Totally depends on who we’re talking about. Take Jodi’s first example: the guy who thinks his mother is poisoning his coffee. First, I’d want to know if there was any truth to that. Had she ever tried to slip drugs into his coffee? It has happened. Then, I’d want to know if he was happy in his living circumstances. Is there some reason why a (presumably) adult man is still living with his parent(s)? And if he would prefer to be living independently, I would help him get there.
IANAD but I think you are overstating things here. Do you have support for this?
I think it’s accurate to say that there’s a gap between scientific understanding of physical and mental illnesses, but saying that there’s no evidence of a neurological basis for mental illness goes too far. Neuroimaging studies show differences (e.g., in the temporal lobe) in the brains of schizophrenic individuals during periods of hallucinations as compared to periods without hallucinations, and differences between the brains of schizophrenic and neurotypical individuals. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=19753095
And many clinical trials have shown that antipsychotic medications alleviate symptoms during an acute psychotic episode. Psychiatry Online Granted, the side effects of the drugs can be bad. Relatively little is known about their biochemical mechanism of action (i.e., not much more than “believed to reduce dopamine activity”), but the evidence is consistent with a neurological basis for mental illness.
Lots of fascinating books have been written on the subject; one of the best is by Valenstein (a neurologist): “Blaming the Brain.”
Lots of problems with neuroimaging studies. Many of them are merely measuring blood flow in various areas of the brain, the assumption being that increased blood flow equals increased neural activity when it’s not clear at all there’s a correlation. Secondly, assuming there are brain changes with varying mental disorders, there’s no way of knowing which is the cause and which is the correlate. In other words, does a person’s brain spontaneously make these changes and hallucinations are the result? Or is the changed brain merely how a brain looks while it’s hallucinating? Also, it is not clear how much of these purported differences are as a result of the medications themselves. It’s quite unusual to find drug-naive schizophrenics. Lastly, even with all this exciting new science, it is still not possible to diagnose someone on the basis of a brain scan. I don’t think it ever will be possible.
Well, that’s no surprise. Before the marketing term “antipsychotic” was invented these drugs were called major tranquillizers. They diminish the nervous system and alleviate symptoms and reduce functioning. At the doses used in hospitals, they put patients into a near-vegetative state and make them easier to handle.
No, that’s an understatement. The side effects are devastating and are a major reason why people who take them die on average 25 years earlier. Diabetes, hypertension, heart disease, liver disease, kidney disease, you name it, psych meds are killers.
Not at all. Taking these drugs affects your brain’s biochemistry and changes your behaviour. That doesn’t support a neurological basis for mental illness. I think the most salient point is: If mental illnesses are neurological, then why aren’t neurologists interested in them?
The World Health Organization has twice found that outcomes are better without psychiatric intervention. Being treated with psych meds is strongly correlated with chronic disability. That alone should give psychiatrists pause.
Missed the edit window.
Just wanted to add that even though alcohol often alleviates anxiety, that wouldn’t support any theory that “anxiety disorders” are neurological (they’re pretty clearly psychological). The same reasoning applies to antipsychotics and hallucinations.
Wonderful article here: http://psychrights.org/articles/EHPPPsychDrugEpidemic(Whitaker).pdf
Robert Whitaker is the author of “Mad in America.”
I’ve got no problem at all with people who want to take these drugs so long as their consent is informed consent. It’s your brain, do what you want. My issue is with forcing people to take them.
• Operationalizing “hallucination” is a bit tricky
•If they did not test nonschizzies to see if THEIR brains ALSO showed differences during periods of hallucinations as compared to periods without, they were remiss
• There are very few tests that have been done on peopel diagnosed ‘schizophrenic’ that control for years of psychiatric medication. Psych meds change the brain permanently so such tests needs to be performed on schizophrenics who have not been exposed to years of psych meds.
Antipsychotic meds are not very specific to anything; they disable neuroactivity (not very selectively) by interfering with neurochemistry. They “alleviate” a lot of things, mostly with the effectiveness that turning down your home audiophile system will get rid of buzz and distortion in your sound.
Edit: or what G. Pie already said better.
Thanks for the information, G. Pie and AHunter3. I was aware of Peter Breggin’s work but not Valenstein’s and Whitaker’s.
Having watched a loved one go through psychotic episodes, it’s hard for me to imagine a causation other than a “biochemical imbalance” or some type of as-yet-unidentified physical brain malformation (no offense intended – I can’t think of better words). IMO it’s easier to accept a psychological explanation for anxiety or depression than psychosis. I’m not saying that if “biochemical imbalance” is not the cause then the cause must be psychological, I’m just saying that that the “biochemical imbalance” theory has a lot of intuitive appeal.
