How difficult should it be to commit someone against their will?

[Snake Alchemist]

I see it everyday. Homeless people muttering gibberish, complete with body tics wandering the streets, riding the light rail, etc. Some are unintelligible, others say things that are truly terrifying. One woman muttering "I'm so weak and diseased" over and over comes to mind.

I always wonder how hard can it be for the police or other professional to come and pick these people up and take them somewhere for help? I've been told by people that it's almost impossible to legally do that without their willing participation, but why and is it really THAT hard?

[mysuzuki2]

1. Commit them to where?

Most of the long term mental health hospitals were closed years ago.

[Snake Alchemist]

7. Maybe it is time to open new facilities BUT I am asking how difficult it should be to

start the process

[Lint Head]

22. Yep. Raygun did that.

[Demeter]

2. Please think about this

There have been CENTURIES of people held against their will, often for economic or political reasons, or because they were otherwise "inconvenient" to their family or community.

The current situation regarding free will was because of that abuse.

And then, when Reagan closed all the mental health facilities, it got really hopeless and ugly. Even people who wanted and needed help couldn't get it.

This is precisely why we need universal, government paid health care NOW.

[Snake Alchemist]

4. But there will always be people who refuse care.

Those are the ones I am asking about. The one's who will not go willingly.

[Demeter]

9. There has to be care available, first

Real care. Care that is effective and freely available, and not just punishment and prison in disguise.

Illness is not a crime. Not giving effective treatment for the ill is.

[dkf]

11. You really think all they need is a few meds then things are hunky dory?

I'm skeptical.

[Demeter]

16. NO, that's a psychiatrist's point of view

but there are people not getting those meds, because they cannot. And there are people getting meds that are killing them. And after the meds, there are a lot of other issues that must be dealt with.

It is a community, a societal problem, that has gone generally ignored for centuries. Very rarely, and usually only for limited times, has any relief ever been available to people who need it.

[dkf]

24. I would think a homeless person would be eligible for Medicaid

I don't think health care for all is their main stumbling block. They need all around support, the meds would just assist them in being even keeled. It's the rest of providing a decent living that is difficult.

[Marrah_G]

29. The problem is getting them to take the medication or even request help

When you are deep into a mental illness sometimes that is impossible.

[pipi_k]

42. That's the problem

a friend of mine is having with her ex-husband, who has a relatively severe mental illness.

He refuses to take his meds, then when he gets into difficulties he calls her and she feels responsible for some reason and rescues him every time.

What can you do when someone refuses to take his meds...

[Marrah_G]

45. Its really a tough thing

There has to be some balance between personal freedom and being able to aid someone who cannot help themselves. I wish I knew what the answer was.

[LiberalEsto]

30. Getting folks to stay on their meds is also very difficult

They might take their pills for a week or two, decided they no longer need them, and stop taking them.

Or they stop taking the meds because they don't like side effects like weight gain or dizziness.

It can be heartbreaking for a family when a family member with a psychiatric illness disrupts family life, terrifies the others, or even attacks them violently. There is often very little they can do if the family member is an adult.

What's frustrating is that the best treatment options for them usually don't exist. In-patient hospitalization is very costly, and spaces are limited. Jail and homeless shelters are not the answer.

[Snake Alchemist]

31. I can see why that would be a difficult problem. I wonder what other countries do. nt

[Demeter]

34. There's no point on staying on bad medications

Which is my point exactly.

I agree 100%--jails and homeless shelters are not an answer for anything, and certainly not for mental illness.

[LiberalEsto]

41. I was mainly thinking about appropriate medications

It is hard to keep some people on their medications, no matter how well the meds work.
The inability or unwillingness to continue taking necessary medication on a regular schedule can be part of the illness. I have some personal experience in this area with people who have mental illness.

If the meds aren't working, or are causing side effects, of course the patients need to be closely monitored and their medications changed as soon as possible.
If people aren't taking appropriate medication or aren't taking it on the right schedule, they also need to be monitored closely.

In such cases, a person may be fully functional as long as they take their medication, meaning they do not need to be in a hospital or sequestered away from everyday life. But instead of hospitalization, there should be some level of regular monitoring available, possibly by visiting nurses, or at local drop-in clinics, to ensure that these patients stay on their treatments and stay functional.

I believe the first step is universal single-payer healthcare to make sure that everyone who needs treatment can afford to receive it.

[pipi_k]

43. Inability or unwillingness...

yes, that's a problem with my daughter, who has been on antidepressants for a long time.

There were times when she didn't have the money for the co-pay, and couldn't afford her meds.

Other times she decided that she should be "cured" by now and just decided to stop taking her meds because she's tired of taking them.

The results are always the same...not good.

[Atman]

3. Oh, I thought you were talking about Santorum.

He's nuttier than a squirrel turd, and the stuff he muttters is REALLY disturbing!

[smirkymonkey]

44. +1000

[sharp_stick]

5. It's almost impossible

for someone to be admitted at will to an institution these days. There really isn't much of an infrastructure in place anymore for these people to go.

