46 ms·

On one hand I want to be sympathetic to the author here, who has personal stake in preventing the severely mentally ill from murdering people. At the same time,

On one hand I want to be sympathetic to the author here, who has personal stake in preventing the severely mentally ill from murdering people. At the same time, the author doesn't at all go into the deeply personal and often traumatic reasons the mentally ill may resist being forcibly hospitalized in the way the author suggests should be done to them. The author doesn't go into cases like Brittney Spears's conservatorship, forced to take medication and have an IUD inserted and have her estate taken over by her parents under spurious claims of being unable to care for herself. The author doesn't go into how little oversight there is over ensuring the safety of patients once they're in the healthcare system, many of which go on to develop medical trauma due to rape, assault, etc. There has to be some kind of middle way where people who are deeply sick can have healthcare even if they are resistant and also heavy guardrails in place to prevent them from being abused while they're vulnerable.

teeray 4y ago
The judicial system should, ideally, serve this function since both arguments for and against compulsory care can be represented and a judgement can be made. The problem is that it is so costly financially and temporally that we can manage one judgement in years for a case rather than the greater re-evaluation frequency that is probably required for mental health.
- jonhohle 4y ago
  Replacing one dysfunctional system for another doesn’t seem like the best option.
- marcinzm 4y ago
  The judicial system is far from perfect even when the people involved are free to find their own representation or are able to freely do their own research. Someone who is not allowed to even access their own finances or sign legal contracts will naturally have a much harder time finding good legal representation. Someone in an institution even more so.
- ada1981 4y ago
  The challenge is you then have someone whose specialty is law making psychological / spiritual / developmental determinations.
fineIllregister 4y ago
> There has to be some kind of middle way where people who are deeply sick can have healthcare even if they are resistant and also heavy guardrails in place to prevent them from being abused while they're vulnerable. The only guardrails that work to prevent abuse are community connections and the right to refuse. In clinical treatment, many human rights abuses are normalized to the point where people being abused believe that's just what treatment is without someone outside the system to provide perspective (and usually abuse will continue without someone to advocate alongside the person being abused). It's just an obvious matter of course that people who can't say "no" will become objects to the treatment provider. Without some counteracting force, providers will manipulate people in their care to satisfy their own incentives and convenience. If people don't want treatment, we should ask what's wrong with the treatment, rather than forcing people into it. It's rarely helpful and makes things even harder down the line.
- retrac 4y ago
  > If people don't want treatment, we should ask what's wrong with the treatment This reasoning works with most illnesses, including most mental health problems. But it sort of falls apart with psychotic illness. A common symptom of schizophrenia is a denial of any illness, or ill-functioning. In extreme cases, an individual may show no appreciation of the fact that e.g. being socially isolated and with no income will probably quickly kill them. I'm usually the advocate for the agency of people -- I do point out the opposite in another post in this thread, that many people with schizophrenia are aware of their illness and impairments, because many are. But many are not. Even with truly perfect treatments with no side effects that completely cleared delusions and clouded thinking, many, because of their illness, would choose not to take such treatment.
  - shkkmo 4y ago
    The awareness can also wax and wane within a single individual. A friend of mine has been forcibly hospitalized several times and the trauma inflicted severely impacted his desire to seek treatment during his more aware periods. When I finally got him to reach out to care providers (since as just a friend, there was no way to setup inpatient care as an intermediary) they made it so difficult for him to enroll that no only did that moment of clarity pass without getting treatment, it also burned up whatever status as an ally that I still had with him. So while changes to commitment laws absolutely can be part of a solution, they must be paired with deep introspection into the despicable failures of our mental health system to provide appropriate care. Otherwise we risk inflicting additional trauma that will make managing future crises far more difficult.
vkou 4y ago
Indeed. Its strange how people have no issue with forcing medical treatment (which carries serious side effects) on the mentally ill, while at the same time, opposing mandatory vaccinations (which carry vastly less serious side effects, and are incredibly effective at reducing injury and death from infectious diseases). It's obvious why this hypocrisy is present. Mentally ill people are 'scary' and forcing treatment on them makes them uncomfortable, and me comfortable, it's an easy sell. But when medical treatment is forced on me, all of a sudden, my body autonomy becomes the most important thing in the world, and I'm dipping into horse paste and counting each myocarditis case. (And conspicuously neglecting the consequences of not vaccinating.)
dclowd9901 4y ago
Why are we acting like there aren’t objective evaluations for “dangerously mentally ill?” Everyone here is talking about how the justice system fails at this. Well yeah, it’s the justice system. They shouldn’t (and wouldn’t) be there in the first place. This is a psychological problem and it would be dealt with by people who have domain knowledge. We’re not talking about hungry DAs with a political agenda or overworked public defenders not doing their job. We can and should evaluate people to determine the extent of mental illness and mandatorily treat them. Anything outside of that is passive misanthropy.
- woeirua 4y ago
  As the article makes so plainly clear though, we cannot wait until someone is objectively dangerous for two reasons: 1 - it leaves very little time to actually intervene before something bad happens, and 2 - it removes our best chance to actually help someone. The mentally ill need to be treated when symptoms first start manifesting if we want to actually solve this problem.
