Discussion [Article] To advocates of involuntary commitment, forced interventions: A compromise/reform

[TAW122]

It would simply be naive to just say involuntary commitment should be abolished (while nice and ideal is not really bound in reality or likely to be reality given how things are in the world), but for the sake of discussion and exploration of this topic, I will give my two cents and input. If we cannot FULLY abolish involuntary commitment (in the real world), then at the least we should have a serious overhaul and reform towards the practice of civil commitment, involuntary commitment, and forced intervention, which would at least improve the current situation in the real world. This would give us more rights and protections AGAINST harm (psychological, physical, financial, etc.), infringement of our rights (personal freedom, civil liberties, bodily autonomy), and also limit the scope in which institutions, individuals, entities, and the state (government) can impose their authority and rule over an individual.

This would involve understanding the definitions and terms (both in the medical and legal fields), then changing what they represent to ensure that people are treated better in general (not limited to legal system and healthcare system). Note: I also want to mention that this applies to psych holds, 72 hour holds, and/or any other non-voluntary procedure, practice, or action against the subject/individual.

Suggestions and recommendations for reform (or even a compromise):
Before intake, have patients arrange (unless imminent risk of harming others, but even then, the moment the patient is stable, coherent enough) their affairs and important responsibilities such as notifying their employer (so they won't get fired for no-shows), getting their bills paid (if deadline is close, or otherwise make arrangements for that), ensuring their abode is intact (not getting evicted, having rent/mortage paid), and other general affairs in order.

Make patients who are involuntarily committed against their will be exempt from any medical bills, or at the least cap the amount of each bill so that they will not have to pay for the treatment that they NEVER asked for. (While this may open up another rabbit hole with regards to "BUT WHO WILL PAY THESE BILLS?!" and people bringing up the problem about taxpayer burden, firstly, I won't go down the rabbit as that is for another topic altogether, but I will also say you cannot have your cake and eat it at the time. You would either up the threshold (even more) for people who can get involuntarily committed (detained or locked up against their will), or have someone foot the bill other than the person who is being 'forced treatment' that they NEVER asked for). Either way, this would be beneficial towards the patient, meaning that the patient cannot be financially ruined just from something they never (willingly and deliberately) consented to, or at the least, make it where providers have to have real cause (not just hearsay) for committing, detaining someone against one's own will.

Make even more stringent criteria (even harder) to get someone in a psych hold and allow recourse (more than just the patient advocacy stuff) for people to appeal and perhaps even have an external regulatory body that oversees patients' rights. This is more than just a patient advocacy group. Perhaps strengthen the patient advocacy group.

When a person talks about CTB (while in theory and in textbook it should be this way, in practice it doesn't always play out this way), they are not automatically hospitalized, detained, or locked up against their will. If they are, then patients should have recourse against their provider up to and including litigation, have the provider be reprimanded and have it on their license (a blackmark on their record). Furthermore, the legal system should change to where patients have an easier time to seek legal recourse and is not burdened by unnecessary bureaucracy and many different, contrary answers to what he/she can do. By allowing recourse, this would not only help patients seek justice and reparations for harms done, it would also hold the medical providers accountable for any kind of abuse or mistreatment of the patient, including violation of process and defamation.

Make it easier (this would require changing the criteria for length of time of detainment and the criteria for it) for a patient to be able to come forward with any abuse, mistreatment, or unethical treatment by their provider and have laws that help protect patients' rights. Therefore, making involuntary commitment as a last resort or when there is imminent, demonstrable risk of harm. In short, giving every opportunity for the patient to comply and/or de-escalate, in addition to informing them that if they are imminently at risk for harming others or so, they can and will be detained for the safety of others. So for example, informing the patient about his/her rights, giving them the opportunity to ask questions about confidentiality and/or mandated reporting without being scrunitized or suspected of trying to circumvent the system/abuse rules, if there is risk, make every effort first to de-escalate, form a safety plan (Note: This does not mean threatening them or using duress (including a false choice) to get them to go), and only after all other efforts have failed, then involuntary commitment would be used.

Improve the conditions of the facility. By improving the facilities and it's amenities to something that is more humane and less barbaric, this would limit and minimize the damage caused by said facility towards the person being held there. It is already traumatizing to have one's freedom and civil liberties stripped away in the name of safety and protection of others, but worse if the conditions at said place(s) is horrid. These improvements can include, but not limited to: Improving food quality, treating each person with basic dignity (not treating them like cattle, animals, or criminals), improve the amenities such as a clean place, the general area and rooms kept clean and hospitable, having basic entertainment and some privileges (how they manage it will vary facility by facility) which includes the ability to have contact with their loved ones or manage important matters even while detained (maybe an incentive for good behavior and such). Note: This is not to glorify the process or practice of this kind of detainment, but to highlight the systemic issues and conditions in which patients are kept in. I also know that not all facilities are like this, but there are enough of them to justify mentioning this as an issue to fix.

The paragraphs bolded and in green are the ones that are most impactful (in my opinion) that will help reform the system in such a way that people will be better off and have more recourse in the event that the authorities have done wrong. There are likely more points that can be addressed, but these are the ones that I can come up with as well as believe to be the most impactful towards improving the system we have now.

