But isn’t that as it should be? Mental illness is not a crime. A mentally ill person who is not dangerous and who is not gravely disabled, a person who is meeting his or her own ADLs appropriately – that person should be allowed to live his or her life in society. I don’t think the state/the government/ the system should care if you’re “only” crazy. And they don’t want to care, believe me; committed persons cost a lot of money. They would far prefer it if a person could just contrive to be quietly crazy and not enter the system at all.
Well, the psychiatrist could predict a lower chance of successful maintenance of stability based on a declaration to be non-compliant with meds, but in theory that should not be enough to justify continued commitment since the standard is a current or imminent danger to self or others, or present grave disability, not just a high likelihood of future dangerousness/disability. On that basis alone, a good PD would probably object to any such testimony from the MHP as irrelevant and prejudicial. (Another issue I ran into: Assist Public Defenders who hadn’t been on the job long enough to really understand the statutes or what objections they should make. Dude, I can’t do your job for you, I’m not allowed to.) In reality, would the judge likely consider it? Yeah, probably. It might also depend on whether the patient could articulate a rational reason for refusing the meds (“I can’t take Thorazine, it makes me feel like I’m buried in mud”). Obviously any halfway savvy person in that situation is going to do just what you suggest, which is to either not say anything about their intention or lie about it to get out. That’s what I’d do. Lie, I mean. Lie my ass off. Yes sir, no sir, whatever you say sir. Same thing I’d do to get out of jail.
If you need to see a psychiatrist (a medical doctor who specializes in psychiatry), ask another doctor whose opinion you value. If after a few sessions you do not feel comfortable, you might want to try another psychiatrist.
A psychologist does not have a medical degree but can be very helpful in counseling.
Psychiatrists are human beings. Some are good – even very good – at their professions. Some are not good. Since the people seeing the “not good” doctors can be extremely vulnerable, the situations can get ugly. I hope that there are more safeguards than there used to be. Thanks to people like Jodi and AHunter3 – who both seek the well-being of all – I know that things work better than they used to:
In 1966 I didn’t even go before a judge. The psychiatrist that had misdiagnosed me and put me on the wrong medication and predicted my own demise – died by his own hand within a few years.
Under the “care” of another psychiatrist, I was admitted and then released from involuntary committment after 3 days. I caught a glimpse of the admitting psychiatrist when I entered and when I left, he told me I was spoiled. Those were the only times I saw him.
I was sick while I was there, but they wouldn’t let me lie down. I had to scrub floors and had no privacy for bathing.
It is not that way anymore.
Beginning October 3, if your insurance covers mental health, it is supposed to cover it at the same rate that it covers other medical problems. This is true for most large employer-provided health insurance programs. The same is true if you have to be in the hospital for mental health reasons. And hospital mental health units are usually not at all dismal places like state facilities could be.
This is a Federal law, but don’t depend on me to have all of the facts straight. Check with your insurance or HR or google something like “Federal Mental Health Parity Law.”
Hate to break up the exchange between you and G. Pie, but would this also apply to folks who have been alleged to have contemplated suicide? If the supposed suicidal appeared perfectly rational and composed but his family and friends swore he was faking–and the MHP concurred–would that guy get committed to the next stage?
Suicide is in most cases an irrational act of self-destruction. There are exceptions where the choice can be rational, such as the terminally ill, but in most cases it is not a rational act. And suicidal ideation is AFAIK usually a symptom of an underlying problem – frequently depression. (Jump in and help me here, mental health professionals.)
So I would assume a declared intention to kill oneself would immediately raise questions as to rationality and the possibility of an underlying disorder – because rational people do not intentionally literally self-destruct. So there would be an apparent conflict between the guy being suicidal and being rational. (Assuming no terminal illness.) The legal standard is PRESENT “danger to self” supported by clear and convincing evidence. In the absence of a very recent overt attempt, IME there’s very little that will stand as “clear and convincing evidence” if the patient simply denies PRESENT suicidal intent.
IME, the people who were committed as “danger to self” had both recent overt attempts (or steps taken in furtherance of an attempt) and a declared intent to kill themselves. IME nothing short of that would sufficiently prove a PRESENT danger to self. These cases were very rare, BTW; “danger to self” was the least-used legal basis for commitment.
That reads to me as more of a cut-and-dried police brutality case. But then again, as I have said, I know nothing about Canadian law in this or any other area, and have no idea how flimsy the grounds are in Canada for initial detention on a mental health call.
What if we left out the suicide issue? What if a guy presents as lucid and rational but his family insists he needs to be committed? What if the family gives examples of the guy’s craziness but he denies them? Say the psychiatrist believes the family (because it would be an odd thing to lie about it) but the guy actually presents as stable.
In the jurisdiction in which I handled these hearings (Washington), the provision for initial detention is this:
So allegations of serious harm or grave disability must be made; the MHP must investigate those allegations and evaluation the credibility of the person making them; and the MHP must conclude that the allegations are true and the person will not voluntarily seek treatment. Only then may the person be detained.
If there is a conflict between what the patient says and what the family or other concerned party alleges, then the MHP must determine which party he or she believes is credible and truthful and act accordingly.