Tag Archives: involuntary commitment

Psychiatry Misusing the Political Process

On March 27, the US House of Representatives approved by a voice vote with no debate a Medicare bill, HR 4302, Protecting Access to Medicare Act of 2014.  The purpose of the bill is to avoid cutting Medicare payments to physicians, and there was, and is, general agreement on both side of the aisle that the bill needed to pass.

However, tacked onto the bill was a rider which authorized $60 million to expand involuntary outpatient commitment (IOC) in states that already have provision for commitments of this sort.

Involuntary Outpatient Commitment is widely advocated by organized psychiatry.  Their general position is that people who are seriously “mentally ill” are often incapable of making prudent decisions, particularly with regards to the ingestion of neuroleptic drugs.  For this reason, they contend, there needs to be legal compulsion to ensure “treatment” adherence, which usually means forced ingestion of neuroleptic drugs (sometimes in long-lasting injectable form.).

In this debate, psychiatry routinely ignores the truly devastating side effects of these products and the fact that their long-term use is associated with increased neurological damage, deterioration in quality of life, and reduced life expectancy.  They also ignore the well-established fact that forced treatment is simply not effective.

There are also some very obvious civil rights issues involved.

The National Coalition for Mental Health Recovery has taken a strong position on this bill and have posted a press release.

The Senate is due to vote on this bill tomorrow (March 31).  If you oppose this rider to the bill, please ask your Senators to reject this counter-productive amendment.  You can contact your Senators through this link.

The APA has been developing their political lobbying machine in recent years.  On their website you will find the following tabs: Congressional Action Network; Government Relations; State Relations; and Legislative Action Center.  Obviously they’re taking this seriously.  Psychiatry has received a good deal of criticism in recent years, but have consistently refused to take any of this on board.  Instead, they have relied on spin, tawdry PR promotions, and now stealth legislation to promote their expansionist and destructive agenda.

Please contact your Senators today.

Involuntary Mental Health Commitments

The recent publicity surrounding the Justina Pelletier case has focused attention, not only on the spurious and arbitrary nature of psychiatric diagnoses, but also on the legitimacy and appropriateness of mental health commitments.  It is being widely asserted that these archaic statutes are fundamentally incompatible with current civil rights standards, and the question “should mental health commitments be abolished?” is being raised in a variety of contexts.

CRITERIA

Here in the US, each state has its own laws and procedures for pursuing a mental health commitment.  Some states allow outpatient commitment as well as inpatient.  There is wording variation from state to state, but in most jurisdictions there is provision to commit a person involuntarily for psychiatric treatment if there is convincing evidence that the person has a “mental illness” and as a result of such “mental illness” is a danger to himself or others, or is gravely disabled.  The term gravely disabled is generally defined along the lines of being unable to care for oneself or provide for one’s basic needs. In recent years some states have expanded these criteria to embrace:

  1. Individuals who have a psychiatric history and are on a “deteriorating course.”
  2. Individuals who are being cared for by a family member, and this care is about to be terminated.

SHORT-TERM EVALUATION HOLD (72 hours)

Here again, the procedures vary from place to place, but in most cases the mental health center is involved.  Typically the police bring the individual to the mental health center to be evaluated by a mental health professional.  The professional evaluates the individual to determine if the legal criteria are met.  If they are, he fills out the necessary forms, swears to their accuracy in front of a judge, who , if he agrees with the assessment, signs the hold order.  The individual is then taken to the state hospital, or an alternative approved facility, by a police officer.

THREE-MONTH HOLD

Before the expiration of the 72-hour hold, the hospital personnel decide whether to allow the individual to convert to voluntary status (which he can do by signing the appropriate forms) or pursue a longer-term commitment.  The latter usually involves a formal hearing conducted in the local courthouse, or more usually, in a room at the state hospital.  A judge presides, and both hospital and client are represented by lawyers.  The hospital calls as witnesses psychiatrists and other staff who have worked with the client.  Clients may also call witnesses, but seldom do.

DISCUSSION

The fundamental premise underlying all mental health commitment legislation is that mental illnesses exist, and that these putative illnesses cause people to think, feel, and behave in a problematic, and sometimes dangerous, manner.

It is my position that this premise is spurious.  I have developed this theme throughout the website, and the details need not be repeated here.

It is also my position that psychiatric treatments, which almost always mean psycho-pharma drugs, and/or shock treatment, are for the most part unhelpful and disempowering, and usually damaging, especially in the long term!  They generally reduce, at least somewhat, an individual’s level of agitation, aggression, and/or disruption, and this is the essential justification for their use in these situations.  The notion that they are medications and are being used to treat illnesses is false.  The stark reality is that the individuals are being forcibly drugged into quietude, and this is being done under the guise of providing “treatment” for an “illness.”

