar or schizophrenic or whatever, everything that you do is viewed through that lens. That was one of the most interesting things about the Rosenhan experiment. One of the nursing notes was “patient exhibits writing behaviour” whereas a normal person would just be said to be writing.
