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I believe you. That said, my friend just tried to kill herself because she couldn't get anyone, including the State, to help her with BPD. There's also a TON o

I believe you. That said, my friend just tried to kill herself because she couldn't get anyone, including the State, to help her with BPD. There's also a TON of literature about how the inability to voluntarily commit family members is horrific for everyone around them, including innocent bystanders. This is probably the most moving: http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-father-actually-lost-his-mind.html http://www.nytimes.com/2012/06/24/magazine/when-my-crazy-fat...

tptacek 10y ago
The acute mental health care system in the US is a travesty, something I believe we'll look back on in 50 years with horror. I don't doubt it has some effectiveness and that it ultimately helps many people, but I wouldn't want to be the person mounting the argument that it is blameless or unfairly maligned; it isn't maligned enough. But: acute mental health care happens for a pretty short period of time, and then, from what I can tell, "the State" gets completely out of the picture.
- tcj_phx 10y ago
  > But: acute mental health care happens for a pretty short period of time, and then, from what I can tell, "the State" gets completely out of the picture. This is not what I've observed. If you have a court order for outpatient treatment and miss your appointments, they'll issue an arrest warrant, for example.
  - JBReefer 10y ago
    I really, really wish that was true. I have done a ton of work with the homeless, and so many have very serious mental health issues. Where I worked, we had a holistic approach with therapists, case workers, social workers (for benefits and housing), and sometimes the police - it did basically nothing. In the thousands of people I worked with, I never once saw what you described, despite the pro bono effort of high-power Manhattan lawyers. People who are not acting under their own volition can be dangerous, and it's a travesty that there's no functioning mechanism to return their agency with things like mandated medication.
    - tcj_phx 10y ago
      What state are you in? Laws vary... > and it's a travesty that there's no functioning mechanism to return their agency with things like mandated medication. My observation is that most of the commonly-used medications make the patient worse. This is confirmed by the epidemiological research. See Robert Whitaker's Anatomy of an Epidemic [1], for example. [1] http://robertwhitaker.org/robertwhitaker.org/Anatomy%20of%20an%20Epidemic.html http://robertwhitaker.org/robertwhitaker.org/Anatomy%20of%20...
      - tptacek 10y ago
        I think we all want to be very careful using HN comments to relate medical advice.
    - snikeris 10y ago
      > People who are not acting under their own volition can be dangerous, and it's a travesty that there's no functioning mechanism to return their agency with things like mandated medication. I think there is a bit of an ethical quandary here. Perhaps the person prefers their unmedicated state and although their life is a mess from your perspective, they are in fact acting under their own volition. The act of feeding someone pills against their will because you're sure it's better for them is...ethically treacherous.
      - tptacek 10y ago
        It is treacherous, but really you're just capturing something basic about mental illness and the extent to which it disrupts our sense of agency. Rescuing someone from suicidality also involves intervening against a patient's agency, but we generally don't feel alarmed about that.
  - tptacek 10y ago
    I don't believe you get a court order for outpatient treatment as a result of being voluntarily admitted to a hospital.
    - tcj_phx 10y ago
      > I don't believe you get a court order for outpatient treatment as a result of being voluntarily admitted to a hospital. The hospital can "petition" you for court-ordered evaluation if they find an excuse. It happens all the time. (Edit: usually for depressed/suicidal patients, I think.) In my friend's case, she had cocaine metabolites in her initial bloodwork. Her mother had told the "crisis team" that my friend had "disappeared" for the weekend, and when she came home she was psychotic. She was actually with me for that weekend, and ran out of alcohol [methadone-induced alcoholism, methinks] when she got home. My friend signed herself in to the hospital while acutely psychotic from alcohol withdrawal. After a week+ she'd come out of it, but they wouldn't let her go. The first mental health court case was dropped because she'd mostly recovered with a month of sobriety. But the drugs they made her drinking problem worse, and she got re-petitioned for court-ordered evaluation a month later. That time they injected her with Haldol (neuroleptic/tranquilizer) just before letting her out. She later said it "hit her like a truck", and was back at a real emergency room a few days later, due to trying to undo the akathasia the only way she knew...
      - tptacek 10y ago
        I don't have any experience with people engaged with the mental health system for chronic substance abuse problems and have no trouble believing that the system overreacts to them.
      - bryondowd 10y ago
        Would you mind sharing what jurisdiction this was in? As others have pointed out, this can vary by state, possibly also by city/hospital.

