First please explain what “vesting interest” the psychiatrist has in incarcerating the person. Are you under the impression MHPs work on commission? Second – again – none of the patients I ever dealt with were in a position to prove anything, because they were acutely mentally ill at the time. This precluded any sort of rational communication, much as you seem to want to attribute rationality to them.
The inquiry IS into a patient’s mental state right now. The MHP DOES testify that the person is mentally incompetent right now. Even if you’d like to declare that past diagnosis or predictions of future behavior should be inadmissible, that would not change the outcome for any patient I can recall. The operative legal inquiry is “Is this person a danger to self or others” NOW, or “Is this person gravely disabled” NOW. And all the people you just listed as “an unbiased panel of observers” ALREADY interview and/or observe the patient prior to the hearing.
Never in my experience, nor does that reflect the standards set forth by the law.
Never in my experience, nor does that reflect the standards set forth by the law.
:: Shrug :: I never dealt with those who voluntarily committed themselves, them being obviously outside the realm of involuntary commitments.
Blah blah blah. I’ve already stated I’m not interested in your opinion on the validity of mental illness qua illness.
Here’s a newsflash: Your experience is not universal. Frequently the police are not involved in conflicts with the mentally ill, for reasons I’ve already set forth. And by referring to the experience as a “wake up call,” you are yet again, as you so frequently do, importing an element of sanity where IME none existed. These people might be frightened of the police, but they could not reorder their thoughts or adjust their behaviors in order to avoid police interaction, because they were far too decompensated.
Civil commitment is not “treating someone like a criminal,” nor is it “incarceration.” Your conflating of the two reveals that to your great fortune you’ve never actually been incarcerated, especially in the midst of an acute mental illness episode.
I don’t know if it’s odd or not, because I don’t know what your “decade of interaction with the mental health system” consists of – nor am I asking, so don’t think that I’m seeking personal information.
That’s because you’ve never been in jail as an acutely mentally ill person and therefore don’t know what the hell you’re talking about. Mental health services do NOT exist in many jails, though they are more likely to have programs the larger the facility we’re talking about. Jails are not equipped to deal with the acutely mentally ill. Staff aren’t trained for it, other inmates don’t understand it, and an acutely mentally ill person is likely to be placed in isolation for his or her own safety – until steps can be taken to transfer him or her to a secure mental health facility. You know what else is worse than the local psych ward? The state hospital forensic psych ward. The people there aren’t just crazy, they’re criminal, frequently violent, and crazy.
Group homes DON’T lock people in. Which is why a person who must be in a secured placement is sent to the hospital or secure clinic. Frequently involuntarily. As in “involuntary commitment.”
I have no idea what is involved in “extended leave” because you haven’t explained, nor have you explained how it would work for the paranoid schizophrenic we’ve been discussing.
Because he wouldn’t use the money to buy the food, and then he wouldn’t eat because he didn’t have any food. Because he would still get evicted for trashing the apartment or threatening the neighbors. Because he would leave and the next time they’d see him was the next time he was brought to the hospital by the cops.
Casting the issue in terms of breaking the law or not breaking the law, completely ignores the category of persons for whom involuntary civil commitments were intended: Those who are a danger to self or others or who are gravely disabled, but whom we do NOT want shunted over to the criminal justice system, because the criminal justice system cannot handle them. The criminal justice system deals with criminal behavior. The mental health system, including civil commitments, deals with mental health issues. Again, the vast majority of persons held on a 72-hour hold will be released at or before the three days are up. Of those held over on a 14-day hold, the vast majority of them will be released before the 14 days are up. They then can go back to their lives in society without the stigma or stress of further involvement in the criminal justice system. Why you think it would be better to have them all carted to jail instead, I cannot imagine.
NO. NOT “as proven by his unwillingness to conform.” The guy was mentally incapacitated due to mental illness. His thoughts were acutely disordered, he had limited ability to even absorb what was being said to him, much less communicate meaningfully regarding his situation or his care. You can’t spin the situation to make him competent, because he just wasn’t.
You embarrass yourself when you make universal declarations as to the preferences of the homeless.
No, I’m pretty clear on the choice, it’s not like it requires first-hand experience to grasp. I have no doubt that YOU would prefer to be homeless based on YOUR personal experience, but unlike you I make no attempt to insist that my personal experience must be universal.