In conclusion, I would rather have a world where, while there are still special cases in which such a practice is invoked (such as a threat of real harm to society and/or others), but with much higher bars to meet and also much less frequently used. Then more protections; checks and balances; recourse(s) built in for the person being subjected or indicted by such a process. Also "due process" during the process with no automatic presumption of irrationality and illogical assertions/claims by the complainant, initiator. Then also a system of recourse for the individual if/should the individual ever be wrongfully committed and be able to be vindicated as well as have reparations made to said individual.

What are your thoughts on these suggestions for reforming the mental health system with regards to involuntary commitment and CTB?

 

[TAW122]

I'm not sure if anyone has anything to add to these suggestions as a possible way to reform the mental health system and society's way of forced interventions against people? Sure it isn't perfect, but I think one of the first steps into progress and fixing our current system is reform, and then one day become the change that we hope to see.

 

[ptolemaea]

i'm not sure if i'm entirely opposed to involuntary commitment, but it largely isn't effective in remission of mental health issues. i do think any patients who are involuntarily committed should have access to legal counsel, if not the complete right to legal representation. you're dealing with people who are in very vulnerable mental states, who have likely been traumatized by the experience of involuntary commitment. they need to have some kind of protection from malpractice or abuse.

 

[Forever Sleep]

It's an interesting topic and I agree with your suggestions. I also agree that while involuntary commitment DOES seem necessary if the person is threatening harm to others, self harm and ideation- even attempting suicide seems different to me.

I guess I struggle though- because I don't see my ideation as a result of mental illness. Certainly not chronic mental illness that prevents me from functioning in life and making my own decisions. I'd be pretty angry if I was hospitalised against my will. I would see it as an utter waste of resources.

I guess then- it depends... Are someone's suicidal thoughts temporary and unwelcome/intrusive? Does the person themself attribute them to mental illness AND do THEY want to be helped?

I've never been sectioned but I've known people who have. What shocks me is that- from what I can see- there don't seem to be that many grades/levels of psychiatric care- yet- there are clearly MANY levels/severities of mental illness. People I've spoken to- who were maybe suffering less severe problems have said it did them no favours to be confined with other people suffering illnesses that were VERY severe- causing them violent outbursts. It shocks/surprises me that there aren't kind of half-way places that facilitate people with mild to moderate symptoms.

I guess the cynical side of me wonders how much all of this is from genuine concern for an individual and just how much is prompted by our culture of blame. Ie. why wasn't that person stopped? 'Helped' before they took their own life? People don't seem to care too much about the nature of that 'help'.

What also fascinates me is your perspective from a private healthcare perspective. I'm from the UK- so- I'm assuming that we wouldn't have to foot some of the medical bills at least. This is perhaps a subject for another thread but I wonder what the differences are between US and UK mental healthcare. Maybe I'm mistaken but I get the impression it is actually much harder to get commited/sectioned in the UK and I wonder whether this is why- it's public money being spent...

 

[TAW122]

i'm not sure if i'm entirely opposed to involuntary commitment, but it largely isn't effective in remission of mental health issues. i do think any patients who are involuntarily committed should have access to legal counsel, if not the complete right to legal representation. you're dealing with people who are in very vulnerable mental states, who have likely been traumatized by the experience of involuntary commitment. they need to have some kind of protection from malpractice or abuse.

Yeah, I think there are times where it is necessary for such practices and the bar should be set high, like imminent danger to others, clear signs of irrationality (psychosis, schizophrenia, delusions, mania, severe eating disorders, etc.). Also, by involuntary commitment or even temporary holds, it should not be used indefinitely, (for example, someone who has been schizophrenic and what not, they have been admitted multiple times already, and after a certain number of times, they should at least have the option to check out of existence if their mental illness is causing that much suffering) and at SOME POINT, they should have the right to die.

Additionally, yes, I fully support having more legal protection and more due process, patient civil rights against malpractice, abuse, and violation of patient's rights.

It's an interesting topic and I agree with your suggestions. I also agree that while involuntary commitment DOES seem necessary if the person is threatening harm to others, self harm and ideation- even attempting suicide seems different to me.

I guess I struggle though- because I don't see my ideation as a result of mental illness. Certainly not chronic mental illness that prevents me from functioning in life and making my own decisions. I'd be pretty angry if I was hospitalised against my will. I would see it as an utter waste of resources.

I guess then- it depends... Are someone's suicidal thoughts temporary and unwelcome/intrusive? Does the person themself attribute them to mental illness AND do THEY want to be helped?

I've never been sectioned but I've known people who have. What shocks me is that- from what I can see- there don't seem to be that many grades/levels of psychiatric care- yet- there are clearly MANY levels/severities of mental illness. People I've spoken to- who were maybe suffering less severe problems have said it did them no favours to be confined with other people suffering illnesses that were VERY severe- causing them violent outbursts. It shocks/surprises me that there aren't kind of half-way places that facilitate people with mild to moderate symptoms.

