4 ms·

> So, sometimes it's okay to involuntarily treat, but only if there's a present or soon-to-be present physical danger If you weren't aware, that is the current

> So, sometimes it's okay to involuntarily treat, but only if there's a present or soon-to-be present physical danger If you weren't aware, that is the current standard for involuntary hospitalization, at least in the US. I believe the phrase is "danger to self or others."

John23832 10y ago
Just a question, but how strictly is that followed? If a mentally disturbed person (who presents no current physical threat) is put in front of a psychiatric professional, how often is that professional going to say "Ah, let him/her be. They aren't going to harm anyone". Especially in today's climate of preemptive responses to threats. As someone who went to Virginia Tech I've seen how that "eh, he's/she's not bothering anyone" response can go terribly wrong. And when it goes wrong, the first thing people will ask is why that professional didn't do something when they had the chance.
- openasocket 10y ago
  Generally, professionals will not involuntarily commit patients unless the threat is current and pretty explicit, though there are exceptions. Professionals can involuntarily commit people for short periods of time for observation, to determine if they really are or are not a risk. For instance, if someone shows up in the ER with knife wounds on their wrists, that can warrant an observation period. Interactions with the police can lead to observation if the officer believes you to be mentally ill. It's a very fine line to walk between individual liberties and providing treatment to those who need it. If you're schizophrenic and you live on the streets, yell at birds all day, and eat from the garbage, you are not considered a danger to yourself, even though you have a pretty abysmal quality of life and are at serious risk of dying from disease, drugs, homicide, exposure, or starvation. It's a complicated conversation with no clear answers.
- pmoriarty 10y ago
  One thing that wasn't addressed in the original article is that there's not a lot of room in psychiatric hospitals and not a lot of funding to keep people there long-term. So that results in a more or less tacit revolving door policy, and certainly affects the decision to involuntarily commit or not.
bryondowd 10y ago
Sadly, being on the streets and incapable of caring for oneself isn't considered a 'danger to self', at least in the eyes of the hospital that evaluated my former fiancee. Personally, I think we need to set the bar for involuntary intervention higher than being an active threat. If someone doesn't have the mental wherewithal to not lose their coat in the middle of a cold snap, that seems like a clear indicator to me that they need help and their refusal shouldn't be taken any more seriously than their delusions. I may be biased and embittered on this subject.
- sushid 10y ago
  To me, freezing yourself to death seems like a case of 'danger to self' but I'm neither a lawyer nor a doctor. But in other situations, the question arises just like in the article. At what point do you want to dose the individual with a sense of reality? If their mentally-ill self is content with the life they lead and "curing" them of it will leave them empty, sad, and hollow (in addition to the side effects of medication), is the arguably a better option? If you factor in the fact that the hospital won't be there to help him rehab back into society, I can see the decision being difficult to make, as the author mentions.
  - ThrustVectoring 10y ago
    I mean, it could be interpreted as a 'danger to self', but choosing that interpretation loses the hospital money. I'm saddened but not really surprised.
- psyc 10y ago
  That may be the official standard, but in reality the evaluating psychiatrist commits you if he wants to, and they do sometimes err on the side of caution. So it's somewhat arbitrary depending on where you are and when.
vonmoltke 10y ago
Florida's involuntary commitment criteria are probably the loosest in the US[1]: CRITERIA.—A person may be taken to a receiving facility for involuntary examination if there is reason to believe that the person has a mental illness and because of his or her mental illness: (a) 1. The person has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination; or 2. The person is unable to determine for himself or herself whether examination is necessary; and (b) 1. Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; and it is not apparent that such harm may be avoided through the help of willing family members or friends or the provision of other services; or 2. There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to himself or herself or others in the near future, as evidenced by recent behavior. Note that this is only supposed to result in a 72-hour evaluation. It has also been fraught with allegations of abuse by family members, schools, and courts who don't want to properly deal with complex psychological and behavioral issues in more appropriate ways. [1] Full Baker Act is here: http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0394/0394.html http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Displ... The criteria are specifically from 394.463 (1).
- ChoHag 10y ago
  It's interesting that Florida's solution is still fraught with abuse because those conditions are about the broadest I'd consider reasonable when removing a person's autonomy.

