Furious Seasons

September 14, 2009

Seattle Psychiatrist Wants To Change Washington State's Commitment Laws

There was an op-ed in the Seattle Times over the weekend authored by Jeff Skolnick, a psychiatrist at an area psychiatric hospital called Navos, formerly known as Highline West Seattle Mental Health. Skolnick argues that Washington State's commitment laws need to be changed to give doctors and other staff much more leeway in involuntarily committing their fellow human beings to psychiatric institutions. His thinking is straight out of the Fuller Torrey/Treatment Advocacy Center playbook and pretty much echoes what conservative forces in psychiatry argue when they talk commitment laws. In fact, TAC highlighted the op-ed on its blog and dubbed it "Positive Movement in Washington State."

That it appeared in a newspaper with a 300,000 daily circulation and many thousands of more readers on its website is significant. A lot of people have read Skolnick's op-ed and gotten the usual violence card arguments from the conservative wing of the psych world.

Here's Skolnick's lede:

"THIS should be a no-brainer. An idea that could save money for Washington State, make it a much safer state, and allow us to more adequately care for people with severe mental illness: Repair the broken legal system used to commit people with psychiatric illness."

A much safer state? Oh, here we go with the violence card yet again, a special fetish of some in the psych world. And what does he mean by "severe mental illness" since he doesn't say? Depression? Schizophrenia? Bipolar disorder? Preschool bipolar disorder? It's kind of weird that the paper's editors didn't insist upon some precision here, unless the sages over there think that there's a link between, say, depression and violence. In addition, it's odd that there's no news hook for this op-ed piece--no recent local dust-ups between humanity and someone diagnosed with schizophrenia and the rest of humanity; no bills before the state legislature. It sure makes me wonder what event prompted this op-ed.

And how much less safe am I as a citizen of the state under our current commitment laws? Skolnick offers no answer, making his fear-mongering look especially chicken shit.

"In my hospital, at least half of all patients who are committed against their will are discharged by the court against medical advice. Many of these people are very ill, still psychotic and often likely to quickly become a danger to society, their families and themselves."

OK, how many people would that be? Sloppy editing there. My hunch is that Skolnick is not talking about a large number of people and yet he's using them to argue for specific changes to my state's commitment statutes, which I'll come to in a moment. Using small numbers of people to argue for wholesale legal changes that would affect many more people is a rotten way to do public policy.

"Quickly?" "Danger to society?" Skolnick offers not one drop of evidence for making this assertion, but he's a psychiatrist and I guess they are excused from the usual rules of op-ed land, especially when they are trying to appeal to deep-seated public fears. In all seriousness, if Skolnick were at all conversant with the scientific literature examining links between, for example, schizophrenia and violence, he'd find that while there is a slight uptick in violence associated with the disorder--especially among the severely psychotic--much of that increase is associated with substance abuse. He should try reading this recent study in JAMA.

And now:

"It's also an incredible waste of money. People discharged against medical advice are often back in the hospital within days if not weeks. This takes resources from law enforcement, jails, hospitals, ambulances and county mental-health professionals, but more than that, it exposes the community to senseless and unpredictable acts of harassment, vandalism and violence. Read the papers. We shouldn't have to wait for a tragedy to fix this system."

Ah, I do read the papers here in Seattle and they are not a catalog of offenses committed by the mentally ill. There are ugly incidents from time to time and quite often there are underlying drug abuse problems such as with Issac Zamora's shooting rampage last year. Diagnosed with schizophrenia, my sources tell me that Zamora had quite the crack habit.

Speaking of tragedies, why doesn't Skolnick alert the public to the many tragedies associated with the use of antipsychotics--the very drugs used to treat the severely mentally ill--that have gone on in our country, especially since he's interested in protecting people? You know, the deaths due to diabetes, the sudden heart attacks and so on. Why not tell the good people of Washington State about the findings of the CATIE study and how they show what a weak technology these drugs are in treating schizophrenia? Well, he's got an agenda to serve and clearly he values the lives of the non-mentally ill more than the very populace he serves otherwise he'd be barking for safer, more effective treatments.