I guess the cynical side of me wonders how much all of this is from genuine concern for an individual and just how much is prompted by our culture of blame. Ie. why wasn't that person stopped? 'Helped' before they took their own life? People don't seem to care too much about the nature of that 'help'.

What also fascinates me is your perspective from a private healthcare perspective. I'm from the UK- so- I'm assuming that we wouldn't have to foot some of the medical bills at least. This is perhaps a subject for another thread but I wonder what the differences are between US and UK mental healthcare. Maybe I'm mistaken but I get the impression it is actually much harder to get commited/sectioned in the UK and I wonder whether this is why- it's public money being spent...

I agree with you, I too, would be angry (and more) if I had been hospitalized against my will not only because of a waste of resources, but also the violation of my personal autonomy and mental capacity to make decisions; in other words, being infantilized and degraded. I like what you said about being able to be functional in life, coherent, and able to understand and make decisions being a criteria on soundness of mind.

As far as people whose are suicidal thoughts are intrusive or temporary, I will concede to the fact that it can be helpful, but for those whose thoughts are grounded in reality and personal choice (after understanding the ramifications of their choice), not attributed to mental illness then no, involuntary commitment and psychiatric holds are more harmful than helpful. Furthermore, if one has the capacity to make understand the consequences of their decisions and be able to function, make decisions like most people with most other things, then of course, the person doesn't want the help. It angers me tremendously that many pro-lifers always associate the want to die itself is automatically the result of a mental illness rather than the result of a free thinking, rational minded person.

Yes, the ideal of half-way places could be helpful, at the very least separate those who are temporarily in crisis (mild to moderate) and those who are severe are actually hospitalized against their will (but at SOME POINT, should still be given an option of voluntary euthanasia). I also have never been hospitalized or involuntarily committed against my will (and hopefully I will never be as that would likely send me over the edge and other bad things).

Regarding the culture of blame, this is certainly a major factor in why healthcare institutions and professionals take extraordinary measures and treat each patient, each situation as a life or death situation even if it isn't in a lot of cases. They indeed go to great lengths to prevent the (maybe) 1% or so of the most severe cases because even one litigious battle is one too many for them to bear (all the trouble of legal battles, paperwork, and all the resources towards litigation). In the west, and particularly in the US, yes the US in general is notorious for it's litigious attitude, and not even just in healthcare, but just about everything. Whether one has a case or not, let alone would win a legal case, people are so litigious that they will find (just about) anything to litigate over.

While I never been hospitalized against my will, I know of some people who have in the US and it is indeed traumatizing for them (depending on how they were found, how they were admitted, how they were treated while in holding, etc.), and then to add insult to injury, being sent a bill for something that they never agreed to go (or consented while under duress, and implied consent is another matter altogether, could have a separate thread for that topic.) in the first place. If the poor treatment, violation of bodily autonomy and civil rights wasn't enough, then being stuck with a bill for such a harrowing experience would certainly quickly change their tune.

 

[SilentSadness]

I think involuntary hospitalisation is a very dangerous path to go down, after all it's currently used to silence & abuse people whose views are not liked. Wanting to ctb is not a reason to have your rights taken away, and the fact that people think it is just proves they have no arguments at all. I personally believe that wanting to live in this disgusting world, even at the expense of others, is the true mental illness, but I don't try and get those people locked up in asylums like they do. If people are a danger to others then they should be in prison like everyone else. It certainly is degrading to have to live in a world where people want me abused in a psych ward simply for being myself.

 

[TAW122]

I think involuntary hospitalisation is a very dangerous path to go down, after all it's currently used to silence & abuse people whose views are not liked. Wanting to ctb is not a reason to have your rights taken away, and the fact that people think it is just proves they have no arguments at all. I personally believe that wanting to live in this disgusting world, even at the expense of others, is the true mental illness, but I don't try and get those people locked up in asylums like they do. If people are a danger to others then they should be in prison like everyone else. It certainly is degrading to have to live in a world where people want me abused in a psych ward simply for being myself.

I agree and I will say that while we would really love to see involuntary commitment, forced hospitalizations, psych holds be completely abolished (outright blanket banned), it is unlikely in this reality, the real world we live in. Therefore, this thread is to address the current situation and what reforms, overhauls need to take place in order to improve conditions that are there, thus the list of suggestions and ideas are just things that would mitigate and otherwise relieve most of the larger problems with involuntary commitment, forced hospitalizations, and psych holds.

Indeed, the prolifers have no (good) arguments on it and the use of involuntary hospitalization is indeed a dangerous path to go down, but I would say that it should only be used when there is clear evidence of an imminent threat of harm to others. Regarding the last two sentences, I would only slightly disagree with you because if someone is a danger to others, it doesn't mean that they have committed a crime (unless they have threatened harm to someone or some group of people), therefore the legal system wouldn't come into play immediately. I would still say that involuntary hospitalization for those kinds of people would still be a stop-gap between the ones who didn't do anything illegal (a.k.a. didn't commit a crime) but is a risk to others. If found evidence that they have committed a crime (e.g. like an actual threat of imminent harm towards a specific person, target, or group), then yes, the criminal justice system can be involved then.