[jMyles]

It's becoming a difficult situation in the US, where "talking to someone" means being forcibly handled by the brutal mental health system and forfeiting several crucial rights perhaps forever, including the right to own a firearm.

It's not clear whom in the US to recommend people contact in such a situation.

No less than four people who are close to me have sought help through official channels in the US, and in all four cases, were treated disastrously. All of them (including one who was 15 at the time) have told me they'd never, ever do that again.

(Actually, I just thought of another - someone whom someone around them "called for help." Same scenario. So that's five.)

[tptacek]

It is extraordinarily unhelpful to suggest that people who are endangered by mental health problems should avoid the mental health system.

There is a lot not to like about emergency mental health care. The experience is indeed akin to that of criminal justice, and can at times verge on dehumanizing. Our handling of these issues must improve.

But the alternative to being locked in a room with police officers watching the door is something far worse than that.

People with suicidal depression, severe anxiety disorders, or post-traumatic stress disorders can endure episodes where they almost completely lose judgement, or experience dissociation and derealization. You can't simply gut these things out: you need to be in a safe space, ideally attended to by professionals who can intervene medically during the worst of it.

If you are feeling suicidal, or that you're not in control of your own actions and concerned about harming yourself or others, you should call 9-1-1 or go to a hospital ER. It won't be pleasant, but it will be safer than the alternatives.

[0xcde4c3db]

This post comes off as pretty dismissive. For me, the experience did not verge on dehumanizing, it was dehumanizing. "Our handling of these issues must improve" doesn't even come close to acknowledging the severity, depth, or difficulty of the problems I encountered.

[tptacek]

I'm doing my best to capture how bad the experience is and I don't object at all to anyone suggesting that it's worse than I described. I think it's a very bad system.

[chris_wot]

There's a reason I said it doesn't have to be a medical person. I'm in the same boat - I had the worst experience of my life when I spoke to authorities about a suicidal episode. It was degrading and dehumanising. I will never make that mistake again, if I'm feeling suicidal I will never tell authorities, a doctor or anyone who might put me in that situation again.

[tptacek]

That sucks, and, having some little bit of knowledge about the process you went through, I absolutely believe you.

Having said that: if you were my friend, and you told me you felt like you weren't in control of your thoughts and were concerned you might harm yourself, and you had no better options lined up (a long term mental health expert you'd built a relationship with, for instance), I'd help coerce you into the emergency mental health care system before I allowed you to become a victim of a controllable illness.

[teslabox]

Psychiatry is an officially-sanctioned pseudoscience. People who get stuck in the system tend to never get better.

[tptacek]

The former sentence is more a statement of religious belief than an argument. The latter is demonstrably untrue. Either way: the point of my comments isn't to take the side of the mental health care system and argue with all comers. In particular, there's a reason I keep using the term emergency mental health care.

[throwaway1]

Preface: Please, no advice. Please!

You may think that this is coldly logical. It's not. I have dealt with OCD and depression-like systems for a long time now. 90%+ of the time I'm "fine" to "great." Another 9.9% I feel like scum for no good reason. That last 0.1% is what sucks -- that's the suicidal thoughts.

Holidays that are the worst, when everybody seems to be paying each other extra attentions and I find myself feeling lonely/forgotten. Last night, I had raging suicidal thoughts for a few hours (about the length of the usual bout). These thoughts are not directed or particularly purposeful.

When I have these thoughts, I badly want to talk to somebody about them. It's like the monster in your closet -- in the light of day it's less scary. But I can't, and it sucks! If I go to a shrink about this, I would likely be involuntarily committed and be greatly impacted in my professional life, etc.

Suicide is a taboo topic and it's too bad for those who struggle with suicidal thoughts, because they have to keep them inside. I've brought them up to some "friends" before and the reaction is that I must be crumbling, etc. There's almost a sense of shame from these people, like they've accidentally seen you naked.