[Snake Alchemist]

8. Is that due to legal raasons or space concerns? nt

[sharp_stick]

14. A bit of both

there is no space in the hospitals, these places aren't cheap to operate and insurance is rarely used to pay for the treatment. The burden falls on the public to pay for them and as usual in that case the quality of the care suffers because of lack of sustainable funding for infrastructure and staff.

Treatment of the chronically and severely mentally ill seems to be on a pendulum where we go between full confinement and full community based treatment. Neither option is truly viable and it's been almost impossible to come to a compromise that works.

Unwilling confinement to an institution has a very high legal bar to cross for good reasons. There are a lot of people that have mental illness but can still function well in society but their mere presence in the community makes people nervous. These are the people that aren't a danger to anyone but make the walk off the subway a little uncomfortable.

On edit: it's very tough to show whether or not someone is a danger until it's too late and a lot of time people that could really use the help don't know they need it or find the help more difficult than life without it.

[TeeYiYi]

18. I'm pretty sure of one thing...

... Beyond the legalities of committing someone, say a family member,... if you don't have hella money and killer insurance, you won't be successful anyway. And if you do have insurance,... on the day the insurance runs out, your family member will be out as well....

As far as sweeping the streets of our mentally ill homeless population, that's a scary proposition. I grew up hearing stories about people ending up in the ”poor house”... It seems that the United States is sweeping people into its privatized prison system at an alarming rate so be careful what you wish for.

TYY

[safeinOhio]

6. They go by,

if the person is a danger to themselves or others.

[Chorophyll]

10. One thing's for sure...

You personally being inconvenienced or upset by mentally ill people on the light rail is not enough to get them committed. Life is unpleasant sometimes.

[Snake Alchemist]

12. I couldn't care less if they want to ride the train.

Recognizing that they need help is not difficult.

[Chorophyll]

15. Then you'll have to alert someone to their existence.

But they just don't sweep people up off the street the way they used to. The infrastructure is already maxed out. If the person is not harming or threatening anyone, they have as much right to be out in public as the rest of us do.

[Snake Alchemist]

26. Alert who?

There are police that roam the trains. They turn a blind eye. No interest in helping the homeless or no ability.

[Chorophyll]

27. Well, what do YOU do when you see a mentally ill and/or homeless person out in public?

Do you stop and talk to each one and offer your help?

Again, resources have been minimal since about 1980 and the transit police probably don't intervene unless something dangerous is brewing.

[pinboy3niner]

13. I see gibberish on the internets

Maybe we should examine someone's posting history and straitjacket the offender lickety-split.

[zipplewrath]

17. Define "will"

You're in a difficult place, bringing up difficult issues.

You can forcibly send these folks to an institution where they may be able to be medicated into a more stable, and coherent place. You know what they are most likely to immediately do? Check out and stop taking their meds.

Many places have procedures for collecting these people, but it usually has to do with them either committing some crime, or being a threat to someone. The vast majority don't qualify, at least for anything more than loitering.

We used to warehouse them in large institutions. It wasn't pretty. And lo you actually ended up in one because they were unlikely to ever let you out.

In a perfect world, we would monitor these folks continuously, regardless of how they were housed. We'd ensure they had shelter and a diet to maintain the best health we could hope to achieve. We'd do mental therapy and physical therapy as well as dietary support. But the most difficult cases turn out to be the ones most unlikely to "accept" help. Drug addicts, PTSD, and the mildly insane are very likely to resist your efforts to help. So in the end it becomes an issue of how much do you trust your government to decide who should be forcibly treated, and how, and for how long?

[Snake Alchemist]

20. Thanks for the thorough explanation.

It is as I feared.

[FirstLight]

23. + a Million!!!

the institutions that have existed through time have been warehouses for horrible experimentation and Dr. Mengele-style "psychiatry"... It's a GOOD thing those places are no longer funded or functional!

that said, some people are scary and some seem like they could barely stay alive on the streets with no care... but we have to live with it until we can figure out how to care for each other as a society. we have families homeless, we have drug addicts and all walks of life needing assistance just living day to day, some are in shelters, some are on the streets, and some live in really poor conditions... until we find our way out of this social stratification we are currently suffering, we just have to try and care for each other as best we can. I'm all for redistribution of wealth, sustainable communities and universal healthcare, but even that won't fix everything...

[MineralMan]

19. It can be done, but there's no place for them to go.

Committed to what? Today, our jails and prisons are the only places that have space, and they don't have space, either.

Try to find a psychiatric bed in the Twin Cities in Minnesota. They're all full, and there aren't that many in the first place. Then, there's the question of who pays for these people who are committed. That budget is very small where I live.

It's of no use to have a procedure where people who need psychiatric and medical care can be committed to that care if there is no place to which they can be committed. The facilities do not exist in quantities enough to meet the needs. The current laws make it possible to commit people, but without the facilities, they're of no use whatsoever.

I will ask you a question now: Can you describe the facilities in the place you live that people who need help can be committed to? Just a list will do.