  - Pet_Ant 4y ago
    > we cannot wait until someone is objectively dangerous ... it leaves very little time to actually intervene before something bad happens I mean that feels like it's dangerously treading close to "pre-crime". I feel like it doesn't take much to extend that logic to poor rural children whose mothers are raising them in urban gang-run areas. I mean I can see the germ of the idea, but it's ripe for abuse. https://en.wikipedia.org/wiki/Pre-crime https://en.wikipedia.org/wiki/Pre-crime
    - woeirua 4y ago
      CPS can already take children out of homes in spite of the fact that no one has died yet in said situation. That is for good reason. Failing to act before a crime has actually been committed in many of those situations would lead to unnecessary deaths.
      - 4y ago
bnralt 4y ago
We definitely need protections for people who are institutionalized. But we also need protection from the members of society who are being victimized by mentally unstable individuals. Many large cities seem to have no interest at all in the latter, to the point where there’s a class of unwell citizens that the laws no longer apply to. Many are threatening people daily, violently assaulting people, committing frequent theft, using the streets as a bathroom, etc., mostly with impunity, and law-abiding citizens are told to just live with it.
- A4ET8a8uTh0 4y ago
  Sadly, yes. I have all the sympathy, but it stops the moment it gets too close to my nose ( or that of my family ). Anecdotally, my wife works in an environment that sees severe mental cases in a relatively well to do area and the numbers and stories make me mildly uncomfortable ( mostly because I think those are much worse in poverty stricken areas ). And then you have to remember people may be hesitant to just have their name added to the system ( and general distrust and lack of understanding of the rules governing it ); not to mention the social stigma that goes along with it.
- PuppyTailWags 4y ago
  I never said anything at all to disagree with what you said. People who are mentally unstable should be treated as if they're undergoing a health crisis like diabetic shock or sepsis or something like this. I am merely pointing out that the article has a major blindspot that weakens it, in that it doesn't adequately acknowledge that the healthcare system might actually be causing more harm to already unstable people due to the medical staff abusing them, and there needs to be additional guardrails or something similar to prevent further harm.
  - hitekker 4y ago
    The article describes how the author's best friend murdered his fiance in a psychotic episode, while his support network stood around and praised him for his individual spirit. The GP distinguishes between psychotics, who require institutionalizing, the mentally unwell, who need guidance, and their victims, who are dead. You glossed over the first and last category, so it's fair for the GP to point out that ideological blindspot.
woeirua 4y ago
When it comes to mental illness, people should avoid commenting on specific cases because the details matter and only the professionals involved in those situations actually know enough about the state of these individuals to know whether or not treatment is warranted. I know "Free Britney!" is all the rage, but the Court does not order conservatorships lightly. No one is arguing that asylums were perfect places. Far from it. There was a reason they were shut down in the 60s, but the alternative that we were promised never materialized either and the result is that we have severely mentally ill people wandering the streets now, left to their own devices. The results are all too predictable.
- PuppyTailWags 4y ago
  > I know "Free Britney!" is all the rage, but the Court does not order conservatorships lightly. This is an assumption, and there's very limited oversight to this. That's the problem. The reason with Brittney was originally freed was that it was found she was inappropriately in conservatorship for years longer than she needed to be, and that all of the parties that should've been advocating for her were actually paid for by her estate through her parents, effectively making it so that anyone who advocated too hard for her wellbeing was eliminated from her circle. It's unknown how many more people are in this situation and, perhaps worse, we don't even know how many conservatorships exist!
lumb63 4y ago
An ounce of prevention is also worth a pound of cure. More important than investing resources into helping those with mental illness is preventing people from developing mental illness in the first place. Traumatic experiences like you mentioned can be reduced by better education about what to look for in healthy relationships, or providing accessible resources to catch issues early before they become major issues. Other, more subtle, issues like neglect, poor home life (often due ti poverty, difficult family situation, etc.) would require more pervasive changes to address, but if prevent issues in society on the back end due to reduced incidence of mental illness, not to mention the improvement in quality of life for those affected, we should seriously consider those options.
- PuppyTailWags 4y ago
  I fully agree that we should be working on preventing ACES and other environmental effects that specifically have proven out to have causal effects on mental illness. But psychosis cannot be eliminated altogether, and if someone is psychotic I would both like them to be allowed back into health even if they do not give informed consent and also I would like them to not be raped, assaulted, or otherwise abused.
  - lumb63 4y ago
    Definitely agree. It’s not either or, and both issues should be given attention; however I think reducing the incidence of mental illness is more fruitful than correcting the negatives of it after the fact.
DannyBee 4y ago
We used to force hospitalization, and one result was the states would force hospitalize people to avoid having to pay for their benefits/etc. They would lock people up and forget about them forever. There are plenty of examples of institutions that destroyed tons of people (some of whom were not even actually ill)! My older brother, who is mildly bipolar (functional but can't really hold a job long term) was sued by the state of new jersey when he was a teenager to hospitalize him, because they didn't want to pay for school/etc. The judge scolded them in the end, but that was a huge time spend, money spend, and emotional painful thing for my family that lasted years. There are of course no perfect systems, but one of the practical problems is that there is no real part of the system that actually cares about the mentally ill, and is actually incentivized to do that.