I keep this to myself, but the most productive thing is to confront the issue. The best way I've been able to do that is by reading things written by/about suicide not from the perspective of "gotta save you!" This might sound odd, but places like /r/SanctionedSuicide (which isn't really what it sounds like, if you recoiled) actually makes me feel respected and not ashamed. Looking through a different lens, I see that my life is pretty good and I have many things to live for! When I feel this way I read the generally "gotta save you!" stuff too because hey, it's nice and positive, but in isolation it's quite patronizing.

Mentally sound people seem to immediately equate suicidal thoughts with an imminent life-and-death struggle and have the accompanying "EMERGENCY!!" reaction, and that is simply not how this works.

[nyan4]

You are (incorrectly) implying that the only choices are calling 911 or "being locked in a room with police officers".

[jMyles]

> But the alternative to being locked in a room with police officers watching the door is something far worse than that.

This seems like a false dichotomy to me.

[a3n]

An acquaintance was feeling suicidal, and I convinced her to talk to her doctor. Her first concern was being involuntarily committed; she referred to some statute by number, that she thought would prompt whatever provider or authority she talked to to lock her up. What a terrible barrier to help. (She did see her doctor.)

You call 911 for help, and they send someone with a gun.

[tptacek]

When you call 9-1-1 because you're feeling suicidal, the most likely outcome is that you will be detained against your will†, probably for several days --- first in a hospital ER, and then in a mental health facility. If you show any hesitation about submitting to this process, you'll be coerced into compliance, usually by the police. The police will have guns.

It does nobody any good to sugarcoat the unpleasantness. The experience of the emergency mental health process, or stories about it, shock people. That shock deters many from seeking help. So people should know up-front, preferably before they even need to consider emergency care, that getting care will suck a lot.

It also has a good chance at saving their lives.

There probably aren't many people on HN who will agree more strenuously than I do that emergency mental health care in the US needs a drastic overhaul, and that's a conversation I'm willing to have. But we cannot responsibly suggest that we can motivate that reform by telling the mentally ill to go on strike against the system. Many people in need of emergency mental care will return to normal function in days or weeks, even when the safe space that gives them room to recover is unpleasant, the doctors are remote and unhelpful, and the police are at the door.

† (There are subtle differences between this outcome and "involuntary commitment", but I would understand anyone who suggested that they're distinctions without differences; perhaps the best term to use for this would be "temporary involuntary commitment").

[a3n]

> It does nobody any good to sugarcoat the unpleasantness.

I agree, and this is the kind of discussion that should be had.

> But we cannot responsibly suggest that we can motivate that reform by telling the mentally ill to go on strike against the system.

To be clear, I am not at all suggesting that. I am observing that there is a barrier in front of some people to getting help, fear of the system. People are already on strike or hesitant, to more or less degrees, and I think it's terrible that fear of help is even a consideration.

[nyan4]

false dichotomy, again.

[tptacek]

I don't understand this comment. Could you explain more? Thanks.

[chris_wot]

I'm not entirely sure the dichotomy, but if "care" sucks (I'm an Australian, and my personal experience is that it was worse than dreadful) then the only outcome for many is that you do NOT contact authorities on case your already very bad situation becomes a complete and utter nightmare.

I will personally never contact the authorities myself. My experience was so bad that I contacted the NSW health ombudsman and the hospital apologised for: not charting my regular medication; treating me dismissively; not providing enough bedclothes during a wet and freezing night; not providing safe facilities (water ringing through light bulbs, leaking roofs, etc) and for staff who bullied me whilst I was in the facility.

I sobt need to know this, but I'm guessing you've been fortunate enough to have never been involved with state run, coercive mental health systems. There are good and valid reasons why people avoid them like the plague. They are often worse than the cure.

[tptacek]

First, I'm sorry that you had to deal with all of that.

Second, I am not an apologist for the emergency mental health care system. I agree with you about it for the most part, and I think it's me that introduced the word "dehumanizing" to the thread in describing it.