Oh. Super. Well, then we’re done. If you’re under the impression that rather than relay the expereince of hundreds of these hearings, I’m just making shit up, there’s really no point in continuing the conversation. I appreciate your frankness; it has saved me a lot of typing. Toodles.
But that assumption was not operative in my experience. It was very clear from the relevant statutes and case law that the persumption was AGAINST involuntary commitment and the burden of proof was on the state. I honestly don’t believe any participant at the hearings made any inference regarding capacity based solely on the fact the hearing was being held in the first place. Of course, we can theorize as to unconscious bias, but I have never found such theories to be helpful since they are rarely amenable to proof.
What WAS more of an issue, IME, and as others have alluded to, was the reliance on the expertise of the MHP and the hospital’s psych doctor. I was a lawyer; I deferred to the MHP and doctor because I had no expertise in the diagnosis or treatment of mental health. The judge frequently had as little expertise as I. (Parenthetically, having judges with a greater degree of subject matter expertise, is one of the justifications for the establishment of mental health courts, as another form of diversion, meaning another way to keep the mentally ill out of the jails. But mental health courts, like drug courts and CIT units are frequently among the first things to fall during budget crises.) The defense attorney of course did NOT want to defer to an MHP who was recommending commitment – but he or she had no more expertise that I did, and they did not have access to a different MHP who might dispute the opinion given.
If the matter went to a 90 day hearing, the public defender’s office would have the option of getting their own MHP to evaluate the patient and offer a second opinion. But 90 day hearings were extremely rare – I never even did one – since as I have said the very vast majority of those involuntarily held could be stabilized and released within 3 or 14 days. There was no budget for a second MHP at the 3 day or 14 day hearing, a matter that had been challenged in court and the existing process found to be adequate, if obviously not ideal.
Very good point. I learned to do this — to craft “how I come across” so as to engage with the average mainstream nonschizzy person in ways that meet them “where they are at”. And I agree that, pragmatically speaking, if you are a person whose thoughts concepts beliefs experiences etc don’t mesh very evenly with what average mainstream folks think and expect everyone else to think, you need to follow fuzzypickles’ advice here. It’s how you stay out of looney bins. Seriously.
Having said all that, though, a person’s failure to be that type of diplomat or to have and hone that particular skill does not make a person dangerous nor does it make a person’s brain chemistry imbalanced and it is the behavior of other people, not the behavior of our subject here, who puts our subject at risk, and the risk mostly consists of the risk of being involuntarily incarcerated as a nutcase.
So to stay on topic, a person’s failure to do that does NOT make it reasonable to rule that they lack capacity to make their own decisions. It does NOT make them delusional. It does NOT constitute appropriate reason to lock them up, either for their own good or for the good of other people.
In short, we nuts not only have (or should have) the right to be nuts without unwanted cures being forced upon us, we also have (or should have) the right to behave like nuts as long as we are not injuring anyone or violating any general laws. It should NOT be OK to lock people up just because they disturb you or because you can’t figure them out.
Umm, I believe G Pie is a fully employed tax-paying lunatic and said so. Dunno about health spa memberships.
Until the recent economic downturn, I, too, was a fully employed schizzy, I have hobbies and pasttimes, etc. And even during the current spate of relative unemployment I’ve been able to knit together consultation gigs sufficient to stay off the dole.
I don’t see anyone in this thread who acknowledges having receive a psychiatric diagnosis who is among those who are displaying a juvenile attitude or spouting vitriol and hatred.
• I’ve been homeless (both in shelters and just out on the street) and I’ve been on a locked psych ward. As soon as you get anywhere near to the point where homeless mentally ill people with an OPTION of being on the street or of being in a facility that provides psychiatric services choose the latter more often than the former, you might be entitled to assume the latter is an improvement over the former. I myself would escape from a locked ward for the privilege of being a homeless person living on the street.
• I have NOT been sentenced to jail or prison time. I know some folks who have been in both institutional settings who say that for the most part, although exceptions certainly exist, forensic incarceration is for a finite span of time and that although they do mess with your head there they don’t literally invade it the way psychiatric bins routinely do, or at least WHEN they do it is specifically due to psychiatry’s insertion of itself into the jail or prison system and can’t be viewed as a separate risk.
