I think I'd like to get AVI's opinion on this issue.
It's hard for me to imagine trusting the government with the power to involuntarily commit people for "mental issues," given that there's no lab test for mental health and our opponents are eager to assign diagnoses to things like conservatism (or reasoning from principles, rather than from feelings). The potential for abuse is obvious and huge.
On the other hand, I hear AVI saying things periodically that suggest that there are clear-cut cases with no vagueness that might be usefully addressed in this way. Whether these kids who engage in shooting up the world are such cases is another question.
Instead of involuntary commitment. I would suggest that City Council members who vote big bucks for homeless programs be required to host homeless people in their own homes.
ReplyDeleteThat was my comment.
ReplyDeleteErrmmmm.....but people who work with individuals who have 'mental disorders' say that most all of those disorders do NOT result in violence.
ReplyDeleteGiven how Red Flag laws are already being abused in the states that have them, I'm sorry, but no. I can see cases when a psychiatrist or other person says, "This individual is a threat to herself and society right now, and should not be out on the streets because [reason]," or "This person should not have access to firearms/knives/poison because [reason." But "the government" should not have such power.
ReplyDeleteCharles Krauthamer wrote about how difficult it was to get a person involuntarily committed, even when it really was a matter of family and public safety - and he was in practice in the 1970s-early '80s.
LittleRed1
Authoritarian abuse of the mental illness treatment process to punish political (or even economic) rivals is a real risk.
ReplyDeleteIt is ALSO a real risk to diminish or neglect our social processes for helping the mentally ill. Therapy, drugs, surgery, electro-shock, prayer, and negative-reinforcement bordering on outright torture may all have a place. But even the combination is not enough to substitute for many who need what amounts to parental supervision. Which group supervision requires some sort of institution.
We imperfectly know things about penal institutions and processes for confining and releasing people in and out of various levels of such institutions. Presumption of innocence and trial by jury are the most vital protections in that side of things. Maybe we need to amend the constitution to declare an adult is presumed sane until declared mentally ill by a jury - and that the state's pysch-prosecutor must make accusations against a suspected ill person in an adversarial court-like process against the accused's pysch-defender.
But we can't afford to neglect treatment of people with legitimate -- dangerous --illnesses. A crazy guy with a rifle sniping at imaginary pink elephants and space aliens is just as dangerous as a hate-filled bigot shooting at crowds of country-western music fans.
It's not the locking people up for political reasons that is the problem. Political enforcement will be along the lines of costing you customers, promotions, money, or even your job for political reasons. That is already happening.
ReplyDeleteThe standard in most states is that you can be as ill as you please, but the state has to prove dangerousness. Proving dangerousness is not quite the same as prosecuting a crime, though it is similar. The hospital or MHC cannot just go before a judge and say "Your honor, he just seems crazy and we think he will be dangerous eventually." New Hampshire has a Conditional Discharge law, which is a sort of civil commitment to community treatment. These are becoming more common around the country and I support them, but they are often limited or even toothless. By their very nature they provide less containment than being in a secured hospital.
Rights do matter and protect you from being held against your will, but budget constraints may protect you more. Because the requirement for admission into our 150-bed hospital is dangerousness, and the average stay is 3-8 days, we are discharging dangerous people every day. Last week we had an ongoing debate about discharging a person who was making veiled homicidal statements, as in "I killed the last woman who betrayed me," and "Chris is organising a group against me and deserves to die." His initial paperwork was done incorrectly and we were approaching having no legal ground to hold him, and eventually took extreme measures (not so extreme for us, though) in hopes of at least buying a few more days, as he was taking his medication. Well, he did kill his wife in 2004 and did ten years for it and is still on parole. Fifteen years is a long time in our business - sometimes fifteen hours is a long time - but manslaughter is manslaughter, even at that distance.
Obviously, we try to keep the most dangerous ones, and meet every day to determine who those are, and who from the waiting list sitting in an ER in Wolfeboro or Nashua can come in instead.
People say they want more of these folks locked up, and the implication is of regardless of their rights. I supposed every society has the practical right to draw those lines where it wants. But if you want a lower standard to keep people locked up, then you will have to fund more beds. Twice as many? Ten times as many? And a certain percentage of those beds will be filled with false-positives, of people who reached the new lower standard to be committed but weren't actually going to hurt themselves or others. Or not so badly, anyway.
Tangentially, this may explain to you why providers dislike some diagnostic categories who they perceive as wasting precious resources.
Thank you, AVI. Your perspective is enlightening on this subject.
ReplyDeleteIn a way, I'm delighted to hear that resources pose such a constraint. That's the best kind of limit on abuse, i.e., a practical one.
Stop taking psychotic drugs that make people temporarily psycho.
ReplyDelete