First, the person initiating the hold isn’t likely a psychiatrist - it’s a cop or a social worker-level professional. The psychiatrist is probably the one who decides whether to admit the patient to their facility - in your example that’s the person I’d be ‘accountable’ to, although if I demonstrated consistently poor clinical judgement about these questions I’d probably lose my job, and that would be decided by superiors in whatever organization I’m employed by).
The crux of the matter isn’t “could he benefit from treatment”, it’s mostly a “is he a danger to self” question in your hypothetical. Reasonable people could disagree at a couple of points: wandering a bad neighborhood at 3am is far from ideal, but just how unsafe do you judge it to be? (I wouldn’t think it meets criteria, or, again, a goodly percentage of the people wandering the urban landscape at 3 am would meet criteria.) Does this pt represent an actual threat to someone else. (If I write a somewhat odd or threatening letter to the Prez, I’ll likely get a visit from the Secret Service, but I may or may not be arrested or detained - see Ted Nugent).
There is an important and profound discussion to be had between individual rights to be let alone, vs the state’s obligation (if any) to protect people from the effects of their untreated mental illness. At some point, there’s sure to be areas of fuzziness to be discovered and explored. I don’t think I’d write a hold on the hypothetical family member. And I’m sure that would cause a lot of anguish to his/her family. What if it were your child?
Good post. This fits with my experiences working in mental health as well.
It’s not enough to just be mentally ill - there are a ton of mentally ill people walking around free. The admitting doctor, the doctor who cares for you every day on the psych unit, AND the judge all have to believe that you are dangerous in a way that requires inpatient management. And they will base that opinion not just on what people say about you but how you behave in front of the doc/judge.
In many states, patients have to wait for days in the ER to find a psych hospital with an open bed, because there aren’t that many inpatient psych hospitals nowadays. It would make no sense to hold people who don’t need to be there. Even many very sick patients only stay on the inpatient unit for a few days before they go back home.
My doctor would say the same thing - as long as I recognize that my thoughts are nuts and am able to control them, I do not pass the threshold for being involuntarily committed. They COULD have me locked away for 48 hours - perhaps more if a weekend was involved - for a psychiatrist to evaluate, but as long as I know I’m not rational and am able to control my non rational thoughts, they’d have to release me if I didn’t want to be there.
I do have personal experience with involuntary commitment of my sister for alcoholism. They could hold her (in Arizona) for 48 or 72 hours (I can’t remember exactly) in the rehab facility - long enough for her to more or less detox. After that, although we would have loved to have had her on lockdown and made her stay to finish the program, there was no way we could do that. If she wanted to leave, they had to hand her all her possessions she checked in with and let her walk out. Killing yourself slowly with booze or driving drunk is not enough of a danger to yourself or others. She did stay and finish the program - though the howls from her the first week or so made it sound like we’d consigned her to hell, relapsed shortly after released, finished an outpatient program two years later, and has been sober for several years now.
Now, taking your stuff and walking out of rehab is not easy - they have no obligation to call you a cab to the airport - there is a reason that residential centers tend to be in the middle of fucking nowhere. And by the time you hit rehab, you may or may not have the financial resources to pull yourself out of the middle of nowhere and get yourself home. But addicts tend to be very resourceful and a cell phone and a credit card are often good enough.
well, even then, a family member couldn’t have you ‘locked away’, the most they could do would be to have someone certified come and take a look at you. I can’t just arrange a 48-hour involuntary hold on my teenaged son like I’d order a pizza.
There are times…
It’s kind of funny, honestly, this whole thing - we’re a public library, we’re full of crazy people. Absolutely packed to the brim! Crazy people call me on the phone all the time! I couldn’t get rid of this guy at the desk yesterday who’s an absolute asshole who we KNOW tears our newspapers up (but we can’t prove it) who wanted an obit, which I found for him, which turned out to be for the psychiatrist who had him committed a few years ago, and he went on for a good half hour about how that guy deserves to have died of cancer because he’s obviously not crazy, he was an altar boy! He at least paid me for the printing.
They’re just usually not coworkers.
Quite a few years ago a colleague was in a similar position. She had a really tough year and was diagnosed with cancer and lost her mom in a short period of time.