In broad general terms, YES it is better to let some people suffer and die as a consequence of you NOT overriding their choices to make what you deem to be better choices, than to go around overriding other folks’ choices and thereby some of the time shredding their self-determination and exposing them to experiences they gain no appreciation for after having had them.
I’m familiar with the Patient’s Bill of Rights, and I suspected that this was what you were referring to earlier. I posted my questions in the naive hope that in considering them, you would realize how much you’re overstating your case here.
As has been pointed out by several people in this thread, and others, the situation is rather stacked against those who have been accused of mental illness, and some have attempted to address the disparity between the protections offered accused criminals (presumed innocent), and those offered people accused of mental illness (presumed that the psychiatrist is informed, expert, and unbiased). Your bellicose arguments remain unconvincing that all of the cases and experiences discussed just “aren’t so”.
It’s a difficult situation. There are families who are desperate to get help for severely ill loved ones, but are hampered by lack of resources and patients’ rights laws. There are individuals who are trying to break free from severely dysfunctional families who use commitment as a tool against them. There are people who cannot refrain from engaging in dangerously inappropriate behavior even in front of the judge to whom they are pleading their case for freedom (as Jodi describes), and there are vulnerable people who do not have the resources to counter the lies of a (hopefully rare) narcissistic psychiatrist or therapist with severe boundary issues.
I don’t have a solution, but I do know that part of the problem comes when lawyers pretend not to recognize the very foundation of our system of justice (presumed innocence) when stating their case, and mental health workers take a hostile and demeaning attitude, attempting to negate the experiences of those for whom the current (or recent) system has failed.
Yeah, well, that’s you, and while I respect and sympathize with your experience, anecdote != data. You, like G Pie, generalize from your experience to the point of declaring that it is universal. For example, do you have a cite for the assertion that “homeless mentally ill people with an OPTION of being on the street or of being in a facility that provides psychiatric services choose the latter more often that the former”? And even if that is in fact the case, which you have hardly demonstrated, the acutely decompensated are obviously not the best judge of their own best interests or personal safety, precisely because they are acutely decompensated. So what they would prefer is not – cannot be – the end of the inquiry.
You are mixing your terms. “Forensic” in this sense means “of the courts,” criminal courts specifically. All incarceration is forensic, and so the term isn’t used to modify “incarceration.” “Forensic” is used to modify “psych ward” or “mental hospital” to distinguish the ward holding those who are mentally ill AND criminal (or allegedly criminal, and I mean serious crimes, not misdemeanors), from the ward holding those who are “only” mentally ill. So I don’t know what you mean by “forensic incarceration” as opposed to “psychiatric bins.” I also don’t know what you mean by “WHEN they do it, [it] is specicially due to psychiatry’s insertion of itself into the jail or prison system and can’t be viewed as a separate risk.” I’m not being evasive; I can’t parse that.
Suffice it to say that I am rarely (never?) going to agree with any opinion that starts “YES it is better to let some people suffer and die . . . .” As should be self-evident, that must really depend on which end of the stick a person has ahold of.
See, and part of the problem with keeping discussions such as this civil, much less informative, is posters who don’t know enough about the foundations of our system of justice to even use the term “presumption of innocence” in an appropriate context.
Here’s a hint: You are presumed innocent of a criminal charge. “Innocence” or “guilt,” with the accompanying implication of personal responsibility and “right or wrong” conduct, have no place in an evaluation of mental status, in any judicial context.
I think part of the reason that people have been butting heads on this one - and again I apologize if I’m misreading - is that your experiences have been 1)purely legal in nature (ie a formal hearing process conducted under the direction of a judge etc.) and 2)With very clearly actively psychotic people.
What others have been talking about is outside of the formalized setting and dealing with people in the “post acute-episode” phase of treatment in an actual psychiatric facility.
My limited experience is that such an assumption - consciously or unconsciously - does seem to exist and is acted upon.
I was most likely wrong to include lawyers and judges in that assumption as I have had no experience with the judicial side of things (except in that you agreed that you would defer to the psychiatrist owing to their expertise - which is understandable) For that I’m sorry.
