[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.

[chris_wot]

Fair call.