Are Federal "Advocates" Standing in the Way of Sane Mental Health Laws?
Psychiatrist Sally Satel has a thought provoking piece in The Weekly Standard entitled, "Sane Mental Health Laws?" Thanks to Bugs for pointing out the article:
The article tells about a case where a son is released from a mental hospital because of a patient advocacy group even though he had already assaulted his father but he was released anyway only to kill his mother with a hatchet two months later. Many of the readers here and others in society want to believe that oodles of slightly eccentric people are being rounded up in straitjackets to be warehoused at a hospital. This is so far from the truth, it is actually laughable. I have never met a patient who told me he or she was unfairly kept in a hospital but I have met and worked with many who cannot get the help they need or who have been released from treatment way too early. And what about the families of those mentally ill individuals who have been assaulted and are in fear for their lives or the lives of other family members. Do they have no rights at all? Apparently not.
The Virginia Tech massacre last month will surely prompt changes in commitment laws too. Virginia governor Timothy M. Kaine has created a panel to review events and issue recommendations. The governor's panel will join several other Virginia bodies already reviewing the state's mental health laws.
The most prominent is the Task Force on Civil Commitment. It was established six months ago by the chief justice of the Virginia Supreme Court to scrutinize the state's unusually narrow standard for committing someone to a psychiatric facility against their wishes. (A patient must be "imminently" dangerous--in short, clearly ready to kill himself or someone else--before a judge can mandate treatment.)
The task force proceedings are bitterly contentious. On one side are civil liberties lawyers and disgruntled patients who insist that lowering the "imminent" danger threshold would threaten individual rights. On the other side are psychiatrists caring for people with schizophrenia and bipolar illness and their relatives who have lived through the nightmare of not being able to get timely treatment for desperately ill loved ones.
The article tells about a case where a son is released from a mental hospital because of a patient advocacy group even though he had already assaulted his father but he was released anyway only to kill his mother with a hatchet two months later. Many of the readers here and others in society want to believe that oodles of slightly eccentric people are being rounded up in straitjackets to be warehoused at a hospital. This is so far from the truth, it is actually laughable. I have never met a patient who told me he or she was unfairly kept in a hospital but I have met and worked with many who cannot get the help they need or who have been released from treatment way too early. And what about the families of those mentally ill individuals who have been assaulted and are in fear for their lives or the lives of other family members. Do they have no rights at all? Apparently not.
posted by Helen at 1:59 PM
35 Comments:
Many of the readers here and others in society want to believe that oodles of slightly eccentric people are being rounded up in straitjackets to be warehoused at a hospital. This is so far from the truth, it is actually laughable.
Actually, google "psychiatric" survivor" and start reading. If you want to laugh at them it doesn't reflect well on your alleged "empathy".
I even knew a practicing psychologist who maintained his commitment was unfair and unwarranted.
I don't think it is society's or a family's place to ever lock someone up to protect them from themselves.
The right to exit this world is the most basic human right there is and no one is competent to judge another's decision on timing this most personal of choices.
Once you leave the standard of "an imminent danger to others" behind, where do you stop?
Where do you stop? Not at Alan Turing, damn them to hell.
Lowering the standard below imminent harm certainly does pose a risk to individual liberties. And not lowering it ensures more deaths due to dangerous and/or helpless ill people remaining untreated.
This is a question of risk management, and the germain discussion acknowledges both risks.
Trey
In a good Libertarian world, we wouldn't have mental illness. If someone became a threat to those near them, the defender would pull out his .75 magnum pocket cannon, and blast them down.
Problem solved, and no one's rights were violated.
Back in the real world, its a good question. How to properly manage risk? I'm not a mental health pro so I'd be interested in hearing the perspectives of those who are on the right place to draw the line.
Tennwriter
I used to be the billing clerk in a psych hosptial in the SF bay area. Every morning there would be a small stack of intake sheets on my desk so I could start a financial file on the patient (93% were on medicaid or medicare).
The intake sheet had a brief history of the patient and I was really shocked to learn how many people there are out there walking around who have killed a family member (usually a parent).
