Why Do We Say That Mental Health Detention is Discrimination?

Tina Minkowitz, Esq.

June 13, 2014

The disability community, including users and survivors of psychiatry, has sent a letter (drafted and circulated by WNUSP) to the UN Human Rights Committee urging that treaty monitoring body to follow the Committee on the Rights of Persons with Disabilities in prohibiting all mental health detention.  The signatories came from all regions of the world and include user/survivor organizations, disability organizations, other human rights organizations and individual experts.  The Special Rapporteur on Disability sent his own statement elaborating this point, and the organization Autistic Minority International has also submitted an excellent paper.  All these submissions can be found on the website of the Human Rights Committee.

Since our letter is quite technical in pointing out the divergence of the Human Rights Committee’s position from that of the CRPD, which is a higher standard of human rights protection, I would like to bring out some additional points that may be helpful in our advocacy.

Why Do We Say That Mental Health Detention is Discrimination, and Why is it Prohibited Under the CRPD?  

Detention in the mental health context is discrimination because the threshold criterion for such detention is the existence of an actual or perceived disability as evidenced by a psychiatric diagnosis.  Indeed, UN standards in force prior to the CRPD, such as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care (MI Principles), permitted mental health detention only of individuals who are so diagnosed according to international standards.  This criterion that is similarly found in mental health legislation throughout the world exposes mental health detention per se as a discriminatory detention regime that is contrary to the Convention on the Rights of Persons with Disabilities.

Mental health detention cannot be disability-neutral in theory or in practice.  Its raison-d’être is to confine people with psychosocial disabilities.  The individuals so confined are subjected to a regime of medical supervision, as well as to medical and psychological interventions without their free and informed consent.  Medical personnel have a decisive influence in determining how long the person remains under detention, according to medical opinion about the person’s behavior and decision-making skills.   This represents a medical model approach to psychosocial disability, which is contrary to the CRPD and in particular contrary to Article 12 as explained in General Comment No. 1 of the Committee on the Rights of Persons with Disabilities.

People who experience difficulties in living that are labeled as madness or mental illness, or whose behavior and self-expression are perceived as such by others, are people with disabilities under the CRPD and under the earlier non-binding Standard Rules for the Equalization of Opportunities of Persons with Disabilities.  It is untenable to claim that a mental health detention regime, which exclusively targets such individuals for deprivation of liberty and medical interventions against the person’s will, is anything other than discrimination.

Mental health laws typically include criteria in addition to the existence of a psychiatric diagnosis, in particular a forecast that the person may harm oneself or others.  It is important to underline that this is a secondary criterion, applied only to individuals who have been labeled with a psychiatric diagnosis.  Neither the international standards in force prior to the CRPD nor any domestic mental health legislation would countenance the detention in mental health facilities of any individual who is not labeled with a psychiatric diagnosis, even if there is reason to believe that the person may harm oneself or others.  Police and the criminal justice system are the usual mechanism to deal with threats to others; if they are not adequate the society needs to debate the balance of public safety and individual freedoms and develop more effective measures that do not discriminate based on disability.  Danger to oneself is addressed either by laws that apply to the entire population (such as laws requiring the use of seatbelts) or by harm-reduction campaigns that promote safer behaviors while respecting individual autonomy.

A preventive detention regime that does not target people with psychosocial disabilities and does not rely on a medical model of psychosocial disability for its definition and functioning, would not be discriminatory.  The CRPD does not prevent any state from adopting a preventive detention regime by which security personnel (not medical personnel) identify and incarcerate individuals who are believed to be dangerous to society.  Persons with disabilities would be subject to such detention on an equal basis with others, with no violation of CRPD unless there were a disproportionate impact or hidden purpose to confine people on the de facto basis of psychosocial disability.  However, even a disability-neutral regime would raise questions as to legitimate aim and proportionality of detention based on a prediction of future behavior, which can never be effectively disproven and is thus likely to be arbitrary.

In sum, the essential nature of mental health detention as a discriminatory regime of detention cannot be hidden or legitimized by combining it with secondary criteria.  Discrimination plus disability-neutral criteria still equals discrimination.  As applied by the Committee on the Rights of Persons with Disabilities, CRPD Article 14 prohibits all mental health detention, including detention regimes that characterize persons with psychosocial disabilities as being dangerous to oneself or others.

Mental health detention has been regulated by civil commitment laws and also under laws of criminal procedure.  Mental health detention is no more legitimate when used as a security measure pursuant to criminal proceedings, than it is in the civil context.  The CRPD Committee has stated that persons with psychosocial disabilities who are subject to criminal proceedings must have the same guarantees and penalties that are applied to others, thus ruling out the use of medicalized security regimes such as mental health detention.  Beyond this standard, it is expected that the CRPD Committee along with disabled people’s organizations and others will develop an appropriate framework to take account of concerns for substantive fairness in the attribution of criminal liability in ways that do not single out people with psychosocial disabilities or characterize them offensively as being incapable of moral judgment and thus dangerous to the community.

 

Tina Minkowitz, Esq.

Mad Law and Human Rights: An attorney and psychiatric survivor, Tina Minkowitz writes on the new perspectives in human rights law that emerged in the work by users and survivors of psychiatry on the Convention on the Rights of Persons with Disabilities.

 

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69 thoughts on “Why Do We Say That Mental Health Detention is Discrimination?

  1. Tina–Way to go.

    Although I know that it is not literally correct to say “No one gets this–” about the point you clearly elucidate here, but it is a fact that the words function right. Whole hospitals are staffed with people who remain confused about the logical implications of their exercise of powers to detain and coerce based solely on the figural mental disease component of the person and its conception.

