[matheusmoreira]

Yeah, I've read some incredible stories. Locking the doors behind the patient. Using some tiny remark as cause for involuntary institutionalization. It made me think american psychiatry was like american prisons where they get paid per person and are therefore incentivized to stuff as many people in the building as possible.

[lotsofpulp]

All the while I can drive 15 min and find thousands of obviously mentally ill people in need of involuntary mental health treatment (the type perhaps not even available at this point in the US) wandering around and the police cannot do anything about it because their only avenue for detaining them is to wait until they catch them committing a crime. And even then they are shortly released onto their own recognizance if it is anything short of attempted murder.

[jac241]

The reason they aren't in a psychiatric hospital is because the only reasons we can involuntarily commit someone is if they are a risk to themselves or others, and like stated elsewhere in the thread is generally reassessed by a judicial process every 72 hours depending on the state. What I'm reading in your post is that you're in favor of involuntarily holding more people which I find interesting because many others in the thread are complaining that it's too easy to have someone committed. There are a lot of armchair psychiatrists in this thread who have never seen someone in psychosis or truly manic suggesting that it's a joke to have someone committed. I spent 3 weeks rotating in a psych emergency department and only saw 2 patients out of probably more than one hundred total patients admitted for being suicidal. Neither were involuntary. From what I've seen unless you have just attempted or have a concrete plan to attempt suicide again you're not going to be admitted. There are just too many people who are in not-on-the-same-planet level of psychosis or mania that are taking up beds to admit someone who is not really about to attempt suicide.

Not trying to pick on your post or anything just thought it is a good example to say that it's maybe not as easy as it may seem to decide who gets admitted/committed, and the dichotomy in this thread shows that point.

Regarding potential overuse of sedation (benzos) or antipsychotics in nursing homes, it's easier for a nurse to push a doctor to prescribe meds to "snow" a patient than to spend time in the room and try to reorient a sundowning delirious dementia patient.

[lotsofpulp]

> Not trying to pick on your post or anything just thought it is a good example to say that it's maybe not as easy as it may seem to decide who gets admitted/committed, and the dichotomy in this thread shows that point.

Of course the topic of involuntary committal and people’s rights and prevention of abuse is extremely difficult, and that is why the pendulum swings back and forth. I just think it might be at or nearing the other end of the swing.

[vkou]

Keep in mind that the involuntary commitment system that was largely dismantled in the 80s was a hotbed of abuse - both of the people committed to it, and of the reasons for which people would get committed to it.

Falling out with your business partner? Want to get rid of your wife, so you can move in with your mistress? Your kid came out gay, or atheist? Dad has money, and you don't want to wait for him to die? Involuntary commitment was a fantastic solution for all of these problems.

If you weren't crazy before you get sent to a mental institution, you almost certainly would be after you involuntarily spent some time in one.

[lotsofpulp]

Yes, there is of course potential for abuse, but I am thinking the pendulum has swung too far in the other direction now.

[EMM_386]

> All the while I can drive 15 min and find thousands of obviously mentally ill people in need of involuntary mental health treatment. because their only avenue for detaining them is to wait until they catch them committing a crime.

Let's say you were wandering the streets of a major city, looking very odd to everyone else and muttering to yourself (likely someone you'd see on a drive who is "obviously mentally ill"), but otherwise very happy and not breaking any laws, would you want the police to be able to snatch you off the street and involuntarily lock you away?

Likely not, and this is why the laws in some countries like the US are the way they are.

[lotsofpulp]

> but otherwise very happy and not breaking any laws

This is obviously not the case with a sizable portion of the people wandering the streets. An ideal world is nice to theorize, but practically, there will always be type 1 and type 2 errors.

Transparency and other efforts to reduce them should of course be a never ending goal, but abandoning a problem completely because it cannot be done perfectly is not a long term solution either.

> Likely not, and this is why the laws in some countries like the US are the way they are.

I think the laws are the way they are because it was cheaper to simply dismantle whatever existed of the mental health care system rather than invest in improving it. And it is still cheaper to ignore it on the federal level while the rich people cloister themselves in affluent suburbs and gated communities.

[EMM_386]

> This is obviously not the case with a sizable portion of the people wandering the streets.

I'll bite.

Give me an example of someone who fits your definition of someone who should be forcibly taken under the wing of mental health treatment (whatever that entails) who isn't breaking any laws. Putting someone into a mental institution strips of them of all rights and requires convincing a judge to ever get out.

This logic essentially wants to "arrest" people without "arresting" them because they aren't doing anything illegal. That requires a very precise definition of the conditions under which you can do this.

Very much like a law.

[lotsofpulp]

> Give me an example of someone who fits your definition of someone who should be forcibly taken under the wing of mental health treatment (whatever that entails) who isn't breaking any laws.

I did not suggest involuntary committal for those not breaking laws. I wrote a sizable portion of those who need mental health treatment are breaking laws (more importantly, they are behaving in a manner that is destructive to other members of society - littering, biological hazards, fire hazards, property crime, etc). Whether it be for schizophrenia, meth and drug addiction, or some combination thereof that make involuntary mental health treatment the only option.

[SkyPuncher]

It's less about pay and more about liability. Mental health is terrified that someone will do something to harm themselves.

The incentive systems have yet to realize that there needs to be some balance in bad outcomes to support the good ones. It results in a system where any mention of self-harm is taken extremely seriously, even at the cost of a larger treatment plan.

[matheusmoreira]

> Mental health is terrified that someone will do something to harm themselves.

I can understand that but involuntary institutionalization should be implemented only if there's an immediate danger to someone's life.

A currently euthymic person mentioning casually there were times they wished they were dead is not cause for institutionalization.

A depressed person who not only thinks about taking their own life but has made plans for it and has the means to execute that plan is in great danger and in need of immediate help.

[jac241]

I think we are seeing literal survivorship bias here where the person whose texts were taken too seriously is alive to tell their tale and everyone whose weren't successfully committed suicide.