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   Involuntary Mental Health Commitments   
      
      
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   Philip Hickey, PhD   
   Philip Hickey, PhD   
      
   March 16, 2014   
      
   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.   
      
   Individuals who have a psychiatric history and are on a "deteriorating course."   
   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 my own 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:   
      
      
   [continued in next message]   
      
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