5 ms·

I have no personal experience with mental illness, but judging by your story it seems that part of the problem was your sister's lack of willingness to seek hel

by maxaf 7y ago

I have no personal experience with mental illness, but judging by your story it seems that part of the problem was your sister's lack of willingness to seek help. Most health insurance plans cover some kind of mental health services, but the afflicted person must actively seek out such help. Compare this with a broken leg: if I stepped wrong off the curb and broke my leg, I'd be in in pain and clearly unable to walk. I would call 911 and have them pick me up, take me to a hospital, patch me up, etc. The system to make all of that happen is there. It would appear that mentally ill individuals are unable to seek help. Is it not the case that psychiatrists and mental hospitals exist and are covered by health insurance? It seems unfair to point the finger only at the system without acknowledging that helpers can't help without explicit consent on the part of the person being helped, or without some legal means by which they can be coerced to accept help.

automated_toast 7y ago
The crucial point is that the sister did not think she needed help. She had to be 'pushed' into it. And that's the crux-at what point do we do for them what they can't/won't do for themselves?
ceejayoz 7y ago
> I have no personal experience with mental illness, but judging by your story it seems that part of the problem was your sister's lack of willingness to seek help. Would you be willing to take serious anti-psychotic medication, with significant side effects, if you were 100% certain you were perfectly sane?
- vkou 7y ago
  Or, say, 90% certain that you are perfectly sane?
- maxaf 7y ago
  I for one am currently 100% certain that I'm perfectly sane, but that's just my opinion, which, on balance, is worth about as much as the opinion of the homeless guy on Broadway who yells at passersby all day long. I'm sure he also thinks he's perfectly sane. Both such opinions are extremely subjective. In fact, I'd brand as psychotic anyone possessing enough audacity to diagnose me with mental illness. How dare they suggest that I've lost my marbles? So, to answer your question: no, I'm not willing to take drugs, because I'm 100% certain that I'm perfectly sane. IMHO this is what makes the mental health conversation so difficult: we don't all seem to share a consistent worldview in the best of times, let alone when one's mental faculties are impacted by illness. How can we find neutral cognitive ground where a mentally ill person can be brought up to speed with the Objectively So? I suspect that the level of trust and compassion required to do this can only materialize in a family setting. I also find it ironic that the absence of a solid familial fabric is surely a significant contributor to mental illness to begin with.
  - munificent 7y ago
    > I suspect that the level of trust and compassion required to do this can only materialize in a family setting. I also find it ironic that the absence of a solid familial fabric is surely a significant contributor to mental illness to begin with. Hard to imagine a familial fabric more solid than the Kennedy dynasty, and yet... https://en.wikipedia.org/wiki/Rosemary_Kennedy https://en.wikipedia.org/wiki/Rosemary_Kennedy
    - maxaf 7y ago
      Straitjackets are also made of fabric.
MrAlex94 7y ago
> I have no personal experience with mental illness, but judging by your story it seems that part of the problem was your sister's lack of willingness to seek help. That's kind of the problem though. You can't just blame someone who is mentally ill for not seeking help. In the UK, for example, you can be sectioned. "The Mental Health Act says when you can be taken to hospital, kept there, and treated against your wishes. This can only happen if you have a mental disorder that puts you, or others, at risk. You should only be detained under the Mental Health Act if there are no other ways to keep you, or others, safe." https://www.rethink.org/advice-and-information/rights-restrictions/mental-health-laws/mental-health-act-1983/ https://www.rethink.org/advice-and-information/rights-restri...
- 0xffff2 7y ago
  The law says nearly the exact same thing in California (and I'd guess most of the US). Is there a substantial difference in the way it's applied in practice in the UK?
  - DanBC 7y ago
    In England the most commonly used bits of the mental health act are Section 2 (28 day hold for assessment and treatment), Section 3 (6 month hold for treatment) and Section 136 ( a police officer can take someone from a public place to a place of safety for a 24 hour hold for assessment). There are also forensic sections of the act and there are community treatment orders. Section 2 and 3 require two doctors and an approved mental health professional (AMHP). One of the doctors has to be specially trained in using the MHA. The other doctor should be someone who knows the patient. The AMHP is usually a social worker who knows the mental health act law and is there to protect the rights of the patient. There are legal requirements placed on the patient's local MH Trust. One of these is that when that patient's nearest relative tell the trust about concerns and asks for an assessment under the act then the trust must consider that request. A person detained under the act is provided with an advocate from an independent advocacy service. This is free legal advice. If they feel they are being unjustly detained they can go to tribunal to get the section overturned. And that process is also open to relatives too. There are no fears that your loved one will be shot and killed if you involve the police. I don't know anything about the US law, but it seems somewhat complex and expensive. There are laws at the state level, and at the county level. Some states say that the harm to self or others must be "imminent" which is a pretty high barrier to meet. Most states allow a forced treatment in the community option, but California requires the counties to adopt that law. So for California where you live decides whether your family can ask the courts to force you to take medication in the community.
knightofmars 7y ago
When someone has an illness that affects their brain you're saying they should both be aware of the illness and then seek help for the illness? They should use the logic and reasoning capabilities of said brain, with an illness, to achieve this. Think about what you're saying. Really think about it. Your broken leg comparison completely misses the mark. How about this scenario? You are walking and step into the street. You are hit by a bus but survive. You have massive head trauma. At this point nobody else should administer care without first speaking with you and having you acknowledge that you need care. You need to then respond in a coherent manner that explicitly allows you to be cared for before anyone is legally allowed to help you. How do you think that is going to work out for you?
kvartz 7y ago
To make this a bit more on point, try jogging back to the ER after breaking that leg. That's what essentially you are asking of people
DanBC 7y ago
> without explicit consent on the part of the person being helped But that's part of the brokenness of the system being complained about. We need to be careful about compulsory treatment and detention without trial, but other countries manage it without it being catastrophic - at least not as catastrophic as leaving people addicted to drugs, mentally ill, and living on the street.
munificent 7y ago
Anosognosia[0] is a typical aspect of many mental illnesses. If they knew the delusions weren't real, they wouldn't really be delusions. There is a fundamental hard problem here that many people who think there are easy solutions ignore: how do we as a society fairly determine who can have their autonomy taken from them? Where do we draw the line between personal responsibility, mental illness, and willful criminal intent? In the past, the line was drawn too far towards the state and family and there were innumerable horror stories of "difficult" women being lobotomized and locked up in sanitoria for life because their family didn't want to deal with their rebellious ways. The deinstitutionalization movement swung the pendulum the other way and said, basically, you're completely responsible for yourself all the way up until you commit an actual crime. Because criminality is now the line, it means the police end up dealing with the mentally ill more than they should. The right point is somewhere between these, but drawing it fairly is hard and we don't have great social structures to support it. (In particular, how does society allow the medical infrastructure decide who should have autonomy in a country that doesn't even provide any right to medical access in the first place?) [0] https://en.wikipedia.org/wiki/Anosognosia https://en.wikipedia.org/wiki/Anosognosia