teeray 4y ago

The judicial system should, ideally, serve this function since both arguments for and against compulsory care can be represented and a judgement can be made. The problem is that it is so costly financially and temporally that we can manage one judgement in years for a case rather than the greater re-evaluation frequency that is probably required for mental health.

jonhohle 4y ago
Replacing one dysfunctional system for another doesn’t seem like the best option.
marcinzm 4y ago
The judicial system is far from perfect even when the people involved are free to find their own representation or are able to freely do their own research. Someone who is not allowed to even access their own finances or sign legal contracts will naturally have a much harder time finding good legal representation. Someone in an institution even more so.
ada1981 4y ago
The challenge is you then have someone whose specialty is law making psychological / spiritual / developmental determinations.

fineIllregister 4y ago

> There has to be some kind of middle way where people who are deeply sick can have healthcare even if they are resistant and also heavy guardrails in place to prevent them from being abused while they're vulnerable. The only guardrails that work to prevent abuse are community connections and the right to refuse. In clinical treatment, many human rights abuses are normalized to the point where people being abused believe that's just what treatment is without someone outside the system to provide perspective (and usually abuse will continue without someone to advocate alongside the person being abused). It's just an obvious matter of course that people who can't say "no" will become objects to the treatment provider. Without some counteracting force, providers will manipulate people in their care to satisfy their own incentives and convenience. If people don't want treatment, we should ask what's wrong with the treatment, rather than forcing people into it. It's rarely helpful and makes things even harder down the line.