The examples that I and others have given are of being in a psych ward and trying to participate in treatment or at least have their concerns heard and fairly evaluated.
I have seen the effects of over medication (which sometimes mimic the symptoms of psychoses - thorazine for instance, in too high a dose, can cause rambling incoherent speech and catatonia which were given earlier as definitive symptoms of schizophrenia). I have seen the effect of a psychiatrist that “knows what’s best” despite a patient saying the medication is as destructive as the illness. I’ve seen the results of a psychiatrist punishing a patient for questioning his judgement.
It seems that the two opposing viewpoints are of two different environments: legal and medical.
Do I think a psychiatrist could tell the panel that you have described that a patient needs to be kept in out of malice or spite? Yes. Do I think that the lawyers and judges would defer to that evaluation? Yes. Do I think it happens frequently? No, but more often than any compassionate person would be comfortable with.
Just like a criminal’s experience of the justice system will differ from an attorney’s so will a patient’s experience with the psychiatric system differ from a professional’s.
If I did, that would be in support of YOUR position, I think? I never made any such assertion. I said that as soon as you GET TO the point that such a situation is true, you might (in that hypothetical situation) be entitled to assume that otherwise homeless people would be better off in a psych facility than they are on the street.
I did sort of imply, by that, that such is not currently the case. Are you claiming that it is?
::rereads Jodi’s post again::
Umm, at the risk of being insultingly condescending, you do get that “latter” means “the second of two listed options” whereas “former” means “the first of two listed options”, and just misread it the first time, yes?
And therein lies the problem. You JUST DON’T GET IT. If I have a brain clot which will kill me 99% of the time, and you are a brilliant neurosurgeon with the skills to cure cases like mine 99% of the time, but the surgery may cause brain damage 1% of the time, and I say “No, I do not want you to operate on me, don’t want to live with brain damage, I’ll take my chances on surviving without the surgery”, **YOU DO NOT GET TO OPERATE!!! (Not if I am competent at any rate). You do have to let some people suffer and die rather than impose your will on competent people because, in the absence of you imposing your will on them, some competent people will make some decisions that will be NOT what you would have decided, some of which will be BAD decisions, even LETHALLY bad decisions, but they are still THEIR DECISIONS TO MAKE.
If you do not concur with that, I would have to regard you as a dangerous person, from whom society is at risk. (I, myself, do not think we should do anything about that unless you actually ACT ON this and impose medical treatment on folks against their will, but if you do so I would consider that an assault).
True. It should of course be an assumption of competency not an assumption of innocence.
But the court SHOULD assume that any person alleged to lack decision-making capacity and the ability to take (and be held) responsibility for their decisions and actions IS COMPETENT until proven otherwise, and the relevant standard for the burden of proof should not be a preponderance of evidence but rather “reasonable doubt”.
That was my experience, and what I tried to convey. But since the thread started in General Questions with specific questions on involuntary commitment, I did think, and do think, my experience was pretty relevant. And I disagree that others have been “talking about it outside of the formalized setting.” If they were doing so, I would have no basis to continue to participate, as I have no experience with that at all. My experience back then was as a lawyer handling the hearings on behalf of the state. My experience now is as a lawyer dealing with medical issues in corrections, including spending a lot of time trying to keep the mentally ill OUT of jails, which is why I find the whole reliance on corrections and the criminal justice system to be so frustrating. These people DO NOT belong in jail. They do not do well there. They don’t need their mental needs evaluated by law enforcement, because law enforcement doesn’t do that at all well – to them, oppositional or noncomplaint behavior reads as intentionally defiant, anti-social behavior, not as mental illness. Those conflicts rarely go well for the mentally ill person, and sometimes go very badly indeed.
I have no problem with other people sharing their perspectives. I don’t know what’s involved in being heard or fairly evaluated from a patient’s pespective. I find those posts very illuminating, and I have tried to be respectful of others who are sharing such personal and difficult experiences. But I cannot allow anyone to inform me that my experience was false or that I am conveying it wrong or lying about it, because it wasn’t and I’m not.
Very fair. But of course that doesn’t mean that either party is necessarily wrong. I haven’t tried to argue anyone out of their perspective, and I don’t understand why some seem so vested in declaring that mine must be invalid.
