Talk:Involuntary commitment

The contents of this article have been dealt with in a much more informative, neutral, and coherent manner in Involuntary commitment. I would advise that this article needed cleaning up, but the article itself is unnecessary. Therefore, I recommend that it be deleted in its entirety. IronDuke 22:24, 4 November 2005 (UTC)[reply]

What are you talking about? This is the talk page for that article! --Daniel C. Boyer 17:26, 5 November 2005 (UTC)[reply]

Added mention of controversy (from a civil-liberties perspective) over civil commitment.

Daniel C. Boyer

Added more text. One needs to make a distinction between psychiatric commitment and civil commitment. People have been arguing about psychiatric commitment since the 1960's, and that issue is well argued. Civil commitment for sex offenders is something entirely new.

Added mention of Lawerence Stevens as exception to "few would argue that under no circumstances should a psychiatric patient be held against their will".

Daniel C. Boyer

Added mention of ordering people to take psychiatric medication as an alternative to involuntary commitment and a cause for the decreased incidence of involuntary commitment.

Daniel C. Boyer

Added link to Lawrence Stevens article.

Daniel C. Boyer

Added parenthetical mention of "mad liberation."

Daniel C. Boyer

Added mention of nearly-synonymous "mental hygiene" laws.

Daniel C. Boyer

The "danger to self or others" standard of the Baker Act (paralleled in many other mental hygiene laws) is supposed to be protective of the civil liberties of those who might be wrongly committed, which is ridiculous as it is hardly a bright-line test and is indeed one of nearly infinitely open-ended ambiguity. The test is based on the assumption that it will be used in a certain way, but facially almost every individual could be called a "danger to self or others." Judge Watchler has pointed out (and I maintain this is putting it mildly) that "dangerousness" is "open to various interpretations" (Mtr. of Torsney, 47 N.Y. 2d 667, 686-87 (Ct. App. 1979)(Wachtler, J., dissenting).

Daniel C. Boyer

Might the mention of the Stevens article on suicide be better placed under the article on suicide? What is its relevance to this?

Daniel C. Boyer

I am concerned that the passage relating to the 1960s ("the involuntary commitment were lax and this led to a number of horror stories of people with no mental illness being trapped in an institution") might lead readers to believe this does not occur today when it can and does. Could this be reworked to relieve this possible misimpression?

Daniel C. Boyer

See here for a possible criticism of involuntary commitment. --Daniel C. Boyer

How can criticism of involuntary commitment by believers in the theory of reality enforcement be mentioned in this article (what is the best NPOV way to do this)? --Daniel C. Boyer

"It is typically used against patients with mental illness, particularly schizophrenia."

This begs the questions: Are people wrongly committed, even accidentally or on purpose? This needs to be more clearly explained to allow for the possibility that people who have no mental illness are wrongly committed. This has a pro-involuntary-commitment bias. --Daniel C. Boyer

"Unfortunately, community care facilities were in general not well-funded, and this resulted in many mental patients left to fend for themselves." This is not NPOV. Perhaps this should be rewritten to indicate that the flaw in the theory, when put into practice, was that "community care facilities were in general not well-funded" rather than using the word "unfortunately". --Daniel C. Boyer

This entire article is U.S.-centric and revisions should be made to it to make it less so. --Daniel C. Boyer 14:16 Oct 2, 2002 (UTC)

The practice of involuntary commitment does not necessarily violate the First Amendment (see anti-psychiatry), but it might. --Daniel C. Boyer

I am puzzled by commitment of persons suffering from dementia (senile aswell as pre-senile) isn't focused in the article. That ought to be a pretty large group, also in USA. -- Johan Magnus 01:08 19 May 2003 (UTC)

State law varies as to whether people can be committed for reasons that are not, stricta sensu, "mental illness" (if you believe in such a thing or if such a thing exists); for instance, Michigan law specificially excludes the involuntary commitment of epileptics, drug addicts and alcoholics unless they otherwise qualify under the statute. This is going to be a very complicated subject if we include it in this article, although I think someone should make a start on this. --Daniel C. Boyer 18:03 12 Jul 2003 (UTC)