Also common were assaults and arson.
I don't really think we'll ever be able to tell which patient is going to snap and kill their mom or shoot up a school.
I have a child who has had psychotic issues. He's 18 and I'm holding my breath. I don't want him locked up for no reason. But if I thought he was turning into a threat, could I get him help? And would I even be able to tell?
Satel's comments on the Commitment taskforce in Virginia, of which I am a member, are completely inaccurate. There are only 2 people with experience as patients out of 22 members and no full time civil rights attorneys at all.
As to getting people committed, it's very easy in most parts of Virginia outside Fairfax county. There are very few places where Cho wouldn't have been inpatient committed and it's not clear why that happened except that if outpatient commitment hadn't been an option in the law he would have been inpatient committed.
If you have truly never met a psychiatric patient who complained about being kept unfairly, I suspect your clients aren't being honest with you for some reason and you may want to figure out what that is about. Or perhaps being a forensic psychologist, people are glad to be in the hospital rather than a prison? In non-forensic mental health, it's hard to not meet people who feel they were or are being kept too long in the hospital.
On the other hand, there are people who want to be in the hospital and can't get in at all or who are released much too early due to bad or no insurance or simply bad judgment on the part of psychiatric staff. Especially suicidal patients are likely to be released long before they want or are ready to be released in my observation and experience.
alison,
Interesting info about VA from someone who's in a position to know. Hope you can share some more.
Just to play devil's advocate - Isn't anyone who's been detained against their will likely to say it was unfair and that they were locked up too long? Their negative feelings about being incarcerated don't necessarily mean they shouldn't have been locked up. I think it might, however, call into question the treatment they received while in the system.
I am a moderator on a forum for the mentally ill. After all this Cho business--well, people on the board are afraid to commit themselves, however much they may want to, for fear of rights being stripped from them. not necessarily 2nd Amendment rights--many of them are against firearms--but ANy rights at all.
And, one wonders how far commitment could be taken? I mean, I knew my fiancee was afraid of me--but I just found out that even my mother thought I was going to get physically violent before I got medicated. And now? No worries.
I should note: not only am I bipolar, but my fiancee has been dx'ed schizophreniform. Talk about stereotypical psychosis--she has asked me to hide the knives in the past.
The balance to strike is, I think, between those who want to commit themselves so they can get help and function in the larger world and those who very much need to be locked up for the safety of all. It's a delicate balance, and I have little trust of politicians or the general puiblic to make any rational or educated choices on the issue.
bugs-
Just to play devil's advocate - Isn't anyone who's been detained against their will likely to say it was unfair and that they were locked up too long? Their negative feelings about being incarcerated don't necessarily mean they shouldn't have been locked up. I think it might, however, call into question the treatment they received while in the system.
The ones that were fraudulently or illegally committed will tell you that it was improper too. Without some objective fact-finding you won't know which is which.
CNS wrote: "It's a delicate balance, and I have little trust of politicians or the general puiblic to make any rational or educated choices on the issue."
Agreed, and thanks for contributing to the discussion. Most of my fear is for those committed rather than the public at large. I think that self harm or being attacked is more of a risk than people with mental illness attacking others. But with recent developments, I understand your concerns with the public engaging in needless and harmful forced inpatient treatment, which is very close to incarceration.
Before your post, I had not really given that the weight it deserves. As preventing rare (but obviously horrible) mass murders was not my main concern , I failed to consider the backlash against ill people because of Cho's acts. My bad, and thanks for the assist in taking a more balanced view of the issue.
Trey
The subject is a powder keg, that's for sure.
All I know is personal experience. One case, one family. The result was bad for all involved, I believe. I guess it depends, among other things, on where you live (local laws pertaining to the situation and individuals' rights), who the doctors are, the institutions involved. Outside the family, no threats were made, or scary actions against others taken. As such, voluntary entry into treatment was acceptable to the law enforcement and medical powers that be. The result: "I feel better now, let me out." With nothing in the way of proof on camera, or eyewitness account, it was "she said", "they said". Crazy and stupid are mutually exclusive most of the time. The final recommendation from the professionals was, "You need to pack up your kids and move well away, not telling anyone else where you are going."