If I somehow got bit by a radioactive Zuckerberg and had unbounded funds to tackle public policy problems, emergency mental health care is the one I'd tackle.

Third, it is absolutely not my contention that anyone dealing with any kind or level of suicidality should admit themselves to emergency care. Suicidality, depression, and anxiety are complicated subjects and --- I strongly agree with everyone else who's said this --- they're also taboo issues that millions of people struggle with quietly and without institutional "help".

My contention is merely this:

IFF you find yourself in circumstances where you have lost control of your thoughts or have impeded judgement to the point where you or a trusted friend are immediately and urgently concerned that you might harm yourself, THEN it is much better to submit yourself to the almost invariably unpleasant and often dehumanizing emergency mental health care process than to try to gut it out alone.

This is especially true of sudden onset problems like PTSD. Severe PTSD is a motherfucker of an illness and if you don't have the experience and self-knowledge to handle it yourself (and many sufferers do not, since it tends to come at you out of nowhere), you shouldn't try.

[TazeTSchnitzel]

I seem to recall the case of at least one black person with mental health issues whose neighbours called 911 to get help for, and soon enough he was shot dead.

[DanBC]

About half the people that police shoot and kill each year have a mental illness. This amounts to about 500 people with mental illness shot and killed each year.

This compares to the 35,000 to 40,000 people who die by suicide in the US each year.

If someone needs help there are probably things you can do - be there with them; make sure you say they're calm when you talk about them on the phone; make sure there are no weapons around.

[a3n]

"Young black men killed by US police at highest rate in year of 1,134 deaths" http://www.theguardian.com/us-news/2015/dec/31/the-counted-p...

Data on race, mental health, etc.

[tptacek]

If you go through that data entry by entry, you find that in the majority of cases, the victim was brandishing a firearm, and has usually discharged it.

It's an incredibly useful data set; take a month or two and a pair of specific areas and tally the data up. I learned a bunch. For instance: tasers? Way the fuck more dangerous than I thought (and I didn't think they were benign before).

[tzs]

Just to be clear, 1134 is the number killed of all races, genders, and age groups. Young black men were 15% of those, or about 170.

[njloof]

That number would be 5150.

If you ask to be committed, you remain in control and can get help. If you are not in a condition to admit yourself, the only way to deprive you of your civil rights in the US, even for your own safety, is the police.

[tptacek]

That's not quite true in the US. Whether or not you ask to be "committed" (a word you should not use), admitting yourself to the ER or a mental health facility will likely remove most of your control over the situation and will indeed curtail your civil rights.

But if you have to ask whether you should admit yourself to a hospital, do it. If you admit yourself voluntarily, you'll have the option to leave within days, and during those days, you won't have to worry as much about the consequences of your own actions, which by itself can help clear your head.

[mikeash]

When you say "official channels," do you mean 911, a suicide hotline, or something else? I wouldn't be surprised if 911 was a bad choice but I'd have thought/hoped the hotlines would be good.

[jMyles]

Two cases were 911, one case was a campus health center, and the other two were a mental health hotline.

[TazeTSchnitzel]

Awful mental health services are not exclusive to the US either, though perhaps the US is especially bad.

[umanwizard]

I flagged this and tbh I hope dang deletes your comment and this reply.

I agree with you that these are serious problems. But you're still much better off dealing with them than being dead. This post is very unhelpful.

[a3n]

I don't think that was flaggable. This is a real problem, and it is a real dilemma at times whether calling 911 might make things worse. We should feel absolutely free to call for help and not worry about it. But there are risks.

And yes, I agree, if you feel suicidal you should definitely get help, including 911 if your crisis is immediate.

[jMyles]

> I flagged this and tbh I hope dang deletes your comment and this reply.

So, in your mind, we're not even allowed to discuss this problem?

[umanwizard]

Sure, but not in response to this particular comment, IMO

[mei0Iesh]

You make it sound like "If you're a criminal, please talk to someone. Call 1-800-CRIMINAL and tell us your crimes. It's time you got help, by being locked up."