Involuntary commitment: it needs to be on the table

There is a great, blunt editorial by a man named Tom Zoellner published, “Reforms shouldn’t protect ‘Big Mental Health“. Though the issue is contentious in the mental health community and among those living with mental illness, Zoellner is absolutely right: involuntary commitment could save lives if it could be used more. This is both in more public situations (mass shooters with obvious symptoms and warning signs), and to save the lives of individuals who will otherwise kill themselves.

Charles Krauthammer is wrong about most things (he’s just a more intellectual-sounding Rush Limbaugh), but his experience as a psychiatrist and his work with mania is extensive and undeniable. Thus even in a column where most of his logic is shaky, like this work after Newtown, his point on mental illness is correct. Several social problems persist due to inadequate resources to treat those who suffer from psychosis, major depression, and mania. And if involuntary commitment was a possible option in more states and situations, some prominent shootings would likely not have happened. Jared Loughner and Seung-Hui Cho (the Virginia Tech shooter) had plenty of warning signs that teachers and friends recognized, but this didn’t filter up to the relevant authorities, and even then their hands can be tied by personal rights and privacy.

This is a balancing act, which is par for the course with mental health. People shouldn’t be locked away like in the days of the massive mental facilities, but they shouldn’t be left to rot when they reach the point where they can’t help themselves. People should be entitled to their privacy and autonomy, but there are times when an imminent threat exists, towards self-harm or harm of others. People should be treated with empathy, but should recognize that involuntary commitment can be an expression of that empathy. The heartless thing is to nothing when nothing is not the best option.

The opening point of the oped, that Republicans currently have a better understanding of what needs to be changed than Democrats do, is correct. Though given the Republican interest in reducing healthcare spending, that basic good idea shouldn’t mean they get the keys on overhauling the system. It points to a need to look at American mental health policy and figure out what works and what does not. Zoellner is right that services may have no track record of success. It’s true that services are redundant and mismanaged- I’ve volunteered at the county level and it’s a complete mess. Even experienced people are finding new groups and services year after year they didn’t know about. The uniting factor is that most of these places get government grants and subsidies; transparency about where this money goes and whether it is overlapping is key.

There are two ways to look at mental illness, where neither is full right nor wrong. One is that anyone with a diagnosis is incapable of living independently and needs to be locked up. The other is that someone with a diagnosis should be given full privacy and any suicidal or dangerous statements shouldn’t be communicated to relevant authorities. It’s key to see involuntary commitment as a tool that shouldn’t be used carelessly (like in the past), but it shouldn’t be ruled out entirely. There have been points where I was in a dangerous place, and the last thing I wanted was a culture of silence where nobody felt obligated to get me more direct help.

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6 thoughts on “Involuntary commitment: it needs to be on the table

  1. Having been a mental health consumer for many years–there is not much basis for the idea that involuntary commitment works. People such as Peter Breggin, Robert Whitaker. and Allen Francis (who chaired the DSM-4 committee) have warned of the overreach of psychopharmacology–often drugs that don’t accomplish what they are supposed to accomplish.

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    1. Well the opposition is fairly widespread regarding outpatient treatment. Looking at consumer groups and academic sources, I don’t see substantial opposition to my point, which is inpatient commitment in the case of a self-evident, grave threat to a person’s self or others.

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  2. As far as I know–and I could be wrong–involuntary commitment is primarily in an outpatient setting–and often needs to be authorized by a judge after testimony is given. Inpatients have very little rights and are often coerced into taking meds against their will.

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