If the treatments that individuals received at state hospitals and other approved facilities were extremely beneficial, then one might be posed with an ethical dilemma.  To illustrate this, consider the case of a person who has, say, a gangrenous finger, but is refusing treatment.  The treatment would involve losing the finger, but saving his life.  Refusing treatment will result in death.  One could certainly make a case for enforced treatment, especially if his family, friends, etc., were petitioning the courts in this regard.  But in fact, in the US, the general principle is that such an individual is legally entitled to refuse treatment, and die from his illness if he so chooses.

But mental health commitments are entirely different.  Individuals get committed to state hospitals, not because they are sick in any conventional sense of the term, but because they are agitated, and/or aggressive, often as a result of conflict with family members, neighbors, local officials, etc…  Usually they are people who have been committed previously, sometimes very frequently, and their social and other abilities have been severely compromised by a history of ingesting psychiatric drugs.  Often their agitation/aggression at the time of the commitment is caused by withdrawal from psychiatric drugs that they had previously taken.  In most cases they have received large quantities of neuroleptic drugs, over extended periods, the devastating side effects of which are all too obvious, and contribute to the perception that they are “different” and need to be locked up.

Because the agitation/aggression is conceptualized as a “symptom” of the putative illness, little or no attempt is made by the police or by the mental health staff to explore the reasons for the agitated, problematic behavior, or what remedies might be available.  The individual is deemed to be “mentally ill,” and it is assumed that attempts at discussion or dialogue would be pointless.  It is also assumed that the individual has zero credibility.

So the kind of ethical dilemma that might exist in the case of the man with the gangrenous finger, doesn’t arise here.  We’re not having to choose between respecting the person’s civil rights vs. saving his life.  We’re choosing between respecting his civil rights vs. forcing him to undergo procedures that will damage him further and will likely cause further deterioration in his relationships with family and other members of the community.

“KANGAROO” COURTS

The Fifth Amendment to the US Constitution states:

“…nor shall any person…be deprived of life, liberty, or property without due process of law…”

The Fourteenth Amendment states:

“…nor shall any State deprive any person of life, liberty, or property without due process of law…”

In practice, the procedures outlined above for the 72-hour hold and for the 3-month committal are considered to be due process of law.  Strictly speaking this is true, because they reflect the law as enacted by the particular state legislature.

The more fundamental question, however, is:  do these procedures provide adequate protection for the civil rights of the individual who is being committed?  In my view, the answer to this question is no, for the following reasons.

1.  In practice, the 72-hour hold is decided by the mental health worker, often a fairly junior intake worker, who in many cases has been trained to think of involuntary commitment as the only reasonable response to a crisis.  Even in cases where a judge’s signature is required, it is extremely rare to find a judge who will attempt to second-guess the mental health professional.  The unspoken ethos here is that “crazy” people are fundamentally different from “ordinary” people; that they can only be understood by trained professionals; and that interference from non-professionals is likely to be counterproductive.  This ethos, incidentally, is actively promoted by organized psychiatry.  Indeed, I would suggest that it constitutes one of the fundamental pillars of psychiatric “treatment.”  It is also false.  People who are “crazy,” or despondent, or agitated are not fundamentally different from “ordinary” people.  Their craziness, despondency, and/or agitation are usually understandable if one is willing to listen attentively and respectfully and patiently.

2.  In practice the judge’s signature tends to be a rubber stamp, and there is no attorney present to argue for the client.  There is usually not even a requirement that the client be present at the initial meeting between the mental health worker and the judge.

3.  Although danger to self or others or grave disability is usually required by the statute, in practice a 72-hour hold can be obtained in situations that don’t actually rise to this standard.  In most cases, if a client has come off his “meds,” and is agitated, a 72-hour hold will be granted even if his agitation is for some legitimate reason and is perfectly understandable, and even if he poses no particular threat to self or others.  The tacit, and incidentally false, assumption is that his agitation/aggression will inevitably escalate unless he is sent to the state hospital for “stabilization.”

4.  Once the 72-hour hold has been activated, the process is very difficult to reverse.  The client is taken to the state hospital and is often “persuaded” to convert to voluntary status.  The persuasion usually entails the threat that if he doesn’t convert, he will be committed.  I suggest that this kind of tactic makes a mockery of the term “voluntary.”