She had a mental breakdown just after her chemo ended and was hospitalized for a short time. One of her doctors explained that sometimes the chemo can change brain chemistry in some people and make them vulnerable to episodes like this. He called it extreme chemo brain. She’s cancer free now and better in terms of mental stability. She remembers quite lucidly what happened and said she doesn’t know why she behaved that way as it was totally out of character for her.
I don’t have that idea. Those are not criteria for involuntary committment. What I said was this constituted “circumstances are otherwise ripe for an involuntary committal”.
Meaning, a person has an escalating dispute with their family, the family decides that “they’re crazy” and eventually go to someone to have them committed, using their own version of events, which may be quite distorted in portraying themselves as longsuffering helpless victims of this person’s mental disorders. With this as the backdrop, then the tendency of psychologists to overdiagnose mental disorders comes into play.
It’s not comparable to a situation where someone walks into a mental health professional out of their own initiative.
Of course. I alluded to this earlier. But whether you determine that a person is a danger to themselves and/or others will be influenced by what their family says about them when trying to have them committed.
These work in theory. They may work many times in practice. But they’re far from foolproof.
If psychologists as a rule tend to find things wrong with people - and I’ve linked to several studies which said they do - then having more of them involved will not necessarily be a safeguard. And as for the judge, I think it’s even less. My understanding is that the patient has minimal involvement in these hearings, and even to the extent that they do, I doubt if too many judges take them seriously. In theory, a person has a right to represent themselves in traffic court too, but if it’s the person’s word againt a cop’s, the cop will almost always prevail - and the standards of proof in traffic court is a lot higher than in these cases. So who is the judge going to believe? Some guy with mental issues, or an expert?
This is probably true. As in: more likely than not. But people were saying things like 99.9% likely, and I think this degree of confidence is way overstated.
Nothing in life is foolproof. Granted.
What is your basis for “I think this degree of confidence is way overstated”? Where is your actual evidence for the proposition “the tendency of psychologists to overdiagnose mental disorders”? You assert it, but I consider if far from a given.
BTW, quoting Rosenhan’s “On Being Sane In Insane Places” is only marginally relevent, and doesn’t prove what you seem to think it proves. Care to offer more actual cites for evidence of the **actual incidence **of ‘erroneous’ involuntary committment? What do you actually know about this issue, and how? Or just your WAG based upon hypothetical scenarios you can imagine?
Zsophia, how are you doing with your dilemma? Hope you’re feeling more reassured.
You’ve had a tendency in this thread to just declare things to be irrelevant without explanation. I don’t think much of this. IMO, Rosenhan’s experiment is highly relevant to the specific issue that I raised it for, i.e. the ability of mental health professionals to ferret out the true lack of serious mental health disorders when there is otherwise reason to assume it.
I noted that there were related cases cited in the Wiki article that I linked - about 3 or 4 other studies which showed comparable results to Rosenhan. I am not aware of other studies which measured the same thing and came to the opposite conclusion. Can you cite some?
You can call it the latter, if you like.
More like: based on what I’ve read of reports of people being involuntarily committed (the “family member” situation is not uncommon, although probably justified in most cases) and having seen a lot of studies of mental health professionals’ diagnostic abilities - including but far from limited to Rosenhan’s - over the years.
Fair enough. Rosenhan’s study took place in a facility where subjects (confederates) had already been placed with bogus diagnoses and histories, and then they were instructed to act normally. Often, the legimate patients noticed the confederates were ‘sane’ before the professionals did. So, what Rosenhan was looking at was specific to that particular situation and the effect of pre-existing labels. I’m being really brief here, I only have a few minutes). Rosenhan did NOT ask the staff to do a psychiatric assessment, so it was not measuring the accuracy of their diagnostic abilities, which is the essential issue in the ‘involuntary hold’ scenario, only to see how quickly the system would notice that patients were no longer acting crazy.
You might make the case that this ‘proves’ a general tendency of MH professionals to over-diagnose and label ‘normals’ but I think that’s a pretty big stretch. I would argue that in the intervening 4 decades or so, the processes for both admissions and discharges to inpt facilities have become much more stringent than they were then (and I’ve worked in inpt facilities since the 70s, so I know this to be the case, FWIW).
Basically, Rosenhan was a really interesting experiment in Social Psych, but I think you are WAY overgeneralizing based on a 40+ yr old experiment, and not giving enough credence to the several voices in this thread with relevent, current experiences directly relevent to the question at hand.