Regardless of the cause, the problem remains what treatment(s) are best for the long term health and wellness of a schizophrenic individual. For my family member, therapy and support plus two psych drugs at low maintenance doses has produced a better outcome than therapy and support in the absence of psych drugs. I worry about the psych drugs, particularly long term, but in this case the benefit seems to outweigh the harm.
One of the most useful treatment for any of the conditions called “mental illness” seems to be user-run self-help / mutual support in one form or another. Even for people in major crisis it has proven effective.
That was the philosophy behind the Soteria Houses which had fabulous outcomes without medication. Apparently, a new Soteria House has been opened in Alaska.
No offense to Peter Breggin (who has done some great work re: ADHD) but I don’t think he’s in the same class as the other two.
I agree schizophrenia seems to be a special case but just as psychiatry has promoted the dopamine (overactive) theory of schizophrenia, they’ve done the same thing with serotonin (underactive) and depression. Psychosis is alarming (both for the person who experiences it and for the people who love him) and when experts are providing what seems to be a rational explanation it’s easy to see its appeal.
I know what you mean but I think that “intuitive appeal” unfortunately overrides the actual science. Sometimes in dysfunctional families the black sheep gets hit with the psych label as a way to explain away everything else. I’m not suggesting at all this is true in this case, just pointing out that it does happen.
I’m glad your person has found something that works for him/her and I’m hoping it’s a voluntary choice they are making. If we’re talking about a neurochemical imbalance, though, it’s hard to understand why “therapy and support” is needed. Then, again, throughout the mental health system therapy usually consists of teaching people they’re dysfunctional and damaged.
I think psych drugs have their place: for short-term use in an emergency. If I ever go off the rails again, I won’t hesitate to use them. It’s just the lifelong, chronic model that creeps me out.
Obviously what you should do is ask random people their opinion, and do the exact opposite. Then you have a 90% success rate.
Can these numbers be real? A 33% success rate says that a trained professional is not only no better than flipping a coin (which I might believe), but is significantly worse. That’s very hard to take seriously.
I don’t know. The agenda that crazy = dangerous is pushed pretty hard. If you’re predisposed to falsely believe in a phenomonen, then that will drop your predicting accuracy considerably. As the great man said, “the problem is not what you don’t know; the problem is what you ‘know’ that just ain’t so.”
G. Pie, I started to type out specific responses to your posts, but then realized I really have no common basis for discussion with someone who doesn’t consider mental illness to be “a real illness.” It’s not so much that we’re not on the same page, we’re not in the same book. Your opinions on psyciatry remind me greatly of the positions advocated by Scientologists. So I will limit myself to addressing the specific example of mine you chose to allude to, and only because the reality of that situation could not possibly have been resolved as neatly as you seem to want to assume:
No :rolleyes: There was no reason to believe his sweet, elderly, distraught mother, who had dedicated her life, her happiness, and all her money to keep him out of an insitution, was poisoning his coffee. He was paranoid schizophrenic and had decompensated to the point where his paranoia was making him act out, not just against his mother, but against his case worker, his doctors, and random strangers on the street.
“Happy”? Happy isn’t really an operative adjective for an acutely ill paranoid schizophrenic. Considering that he believed his mother was poisoning him and had (a) stopped eating and drinking because of it and (b) disclosed considering harming his mother to get her to stop, I think it’s safe to assume he wasn’t “happy.”
Yes. He was paranoid schizophrenic. He could not live alone. He had a string of evictions behind him as proof of that, due to trashing apartments, scaring the neighbors, or not paying his rent. He could not hold down a job, so he had no money. If his mother did not allow him to live with her – at risk to her own personal safety when he decompensated – he would have been homeless.
And how would you do that, precisely? He does not have the skills to “live independently” and, believe me, you’re not going to be able to magically bestow them upon him. He had no money, no job – and no way to get either," no way to obtain resources (like groceries or heat), no way to pay bills, no way to maintain an apartment even if he could get one, which he couldn’t, and no minimal social skills to avoid conflict with others. He had already been hospitalized after being severely beaten by a man when he grabbed the man’s wife’s arm and accused her of reading his thoughts. He was not even eligible for semi-independent living in a group home in the community under close case-worker supervision and a strict regimen of meds, because he was so consistently non-compliant and his schizophrenic episodes were so frequent and so severe. The only thing keeping out of Western States Hospital on a long-term commitment was his mother, and even she occasionally got to the point where she could no longer cope with him. So I would love to hear what you would do to assist this man, because I’m sure you have a very innovative solution.