5.  If the client refuses to convert to voluntary status, he can be brought before a formal mental health hearing.

6.  This is an improvement over the 72-hour hold procedure, but in my view, the individual’s rights are not adequately protected.  As mentioned earlier, the hearing is often (perhaps usually) held in the hospital. This confers clear advantage to the psychiatrists.  They can call all the witnesses they want.  They’re on the payroll and just a few steps away.  The client is at a marked disadvantage, in that any witnesses he might want to call are likely to be in his home area (usually hours away), and at work.  The client is often unfamiliar with the procedure, and has had little opportunity to prepare his case.  Usually he gets to meet his defending attorney for only a few minutes prior to the hearing, and, in some cases, his cognitive ability has been compromised by prior “treatments.”  I recently received an email from a woman who has been through this kind of proceeding.  She pointed out that: 

“…having a patient address her involuntary status at a Review Panel while drugged and wearing hospital pajamas does tend to work against her.  If you’ve decided that someone’s incompetent, that’s pretty much what you’ll see.”

7.  If the client expresses the belief that he is not ill, and that he doesn’t need treatment, this will be interpreted (and sworn to by the psychiatrists) as convincing evidence that he is ill, and that he does need treatment.  Imagine, in a criminal trial, if a plea of not guilty were routinely construed as evidence of guilt!

8.  There is usually a great reluctance on the part of the defending attorney to challenge the psychiatrists and other professional witnesses, and in most cases the hearing endorses the psychiatrists’ recommendation – which is usually:  keep him here until we say it’s OK to let him go.

9.  Eventually, even the most heavily-drugged client realizes that the only way he’s going to get out of the hospital is to cooperate with the psychiatrists and staff.  This entails saying things like:  “I was a fool to go off my medication;” “I realize now that you people are just trying to help me;” “I’m my own worst enemy;” “I need to stay here until you people say it’s OK for me to go.”  If he can keep this up for a week or so, he’ll probably be released.

So to get back to the original question:  should this kind of practice cease? The answer is obviously yes.  The recent Justina Pelletier case has drawn much-needed attention to the abuses inherent in the psychiatric commitment system.  In particular, this case has highlighted the fact that psychiatry is a closed system that routinely rejects, marginalizes, and even pathologizes any attempt to challenge or even question its pronouncements.  Such a system has no place in a democratic, transparent society.

THE WAY FORWARD

The most significant step forward at this juncture would be the removal of the concept and term “mental illness” from all statutes.  The term has no explanatory significance, and no clear meaning.  In the area of civil commitment, it serves merely as justification of enforced drugging for individuals who are agitated or aggressive or otherwise disruptive.  It also serves as justification for denying these individuals some very basic civil rights.

Commitment is essentially a form of imprisonment.  But it goes beyond ordinary imprisonment, in that it entails the forced administration of neurotoxic chemicals and electrically-induced seizures.  What happens in practice is that the individual takes the drugs under duress in the facility, then semi-voluntarily in the community for a few weeks or even months.  He then stops taking them, or tapers himself off, until the next bout of agitation or aggressiveness.  This precipitates another trip to the state hospital, and this revolving-door travesty continues until he is too brain-damaged to live in the community.  He then goes to a nursing home, where his “medication” is dutifully administered every day, until he succumbs to a premature death. 

If “mental illness” commitments were abolished, there would be a need for a non-psychiatric crisis response team in each county/jurisdiction.  How such a team would be structured and organized is a huge topic, beyond the scope of the present article.  From a practical perspective, it needs to be noted that any non-psychiatric crisis response system will be resisted vigorously by vested interests and will not happen overnight.  What we should focus on in the meantime are those parts of the present system that are particularly unjust or particularly destructive.  These include:

1.  Doing away with the 72-hour hold and replacing it with a formal hearing with mandatory legal representation in front of a judge. 

2.  Providing training to lawyers concerning the spuriousness of psychiatric concepts and the destructiveness of psychiatric treatments.  This training should be geared towards empowering them to challenge mental health testimony in commitment hearings with the same force and vigor that they do in criminal proceedings.  In particular, they should be knowledgeable, or have ready access to knowledge, of the adverse effects of the various psychiatric drugs in common use, and the abysmally poor long-term outcomes for individuals who have been repeatedly committed over a period of years.

3.  Recruitment and training of non-psychiatric “talk-down” teams in every county.  These could be part of the sheriff’s department or, preferably, separate departments in their own right.

4.  Continuing to expose psychiatry as the spurious, destructive, and pharmaceutically-corrupted activity that it is.  The major need in this matter is to expose the damage that psychiatry routinely perpetrates against those entrusted to its care, and the impact that this has on life expectancy. 