tptacek 10y ago

The acute mental health care system in the US is a travesty, something I believe we'll look back on in 50 years with horror. I don't doubt it has some effectiveness and that it ultimately helps many people, but I wouldn't want to be the person mounting the argument that it is blameless or unfairly maligned; it isn't maligned enough. But: acute mental health care happens for a pretty short period of time, and then, from what I can tell, "the State" gets completely out of the picture.

tcj_phx 10y ago
> But: acute mental health care happens for a pretty short period of time, and then, from what I can tell, "the State" gets completely out of the picture. This is not what I've observed. If you have a court order for outpatient treatment and miss your appointments, they'll issue an arrest warrant, for example.
- JBReefer 10y ago
  I really, really wish that was true. I have done a ton of work with the homeless, and so many have very serious mental health issues. Where I worked, we had a holistic approach with therapists, case workers, social workers (for benefits and housing), and sometimes the police - it did basically nothing. In the thousands of people I worked with, I never once saw what you described, despite the pro bono effort of high-power Manhattan lawyers. People who are not acting under their own volition can be dangerous, and it's a travesty that there's no functioning mechanism to return their agency with things like mandated medication.
  - tcj_phx 10y ago
    What state are you in? Laws vary... > and it's a travesty that there's no functioning mechanism to return their agency with things like mandated medication. My observation is that most of the commonly-used medications make the patient worse. This is confirmed by the epidemiological research. See Robert Whitaker's Anatomy of an Epidemic [1], for example. [1] http://robertwhitaker.org/robertwhitaker.org/Anatomy%20of%20an%20Epidemic.html http://robertwhitaker.org/robertwhitaker.org/Anatomy%20of%20...
    - tptacek 10y ago
      I think we all want to be very careful using HN comments to relate medical advice.
  - snikeris 10y ago
    > People who are not acting under their own volition can be dangerous, and it's a travesty that there's no functioning mechanism to return their agency with things like mandated medication. I think there is a bit of an ethical quandary here. Perhaps the person prefers their unmedicated state and although their life is a mess from your perspective, they are in fact acting under their own volition. The act of feeding someone pills against their will because you're sure it's better for them is...ethically treacherous.
    - tptacek 10y ago
      It is treacherous, but really you're just capturing something basic about mental illness and the extent to which it disrupts our sense of agency. Rescuing someone from suicidality also involves intervening against a patient's agency, but we generally don't feel alarmed about that.
- tptacek 10y ago
  I don't believe you get a court order for outpatient treatment as a result of being voluntarily admitted to a hospital.
  - tcj_phx 10y ago
    > I don't believe you get a court order for outpatient treatment as a result of being voluntarily admitted to a hospital. The hospital can "petition" you for court-ordered evaluation if they find an excuse. It happens all the time. (Edit: usually for depressed/suicidal patients, I think.) In my friend's case, she had cocaine metabolites in her initial bloodwork. Her mother had told the "crisis team" that my friend had "disappeared" for the weekend, and when she came home she was psychotic. She was actually with me for that weekend, and ran out of alcohol [methadone-induced alcoholism, methinks] when she got home. My friend signed herself in to the hospital while acutely psychotic from alcohol withdrawal. After a week+ she'd come out of it, but they wouldn't let her go. The first mental health court case was dropped because she'd mostly recovered with a month of sobriety. But the drugs they made her drinking problem worse, and she got re-petitioned for court-ordered evaluation a month later. That time they injected her with Haldol (neuroleptic/tranquilizer) just before letting her out. She later said it "hit her like a truck", and was back at a real emergency room a few days later, due to trying to undo the akathasia the only way she knew...
    - tptacek 10y ago
      I don't have any experience with people engaged with the mental health system for chronic substance abuse problems and have no trouble believing that the system overreacts to them.
    - bryondowd 10y ago
      Would you mind sharing what jurisdiction this was in? As others have pointed out, this can vary by state, possibly also by city/hospital.