Again, I cannot over-emphasize that the people I dealt with who were involuntarily commited were severely mentally ill. I don’t mean with a long history of mental illness, I mean currently, immediately, completely unable to care for themselves due to present mental illness, and no less restrictive alternative was available for their care. Calls to do “something else” completely ignore the bleak reality that frequently for these types of cases, there is no “something else.” These people will not consent to hospitalization – indeed, cannot do so because they lack mental capacity. Likewise they cannot be left out in society any more than a child could just be left out in society – they CANNOT care for themselves, they do not presently have the skills to do so anymore than a baby would. So what, precisely, would you suggest?
As for attempts to cast involuntary commitments as always/frequently some sort of “Frances Farmer” *I’M NOT CRAZY, WON’T SOMEONE BELIEVE ME!!" injustice, I can only say that while I’m sure such cases have taken place – it was formerly much easier to get someone civilly committed that it is today – I believe such cases to be surpassingly rare. I also believe the due process safeguards we have in place to be probably as good as they can be and still have a workable system. The “sane person locked up against his will” scenario makes for an excellent movie-of-the-week, but the reality is simultaneously more banal and more tragic. The movie-of-the-week scenario was never my experience, and I mean ever, and I did those hearings on a rotational basis for better than three years.
Your cite is a Google search? I didn’t see any cite there I could access and actually read.
You’re correct, and the distinction you’re drawing is a valid one. While the diagnosis, report of current condition, and predictions for future successful treatment are medical opinion, the ultimate issue of “dangerousness” is a question of fact decided by the judge in the course of deciding whether the legal standards of commitment have been met. But I’m really not interested in a debate as to whether schizophrenia is a disease.
Who are “you” in this scenario? Are you the mentally ill person? Because I’ll just tell you, if you make any argument even remotely as rational and cogent as those set out in your post, you’re not going to be involuntarily committed. If you’re the mentally ill person in the hearings I dealt with, you didn’t say anything like any of this, because you were currently far too incapacitated. So are you the defense lawyer? Let’s assume that.
Your dangerousness is almost certainly going to be tied to symptoms that are in turn explained by a specific diagnosis of mental illness. If the doctor can’t even say what’s wrong with you in terms the judge will understand, the State is in trouble in terms of explaining why your freedom should be taken away. The doctor presented by the State is almost certainly the only doctor testifying; there will be no competent medical testimony disagreeing with his diagnosis. Besides, in the majority (though not vast majority) of cases, the patients had a long history of mental illness and an established diagnosis by more than one doctor.
As the attorney, you will certainly review the chart for obvious discrepancies or innaccuracies and jump all over them if found, but you are not in a position to challenge the facts as set forth in the chart, because how would you know if it’s correct or not? If you’re the patient, you’re not going to be in a condition to do anything remotely as high-functioning as read, absorb, and dispute your medical chart.
Oh, the judges do. Clearly of greatest weight as evidence is the testimony and behavior of the patient – if the patient is even in a condition to appear and testify, which frequently they are not.
I see from the way these are phrased that you are the patient in this scenario. I can only say again that you are assuming a level of mental competency and functioning that virtually no patient I dealt with ever had. It is therefore not a scenario grounded in reality, at least IME.
A competent person who is experiencing a severe mental health issue will almost certainly accept SOME help in addressing it. IOW, the person may disagree with the type of treatment offered, but they will not refuse ALL treatment. Nor will they offer reasons for refusing treatment that are in turn grounded in mental illness or demonstrate a lack of current insight, i.e., the pills are poison, the voices say not to take them, I’m fine without them. These issues are by no means cut and dried, but you are theorizing a rational refusal of treatment. That was not what we were dealing with.
In the absence of reason to doubt it, the veracity of all witnesses may be assumed.
The court does not “assume” mental illness has been “established.” There must be a diagnosis and medical records that set that out. The court assumes nothing in these hearings, except those facts it may take judicial notice of, just like in every other civil proceeding. A diagnosis of mental illness serves as a root cause for the behavior at issue, but it is neither the starting point nor the ending point for the judicial inquiry into dangerousness or grave disability.