5.  Encouraging mental health centers to hire psychiatric survivors, especially those who don’t support the bio-medical model.  A requirement of survivor representation on governing boards would also be helpful.

6.  Requiring mental health centers to seriously review drug dosages on all clients monthly, and either reduce these dosages or explain why this can’t be done.

7.  Requiring mental health centers to provide active training in social skills to all clients who have ever been committed to a psychiatric hospital.

Going Against the Stream

AN INTERESTING STORY

Yesterday I came across the following on Twitter from Mental Health @Sectioned_.

“I just met someone who told me their remarkable story about falling down the rabbit hole into psychiatric sectioning and forced medication.  I listened with fascination to their intricate story in all its twists and turns, looping backwards and forwards with incredible details.  The longer we spoke the more was revealed, the crazier and more believable it sounded.  I was listening, probing for clarification, trying to grasp what happened and why.  First the overview, then the highlights, then more details, expanding out, backing round, drawing me in.  There were many parallels in our stories, and many contrasts.  It reminded me why I don’t really talk in detail about what happened to me: because, if you’ve not experienced it, it sounds unbelievable.  Unless you’ve experienced the scorching reality of forced drugging, seclusion, assault by nurses and patients, it sounds like a mad fantasy.  It’s too far outside most people’s realities for them to contemplate it being true, and so quietly assume you’re deluded.  So it smooths life’s path to make light, to skirt over the details, to change the topic.  And sometimes, sometimes, when I meet someone who’s been through something similar, I listen to their story and realize I’m not the only one.”

“Sectioning” is the British term for involuntary psychiatric commitment.  (Committed under various Sections of the Mental Health Act).

THEMES

The story is short and simple, but has extraordinary depth and significance. There are several themes.

1.  “I just met someone who told me their remarkable story…”    Contact and sharing.
2.  “I listened…”    In mental health there needs to be more listening.
3.  “…the crazier and more believable it sounded.”    Respect – even when someone sounds “crazy.”
4.  “… trying to grasp what happened and why.”    A lesson for psychiatry.
5.  “…drawing me in.”    Empathy.
6.  “There were many parallels in our stories.”    Human identification.
7.  “…if you’ve not experienced it, it sounds unbelievable.”    Nobody will believe me.
8.  “…it sounds like a mad fantasy.”    They’ll think I’m crazy.
9.  ” So it smooths life’s path to make light, to skirt over the details, to change the topic.”   Keep your head down.
10.  “…I realize I’m not the only one.”    The power of human connection and support.

SIGNIFICANCE

Twenty years ago, victims of psychiatric practice, for the most part, kept silent.  They stayed in the shadows, often feeling guilty about what had been done to them; feeling that somehow it was their own fault that they weren’t skipping happily through the park like the models in the pharmaceutical adverts.

And then something happened.  They began to find each other – through the Internet largely, but also in other ways.  And discovering that you’re not alone is a very empowering experience.  Today the protest against psychiatric damage has become a movement, and is continuing to gain momentum, and will ultimately prevail.

THE OTHER PROFESSIONS

It is time for the other mental health professions to learn from the victims.  It is time for the social workers, counselors, psychologists, job coaches, case managers, family therapists, etc., to learn from the victims.  It is time to stop playing along with the bogus psychiatric theories.  It is time to challenge the claimed efficacy of the drugs.  It is time to remember the shock we felt on first encountering a victim of tardive dyskinesia.  It is time to recognize how we’ve muted that sense of shock and outrage, and how we’ve bought the lie that the benefits outweigh the risk.  It is time to realize that we are not the only ones who have concerns about psychiatric excesses.  It is time to connect with the person in the next office or the next county.  It is time to let in the light.

It is time to speak out – both individually and through professional associations.  It is time to do what’s right.  Modern American bio-psychiatry is not something good.  It is not a legitimate branch of medical practice.  Pharmaceutical psychiatry is an elaborate apparatus for selling dangerous and destructive drugs.

 

More on Involuntary Commitment

In recent times a good deal of criticism has been directed towards the practice of involuntarily committing individuals to state and private mental hospitals.  Most of this criticism focuses on the lack of effective due process; conflicts of interest in the case of private facilities; and failure to adequately explore alternatives.

In my view, all of these criticisms are valid, and warrant attention.

But there is another side to the story that is seldom aired outside the mental health centers.  A great many clients like going to the mental hospital; they plan their trips in advance and “freak out” at the appointed time, knowing that the knee-jerk response of the mental health center will be a court-ordered admission.