This, without any of the benefits of the witness protection program, to draw a parallel line and attempt to add a touch of humor.
It's not as simple as one person's rights ending where they infringe on others' rights. I had absolutely no say in the matter, but had to fork over all the money I had, and could scrape up, in order to help someone whose aim in life after "the snap" was my and my children's destruction. Had we not "disappeared" as recommended, odds are it could have ended up a Cho like scenario. Or I could have been forced at some time to do what was necessary to prevent harm to my children or myself. Something I can't even look in the face.
How do you use a broad pen to write law for such individual situations?
Whatever is cast in stone can't be just politically correct, or incorrect, dependent on where one stands. Actually, law / guidelines would seem to need to be written in pencil - and on the fly.
CNS,
As I understood it, as BR459 says, if you commit yourself, you're allowed to leave at your own free will. Is this not the case nationwide?
Tennwriter
I've met plenty of people who've been unfairly kept in mental hospitals.
(I think I need to get a new set of friends)
The point is...if all these "mentally ill" who commit crimes are hauled off to jail like they should be in the first place, you'd never have to worry about them being sprung like John Hinckley Jr.
The public is a lot safer if criminals would do their normal sentences, rather than go on a theraputic holiday via these nonsense "insanity defenses".
Shut down all these glorified Snakepits, just like President Reagan wanted.
If you commit yourself, yes, you can leave. The problem being, those who commit themselves tend to either have a tough time getting in...or get kicked out due to space reasons. (My own hometown's psych ward shut down a few years ago--hard to commit oneself now, eh?)
Maxine,
It was Robert Kennedy who made the statement about the snakepits and John Kennedy who signed the Community Mental Health Centers Act of 1963 into law, nothing to do with Reagan.
From br459's situation, the Baldwin-Bassinger-Ireland situation, my own experience (which I'm not ready to go into further in a public forum, sorry), a friend of mine's current messy divorce but all children are adults, the Andrea Yates and Mr Yates case, probably additional already public examples if I looked for them...
A law may need to allow for a lower standard if a showing can be made that minor children are at risk.
It gets especially difficult though if incidents are mostly verbal, such as the Baldwin-Bassinger couple are now stating is the case, versus at risk of passing the physical threshold. The physical threshold passage emay be intentional or a result of temp insanity hallucinations.
C
I have never met a patient who told me he or she was unfairly kept in a hospital
Don't almost all paranoid schizophrenics claim this?
This statement just seems off... I only have limited experience with mental patients, and at it seems that at least 80% or so claim to be the victim of a plot to put them in the hospital.
I'm not sure of anything except that it seems a lot harder to get mental health care than it was 30 years ago -- some of my extended family had to commit one of my great-aunts (as far as I know, it was against her will) in the 1960s, and it was no sweat: there was a sanitarium in their county (nowhere near their state capital, and saying their town is the fifth largest in their state is a bit like saying that Washington, DC is only a little smaller than the smallest US state,) given the general poverty in the family at the time I'm guessing finances weren't a serious hurdle, and to the extent that it's possible, my great-aunt has gotten treatment and, more importantly for her case, supervision, for the entirety of her adult life. Another relative was committed in the same facility for a short period (a year?) following a breakdown, but came right back to her family and lived normally after that.
Meanwhile, experience involving family and friends leads me to wonder just how crazy any of the rest of us would have to get before any serious help would even become available: the entire system seems geared towards stop-gap measures and waiting to figure out if you're really crazy or just sad.
I think people have the right to be nuts. If they kill someone, then deal with them as a criminal. And if they are more likely to kill someone, well you can't really incriminate someone for what they are only likely to do.
I just can't see any way to justify locking people up because an authority figure says they are insane. It is a power that can too easily be abused.
Anon 4:50 P.M.
Then let them kill you. And the rest of us will deal with them as criminals at that time.
Much better to prevent a murder, bank robbery, grand theft, world war, than to solve one.
Mental illness brings such misery. Ineffable misery.