Criticism that this article is U.S.-centric (with which I strongly agree) should be solved by adding info on the situation in other countries. --Daniel C. Boyer 21:37, 9 Nov 2003 (UTC)

"Gravely disabled" standard

Should this be mentioned and if so how should it be approached? --Daniel C. Boyer 19:18, 3 Oct 2004 (UTC)

I have made a beginning on this standard but am conscious that it may be placed in the wrong area. Any help with this would be appreciated. --Daniel C. Boyer 15:42, 6 Oct 2004 (UTC)

Halfway house

How in this article should the subject of halfway houses be dealt with? --Daniel C. Boyer 19:53, 3 Oct 2004 (UTC)

Structure and some points

This article currently has no headings in the body of the text. These need to be inserted. As a psychiatrist reading this I find no mention of WHY psychiatrist use involuntary commitment. The article has a creeping POV that seems to imply that involuntary commitment is necessarily bad.

Involuntary commitment is the practice of using legal means or forms to commit a person to a mental hospital, insane asylum or psychiatric ward against the will or over the protests of that person.

No mention is made of it being used in the absence of informed consent or the inability to obtain informed consent because of psychotic thinking. For instance, a severely depressed person may passively accept hospitalisation but be incapable of giving informed consent due to psychomotor retardation.

I would strongly support mention of this if it is recognized that this itself is a POV and prefaced accordingly. --Daniel C. Boyer 16:04, 4 Oct 2004 (UTC)

Involuntary commitment is typically used against people diagnosed with ... [my stress]

What is wrong with the word "for" instead of "against". Does "against" have a special legal meaning in this context?

The commitment hearing or hearing protesting commitment is going to be adversarial, given the nature of the U.S. legal system, with the person wishing to avoid involuntary commitment or be freed from involuntary commitment (and his lawyer) attempting to get that result, and the prosecutor (supported, probably, by a psychiatrist or psychiatrists) attempting to get the individual committed or to continue being hospitalized. If the hearing was not goint to be adversarial, the individual would opt for voluntary commitment. Some psychiatrists and others may argue that commitment hearings should take a different form, or argue that they are acting in the best interests of the individual who has been or is potentially going to be involuntarily committed, and this should by all means be mentioned in the article, but it does not detract from the use of the word "against" being appropriate in this context as it adequately reflects the adversarial nature of the proceedings. --Daniel C. Boyer 16:04, 4 Oct 2004 (UTC)

Thanks, I did think that there might be a special legal reason for its use. --CloudSurfer 18:12, 4 Oct 2004 (UTC)

Though few would argue that under no circumstances should a psychiatric patient be held against his will, ...

This would be clearer as, "Most people would agree that there are circumstances when some psychiatric patients should be held without their consent, ..."

Maybe, but it would have to be tweaked as the passage as it reads now goes on to state exceptions. I would have no problem with this as long as the grammar is edited accordingly. --Daniel C. Boyer 16:04, 4 Oct 2004 (UTC)

The exeptions would still follow this statement as they remain exceptions to the "Most people would agree" statement. --CloudSurfer 18:12, 4 Oct 2004 (UTC)

I have not read the E. Fuller Torrey quote before. Wouldn't it be better to say WHY he said this? I suspect it is because the current laws he was talking about are too restrictive and require violence or danger before a person who needs treatment but refuses it can be treated involuntarily.--CloudSurfer 22:48, 3 Oct 2004 (UTC)

I should introduce where I am coming from. As an Australian psychiatrist I am completely unfamiliar with what such a court hearing would be like. Australian law allows for involuntary treatment without a court hearing but has several levels of checks and balances including a required hearing on request or after a specified time. A lawer is one of the three on the panel of such hearings. Thus there is no adversarial process at all as any legal hearing is more on the inquisitorial model, or whatever the legal term is. I do not think that the mental state of a severely depressed person or, perhaps more extremely, a person with catatonia is really POV. Anyone who observes them will see that they do not respond to questions in a meaningful way. In catatonia there is no response at all. In severe depression there may, perhaps after some minutes, be a mumbled response but that can be the extent of it. Neither is "fit to plead". I am not suggesting that these categories are the majority of people treated involuntarily. The next issue is informed consent and I agree that this is potentially POV but to what extent. If a person is psychotic then the psychosis can lead them to be incapable of understanding the nature of the issues at hand. If they are responding to voices telling them that everyone around them is part of a alien plot to incarcerate and torture them and they have accompanying delusions that fit with this then is it then POV to say they cannot give "informed consent" in the legal meaning of that term?