Why would they do this?  Most of the individuals who carry long-term serious “diagnoses” (dismissively referred to as “the chronics”) are poor.  The closest they can get to a vacation is an annual trip to the state hospital.  When they get there, they are welcomed solicitously by the staff.  They have consultations with the psychiatrists, who adjust their so-called medications.  Meals are provided.  The buildings are heated and are usually nicely decorated.  The grounds are pleasant and relaxing.  If a person is so inclined, he can paint pictures or engage in other activities.  And most of all, he can catch up with old friends and meet new ones.

He can have a reasonably comfortable and pleasant few weeks, provided he goes along with everything the psychiatrists and the nurses say.  He needs to acknowledge contritely that he stopped taking his “meds;” that he realizes this was a terrible error; that he knows he does this every summer and that he shouldn’t; etc, etc. etc.,   It’s called playing the game.  Of course those hapless individuals who either don’t know the game or who simply refuse to play – their situation is not so comfortable.

Nor is this dynamic confined to the state hospitals.  I once became aware of a private mental hospital where similar dynamics prevailed.  At that time Medicaid would pay for up to two weeks a year in a psych hospital.  (This may still be the case; I don’t know.)

Anyway, the word in the “chronic” circles was that this hospital was nicer than the state hospital, and that the facility accepted Medicaid.  Almost all “chronic” mental health clients have Medicaid, and it was common knowledge that these individuals planned and arranged their two-week stays along the same general lines as outlined above.

Now don’t get me wrong.  I’m not trying to make light of the matter.  As mentioned earlier, there are serious problems with the committal concept and with the procedures.

But there is another problem – that the condition of the most helpless mental health clients is so wretched and unfulfilling that they arrange for themselves to be committed to a mental hospital as a vacation!

These are individuals who approached the mental health system years, or even decades ago.  They were assigned disempowering and destructive “diagnoses.”  They were patronizingly encouraged to keep their expectations low.  They were ordered to consume large quantities of damaging drugs.  Seldom was any attempt made to help them acquire the kind of social/living skills they would need to lead an independent, fulfilling life.  Many have advanced drug-induced brain damage.

They are victims of a spurious and brutalizing philosophy which robs people of their sense of worth and encourages them to give up on life.

We don’t need more mental health programs.  We need to abolish the mental health system and replace it with non-medical programs that offer people real help with problems of living.  They need help finding and keeping jobs and saving their money so that they can afford real vacations!

Involuntary Commitment – A Case Study

Years ago I was director of a county mental health center in an Eastern state.  Shortly after taking the position, I became concerned that clients were being involuntarily committed too readily and without exploration of other options.  I issued an instruction that all such activity had to be approved by a middle manager before it could proceed.  This measure aroused enormous resistance from the front-line staff.

There was one client – let’s call him Charlie – who was committed to the State Hospital every year, usually in July.  Every July, he would become “agitated,” would scream profanities at his elderly mother, and break things around the house.  He carried a “diagnosis” of schizophrenia.

Mother would call the intake worker at the mental health center; the intake worker would visit the home, fill out the papers, get a judge to sign them, and take them to the sheriff.  Ten minutes later a squad car would pull up at the house; Charlie would walk out – generally calm – get in the car; and be driven to the State Hospital, where he would be kept for about three weeks.  Mother would breathe a sigh of relief, clean up the house, and take a well-earned rest from the burden of caring for her adult son.

Under the new system, the intake worker had to involve the middle manager.  He visited the house and found that Charlie was “freaking out” and mother was nervous and apprehensive.  So he suggested that mother come with him to the domestic violence shelter.  She was hesitant, but agreed.  There he explained the situation to the shelter staff, who welcomed mother with open arms.

The intake worker was furious.  It wasn’t fair, she said.  Charlie was the one who was being difficult – why should mother have to be “thrown out” of her own home.

The reality was quite different.  Mother was thrilled to find a safe haven and staff who listened to her and offered support and encouragement. Charlie had no one to scream at and was having to take care of himself (a new experience).  The manager visited him twice a day to confirm that he was OK.

When mother had been at the shelter for four days, Charlie sent her a message asking her to please come home, that he missed her, and that he would not be aggressive or violent.  With encouragement from the shelter staff, mother sent back a message to the effect that she was very comfortable at the shelter, and that she planned to stay at least a week – maybe two.

In fact, she returned home after nine days – to a situation the dynamics of which had been altered in fundamental ways.

The moral of the story is that the knee-jerk mental health response of shipping clients to the State Hospital at the first sign of trouble is not always necessary, and usually provides only a temporary fix.  The dynamics underlying and driving the problem behavior remain unchanged, and the problem behavior tends to recur.