[Cleita]

21. We used to do that and then in California,

Proposition 13 was passed making state funding for this stop. It was like almost overnight that the disfunctional homeless appeared on our streets because all the institutions that housed and cared for them threw them out in the street. Soon it had a domino effect and state after state followed. That was in the early eighties and we have what seems to be institutionalized homelessness since then. It got worse and worse as the poor joined them in the streets because the real estate boom made even marginal housing unavailable to them. Now the growing ranks of the unemployed and underemployed are out there with them. We have been turned into a third world country by Republicans who back those policies that make this happen.

[hunter]

25. Everyone needs a safe place to be.

It's not that difficult or expensive to build safe simple places people can call "home."

As a society we can't even provide safe places for ordinary people who don't have mental health issues.

The U.S.A. is very similar to every other American nation with the exception of Canada which has more of a Western European society.

The U.S.A. thinks it's a "first world" nation, but we're not. We suffer a disconnected and exploitive upper class who have an extreme distaste for socialism, who coddle one another with tax breaks and government handouts for very wealthy people, who abandon everyone else to the mean streets to fend for themselves.

[MissB]

28. Sorry, I don't think you can commit Santorum.

[JoeyT]

32. Damned near impossible.

Anyone that has read the history of how the mentally ill were treated when it was possible to drag them off and lock them up should be pretty uncomfortable about it happening again. Not to mention how often people (usually women) were institutionalized and abused because they'd become an inconvenience for their family. Society's ideas about mental illness have barely advanced since then, so there's no reason to think it will be any different this time around.

Given the amount of taserings and beatings we see that are completely unwarranted, I certainly wouldn't want the police to be the ones rounding them up either. Stick time isn't therapy, but it's what will happen, and it will happen frequently.

Seeing as we're currently privatizing our prisons as quickly as possible, there's no way we'd end up with a federal program, and no one would want a state run program in many states lest "Believed in a false god or no god" become a 'treatable' mental illness. What we'd end up with would be private groups that had the power to institutionalize someone without a trial of any sort and an incentive to do it to as many people as humanly possible. Just like the prison industry, only without any rights or trials.

So yeah, damned near impossible sounds about right.

If we really want to help the mentally ill, instead of having them drug off to a dungeon so they aren't bothering us, federally run clinics that give free counseling and medication would be the way to go.

[RobinA]

33. Most States

have some form of "danger to self or others." And this usually means "immediate danger" to self or others.

There is a problem with space for the seriously mentally ill, beginning with, not Reagan, Kennedy, J.F. Liberals are a bit to blame for this, as they fueled deinstitutionalization in the '60's, with JFK buying in. State hospitals were deemed horrendous, and many were, mainly due the LACK OF FUNDING. So people were moved out and into the community. There were supposed to be community resources funded, but they really weren't. This was bad before Reagan and he made it worse. Unfortunately, the deinstitutionalization continued and continues despite the lack of community resources. Hospital waiting lists are long and once you get in, the discharge resources are maintenance at best. This problem is not insolvable, but society has to have the will to do it. I have an advanced psychology degree and work in a psychiatric hospital. We know far more than we use, and this is system wide. Why? Money.

[Snake Alchemist]

35. How much money do you think would be needed to adequately address the problem?

And then there is the issue of what criteria besides danger to others or self could be used?

[Sgent]

36. Define "commit"

The first stage of getting someone committed against their will is fairly easy in most states. In most it just takes 1 or 2 physicians / psychologists to make a certification of danger to themselves or others, and its done for 3 days.

It gets progressively harder from there, involving expert testimony, court hearings, rights of the patient to appeal, bring their own witnesses, etc.

[Snake Alchemist]

37. I guess I mean initially bringing them in for evaluation. nt

[LiberalAndProud]

38. It should be damned difficult -- next to impossible, even.

Too many times in our past, commitment to mental institutions has been used to silence the inconvenient minority.

http://www.tngs.org/library/asylum.htm

[Snake Alchemist]

39. I have to think it's been done better somewhere out there though. nt

[Stinky The Clown]

40. We can thank St Ronald The Motherfucker for that.

I rejoice as his corpse continues to decay.

[rustydog]

46. There are safeguards, but in Washington state, the police can bring a person they believe

is a threat to themself or others to an Emergency room to be evaluated.
If a person is brought to an ER by friends or family and the person is suicidal/homicidal or unable to make a coherent decision for their care:
If the ER doctor or Social Worker believe the person needs psychiatric evaluations, the person can be held involuntarily until a county designated Mental Health Professional (MHP) evaluates the person.

IF the MHP finds the person need further evaluation/treatment, the person can be held involuntarily for up to 72 hours. The person must see a judge before the 72 hours or be released. The person can waive the right to see a judge and be placed into treatment. The judge can release the patient, hold them for treatment and or extend thetreatment time.

[Neoma]

47. Ask in the Mental illness group.

Some have been all throughout the system every which way there can possibly be. They'll have answers.

[donheld]

48. Is this another Rick Santorum thread?