By the way, this does point to an issue that the article should be divided up into jurisdictions that require initial legal hearings and those that do not. --CloudSurfer 18:06, 4 Oct 2004 (UTC)

Yes, it would be quite good if this were done, and this page needs to become less U.S.-centric. Any info you could include on the situation in Australia would be most helpful. --Daniel C. Boyer 19:38, 4 Oct 2004 (UTC)

"classic paper"

I presume you have removed the word "classic" from the description of Rosenhan's paper on POV grounds but I think it should be reinstated. Many papers are produced only to be read and forgotten. Some achieve the standard of being referenced many times and some achieve even more significance. These papers become seminal works that are read, referenced and respected as major achievements in the field. The contents of these papers are taught to all students of the field. This is what is usually understood by the term "classic paper", or at least in my experience. The qualifier "classic" thus imparts information and without this qualifier the impact of this paper on the field of psychiatry is less obvious. For instance, the title of the paper was in my memory when I wrote this section. I was then able to look it up on the internet and found 906 references on Google. By comparison "Outcome of schizophrenia: some transcultural observations with particular reference to developing countries" returns 146 sites. This is not a classic paper but falls into the middle of the groups I have mentioned. The main article on the Rosenhan experiment states, "The study is considered an important and influential criticism of psychiatric diagnosis." The SOED's first defintion for classic is "Of the first rank or authority; standard, leading." That is the meaning I intended. --CloudSurfer 07:40, 7 Oct 2004 (UTC)

CCHR

How should the controversial CCHR (with its connexion to Scientology) be brought up in this article? --Daniel C.Boyer 18:54, 10 Oct 2004 (UTC)

My view is with a link that goes to an article that gives a background of the controversy. I know somewhere else there is a direct link to their site which might mean that unsuspecting people might take it at face value. I think if people have read the Scientology stuff then they can judge for themselves. --CloudSurfer 22:44, 10 Oct 2004 (UTC)

This would be good. --Daniel C. Boyer 20:26, 12 Oct 2004 (UTC)

Protests

Is it true that Anyone may begin the commitment process by filing with the probate court an application alleging that someone has psychiatric disabilities and is dangerous to himself or others or gravely disabled. ? [1] Has anyone tried to use this to say that a politician (ie Bush) was insane by this method? You could propably prove that he is "Dangerous to himself or others "-- Guthrie 17:23, 7 October 2005 (UTC)[reply]

I would be quite interested in use of this as a protest and the results of any research into this. --Daniel C. Boyer 19:28, 10 October 2005 (UTC)[reply]

Suggest merge with involuntary treatment

The topics on involuntary treatment are covered on this page; perhaps a merger? Andrew73 14:40, 27 December 2005 (UTC)[reply]

That may not work, since 'involuntary commitment' infers legal means have been used to enforce commitment or coerce compliance with psychotropic drug prescription regimes, whereas involuntary 'treatment' (a euphemistic term for methods that generally inflict mild to severe brain damage) often begins with forced drugging during a 72 hour hold, even before legal proceedings begin. Even without a court order, prior to release from a ward, patients may be subjected to long lasting injections (e.g., haloperidol). Ombudsman 04:33, 28 December 2005 (UTC)[reply]

Certainly in British Columbia patients can be treated involuntarily without a court proceeding. Francesca Allan of MindFreedomBC 04:56, 28 December 2005 (UTC)[reply]

The same holds true in the United States. In emergency situations, combative or pscyhotic patients are treated with neuroleptics like haloperidol in order to stabilize the patient and permit care. This may be viewed as "forced drugging," though this term seems a bit extreme as well; I doubt that short term exposure to these drugs causes permanent damage (aside from the risk of neuroleptic malignant syndrome). Andrew73 13:18, 28 December 2005 (UTC)[reply]