    Whole schools, whole newspapers, and most decidely whole academic departments in the behavioral sciences. Legislatures? Could be. Judiciaries? It looks like it, but probably is not the case. Conventions of psychiatrists? We have the hypocrites to trust in, understanding that they know better.

  2. Since for myriad rational reasons we’re never going to do away with involuntary hospitalization altogether, I like the idea of disability-neutral policy. If a police officer comes across someone standing on a bridge railing preparing to jump, I think most people are okay with him preventing that suicide. Ditto intervention for somebody expressing their fantasies about killing a group of school children. What the person’s psychiatric diagnosis happens to be (or if there even is a psychiatric diagnosis) is irrelevant.

    You guys have no idea how lucky you are in the States. Up here in BC, the standard for commitment is as low as “has a mental disorder “and is “capable of deterioration.” I would be thrilled if that standard were raised to imminent danger to self or others. Another option I would like to see explored is abolishing the notion that forced hospitalization must mean forced drugging.

    • “I think most people are okay with him preventing that suicide.”
      In what way? By forcing this person to the ground, beating them up and dragging to the ambulance followed by months of incarceration?
      Honestly, if someone wants to jump it should be their decision. It’s an arrogant assumption that someone has a right to decide about other person’s right to live or die.
      That is not the same as saying that one should just stand idly by and do nothing. In most cases if you offer someone mediation, propose some reasonable help and solutions they will come down and talk to you. That is also true for many forms of violence committed under extreme emotional state (but there of course you are right to use coercion to protect others). I don’t see why people who are “danger to self” should be mistreated just because people in the current system don’t know better.

      • No, beating and drugging someone is not humane and effective suicide prevention. You say it’s arrogant to decide that someone can’t kill himself in front of you but then right after that you seem to acknowledge that standing idly by is not the right answer either.

        Sure, in some cases, mediation can be used to talk someone down but in other cases that’s not a possibility. Without mental health legislation, there is no mechanism to prevent a suicide in one of these latter cases. That’s why these efforts are unrealistic and will never gain the support of the public (or, more importantly, our lawmakers).

        This time and energy should instead be put into training suicide prevention and mental health crisis experts so intervention entails as little intrusion as possible.

        • “You say it’s arrogant to decide that someone can’t kill himself in front of you but then right after that you seem to acknowledge that standing idly by is not the right answer either. ”
          Well, here is what I think is a responsible answer to a “public nuisance” scenario aka guy trying to jump of the bridge: you call the right authority and either leave or if you feel like it you can stay until they arrive and try to talk the person out of it. Your choice. Nobody forces you to stay and watch as he’s jumping. What the authority does depends on a situation: if the guy is a danger to public safety and order (like blocks the bridge for the whole city) then sure you want to bring him down asap. Usually how it’s done is by negotiating. When you bring this person down you inform them politely that:
          a) committing suicide in a way that’s stopping traffic in the whole city is not a good idea and will result in an arrest and stay in jail for 24h or whatever period is on the books plus criminal charges so he should not climb back on the bridge
          b) offer him to be taken to a place where he can receive help (voluntarily) c) maybe he’s already changes his mind and wants to go home (and maybe kill himself there – that’s his problem).
          Is that really so difficult? Most people will take help providing that the the current psychiatric system is changed into something reasonable.

          Personally I would have welcomed an offer to go to some place safe and receive support there at the time when I was in an “extreme state of mind”. Providing that I was allowed to leave any time I wanted and that someone would help me to handle my life in that time (got me a leave from work, took care of my pet so it doesn’t starve alone in the house, etc.). No such help was available: even when I went voluntarily to seek help (big mistake) I was forced into doing things that traumatised me and made me much worse.

          • I apologize if I’ve misunderstood you but if you support abolition of mental health legislation, then the only thing left to prevent a suicide is the criminal justice system. If attempting suicide correctly remains not a crime and there are no mental health laws, then there is literally nothing a person can do to intervene without himself committing “assault” against the potential suicide.

          • Well, you’ve missed the point entirely then. Suicide should be legal and you can forcibly prevent it only if it interferes with public safety etc. (like guy climbing on a busy bridge and so on).
            You can also have legislation giving you the right to try to save a person who’s unconscious (I think that’s also on the books – doctors don’t have to ask for consent from accident victims either) but you should not be able to break into someone’s flat and drag them out of there because you think they’re going to hurt themselves.
            Otherwise the suicide is illegal whether you call it that or not and punishable by detention in the psych ward and potentially drugging and other forms of psychiatric abuse.

    • Btw, what about people who try to commit suicide because they cannot handle abuse? I know of cases like that. This is another example of re-victimisation and victim blaming – the perpetrator walks, the victim is labelled insane and not able to decide about herself and locked up involuntarily. Which by the way goes on her permanent record and can ruin her life for good.

        • “However, the answer is not to make it illegal to stop a suicide or to prevent a mass shooting.”
          Stopping someone trying to shoot people falls into the responsibilities of the legal system. Cops show up and handle the situation. No need to get “mental health system” involved. If you’re talking about “preventing” mass shootings with mental health system – most if not all shooters were under such “care”, many taking meds, and it didn’t help much so either you can’t prevent it or the current model sucks.
          On the suicide: depends what you mean by stopping. Sure, if someone has taken pills and is unconscious you take them to hospital and offer help. But when they wake up you don’t lock them up in this hospital and drug them with something else – you ask them nicely if they want to accept any form of support you may have to offer and if they don’t want it let them walk. If there is an emergency, someone tries to jump of the building sure you take them down (it’s a public safety issue afterall) but then you offer them help and not abuse them and detain against their will. The vast majority of suicidal people will take help if it’s offered to them on voluntary terms. And if they don’t they have a right to refuse.