retrac 4y ago
> If people don't want treatment, we should ask what's wrong with the treatment This reasoning works with most illnesses, including most mental health problems. But it sort of falls apart with psychotic illness. A common symptom of schizophrenia is a denial of any illness, or ill-functioning. In extreme cases, an individual may show no appreciation of the fact that e.g. being socially isolated and with no income will probably quickly kill them. I'm usually the advocate for the agency of people -- I do point out the opposite in another post in this thread, that many people with schizophrenia are aware of their illness and impairments, because many are. But many are not. Even with truly perfect treatments with no side effects that completely cleared delusions and clouded thinking, many, because of their illness, would choose not to take such treatment.
- shkkmo 4y ago
  The awareness can also wax and wane within a single individual. A friend of mine has been forcibly hospitalized several times and the trauma inflicted severely impacted his desire to seek treatment during his more aware periods. When I finally got him to reach out to care providers (since as just a friend, there was no way to setup inpatient care as an intermediary) they made it so difficult for him to enroll that no only did that moment of clarity pass without getting treatment, it also burned up whatever status as an ally that I still had with him. So while changes to commitment laws absolutely can be part of a solution, they must be paired with deep introspection into the despicable failures of our mental health system to provide appropriate care. Otherwise we risk inflicting additional trauma that will make managing future crises far more difficult.

vkou 4y ago

Indeed. Its strange how people have no issue with forcing medical treatment (which carries serious side effects) on the mentally ill, while at the same time, opposing mandatory vaccinations (which carry vastly less serious side effects, and are incredibly effective at reducing injury and death from infectious diseases). It's obvious why this hypocrisy is present. Mentally ill people are 'scary' and forcing treatment on them makes them uncomfortable, and me comfortable, it's an easy sell. But when medical treatment is forced on me, all of a sudden, my body autonomy becomes the most important thing in the world, and I'm dipping into horse paste and counting each myocarditis case. (And conspicuously neglecting the consequences of not vaccinating.)

dclowd9901 4y ago

Why are we acting like there aren’t objective evaluations for “dangerously mentally ill?” Everyone here is talking about how the justice system fails at this. Well yeah, it’s the justice system. They shouldn’t (and wouldn’t) be there in the first place. This is a psychological problem and it would be dealt with by people who have domain knowledge. We’re not talking about hungry DAs with a political agenda or overworked public defenders not doing their job. We can and should evaluate people to determine the extent of mental illness and mandatorily treat them. Anything outside of that is passive misanthropy.

woeirua 4y ago
As the article makes so plainly clear though, we cannot wait until someone is objectively dangerous for two reasons: 1 - it leaves very little time to actually intervene before something bad happens, and 2 - it removes our best chance to actually help someone. The mentally ill need to be treated when symptoms first start manifesting if we want to actually solve this problem.
- Pet_Ant 4y ago
  > we cannot wait until someone is objectively dangerous ... it leaves very little time to actually intervene before something bad happens I mean that feels like it's dangerously treading close to "pre-crime". I feel like it doesn't take much to extend that logic to poor rural children whose mothers are raising them in urban gang-run areas. I mean I can see the germ of the idea, but it's ripe for abuse. https://en.wikipedia.org/wiki/Pre-crime https://en.wikipedia.org/wiki/Pre-crime
  - woeirua 4y ago
    CPS can already take children out of homes in spite of the fact that no one has died yet in said situation. That is for good reason. Failing to act before a crime has actually been committed in many of those situations would lead to unnecessary deaths.
    - 4y ago

bnralt 4y ago

We definitely need protections for people who are institutionalized. But we also need protection from the members of society who are being victimized by mentally unstable individuals. Many large cities seem to have no interest at all in the latter, to the point where there’s a class of unwell citizens that the laws no longer apply to. Many are threatening people daily, violently assaulting people, committing frequent theft, using the streets as a bathroom, etc., mostly with impunity, and law-abiding citizens are told to just live with it.