As a general argument, I wouldn’t have considered it that unsupportable. To try and go with something approaching similarity, we could forcibly lock up for life everyone who commits any kind of crime, or who registers as having a worse temper than normal, or who acts irrationally at times. And you’d get less suffering and death. But we don’t do that, because the amount of suffering and death caused by such people doesn’t overweigh the greater good that comes from people in general being free. There are plenty of times when we value freedom, or something else, over possible (or even confirmed) suffering and death.
The question is, at what level of risk are we willing to accept that incarceration is the better option? **AHunter3’s **argument is, as far as I can tell, that the risk for many people is lower than it is generally presumed to be. That the risk is not so great that some deserve their freedom taken from them. I don’t think i’d necessarily agree with him completely, but as far as his argument goes, it’s a perfectly valid one, and one that dictates entire justice systems. Unless you would support locking up everyone, dictating the maximum possible safety measures at any cost, and the like, there is some point at which the benefits of an approach outweigh even suffering and death for you.
I didn’t misread your post but I transposed the terms in my response, which should have read "For example, do you have a cite for the assertion that “homeless mentally ill people with an OPTION of being on the street or of being in a facility that provides psychiatric services choose the former more often that the latter”? So you can go ahead and respond to that question if you want.
Although . . . you know what? In light of the rest of your post, don’t bother. I think the extend to which I “GET IT” must be pretty obvious by this point, though I will note in passing that I “GET IT” to such a degree as to find an analogy involving competent medical decisions to be completely inapposite.
As to your threat to “regard me as a dangerous person, from whom society is at risk,” I find I cannot respond to such a statement with civility and in light of what I now know of your personal history am currently at risk of being not merely uncivil but actually unforgivably so. So you’ll forgive me if I bow out of any further conversation on this topic with you.
But I don’t believe this is true. I don’t think locking up everyone who commits any kind of crime or has a bad temper, or acts occasionally irrationally, would mean less suffering and death. From “bad temper” to “more death” is a hell of a leap in the absence of murderous criminal behavior. So under what circumstance do we value freedom of the few over the confirmed suffering and death of the many? Do you have any examples?
Again, you are talking about incarceration, which is not what civil commitment is. I don’t think I’m being pedantic; the terms have completely different meanings in the context of depriving a person of their freedom, so I think it is helpful to be clear in using the terms. “Incarcerated” means you’re in jail or prison, on a pending criminal charge or under a criminal sentence. Using the term to describe civil commitment confuses the discussion.
Even if I agreed with that, which I am by no means certain I do, I certainly don’t agree with it as proposed in this context, such that society leaves a large vulnerable population at risk of homelessness, vicitimization, or worse out in society, in order to prevent a very small number of people from being wrongly if temporarily involuntarily committed. So I stand by my statement that I will rarely agree with the assertion “YES it is better to let some people suffer and die . . . .” except in the very rarest of situations, of which this IMO is not one.
That is not how your posts come across. At the beginning of the thread, when you were simply relaying your professional experience, every thing was good. Once a couple of posters pointed out that the system wasn’t as airtight as you were conveying, you were fairly hostile and tended to diminish their point of view. I find it interesting that you’re so comfortable lashing out at someone who you acknowledge has had “such personal and difficult experiences.”
The problem is that the well-intentioned people imposing the assistance may believe firmly in the goodness and efficacy of the assistance that they are offering but as I said 6 years ago that ain’t necessarily how the recipients experience it.
One anecdote may not constitute evidence but qualitative evidence comprised of the experiences of a demographic group may essentially consist of anecdotes. I don’t have numbers for you (it being rather difficult to assemble figures on stigmatized experiences that many people are not “out” about) but I’ve been in a large room attended by people who corroborated my experiences with their own. As G. Pie’s presence and mine in this thread serve, collectively, to demonstrate, we are plural.
Incarceration means “to imprison or confine somebody.” It’s perfectly appropriate to use the term to refer to forced hospitalization. I know that psychiatry prefers euphemisms such as “assisted treatment” but many patients don’t.
If I did, that would be in support of YOUR position, I think? I never made any such assertion. I said that as soon as you GET TO the point that such a situation is true, you might (in that hypothetical situation) be entitled to assume that otherwise homeless people would be better off in a psych facility than they are on the street.