          • B, the reason the cops can show up and get involved is BECAUSE of mental health legislation. Otherwise, they would have no authority to do so. Expressing disturbing thoughts (such as fantasies about killing children) is not in itself against the law.

            Your argument doesn’t work in the real world. I agree it is always better to try voluntary treatment first. But the reality is sometimes that’s just not possible. That’s why we will never, ever be able to do without mental health legislation and pushing for abolition erodes the credibility of the entire psych rights movement.

          • Francesca Allan:
            “B, the reason the cops can show up and get involved is BECAUSE of mental health legislation”
            No, they show up because the person is posing a risk to public safety or disturbing the traffic or whatever other legal term is for that action. No mental health legislation needed.
            “I agree it is always better to try voluntary treatment first.”
            First of all, what “treatment”? Because if you’re on MIA you should no that drugging is not an answer, frequently it makes matters worse. In my mind the meaningful “treatment” can only be voluntary, you can’t force someone to want to live. Secondly, there is no voluntary treatment at all in these cases: “are you going voluntarily or should we force you?” is as voluntary as someone putting a pistol to you’re head and asking if you’re going to give them the money “voluntarily”. It’s a legal fiction.

          • Francesca: “B, the reason the cops can show up and get involved is BECAUSE of mental health legislation.” B responds: “No, they show up because the person is posing a risk to public safety or disturbing the traffic or whatever other legal term is for that action.”

            No, I can’t see that standing on a bridge railing is a criminal activity. Sure, it may distract some drivers but what law does that fall under? Ditto writing down fantasies about killing school children. There’s no law against free speech. So, yes, mental health legislation is required.

            “First of all, what ‘treatment’?” Treatment can be any number of things depending on the person and the particular circumstances.

            “Because if you’re on MIA you should no that drugging is not an answer, frequently it makes matters worse.” Well, I have to disagree here too. I am in fact a contributor to MiA and I agree that drugging is not always the ONLY answer and I also agree that it can make things worse but I certainly don’t agree there is never, ever any value in it.

            “Secondly, there is no voluntary treatment at all in these cases: “are you going voluntarily or should we force you?” is as voluntary as someone putting a pistol to you’re head and asking if you’re going to give them the money “voluntarily”. It’s a legal fiction.” Yes, what you’re describing is coercion and that’s one area we should really be focussing on. We need to ensure that consent is true consent, i.e. does not come with the threat of force. That’s not to say though that involuntary treatment is never warranted.

          • “No, I can’t see that standing on a bridge railing is a criminal activity. ”
            If it’s interrupting the traffic – there was a case like that in press a year ago when the guy basically stopped the trains for the whole day because he was standing on the railway bridge. That is not legal.
            “Yes, what you’re describing is coercion and that’s one area we should really be focussing on. We need to ensure that consent is true consent, i.e. does not come with the threat of force.”
            OK, so you’ve got the situation when you pulled the guy off the bridge and he doesn’t want to go to a hospital voluntarily – what do you do? If you coerce him then it basically means that the whole idea of true consent goes to trash because no matter what he says the result is the same (well, maybe if he goes voluntarily he won’t be abused that much… maybe). Why do you think people who feel suicidal or psychotic avoid telling anyone or looking for “help”? You’re taking the right to decide about themselves from them and people realise that. So either you abolish coercion altogether or you can forget about “voluntary” – it will always be under the threat of force.
            ” drugging is not always the ONLY answer (…) but I certainly don’t agree there is never, ever any value in it.”
            Forced drugging? If someone agrees to take a tranquilizer (with INFORMED consent, not how it’s usually done) then I’m also fine with it but forced drugging should be illegal under any circumstances.
            When it comes to the whole thing of mental health legislation – well we’ve tried that for a while and the results are unconvincing to say the least (some would say disastrous): http://www.madinamerica.com/2014/01/evidence-that-more-psychiatry-means-more-suicide/
            Maybe it’s time to actually try it differently? From my experience when you give people trust and allow them to take responsibility for themselves and act as their partner they do things better and more reliably than when you’re trying to control them. It works at work, in relationships and I believe it would work in mental healthcare. Sure there will be instances when it doesn’t work but the track record of coercion is so bad that it’s worth a try.

          • B, you say the bridge jumper is breaking the law IF he’s interrupting traffic. Okay, then, what if he ISN’T interrupting traffic? You’re bogging the argument down with inane details and frankly you’re not offering much here.

          • B, your position on involuntary treatment ignores real world situations that are never going to disappear. There are rare and extraordinary circumstances where involuntary treatment in the form of emergency crisis intervention is the only humane and ethical thing to do. The far more serious issue arises once the patient is stabilized.

            With respect, I am not learning anything from you and I don’t get the feeling you are even understanding what I’m saying so I’ll bow out of this discussion now.

          • “Okay, then, what if he ISN’T interrupting traffic?”
            Then he should not be coerced to coming down or getting “treated”. I am not against the existence of crisis intervention teams which could be called in in order to try to calm the person down and get him/her out of the situation voluntarily but I’m totally against any coercion unless law is being broken. If he wants to jump and a crisis team cannot persuade him not to then it’s his right to kill himself. There is no evidence that coercion prevents suicide – even if you take the guy down by force and “treat” him he can still kill himself (actually a lot of people do that as soon as they’re out of a hospital which shows how pathetically ineffective the whole thing is). On the other hand most people who threaten suicide don’t commit it and getting a crisis team to talk to them and offer some help on voluntary basis would probably work most of the time.