This is a just an argument for requiring an overt act as a prerequisite for holding a mentally ill person as a danger to self or others. Even if I agreed with that – although it frankly sounds stupid to me – you are still ignoring the vast category of those who are held as gravely disabled and for whom dangerousness is never the inquiry.
Really. Please show me a cite for a jurisdiction where “danger to self or others” is the only basis for involuntary civil commitment.
Obviously not. “Statutes concerned with fundamental competency” – and do you mean civil or criminal statutes? – do not include mechanisms to address emergency situations. That is what we are talking about here: The person is taken to the emergency room due to acute decompensation and cannot take care of his or her self right then. Not six weeks or six months from now, now. Nothing in any other laws regarding competency are intended to address that situation.
And what is the guardian magically supposed to do? Does the eventual commitment become less involuntary if you have previously been found incompetent and had a guardian appointed? Since these posts seem to assume a degree of intentional injustice, why not assume the guardian is Snidely Whiplash, intentionally exploiting the ward? And this again completely disregards a need for immediate treatment, as if guardians are appointed overnight.
I absolutely, 100%, unequivocally agree. But you are assuming the patient subject to civil commitment IS able to make rational decisions. I am telling you that in my experience that was never the case. If I was presented with a patient who was able to make rational decisions regarding his or her condition or care, we wouldn’t even have a commitment hearing on that person. THe MHP would recommend release – why would they want to hold them? – and the petiition would be dismissed and the patient released. You continue to impart a healthy measure of sanity to patients that I am telling you were not demonstrating any. THAT’S the problem. If they are sane, if they are rational – no problem.
Yes, well, you may be comfortable with a philosophical shrug or perhaps a “job well done” when your delusional neighbor succeeds in killing himself, but you can hardly insist everyone else be so cold-blooded. “'You always were a good man of businss, Jacob,” said Scrooge. ‘Business!’ cried the Ghost. ‘Mankind was my business!’"
I didn’t say the hearing as not adversarial – it is – I said the psychiatrist hopefully has a neutral viewpoint. “witness having neutral viewpoint” != “hearing is not adversarial.” So “Horseshit” back atcha. :rolleyes: If you want to address what I actually said, I will try to respond.
And how would you suggest that be accomplished on an emergency basis? And when it cannot be accomplished instantaneously – and it can’t be – what do you suggest happen in the meantime. You have a person standing in your emergency room who is gravely disabled due to mental illness. He or she has no more ability to take care of his or herself than a small child would. If you let them leave, they will literally wander into traffic. So what do you do? Not weeks later – what do you do right then? If you choose one part of this post to respond to, please make it this question.
I am. And I’d like to think that, too.
So you’re saying: that in a commitment hearing, even if the psychiatrist is there saying “Your honor, AHunter3 is suffering from some rather disturbed and grandiose delusions, and harbors a sense of himself as special and persecuted. He is capable of rational thought but in my opinion he is highly likely to make highly inappropriate decisions that would fail to take sufficient and reasonable concern for his own safety and security into account, and I cannot rule out violence towards others if he should perceive their behaviors through the lens of the delusions he current harbors”;
… and the attorney representing the state is advocating for commitment; that, as long as I sound as I do in this thread the judge is going to cut me loose and let me walk out and away from the reaches of psychiatric treatment?
The last time I was a patient on a locked ward, I asked to see my chart. Permission denied. But they had them sitting out on the counter at the nurse’s station, see? Well, I walk at a very brisk clip — better than 4 mph — so I came striding down the hall, picked up my chart and walked past the nurse INTO the nurse’s station and into the bathroom, which — unlike any room WE had permission to go into — had a lock on the inside :). Yes I read my chart. It said I was a paranoid schizophrenic. It said I had defensive and projected distortions in my perceptions of others and their behavior. The nurses’ notes often contained phrases like “Continues to display inappropriate behavior”.
The next day I gave notice that insofar as (at least technically) was there on a voluntary basis, I wanted to leave, to check myself out. I was told to wait and the doctor would be there with the paperwork. What did arrive was a stretcher with 6-way restraints, 4 ward orderlies, and a loaded syringe. I was placed in seclusion and told that if I signed the 72 hour notice of my intent to leave, the doctor would take me to court to win an involuntary commitment hearing, that the doctor did play golf with the judge every Saturday and never never ever lost any of these hearings.
Yes I was the patient. If you had been me would you have opted to go into that courtroom? Would you have expected to win?