When someone you have known a quarter century snaps, you know it. When many professionals become involved because of this, and after the fact, who are being fooled (to a degree) by that same person, and never knew the before and after personality changes, you know that as well. As I said earlier, crazy and stupid are usually mutually exclusive. Those in "the system" learn how to play the game. If you learn to say what the professionals want to hear, the door swings open, and out you go.
Personality disorders (once called character flaws) and emotional disorders are different things. Some are more treatable than others. Some are not effectively treated at all yet. I will not take such a chance with my children's lives, or my own. No need to compound a tragedy. Or, be forced to possibly take out someone who at one time meant so much to you, and mothered your children.
And how do you write legislation for this? Each and every case is like no other, it seems.
anonymous 4:50:
Yes, people have the right to be "nuts" although you say that like they enjoy it. No one has the "right" to infringe the rights of others with their illness however. How flippant to say that the mentally ill can just kill someone and act as if no one should intervene. Would you say that to Andrea Yates prior to being left with her children? I wouldn't.
People have the right to be emotionally "nuts", and it can be very very hard on those who were closest to them.
There is, so far, no way to know who will just stay emotionally weird and who/when/why goes physically threatening. Marie Osmond touched on chemical imbalance in her auto-biography. Is there any motivation in the mental health community to do statistically broad hormonal studies?
I personally went from low progesterone ("It'd take a miracle and drugs for you to get pregnant.") to surprise natural conception then the hormone swings of three pregnancies within 7 years. Is there any post-partum depression research that may find chemical suggestions to balance with the talk/personality therapy?
C.
Oh, people have the right to be nuts? Tell that to the folks at Virginia Tech.
Oh, now I see.
Hormone changes during pregnancy and after. I know they can be tough, with sad to dire endings sometimes. And they can raise hell with the individual suffering these raging hormones.
Although using my own family as the example, as it is the only situation I know enough about to speak of, I am trying to bring a situation to light, not just the affects on personal and individual lives. And it is on the personality disorder side, not the emotional disorder side I am speaking of.
If you are suffering from this, I truly feel for you, and hope you are getting well. If you ended up having a psychotic episode similar to that lady in Texas, you must understand, however, that if it were up to me, there is no way you'd be out on the street.
Does that make sense? I hope so.
How flippant to say that the mentally ill can just kill someone and act as if no one should intervene.
I was not trying to be flippant, and certainly if they were in the act of killing someone, there should be intervention.
But how can you take statistics that say mentally ill people are more likely to kill, and therefore should be locked up? It's ridiculous.
What if you had statistics that showed black people living in the inner city are more likely to kill? Should we lock up all black people in the inner cities?
I have a brother who is severely mentally ill and my family absolutely forced him into taking medication and into the mental health system. He resisted absolutely every single step. I wish he didn't, since he obviously has serious problems.... But what right does anyone have to force him???
If a mental person does not break the law, how in the world can you take away their civil liberties?
That's what I meant by "deal with it after they kill someone." Most of them won't kill someone... Just like most normal people won't. You can't just take away someone's rights because they are statistically more likely to commit a crime.
In a previous thread, which I unfortunately never got back to, there was a statement made by an anon commenter of: "I'd rather see 10% of guilty people go free than see one innocent person locked up". I appreciate the sentiment, but I think it's a false choice. It's presented as the choice that allows for the most liberty, but I'm not convinced that that is true. There is no real liberty when good people reasonably fear for life and limb because a bunch of dangerous people are running around loose. Given the choice, I'd rather see a system that only allows, say, 0,001% of guilty people to go free while still assurning that no innocents are locked up.