  3. Also, as I see it, the much more serious problem is outpatient commitment not hospitalization which tends to be traumatic but short. The criteria for involuntary out/inpatient treatment ought to be the same and clearly it’s not because there are far more people on community treatment orders than could ever fit into our psych wards.

  4. Dear Mrs. Minkowitz,

    Please forgive me if I misinterpret and misunderstand your line of reasoning here (the reasons for this being that I am neither a lawyer nor a native speaker of English).

    It seems to me that arguing within the framework of the concept of ‚disability‘ per se implies acknowledging the medical model approach through the backdoor, so to speak, because disability, as it is defined internationally if I am not mistaken, means being impaired, socially and/or otherwise, in day-to-day functioning due to a disease process.

    Since the status of so-called mental illnesses/disorders as diseases proper as in ‚somatic‘ is not only highly questionable but also highly unlikely – given not only (recent) scientific research (as presented and referred to on this web site) but also because of fundamental epistemic questions and problems in perception and definition of behavior and most of all mental processes in general, from my point of view, advocacy against discrimination (based on secondary criteria alone) does not cut it in the mid- to long-term of our advocacy; right to the contrary: it could eventually contribute to consolidating and reifying the initial metaphor of psychosocial problems with living as a disease process in an individual human being.

    A line of reasoning against discrimination and for human rights as in ‚international‘ and generic as well as independent of systems of law (common or civil) in my opinion needs to take into account the fundamental human rights violation that triggers and constitutes all secondary criteria:

    the definition of mental illness as a somatic, a brain disease, including the notorious and tautological ‚lack of insight‘ as well as ‚therefore supposedly being a danger to oneself and/or others‘‚ and forcibly imposing this fundamentally flawed concept in the form of a medical „diagnosis“ of so-called mental illnesses on an individual in the first place.

    Respectfully,
    Britta

    • I think that when it comes to UN we have to accept the current legal framework to be able to affect change. The Convention on the Rights of Persons with Disabilities gives you a tool to address the coercion within the system separately from any discussion on the merit of the medical model behind it. It would be unproductive to argue on definitions – it makes sense to work with the current legal framework in order to ban the coercive measures which harm people daily.

      • Point taken, B, as far as “patients” currently in the system and long-standing victims of the current system are concerned.

        And yet, wouldn’t it be wonderful to be able take this human rights issue one step further and “attack” the medical model and most of all its horrific implications once and for all?

          • That’s a good approach. In any case I think the most important is the practical aspect of it all: to stop people from being physically violated, traumatised, degraded and so on. Involuntary “treatment” should be illegal, same as involuntary detention of “mentally ill” unless they are involved in criminal activity (which can be handled by the justice system).

  5. Unless I don’t understand what you mean by mental health “detention,” then the criteria is not the presence or absence of a mental health diagnosis. The criteria is the presence or absence of immanent danger of harm to self or others. Then, the difference between being involuntarily being sent to jail and involuntarily being sent to a psychiatric facility depends on whether or not a judge things there are extenuating circumstances to the behavior, namely cognitive or emotional distress severe enough that a person can not be said to be “rationally aware” of the consequences of his or her actions/behaviors.

    Before thirty people reply and start attacking me, I am NOT endorsing this. I am however, telling you how it works at least in my State. Because I think if we are going to argue against something, we need to at least be sure we accurately describe it as it really is, and accurately argue against it as it really works.

    • Andrew– The most convenient stop to clarify the right and wrong of what you just wanted to mention would be Thomas Szasz in Law, Liberty, and Psychiatry. As you should be able to tell yourself from mentioning “how it is”, the system is all messed up and gives loopholes galore to orthodox measures for controlling the insane.

  6. Absolutely. These laws apply to “sane” people, too. I think it’s worth noting that in the absence of a criminal act (such as uttering threats), imminent danger by itself will not land someone in jail but could get someone involuntarily hospitalized.

    Although this position enrages many, truly imminent danger does justify intervention and has my wholehearted support. To me, the relevant considerations are who applies the criteria, what does the intervention entail, how are the person’s rights vs. public safety balanced, who is advocating for the person, what safeguards exist, what options are being given, etc.

    Emergency intervention isn’t the real problem with our mental health system and the goal of doing away with mental health legislation altogether is hopelessly naïve. Saddest of all, these misguided efforts not only waste time and resources but also actively undermine steps towards realistic, positive change.

    • “Emergency intervention isn’t the real problem with our mental health system.”
      I guess you’re not a victim of these kind of “interventions”. Because they are a problem, I can assure you and not only for the “crazy” folks – there are plenty of people who land in the closed ward because someone set them up (case of Mr Gustl Mollath), because a friend thought it would be a great prank or misunderstood their remarks.
      Such treatment is extremely degrading, humiliating and traumatising and can cause life long trauma. So yes it is a major problem.
      “truly imminent danger does justify intervention and has my wholehearted support”
      You mean danger to self or to others? Because if you mean others I agree but I still think it should be the criminal justice system to handle that. If it’s self then it’s nobody’s business. Anyone should have a right to do what they please with their bodies and there are plenty enough ways to handle people who are suicidal which don’t involve coercion if only anyone cared to use them (or rather to put resources into them).

      • @B 351pm

        Oh so true that these ‘interventions’ are a problem. They are degrading, humiliating and traumatising. In many cases I believe the interventon does more damage to an individual than any criminal charges would.