by maxaf 7y ago

automated_toast 7y ago

The crucial point is that the sister did not think she needed help. She had to be 'pushed' into it. And that's the crux-at what point do we do for them what they can't/won't do for themselves?

ceejayoz 7y ago

> I have no personal experience with mental illness, but judging by your story it seems that part of the problem was your sister's lack of willingness to seek help. Would you be willing to take serious anti-psychotic medication, with significant side effects, if you were 100% certain you were perfectly sane?

vkou 7y ago
Or, say, 90% certain that you are perfectly sane?
maxaf 7y ago
I for one am currently 100% certain that I'm perfectly sane, but that's just my opinion, which, on balance, is worth about as much as the opinion of the homeless guy on Broadway who yells at passersby all day long. I'm sure he also thinks he's perfectly sane. Both such opinions are extremely subjective. In fact, I'd brand as psychotic anyone possessing enough audacity to diagnose me with mental illness. How dare they suggest that I've lost my marbles? So, to answer your question: no, I'm not willing to take drugs, because I'm 100% certain that I'm perfectly sane. IMHO this is what makes the mental health conversation so difficult: we don't all seem to share a consistent worldview in the best of times, let alone when one's mental faculties are impacted by illness. How can we find neutral cognitive ground where a mentally ill person can be brought up to speed with the Objectively So? I suspect that the level of trust and compassion required to do this can only materialize in a family setting. I also find it ironic that the absence of a solid familial fabric is surely a significant contributor to mental illness to begin with.
- munificent 7y ago
  > I suspect that the level of trust and compassion required to do this can only materialize in a family setting. I also find it ironic that the absence of a solid familial fabric is surely a significant contributor to mental illness to begin with. Hard to imagine a familial fabric more solid than the Kennedy dynasty, and yet... https://en.wikipedia.org/wiki/Rosemary_Kennedy https://en.wikipedia.org/wiki/Rosemary_Kennedy
  - maxaf 7y ago
    Straitjackets are also made of fabric.