In many cases, "combative" patients are just trying to prevent psychiatric assault. Resistance is considered assault. And it's not only emergency situations -- such "treatment" can go on for months without a court proceeding. Being jumped by guards, thrown on the floor and injected is the very definition of forced drugging. I can't imagine wanting to dress it up as anything else. Once you're incarcerated on a psych ward, it's up to you to prove yourself sane. It's the complete opposite of the way it works in the criminal justice system. Francesca Allan of MindFreedomBC 15:54, 28 December 2005 (UTC)[reply]

At the same time, "combative" patients may be posing a physical threat to themselves and or other individuals. "Forced drugging" in this situation, on an emergent, short-term basis is justifiable. Long term involuntary commitment/treatment, at least in the state where I work, is regulated and cannot be done arbitrarily. Andrew73 17:12, 28 December 2005 (UTC)[reply]

Really? What if the only source of the "combat" is that the patient very much doesn't want to be treated? Is slamming people onto the floor and injecting them with neuroleptics still okay? Francesca Allan of MindFreedomBC 02:05, 29 December 2005 (UTC)[reply]

I was referring more specifically to patients who pose a danger to themselves or other individuals; not a harmdless individual who was only refusing treatment. Andrew73 02:30, 29 December 2005 (UTC)[reply]

The trouble is that it's impossible to correctly judge who poses a danger. And the standard of what constitutes danger varies wildly. "Only refusing treatment" gets many people locked up. Psychiatric treatment, especially in emergency situtations, is brutal and tends to escalate violence. We wouldn't allow convicted felons to be treated as poorly as we treat mental patients. Forced drugging is NEVER justifiable. It's a human rights violation that's got to stop. Francesca Allan of MindFreedomBC 03:13, 29 December 2005 (UTC)[reply]

I Oppose the merger as the two articles describe separate things. It is possible (although not necessarily legal) to be involuntarily detained/committed without being treated and involuntarily treated without being detained. The latter possibility is currently being discussed in the UK in revision of the Mental Health Act. The discussion above about the issue of human rights and involuntary treatment I believe qualifies this article for inclusion in category:medical ethics. --Vincej 05:59, 30 December 2005 (UTC)[reply]

Of course the two articles need to be combined. Contrary to the remarks of Vincej, commitment does not necessarily mean detainment. One can be committed for involuntary treatment without being detained (see Assisted Outpatient Commitment) This is just another article in which fringe antipsychiatry advocates and Scientologists will ply their wares. I will keep an on eye on the site and eliminate the nonsense POV until it is inevitably merged.--24.55.228.56 16:04, 30 December 2005 (UTC)[reply]

Actually, 24.55, perhaps you should try reading Vince's comments again as you appear to have completely misunderstood what he was saying. Any reason you must be so offensive? I support human rights in psychiatry. I am not a "fringe antipsychiatry advocate" nor a "scientologist" nor am I "plying any wares." Contrary to your self-serving delusion, you haven't been "eliminating nonsense POV" but just offensively and anonymously reverting various editors' useful input. Your edits are just as POV as the ones you attempt to "correct." As is evidenced on your talk page, your conduct has not gone unnoticed by wiki admin. Francesca Allan of MindFreedomBC 02:51, 31 December 2005 (UTC)[reply]

"[T]here’s no question that MindFreedom Support Coalition International is on the fringe of psychiatric-reform advocacy." - The Boston Phoenix[2] --24.55.228.56 04:39, 31 December 2005 (UTC)[reply]

If you read it, then it must be true. Francesca Allan of MindFreedomBC 04:42, 31 December 2005 (UTC)[reply]

And now let's have that quote in its context:

"That said, there’s no question that MindFreedom Support Coalition International is on the fringe of psychiatric-reform advocacy. Toby Fisher of the National Alliance for the Mentally Ill (NAMI), in Massachusetts, declines to comment specifically on the group. "I don’t know much about them," he says."

So, 24.55, you're as dishonest as you are offensive. Francesca Allan of MindFreedomBC 04:43, 31 December 2005 (UTC)[reply]