        There are private investigators here in Australia who are teaching methods of ‘bait and switch’ during acrimonious relationship breakdowns. The difficulty of using police as a weapon is known, so the method involves ‘gaslighting’ ones partner, and then involving mental heath services. A finger point is enough to have someone detained as a result of liability issues. The partner is detained and this tends to anger them. One now calls police and lets them know that the partner has recently been detained by mental health and is angry and aggressive. Police are now weaponised and quite prepared to act. Its working a treat in the Family Courts.

        On the issue of ‘potential for harm to self or others’ I always think about the way that Dante described the heretics in the Inferno. People who believed they could predict the future. Their contrapasso was to have their heads reversed and they had to walk backwards. This might be a solution, in that psychiatrists might get the horse back before the cart.

        Id much rather be detained by police for something ive actually done, rather than have someone detain me for something they think I might do. The first can be resolved in ones own mind, the second leaves one wondering when its all going to happen again at anytime chosen by others. Thats whats so traumatic about it all, for me anyway.

          • It’s the same in Austria and I bet you in many other places in Europe. If the psychiatrists are prosecutors, judges and executioners how can it be really different? Judicial oversight is a joke, patient’s advocacy is a triple joke. It took 8yrs for a guy in Germany who never had anything close to a “mental illness” however defined to get out of the system. And it wasn’t one person who “evaluated” him. Psychiatry’s diagnostic criteria are a joke – give me a DSM and 15 minutes to observe you and talk to you (especially under stressful conditions of being brought in by police and such) and I can give you not one but several diagnosis. There is no oversight over what is written into the documents: there are straight out lies in mine and omissions (such details like what drugs I was given, when and in what dose). Try to prove them wrong. Try to find evidence other than “the crazy person says so”. There are no cameras, no voice recording, it’s all the professional staff, which consists of “good people” vs crazy woman with no insight. “Danger to self and others” – because the doctors “don’t have time to deal with you” – that’s an actual quote. Them having to many patients to actually have time to consider you don’t want a physical exam is the same as you being dangerous. Because you don’t want to do what they want you to do NOW. Legal protections? JOKE. It may look nice on paper.
            Everyone can become a prisoner of psychiatry at any time. It doesn’t matter if you are in extreme state of mind or you just have a family member who wants to fuck you over. There is no due process. This system has to be abolished.

      • You are absolutely right, people are being “set up,” and I’ve learned this has historically been the function of the psychiatric industry. In my case, I was “set up” (given a bad drug cocktail) by a PCP who was paranoid of a malpractice suit because her husband had been the “attending physician at a “bad fix” on a broken bone of mine. Then, when I went outside my insurance for a second opinion, I was “set up” again (the ADRs of the bad drug cocktail were misdiagnosed as bipolar) according to my medical records, based upon a list of lies and gossip from the people who sexually abused my four year old child.

        Perhaps, too many people know how to screw others over via psychiatric defamation now, and we should get rid of psychiatry’s unethical way of unjustly destroying the lives of innocent people? Since, logically speaking, only unethical people would destroy someone’s life in this deceptive way. So perpetuating this, will only lead to the incompetent, deceitful, and unethical having the power. And that’s not actually in society’s best interest, but it does explain why our society is so misguided right now.

        • Set-up is precisely the right word, but the set-up is sometimes simple and mean, and other times complicated and impossible to explain fully, because people may all believe the psyhciatric mumbo-jumbo and no one involved in the situation has had an original thought. The patient can’t be sure whether his Stockholm syndrome or his resistance represents his true feelings.

      • Well, B, you guess wrong. I have frequently been arrested and involuntarily hospitalized and I really cannot see how it could happen as a result of a “prank.” You can’t call the police up and have them arrest Crazy Person A when there’s no evidence the person is suffering from a mental disorder. And if it did ever somehow happen, the prankster would be subject to severe penalties, both civil and criminal.

        And you also read wrong. I said emergency intervention wasn’t the REAL problem; I didn’t say (or even imply that) it wasn’t A problem. As I’ve made clear in many comments, the REAL issue is outpatient commitment which is based upon the notion that mental disorders are permanent and necessarily debilitating.

        We’ll just have to agree to disagree on the criminal responsibility issue. I believe prison is no place for a delusional person.

        As for suicide, I agree everybody has the right to take their own life. I also have the right to prevent you from exercising that right if you choose to do it right in front of me. That’s not going to change.

        • Not here in Australia. Police attend with a mental health professional. What they do is because they will be liable if they do not detain is they use a corrupt practice called “verballing”. In a nutshell it involves removing the context and making the person look crazy.

          The liability is shifted to the psychiatrist this way and the mental health professional is off the hook.

          Zero penalties for doing this because you will never be believed. There are protections contained in our laws, but you have absolutely no chance of having them enforced.

          The attitude is one of lock em up and sort it out later.

          I literally got detained because of an argument with my in laws three weeks earlier. Of course the psychiatrist figured out what was going on, but I’d been subjected to significant trauma in the meantime.

          It really does only take a finger point here, and i have the documents to prove it.

          How to destroy someone’s life with a phone call.

          • How to verbal a statutory declaration 101.

            The Form to detain someone in Australia is to “specify the facts that are the basis on which it is suspected that a person be made an involuntary patient”.

            The facts were that i had an argument with my in laws who lived next door three weeks earlier and they threatened to have my home invaded and me assaulted by some meth users.

            The “facts” on the form.

            Concerned about being observed by neighbours

            Rational concerns about significant others becomes irrational concerns about generalized others. Paranoia?

            Not sleeping eating.