I rescinded my 72 hour letter and took the vile brain-poison the doctor insisted I take (Navane) and I was returned to my regular ward; and approximately 20 hours later I used a plain old kitchen table knife to take the screws holding a retaining tongue out of the middle of a locked double doors, then pushed in the middle where the doors came together so that they folded apart and opened although still locked, and left the institution, and hitch-hiked my ass out of the state in which the institution lay.
Yes, I read my chart.
I’ve been a witness to other court hearings, including these hearings which were not commitment hearings but Rivers (right to refuse medication) hearings — in NY at least on paper you can be in a mental condition sufficiently impaired or dangerous to require involuntary commitment and yet still be considered to have capacity to make decisions. So to be found to be lacking that level of mental capacity one must be found to be even more impaired than the level at which they hold you on an involuntary basis. I heard some pretty damn lucid and clear-spoken rational-sounding individuals explain their understanding of the psych meds prescribed for them and delinate their reasons for not wanting to take them. Nearly every one of them was ruled against.
But you seem to be arguing here that by definition you could not be dealing with a rational refusal of treatment.
The pills really ARE poison. They do permanent brain damage, they disable higher thought and wreck the integrity of your feelings as they participate in your thinking processes (your passion for an idea, for example), and they are medically risky substances overall with a nasty set of nonrare effects and reactions.
The mental patient is entitled to feel that he or she is fine without the prescribed treatment.
A competent person who considers the entire arsenal of possible psychiatric treatments to be meaningless quackery at best and lethally harmful assaults on the brain at worst may indeed refuse ALL treatment and quite emphatically at that.
You cannot ASSUME non compos mentis in a hearing that exists for the purpose of ascertaining whether or not the mentis who is the subject of the hearing is compos or not. That is circular reasoning. It’s begging the question.
You have implied that the court system is not set up to be able to hold civil competency hearings (of the sort that people NOT alleged to be mentally ill, per se, would be subject to were they thought to be ‘senile’ or to otherwise lack decision-making capacity) on a sufficiently rapid basis to handle emergencies. I do not know why that should be the case. If it is, that’s where we start: we make it NOT the case. Then this standard competency hearing is how we handle emergencies.
I don’t believe a neurological basis has been established for any mental illness. I certainly consider mental illness to be real, however, real and devastating. That doesn’t make it a brain disorder. I resent being linked to Scientology. It’s a common slur against critical thinkers who see psychiatry as a dangerous pseudo science. I would think the fact that schizophrenics do better without treatment (according to the World Health Organization) should cause any intelligent person to question the validity of this branch of medicine.
According to you. The son obviously felt differently. Is there any chance, even one chance in a billion, that his mother put neuroleptics into his coffee?
Which means nothing except that his particular group of troublesome and unwanted behaviours fit that particular label.
And if his “act[ing] out” involved criminal behaviour then I presume the police were involved. So what were the results of that interaction? And if his acting out wasn’t criminal then I guess we’re back to a bunch of troublesome and unwanted behaviours.
What I meant was: Is living with his “sweet, elderly, distraught” mother the healthiest home for him? In my experience, the mentally ill do much better living apart from their parents. Sadly, parents are some of the biggest supporters of the brain chemical imbalance theory, for obvious reasons. If neurotransmitters are to blame, then family dysfunction is off the hook. Have you ever checked out statistics on childhood abuse as compared to psychiatric labels?
Again, this sounds like criminal behaviour so I presume the police were involved. What happened?
Is he not eligible for disability income of some sort? I’m in Canada and here we have both federal and provincial plans. The net income is approximately $900 (plus many other benefits including a subsidized bus pass and free psych meds) which is plenty to afford a modest standard of living.
I agree that some people can’t or don’t want to live on their own. We also have psychiatric group homes with varying levels of staffing. Of course, nobody can “magically bestow” skills but everybody can be encouraged to live as full and meaningful a life as possible.
Yeah, sounds more like a group home situation then.
I hope he was legally represented and pursued a claim for damages.
What about the American equivalent of extended leave provisions? I believe you call it “assisted (or assertive) community treatment” or some such. In that case, being non-compliant isn’t an option if you want to stay out of the hospital.
Not very innovative, I’m afraid, but I would start with treating him like a human being and asking him what his preferences would be.
Well, I’ve been there and I disagree. Almost any “something else” (including living under a bridge) is an improvement over isolation cells, four-point restraints, forced drugging and electroshock.
Ah, yes, the dreaded lack of insight the psychiatrists are always on about. We want you to do this. If you are willing, then we’re happy. If you are unwilling, then that proves you’re incapable and lacking insight. But, somehow or other, we will make you do what we want you to do.