There is also the question about, how do you ultimately decide whether an involuntary admission was justified or not? Clearly, you can’t just ask the patients involved, many of them will continue to lack insight into the severity of their condition, so how do you pronounce one way or the other?
I agree with this distinction (though you seem to be exagerating a bit about Rosenhan’s experimenters). That’s why I think it’s a mistake for you and others to drag in comparisons to situations which would involve a mental health professional deciding out of the blue that so-and-so needs to be locked up. That would be an extremely rare situation. But I’m talking about a situation where there is already pre-existing reason to believe that the person has a disorder, in the form of family members providing a (distorted) backstory. That would be more comparable to the Rosenhan situation.
I would agree with that, although I would also note that in one of the cites in the Wiki link, they also failed to identify the people who did have disorders.
I can’t argue with that. I have zero personal experience in this area.
I would tend to agree. ISTM that the main way to assess it is to make Rosenhan-like tests.
I suppose it could be possible in individual cases for people who are familiar with the case to make the assessment, in egregious cases.
I’m only saying that I don’t think you can really know in any individual case that the mere fact that so-and-so is committed proves that they deserve to be there. They probably do, but there’s still a possibility that they might not.
I know from personal experience that if someone who is out for revenge tells the cops you are suicidal, you can be held for 72 hours and forced to take any “medication” the hospital wants to give you, without telling you what it is. If you refuse to take it, they can hold you longer for “refusing treatment.”
I can only speak from limited experience, but I’ve found it far more likely that a medical professional (me) will see a person who actually is a danger to others and/or unable to attend to his Activities of Daily Living, report it, and then nothing meaningful happens. I’ve had two patients now whom I’ve reported and they weren’t held after evaluation, and then they attacked someone in their building the next day. 
(Let’s hear it for documentation; my butt was covered, but it still sucks that it happened at all.) Another I reported, she was held a couple of days and released back to home against my protests, and then she stopped bathing entirely and got a hell of an infected bedsore which required hospitalization for IV antibiotics and a wound vac.
On the other hand, I’ve never seen a hospitalization history where the person wasn’t, weeks/months/years later and living at home again, clearly mentally ill, if not a current danger to themselves or others.
Perhaps the pendulum has swung the other way in 40 years, or perhaps the pendulum is just really erratic.
Just because what you describe is more likely doesn’t mean that the opposite doesn’t also happen.
I would expect it would be somewhat erratic, but would also possibly be influenced by what type of insurance and/or financial means the person has. (Meaning, if the hospital thinks they might not get paid, or will get paid Medicaid rates, they might be more anxious to clear them out, and so on.)
I simply don’t believe this is all there is to this story. And judging by other anecdotes you have shared, it’d be wise to take your words with a large grain of salt.
I agree, which is why I never made that claim.
True, but people sometimes take that to be the implication, so I thought I might point that out.
I think we’re moving towards general agreement, as no-one here is saying it could never happen.
I don’t understand what you mean about "I agree with this distinction (though you seem to be exagerating a bit about Rosenhan’s experimenters).
What part do you think I’ve exaggerated? Perhaps I can clarify.
There is always some possibility of mistakes - but the checks and balances that have been put into the system plus the limited resources within the system has really changed the entire mental health industry over the past 40 years or more. Its much less likely than it was five years ago, much less twenty years ago or forty years ago to be involuntarily committed for a period of longer than a week without having a real issue. For one, unless you have a real issue, who is going to pay for it? Insurance companies hate impatient and watch it like a hawk (if a psychiatrist has a statistical variation in treatment from doctors who similarly specialize, his case load can be pulled and reviewed) and the state hates impatient and will also watch it. In both cases because its really freaking expensive - and much more expensive than when my grandmother was thrown into a communal locked ward, kept doped on valium or lithium and shocked once in a while in the late 1950s
That doesn’t mean it never happens, it does mean that it happens seldom enough that unless Zsofia has some reason to believe her former coworker, she should feel comfortable chalking this up as “disturbing phone call” and moving on with her life. And if she still feels a nagging need to do something, calling the hospital’s patient advocate to mention the concern is the right move. But she shouldn’t expect to get any information - its a one way delivery system due to privacy issues.
(By the way, I wish it were the case that inpatient mental health care - voluntary at least - were more available and affordable - in our stressful lives the idea of old fashioned “rest homes” for “nervous breakdowns” seems like something we could actually use.)