            The mental health worker woke me up, and i said that for two days my sleep had been disturbed, and my eating wasn’t what it usually was. Mania?

            Thoughts of harming others.

            Yep, three weeks earlier i was angry enough to send an email to the person i was angry with. Psychosis?

            Agitated and pacing.

            Yep, once I was told i was going to be locked up i did get agitated and paced. How can something that happened as a result of being detained be cause for detaining someone.

            Get the picture? Just misrepresent the facts so that it sounds like a mental illness. Easy.

          • Nothing different in Austria – there was a letter to a newspaper recently, where the guy describes how he got detained for I think over a week because he had a bad evening and wrote on facebook that “life’s not worth living” or something. He got a visit from police, was taken to a hospital and kept there for observation. When he tried to argue he was asked: “will you stay voluntarily or should we make it involuntary stay?” – guess what he chose (I was in the same situation, I also chose “voluntary” although that wasn’t true at all but I’d have to stay anyway and for longer if I refused). Fortunately for him they didn’t drug him by force. This whole system is a farce, a random criminal has more rights than a non violent “patient”. Everything you say or do can and will be used against you and try not to speak – they’ll fuck you over even more. I’m not even mentioning verbal and physical abuse and drug/restraint/isolation torture.

          • I’m not sure what you mean by “verballing.” Can you give me an example of something that, taken out of context, would make a sane person sound crazy?

            As for this actually happening, if “you have the documents to prove it,” shouldn’t you be consulting a lawyer?

          • Something taken out of context that makes a sane person crazy.

            A person who is being subjected to domestic violence. Simply remove the persons claim that they are being subjected to abuse, and you have all the evidence you need that they are crazy.

            Any physical damage becomes self harm, fears about beatings becomes paranoia, loss of appetite and sleep becomes mania.

            A person who works in a bank is subjected to an armed robbery. They have a reaction as a result of the stress. Just don’t mention the triggering event and their behaviour seems crazy.

            It’s one of the first lessons i learned when studying psychology. Context is vital to understanding behaviour.

          • “As for this actually happening, if “you have the documents to prove it,” shouldn’t you be consulting a lawyer?”
            Sure.
            a) Providing that you have money to fight the system.
            b) If you don’t you can always go to patient’s advocacy, which in my country serves to basically for reading the documents from the hospital (which got properly redacted before sending) and concluding there is nothing mentioning abuse or malpractice in them. Duh. Of course, they advice you that if you find a problem with that you can always go back to a)
            The whole system is a joke and the legal protections are meaningless if there are no reasonable means of enforcing them.

        • http://derstandard.at/1363707405833/Nach-Facebook-Posting-in-der-Psychiatrie
          Here you go – it’s in German but you can throw it into Google translate to get an idea. Happened in Austria. Mr Gustl Mollath in Germany is another egregious example. And I can guarantee you that’s just a tip of the mountain.
          So yeah, it’s enough to call up the police and tell them “this and that guy told me he wants to kill himself” or something similar and the person is screwed.

        • “As for suicide, I agree everybody has the right to take their own life. I also have the right to prevent you from exercising that right if you choose to do it right in front of me.”
          Yeah, I suggest you could give a ticket to everyone who’s trying to commit suicide in public… That won’t be more ridiculous than the laws which are on books right now.
          People who are trying to commit suicide are treated like criminals which is stupid, inhumane and counterproductive. And can lead to violence as well.

          • After pursuing my cause for over two years now i have some letters from both our Chief Psychiatrist and the Minister which demonstrate some facts.

            They are happy with a situation that allows unlawful deprivation of liberty as long as the mental health worker is prepared to commit fraud to make it seem lawful.

            The Chief Psychiatrist whose duty it is to protect the rights of the community, reworded the relevant section of the Act in order to make the protections of the Act disappear. When I pointed out his ‘mistake’ he then used the argument from authority. He can’t see the misrepresentations that were made. Which is strange because 3 psychiatrists and 2 clinical psychologists i have spoken to can.

            To me, this is an admission that his whole profession is a mockery, and he is failing in his duty to protect the community. It is carte blanche and zero accountability. And until it is your door that they decide to knock on, you wouldn’t even know. By then it’s too late.

          • You must really misunderstand because “give a ticket” means criminalizing suicide and I’m completely against that.

            What I’m saying is that society has a right to intervene in cases of imminent danger. Standing on a bridge railing preparing to jump puts you in imminent danger.

          • The Mental Health Act 1996

            S29 (1) the referrer who suspects on reasonable grounds that a person should be made an involuntary patient may refer that person for examination for a psychiatrist.

            Power to detain if they have “reasonable grounds” (S26 of the Act, standard to be met) and must complete a statutory declaration (S33 of the Act, accountability ,measure)

            The Chief psychiatrist rewords S29 to read

            the referrer who ‘suspects’ on grounds they believe to be reasonable that a person should be made an involuntary patient….

            This removes the “reasonable grounds” standard and if reasonableness is the property of the individual referrer then it wouldn’t matter what they wrote on the Form. Tomato would be enough.

            The Chief Psychiatrist can rewrite legislation, and did. The objective legal standard that can be tested, becomes a subjective interpretation that can not be questioned.

            He’s a clever man eh?

          • What is verballing?

            See vol 1 part 1 of

            https://en.wikipedia.org/wiki/Kennedy_Royal_Commission

            Pp 96 – 101

            This is how the police use this corrupt practice. Easily adapted for use by mental health workers.

            On the issue of getting a lawyer. By the time these people had finished with me my marriage was destroyed, i was living in a car park with nothing but the clothes i stood in. Tried to get the mental health advocacy service to help me, and they did a little, but there are so many abuses happening in our system that they have little chance of assisting 1% of the people who do require help.