MrAlex94 7y ago

> I have no personal experience with mental illness, but judging by your story it seems that part of the problem was your sister's lack of willingness to seek help. That's kind of the problem though. You can't just blame someone who is mentally ill for not seeking help. In the UK, for example, you can be sectioned. "The Mental Health Act says when you can be taken to hospital, kept there, and treated against your wishes. This can only happen if you have a mental disorder that puts you, or others, at risk. You should only be detained under the Mental Health Act if there are no other ways to keep you, or others, safe." https://www.rethink.org/advice-and-information/rights-restrictions/mental-health-laws/mental-health-act-1983/ https://www.rethink.org/advice-and-information/rights-restri...

0xffff2 7y ago
The law says nearly the exact same thing in California (and I'd guess most of the US). Is there a substantial difference in the way it's applied in practice in the UK?
- DanBC 7y ago
  In England the most commonly used bits of the mental health act are Section 2 (28 day hold for assessment and treatment), Section 3 (6 month hold for treatment) and Section 136 ( a police officer can take someone from a public place to a place of safety for a 24 hour hold for assessment). There are also forensic sections of the act and there are community treatment orders. Section 2 and 3 require two doctors and an approved mental health professional (AMHP). One of the doctors has to be specially trained in using the MHA. The other doctor should be someone who knows the patient. The AMHP is usually a social worker who knows the mental health act law and is there to protect the rights of the patient. There are legal requirements placed on the patient's local MH Trust. One of these is that when that patient's nearest relative tell the trust about concerns and asks for an assessment under the act then the trust must consider that request. A person detained under the act is provided with an advocate from an independent advocacy service. This is free legal advice. If they feel they are being unjustly detained they can go to tribunal to get the section overturned. And that process is also open to relatives too. There are no fears that your loved one will be shot and killed if you involve the police. I don't know anything about the US law, but it seems somewhat complex and expensive. There are laws at the state level, and at the county level. Some states say that the harm to self or others must be "imminent" which is a pretty high barrier to meet. Most states allow a forced treatment in the community option, but California requires the counties to adopt that law. So for California where you live decides whether your family can ask the courts to force you to take medication in the community.

knightofmars 7y ago

When someone has an illness that affects their brain you're saying they should both be aware of the illness and then seek help for the illness? They should use the logic and reasoning capabilities of said brain, with an illness, to achieve this. Think about what you're saying. Really think about it. Your broken leg comparison completely misses the mark. How about this scenario? You are walking and step into the street. You are hit by a bus but survive. You have massive head trauma. At this point nobody else should administer care without first speaking with you and having you acknowledge that you need care. You need to then respond in a coherent manner that explicitly allows you to be cared for before anyone is legally allowed to help you. How do you think that is going to work out for you?

kvartz 7y ago

To make this a bit more on point, try jogging back to the ER after breaking that leg. That's what essentially you are asking of people

DanBC 7y ago

> without explicit consent on the part of the person being helped But that's part of the brokenness of the system being complained about. We need to be careful about compulsory treatment and detention without trial, but other countries manage it without it being catastrophic - at least not as catastrophic as leaving people addicted to drugs, mentally ill, and living on the street.

munificent 7y ago

Anosognosia[0] is a typical aspect of many mental illnesses. If they knew the delusions weren't real, they wouldn't really be delusions. There is a fundamental hard problem here that many people who think there are easy solutions ignore: how do we as a society fairly determine who can have their autonomy taken from them? Where do we draw the line between personal responsibility, mental illness, and willful criminal intent? In the past, the line was drawn too far towards the state and family and there were innumerable horror stories of "difficult" women being lobotomized and locked up in sanitoria for life because their family didn't want to deal with their rebellious ways. The deinstitutionalization movement swung the pendulum the other way and said, basically, you're completely responsible for yourself all the way up until you commit an actual crime. Because criminality is now the line, it means the police end up dealing with the mentally ill more than they should. The right point is somewhere between these, but drawing it fairly is hard and we don't have great social structures to support it. (In particular, how does society allow the medical infrastructure decide who should have autonomy in a country that doesn't even provide any right to medical access in the first place?) [0] https://en.wikipedia.org/wiki/Anosognosia https://en.wikipedia.org/wiki/Anosognosia