Going back to what alison said, what we seem to have today is the worst of both extremes. Putting it in terms of the analogy above, 50% of guilty people are going free, and yet a lot of innocents are being locked up. There's a major overhaul needed. I would be interested in the possibility of something like a jury system for involuntary committments.
anon 1:38: I think you're missing a point. We aren't talking about a person being locked up just because they belong to a certain statistical group. In most of these types of cases that I've looked at, the person in question has a long history of less serious offenses... making threats, simple assault, petty theft, DUI, drug charges, presenting false identification, prostitution, perjury, child abuse/neglect, forgery, fraud. In case you are wondering, I took the entire list above from the acts committed by one relative in my wife's family. Said relative has also three times that I know of committed acts of arson that results in tens of thousands of dollars of property damage. She is sociopathic and it is just a matter of time until she commits a murder, or (more likely in her case) solicits for a murder. And yet the system keeps letting her go, time after time after time after time. She has delusions of grandeur; as far as she is concened, she deserves far better than what life has given her; anything and anyone that she wants is rightfully hers, and she is within her rights to take any action whatsoever to get it. And if she can't have it, then obviously no one else can have it either, and so it must be destroyed. And she has acted on this premise, more than once.
This person's mental issues aren't as extreme as some of the ones being discussed above. There's a line in the article that seems to fit well though to this topic:
"I have also reached the conclusion that if I am doing what I am doing because I am an 'attention whore' then I really need to be committed. "
Good for her in recognizing her recent relationships are as much using her as helping her.
She's trying to reestablish some relationships with her family:
"I have sacrificed a 29 year marriage and have traveled for extended periods of time away from [my children] and my health has suffered and my hospital bills from last summer (when I almost died) are in collection because I have used all my energy [on an Obsessive-Compulsive cause]...
...I am going to take whatever I have left and go home. I am going to go home and be a mother to my surviving children and try to regain some of what I have lost. I will try to maintain and nurture some very positive relationships that I have found in the journey ... and try to repair some of the ones that have fallen apart since I began this single-minded crusade ...."
http://www.dailykos.com/story/2007/5/28/12530/1525
making threats, simple assault, petty theft, DUI, drug charges, presenting false identification, prostitution, perjury, child abuse/neglect, forgery, fraud. In case you are wondering, I took the entire list above from the acts committed by one relative in my wife's family.
I am the same anon you were referring to.
My point is exactly that she should be locked up for those things! If you've actually done all that, there is no reason you should be running free.
My issue is with the possibility of saying this lady did all these things, then diagnosing her as "X." Then later diagnose person #2 as "X". And finally locking person #2 up because he/she might do what the lady in your example did.
How can such a thing be done without violating the 2nd person's civil liberties? What if the "diagnoser" is "X"? Who can say that he isn't? Should their be a supreme "diagnoser" who sits on a throne in our nation's capitol?
And now what if person #2 gets a DUI and steals a pack of cigarettes. Should they now be locked up because they more closely match your example's description??
Just so folks don't worry: My post-partum depression is old history. I did some medication for awhile, but never the super strong stuff Yates was on. My kids were never hurt; they are all now school age.
I just feel comfortable enough that I've recovered to maybe start to talk about it a bit; if that would help others.
No worries here.
Best wishes to Cousin Dave...
C, 10:35 AM
C, 10:35 A.M.
What you suffered would be described as an emotional disorder - treatable, and though perhaps extended, temporary after all. I am very glad you are recovered and well. The brain is an organ, like kidneys, liver, pancreas, heart, skin. It can get sick, it can get well.
I have been speaking about personality disorders. Gary Gilmore, Hannibal Lector (spelling) type stuff. Sociopaths, child molesters (yes, I believe once a child molester, always a child molester) etc. Your "illness" being a major part of who you are, not just something you are suffering from.
One suffering this type illness - no, flaw - big difference - can drive a car as well as anyone, work a job, do complicated mathematics equations, build a better mouse trap, bake a cake, perhaps paint a beautiful landscape, maybe even double on sax. A person with many acquaintances even - yet no real close friends. Yet they are capable of such unspeakable, terrible things. Who, in their right mind, could harm a child? Travel the country for years, methodically picking people out and murdering them, then moving on to the next victim? Cho chained the doors from the inside, evidently intent on killing until he ran out of bullets.
These things are not "clinical depression" type treatable mental illness. And, I do not believe, are they temporary.