A4ET8a8uTh0 4y ago
Sadly, yes. I have all the sympathy, but it stops the moment it gets too close to my nose ( or that of my family ). Anecdotally, my wife works in an environment that sees severe mental cases in a relatively well to do area and the numbers and stories make me mildly uncomfortable ( mostly because I think those are much worse in poverty stricken areas ). And then you have to remember people may be hesitant to just have their name added to the system ( and general distrust and lack of understanding of the rules governing it ); not to mention the social stigma that goes along with it.
PuppyTailWags 4y ago
I never said anything at all to disagree with what you said. People who are mentally unstable should be treated as if they're undergoing a health crisis like diabetic shock or sepsis or something like this. I am merely pointing out that the article has a major blindspot that weakens it, in that it doesn't adequately acknowledge that the healthcare system might actually be causing more harm to already unstable people due to the medical staff abusing them, and there needs to be additional guardrails or something similar to prevent further harm.
- hitekker 4y ago
  The article describes how the author's best friend murdered his fiance in a psychotic episode, while his support network stood around and praised him for his individual spirit. The GP distinguishes between psychotics, who require institutionalizing, the mentally unwell, who need guidance, and their victims, who are dead. You glossed over the first and last category, so it's fair for the GP to point out that ideological blindspot.

woeirua 4y ago

When it comes to mental illness, people should avoid commenting on specific cases because the details matter and only the professionals involved in those situations actually know enough about the state of these individuals to know whether or not treatment is warranted. I know "Free Britney!" is all the rage, but the Court does not order conservatorships lightly. No one is arguing that asylums were perfect places. Far from it. There was a reason they were shut down in the 60s, but the alternative that we were promised never materialized either and the result is that we have severely mentally ill people wandering the streets now, left to their own devices. The results are all too predictable.

PuppyTailWags 4y ago
> I know "Free Britney!" is all the rage, but the Court does not order conservatorships lightly. This is an assumption, and there's very limited oversight to this. That's the problem. The reason with Brittney was originally freed was that it was found she was inappropriately in conservatorship for years longer than she needed to be, and that all of the parties that should've been advocating for her were actually paid for by her estate through her parents, effectively making it so that anyone who advocated too hard for her wellbeing was eliminated from her circle. It's unknown how many more people are in this situation and, perhaps worse, we don't even know how many conservatorships exist!

lumb63 4y ago

An ounce of prevention is also worth a pound of cure. More important than investing resources into helping those with mental illness is preventing people from developing mental illness in the first place. Traumatic experiences like you mentioned can be reduced by better education about what to look for in healthy relationships, or providing accessible resources to catch issues early before they become major issues. Other, more subtle, issues like neglect, poor home life (often due ti poverty, difficult family situation, etc.) would require more pervasive changes to address, but if prevent issues in society on the back end due to reduced incidence of mental illness, not to mention the improvement in quality of life for those affected, we should seriously consider those options.

PuppyTailWags 4y ago
I fully agree that we should be working on preventing ACES and other environmental effects that specifically have proven out to have causal effects on mental illness. But psychosis cannot be eliminated altogether, and if someone is psychotic I would both like them to be allowed back into health even if they do not give informed consent and also I would like them to not be raped, assaulted, or otherwise abused.
- lumb63 4y ago
  Definitely agree. It’s not either or, and both issues should be given attention; however I think reducing the incidence of mental illness is more fruitful than correcting the negatives of it after the fact.

DannyBee 4y ago

We used to force hospitalization, and one result was the states would force hospitalize people to avoid having to pay for their benefits/etc. They would lock people up and forget about them forever. There are plenty of examples of institutions that destroyed tons of people (some of whom were not even actually ill)! My older brother, who is mildly bipolar (functional but can't really hold a job long term) was sued by the state of new jersey when he was a teenager to hospitalize him, because they didn't want to pay for school/etc. The judge scolded them in the end, but that was a huge time spend, money spend, and emotional painful thing for my family that lasted years. There are of course no perfect systems, but one of the practical problems is that there is no real part of the system that actually cares about the mentally ill, and is actually incentivized to do that.