John23832 10y ago

Just a question, but how strictly is that followed? If a mentally disturbed person (who presents no current physical threat) is put in front of a psychiatric professional, how often is that professional going to say "Ah, let him/her be. They aren't going to harm anyone". Especially in today's climate of preemptive responses to threats. As someone who went to Virginia Tech I've seen how that "eh, he's/she's not bothering anyone" response can go terribly wrong. And when it goes wrong, the first thing people will ask is why that professional didn't do something when they had the chance.

openasocket 10y ago
Generally, professionals will not involuntarily commit patients unless the threat is current and pretty explicit, though there are exceptions. Professionals can involuntarily commit people for short periods of time for observation, to determine if they really are or are not a risk. For instance, if someone shows up in the ER with knife wounds on their wrists, that can warrant an observation period. Interactions with the police can lead to observation if the officer believes you to be mentally ill. It's a very fine line to walk between individual liberties and providing treatment to those who need it. If you're schizophrenic and you live on the streets, yell at birds all day, and eat from the garbage, you are not considered a danger to yourself, even though you have a pretty abysmal quality of life and are at serious risk of dying from disease, drugs, homicide, exposure, or starvation. It's a complicated conversation with no clear answers.
pmoriarty 10y ago
One thing that wasn't addressed in the original article is that there's not a lot of room in psychiatric hospitals and not a lot of funding to keep people there long-term. So that results in a more or less tacit revolving door policy, and certainly affects the decision to involuntarily commit or not.

bryondowd 10y ago

Sadly, being on the streets and incapable of caring for oneself isn't considered a 'danger to self', at least in the eyes of the hospital that evaluated my former fiancee. Personally, I think we need to set the bar for involuntary intervention higher than being an active threat. If someone doesn't have the mental wherewithal to not lose their coat in the middle of a cold snap, that seems like a clear indicator to me that they need help and their refusal shouldn't be taken any more seriously than their delusions. I may be biased and embittered on this subject.

sushid 10y ago
To me, freezing yourself to death seems like a case of 'danger to self' but I'm neither a lawyer nor a doctor. But in other situations, the question arises just like in the article. At what point do you want to dose the individual with a sense of reality? If their mentally-ill self is content with the life they lead and "curing" them of it will leave them empty, sad, and hollow (in addition to the side effects of medication), is the arguably a better option? If you factor in the fact that the hospital won't be there to help him rehab back into society, I can see the decision being difficult to make, as the author mentions.
- ThrustVectoring 10y ago
  I mean, it could be interpreted as a 'danger to self', but choosing that interpretation loses the hospital money. I'm saddened but not really surprised.
psyc 10y ago
That may be the official standard, but in reality the evaluating psychiatrist commits you if he wants to, and they do sometimes err on the side of caution. So it's somewhat arbitrary depending on where you are and when.

vonmoltke 10y ago

Florida's involuntary commitment criteria are probably the loosest in the US[1]: CRITERIA.—A person may be taken to a receiving facility for involuntary examination if there is reason to believe that the person has a mental illness and because of his or her mental illness: (a) 1. The person has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination; or 2. The person is unable to determine for himself or herself whether examination is necessary; and (b) 1. Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; and it is not apparent that such harm may be avoided through the help of willing family members or friends or the provision of other services; or 2. There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to himself or herself or others in the near future, as evidenced by recent behavior. Note that this is only supposed to result in a 72-hour evaluation. It has also been fraught with allegations of abuse by family members, schools, and courts who don't want to properly deal with complex psychological and behavioral issues in more appropriate ways. [1] Full Baker Act is here: http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0394/0394.html http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Displ... The criteria are specifically from 394.463 (1).

ChoHag 10y ago
It's interesting that Florida's solution is still fraught with abuse because those conditions are about the broadest I'd consider reasonable when removing a person's autonomy.