So let me see if I can tie some things together from ever and anon (thanks for your reply), anon 10:35 (thanks for the best wishes), and br549. Part of the problem, as br549 points out, is that we're really talking about two different groups of people here. The one group suffers from mental disorders that may cause them to commit acts of violence. However, their illnesses are usually treatable. These people don't usually have a past history of criminal or abusive behavior. I agree with ever and anon's contention that we cannot pre-emptively lock these people up, unless they have made credible threats or actually tried to do something.
The other group consists of the schizophrenics (sp?) and sociopaths. The odds are near 100% that these people will commit violent acts in the future. The problem is: as ever and anon points out, they should generally already be locked up based on their past record -- but somehow or another, they always manage to slide until the commit the Big One. In Cho's case, I know just from the public reports of at least four offenses that he committed in the year or so before his rampage, and he got to slide on all of them. (1) He falsely answered questions on the ATF forms that he filled out to buy the guns. He got by with that because the data needed to cross-check his answers wasn't in the ATF computer system. (2) He committed arson in his dorm room. The university let that slide for some unexplained reason. (3) He used his cell phone camera to take upskirt pictures of female classmates, in class no less. The victims were too intimidated to take any action, and a professor who tried to stop it ran into a brick wall with the university administration. (4) He disregarded a court order to get counseling. He slid by on that one because the authorities had no mechanism for enforcing the order.
Y'know, having just written all that, I'm starting to think that at least part of the answer is in existing law. Cho was under a court order to get counseling, but he knew that he could disregard it without consequence. Had there been consequences, things might have been differet. Had the judge instructed Cho, "Failure to attend these sessions will constitute prima facie evidence of intent to commit violent acts", and had the county actually followed up on it, then Cho might not have had the chance he had.
Now, going back to ever and anon's concern, this still leaves the question of "who gets to decide"? And that's a tricky one, because it isn't like testing for AIDS -- we don't know enough about the illness yet to devise a test that will produce an answer conclusive enough to meet evidentary standards in court. I think the answer is two-fold: (1) base the diagnosis to a considerable extent on recent past behavior, where the person/persons (I still think it ought to be a jury system) making the determination has access to all pertinent records, and (2) use a ramp-up probationary system.
In #1, access to all records is vital because of the uncannyy ability of sociopaths in particular to game the system and slide out from under a lot of things that other people would be held responsible for. So, for example, the evaluators need to be able to see all arrest records, not just convictions. (The relative of which I spoke in my previous post was arrested for DUI in a rural central Alabama county two weeks ago. From the family, I learned that her blood alcohol was .17. This is at least the tenth time since I've known her that she has been arrested for DUI, including one in which she was at fault in an accident with injuries. According to Alabama law, she should be facing at least two years in jail. But somehow she convinced the country to reduce the charge to public drunkneness. She paid a $50 fine and walked free.)
However, since our screening system is still far from perfect, we need #2 to at least minimize the insult to the rights of the innocent people who will, inevitably, get sucked up in the system. Starting out with a kind of probation system, in which the accused is not locked up, but is required to attend outpatient treatment, is not ideal but still better than locking up an innocent person. Like I said before, failure to appear at the mandated counseling should be treated legally as prima facie evidence of intent. From there, you ramp it up. The counseling will, hopefully, screen out the innocent fairly quickly, so that the abridgement of their rights is minimized. It's not perfect, but it's probably no worse than the legal system treats innocent suspects and "persons of interest" in a criminal investigation.
Lastly, from - again - my personal experience, the professional answer to alleviate the possibilities, was for me and my kids to pack up and disappear - uprooting me from the home and hometown I loved, and my kids from the only home they have ever known, and loved. Because the perp had the right to be out and be free since the populace at large was never threatened, just the immediate family. And, it was our word against hers. Who believes a 10, 12 and 13 year old as viable witnesses? The lawyer she had (that I paid for) gave her good advice on how to beat the system.
Taking that to an extreme, were his situation known, Cho would have been the only student at VA Tech.
So, yeah, aside from the heartbreak and financial destruction the situation imposed, I continue to be mad as hell that the kids and I had to pay the price. It just doesn't make a particle of sense.
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