Well, for a start, I’d stop offensively comparing them to babies.
Horse shit. It happens every day. Patient is uncooperative and noncompliant, gets saddled with further psych labels. Speaking up about the injustice only serves to “prove” how ill they are.
Effectively, we don’t even have “safeguards.” And the system is not workable. It’s a sick, out of control monster.
But it happens. You can (and apparently do) choose to ignore it. But if happens. Referring back to your poisoned coffee guy, similar labels (chronic mental illness, no insight, noncompliance) were applied to me. The suggestion was that I should live on a gimp farm and collect disability benefits for life. They would have me be one of those sad cases that shuffles into the health centre for weekly antipsychotic injections. But the truth is I’m gainfully employed and fully competent to live independently. And, yes, I am proudly noncompliant. I do not take medication. If you met me in real life, you would have no idea that I bear a psychiatric label. That is the magnitude of the error that our modern psychiatric system is capable of making. So you’ll have to pardon me for being a little skeptical.
Awesome suggestion. Of course it would never fly. What would society say about incarcerating the allegedly dangerous? Did you ever see the movie Minority Report where the pre-crime division arrested you before you committed a crime?
My dictionary defines poison as “a substance that through its chemical action kills or harms a living organism.” Yes, atypical antipsychotics are poison. So, by your logic, my reason for refusing treatment is either grounded in my mental illness or demonstrates my lack of insight. Bummer.
I am saying that I never had a case where the patient was simultaneously “capable of rational thought” but also “disturbed, suffering from delusions, making inappropriate decisions, and potentially violent.” All of the symptoms or behaviors you’re theorizing are far more likely to be irrational than rational. The rationality of the patients in emergency civil commitment hearings was in my experience s a non-issue. These people were not rational.
You apparently have experience as a patient – not just a patient, but an escaped one. My experience was as a lawyer. But all I can do is relay the truth of my experience, which really isn’t subject to argument. You are free to take the validity of my opinion with as huge a grain of salt as you think appropriate, as, with all due respect, I am doing with yours.
Good thing no one has stated or asserted that impairment is assumed – no one but you, that is. So that’s your straw man; do with it what you will.
Ah. We just “make it not the case.” Again, I ask you to answer the specific question I asked you, not with hand-waving declarations that we magically “make it not the case,” but with specifics of what will be done. I will repost it:
Please note that there is no changes to “the court system” or to “competency hearings” that could possibly handle this situation, short of having permanently empanelled hearings and potential guardians on constant standby, to swing into action if and when a severely mentally incapacitated person happens to be brought in. This is obviously not feasible, if for no other reason than limited judicial and govermental resources. Judges don’t work 24/7, nor does court personnel. Hearings have to be scheduled, evidence has to be marshalled, witnesses have to be found and prepared. How do you propose to have the people, evidence, and court resources in order and ready instantaneously? That’s just not a reasonable expectation.
Moreover, even if you want to drag the whole commitment system over to one of formal declarations of competency, how does that address your concerns? Isn’t a person found incompetent and then committed still committed involuntarily? They still don’t want to be there. They still may disagree with the treatment they are receiving. In your scenario, they have a formalized finding of incompetency to follow them around, instead of just being treated for three days or two weeks and then hopefully released without any ultimate declarations of “incompetency” being necessary.
So what do you do? You have to either make the person stay – which is an involuntary commitment – or let them go back out into a world where they are at grave and immediate risk. Maybe you’d just let them wander out, I don’t know, but if so you’re hardly in a position to insist that I or anyone else agree with the wisdom of that.
Actually, no you don’t. Or, rather, what you have is a person standing in your emergency room who YOU CONSIDER to be gravely disabled due to an alleged condition to which someone at some time or another has attached the label “mental illness”. This person IN YOUR OPINIONhas no more ability to take care of his or herself than what YOU BELIEVE to be the proficiency of a small child in that regard.
But for the moment let us say that I agree with you, that at least as far as this particular person’s competency, I, too, do not believe this person knows up from down at the moment and should not be turned loose to go play in traffic.
Can you clarify your question? To wit: are you asking what we do about this person RIGHT NOW? Because that has no particular bearing on a commitment hearing, does it? This would instead pertain to the 72 hour period in which a person can be snagged by the police (on their own judgment that this person isn’t all there) or medical personnel and held over FOR a hearing, right? OR are you asking about the hearing itself, and asking me what I would do “instead” if we are to eliminate the commitment hearing entirely?