            If they start helping too many people or making any noise, the government will cut their funding so…..

          • “What I’m saying is that society has a right to intervene in cases of imminent danger.”
            OK, and in your mind what should that intervention be? Because if it involved coercion then it is effectively criminalising suicide and penalising it.

        • “Context is vital to understanding behaviour.”
          Great point boans.
          That’s why in cases of “danger to others” caused by psychotic experiences the proper judicial due process is vital instead of psychiatric evaluation. During a normal trial you need to present evidence and establish facts of the matter – the context. A psychiatrist has to do no such thing (and that’s just one of the problems) – he just has to “evaluate” the individual without any evidence or responsibility to explain what is really going on. But most people don’t understand the reality of the process and therefore are prone to thinking that the only people who get coerced and locked up are “dangerously crazy”, which is a super rare thing to begin with and cannot account for thousands of people being stripped of their rights and dignity everyday.

          • No, B, using coercion to prevent a suicide does not criminalize suicide. The coercion falls under the rubric of mental health legislation. It is in your Utopia where suicide would have to be a criminal act in order to be prevented.

          • Boans, psychiatrists do not reword legislation. They can only lobby for governments to CHANGE legislation. A psychiatrist is not entitled just to cut & paste as necessary to accomplish his goals.

          • Boans, it’s certainly possible that legitimate claims are occasionally made to seem fraudulent. However, suggesting that this is a common occurrence is going to raise a few eyebrows.

          • “No, B, using coercion to prevent a suicide does not criminalize suicide. The coercion falls under the rubric of mental health legislation.”
            Well, so what’s the difference in practice today? If suicide would be a crime then for an attempt I’d get an attorney and go before court (so I could actually prove that I wasn’t trying to kill myself if that was the case) and if I’d be found “guilty” then I’d do say jail time.
            In today’s world where it’s “legal” I go to a psych ward where I am not only detained but also abused by physical coercion and drugging. Then in theory I can maybe have an attorney (and everyone knows what a joke that is in mental health system) and maybe a “day in court” but I have already been given a diagnosis which brings my credibility to zero and usually I’m drugged up to my nostrils so that I appear crazy. Plus the people who’re detaining me are also experts in the case.
            I’ll take being a criminal rather than mentally ill anytime.
            But that’s not the point, I actually think that suicide should be legal AND there should be no right to detain a suicidal person or coerce them to treatment unless they break other laws in an attempt.

          • Btw:
            a) suicide is actually ILLEGAL in some countries, which I find ridiculous in itself
            b) “legitimate claims are occasionally made to seem fraudulent. However, suggesting that this is a common occurrence is going to raise a few eyebrows.”
            Well, I’d make a claim that it is rampant and at least in some hospitals common practice. My own documents were doctored (or rather looks like filled in well after the fact) to be consistent, to make up events that could legally justify coercion and omit certain facts (such details like the amount, frequency and identity of the given medication – totally irrelevant in MEDICAL files, right?). This has happened in a hospital that basically has had constant flow of new scandals and allegations from both patients and stuff basically since the war ended (before that it was a good Nazi place used for killing people who were deemed mentally ill – they do rise up to the tradition). There were kids dying there in the 80s from neglect and abuse, in 2008 or around that time they had people dying in restraints, staff member reporting abuse of patients (which continues to this day) and much more. And nobody does shit about it, they just sent in a few regulators to conclude that “everything’s legit” and it continues. That’s Otto Wagner Spital in Vienna Austria. There were scandals like that happening all over Poland recently, involving, among others child abuse – guess what? – nothing happened. There was the case of Mr Gustl Mollath in Germany – he got out after 8yrs and guess what? – none of the “professionals” responsible was even charged. And this is likely just a tip of the mountain so please spare me the “raise a few eyebrows” comment because people who don’t see a problem are either completely naive/have little experience with the system or are willingly blind.

          • Francesca, not jugst any psychiatrist, but our Chief Psychiatrist did reword legislation.

            I’m quite prepared to provide redacted documents to prove this.

            Not only did he reword the legislation, it achieved a desired outcome by doing so.

            A person who was acting in good faith would rectify such a ‘mistake’. One acting in bad faith would acknowledge the mistake and do nothing. The latter is the case and demonstrates that our Chief Psychiatrist is dishonest and has no integrity.

            One the issue of raising a few eyebrows, i have sent letters to our Mental Heath Commissioner explaining how mental health workers are committing these fraudulent acts, and why the community is not being protected by those charged with this duty.

            I have interviewed many people who have been subjected to these types of detentions and the practice of verballing to subvert the protections of the Act is widespread. My hope is that the worst offenders are charged and imprisoned, and hopefully the rest will start performing the duties they are being paid for, rather than making the job easy.

            At present it seems obvious to me that this corrupt practice is known about by the authorities, but the outcomes suit their purposes. A licence has been given to mental health workers to detain anyone they wish, and no one is safe from those who would abuse this power.

            And the community believers that they are protected if they look at the law.

          • The attitude that these people would not abuse the position of trust is a dangerous one to take.

            It is this type of attitude that allowed people who were entrusted with the care of children in institutions to abuse those in their care for years without ever being ‘caught’. I mean who would think that someone we trusted would do such things. An of course the children who did complain? Oh they’re simply liars and troublemakers.

            Im sure that at some point these abuses that are occurring will come to light. It’s just a shame that we are going to have to wait until most of the victims and perpetrators are dead.

  7. “INSANE?
    Your own Choice!”

    “The Pat­Ver­fü, an ad­vance di­rec­tive with a built-in re­p­re­sen­ta­tion agree­ment, in which any un­wan­ted psych­ia­tric tre­at­ment and any de­pri­va­tion of li­berty whatsoever re­sul­ting from a psych­ia­tric dia­gno­sis is pro­hi­bi­ted by law.”

    The above quotes were taken from this website:

    http://www.patverfue.de/en

    I do not have any idea if, and if so, how the PatVerfü approach would work in other countries and other systems of law other than Germany, where the PatVerfu was developed. Then again, I am not a lawyer, it is now up to you people fluent in legalese to…

    Respectfully,
    Britta

    • Thanks for that info. That looks like a step in right direction.
      In some countries (like Austria) you can sign a “psychiatric testament” (a quite unfortunate name but here you go) which outlines what kind of procedures you refuse in case of being deemed incompetent. It doesn’t protect you from getting locked up but it’s a shield against forced drugging, ECT etc.

  8. Thank you for all your hard work Tina.

    With regard to suicide in the above discussion…. imo suicide is a political issue and should be addressed as such. Lumping the issues presented into the same arena as issues that are considered under the banner of so called mental health issues leads to confusion.

    • I think you’re correct when we’re talking about physician-assisted suicide (as in the case of terminal illness) belonging in the political sphere. However, suicide as a result of depression or other mental disorders is a completely different animal.

      • Yeah, and how do you determine whether a person who’s trying to kill himself NOW is doing this because of “mental illness” or because of poverty, loss of a job, getting diagnosed with a terminal illness, public humiliation (like in bullying cases), political reasons etc etc.? Or are all suicides by definition resulting from depression or psychosis?

  9. A client of mine was detained by police who transported him to the emergency room where he was then involuntarily hospitalized after he publicly threatened to set his neighbors house on fire and burn it to the ground with them inside, then proceeded to get a gasoline can and start heading toward the house.

    He did this because at that time he believed that spirits/aliens have kidnapped real persons and replaced them with clones controlled by the government, and that spirits/aliens live under the ground in his house and collude with other people to steal the five million dollars he made by being a famous rock star and writing every song we’ve heard for the last two decades.

    What disturbs me is that a frequent sentiment I hear at MIA is that this person should have simply been sent to prison. That somehow that’s the better, more just and humane response. That seems morally abhorrent to me. I believe someone has to be able to understand the implications of their actions and understand what is happening to them (i.e. they are standing trial for a crime, and facing consequences) in order to be justly convicted and sentenced.

    At the same time, I find it to be equally morally irresponsible to ignore a sense of responsibility to protect innocent people in the community. So, in this case, simply ignoring the actions of this person until he actually set his neighbors on fire under the pretense that “coercive intervention is wrong” is not acceptable. He stated what he intended to do, AND was in the process of carrying that intention out.

    I happen to know that this particular person, a client of mine, also holds very opposite attitudes and intentions when he is not so immediately experiencing such extreme cognitive/emotional states. In those times, he is a kind and empathetic person, who cares about other people and is fearful of the times when he feels like he is “not in control of my own mind.”

    So, I am not able to see how sending him to prison is the moral choice. Maybe prisons are different elsewhere but here in the United States there is no institution, including psychiatry, more abusive and broken than the prison system. I am also not able to see how simply releasing him from the hospital back to his neighbors where there lives were in danger is a moral choice. Once we are aware of his stated intentions, and see those intentions backed up by action, there’s no reasonable way to excuse doing nothing to protect that family from the threat of immanent harm.

    I would like involuntary hospitalization to be (a) safe and (b) rare. I would also like involuntary hospitalizations to follow the mantra of “the least amount of intervention necessary for the briefest duration possible.” And I will continue to speak about about the abuses and failures of hospitalization, pharmacology, psychiatry and the like….

    But I don’t have the luxury of speaking from a place of abstraction on these issues. I have first hand, direct experience with times when it is far more immoral and reprehensible not to intervene than it is to do so, even with the failings and limitations of the system as it stands today. And until someone has a better answer that satisfies my own moral and ethical convictions, I’m not particularly moved by all-or-nothing sweeping generalizations about this subject that frequently get made here.

    It’s very easy to say, “this should never happen period,” from the sidelines. It looks a little different if you are the family that is about to be burned alive, or if you are the individual about to be sent to prison without understanding what is happening to you or why you are there.

    There has to be another option.

    • I find your comment interesting Andrew.

      What did they actually do to the person you speak of apart from send him to a prison with a sign saying hospital? One where the rules of evidence don’t apply, and you can be detained at the governor’s pleasure.

      I agree that detentions should be both rare and safe, but this is simply not the case where i live. People are detained for non compliance with some unwritten standards of housekeeping, and not sleeping or eating properly. The police would have a hard time having people convicted of these ‘crimes’. Not so with mental health workers.

      What i know is that if someone points a finger at you where i live, the mental health worker has a liability issue. If they do nothing and anything happens they may be seen as responsible. If you do not attend a hospital voluntarily, you WILL be detained. Evidence of an illness and risk is fabricated and it all looks lawful. It’s a shame the mental health workers have this liability issue, because their methods of getting around the laws to avoid liability is costing people their lives.

      I’d take prison anyday over what was called ‘care’ when i made a complaint. At least the rules are obvious in that environment.

    • Wouldn’t be a Ghostbusters-like special response team that engage with your client in a playful way to rescue the kidnapped real people and fight the aliens more useful than involuntary hospitalization?

      “I ain’t afraid of no ghost.”

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