Skolnick moves on from rabble-rousing to specific policy recommendations:

"First, stretch out the time of initial commitment from 72 hours to five days, as they do in Oregon, or even a week. Our system was set up as a zealous way to protect the civil rights of people with mental illness (or of those falsely accused of it). Yet, it seems to have gone overboard and is actually violating the rights of people who cannot think rationally in getting the help they need. The days of psychiatric hospitals readily housing the mentally ill against their will for years are as much a relic of the past as female nurses wearing white dresses and hats. The government would do better to involve themselves in overseeing hospital quality and lengths of stay, putting less emphasis on judges and prosecutors who are making what amounts to medical decisions."

While adding 48 hours to an initial involuntary commitment doesn't strike me as onerous, I'm puzzled that Skolnck offers no evidence of whether the Oregon five-day holds are demonstrably better. I'm doubly puzzled that apparently no one in op-ed edit land at the paper asked. Absent evidence that an extra 48 hours does much to improve things, I'd say Skolnick doesn't have much of an argument.

And he wants a government agency to control who gets committed? That is such a bad idea that it speaks for itself.

Finally, Skolnick argues:

"Third, change the criteria — the legal threshold — for civil commitment. For instance, make it less stringent to detain people with psychiatric illness who are dangerous to others, say if they are clearly dangerous but haven't made specific threats or if they kill an animal. Allow more flexibility and deference to treatment teams in hearings about whether to keep someone hospitalized longer, for example, if they are still hostile and potentially a menace but have made no specific threats or acts while in the hospital; or they cannot be discharged without a reasonable place to live or professional follow-up in order to prevent predictable decompensation. Also lessen the criteria for "grave disability" (where someone cannot care for their health and safety) so that they don't have to be so severely incapacitated, in such an immediate risk of death, to be detained."

Let me start with his last point: while working a shelter counselor at a huge shelter in Seattle (DESC's Morrison Hotel shelter to be precise), I saw several people evaluated for commitment and taken away under the "grave disability" portion of state commitment laws. In each case, the person was nowhere near death, but was unable to take care of themselves (couldn't bathe for months, couldn't eat for days, covered with lice, etc.), so I don't know where Skolnick is getting the "immediate risk of death" from.

While I'm sensitive to the idea of not discharging people with no place to live, I wonder how Skolnick would define "reasonable." A homeless shelter? An apartment? The Four Seasons? Joking aside, it's hardly the fault of people who've been hospitalized if they have no place to live and it seems a weak argument for limiting someone's basic human liberty and an argument that should be greeted with skepticism.

I completely agree with Skolnick on his "kill an animal" point, depending on how he would define animal. Cat? Dog? Snake? Rat? Spider?

I really don't know what to make of Skolnick's argument that "if they are clearly dangerous but haven't made specific threats" then the person involved needs to be detained because if someone is "clearly dangerous" then they've either made verbal threats against someone or they have hit someone. Unless clearly dangerous means Skolnick has hit upon some mysterious new rating scale that he's not telling the public about. Or do doctors and their staffs just "know" nowadays?

Globally, Skolnick's arguments are so ham-fisted and imprecise that one hopes that members of the legislature managed to not read his op-ed in Washington State's most influential newspaper.

Posted by Philip Dawdy at September 14, 2009 12:03 AM

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King County (pop. 1.9 million), home of Navos Hospital where Dr. Skolnick works, passed a mental health recovery ordinance in 2000, then suspended it, and then issued a revised ordinance in 2006. The revised ordinance includes, "To date, however, the system as a whole has not been able to show significant progress."

Dr. Skolnick should have considered the failings endemic to Kings County's community mental health system but he would rather find fault elsewhere, "Repair the broken legal system used to commit people with psychiatric illness." It is ironic that he seeks more expansive IOC and involuntary commitment laws to address unfavorable outcomes when King County's mental health recovery ordinance, which should have begun to address the underlying community issues nine years ago, failed to do so.

Posted by: Joe at September 14, 2009 04:45 AM

This Jeff Skolnick is directly out of the Fuller Torrey mold alright: He wants to limit civil rights for those psychiatry deems ill, actually in practice orders forced long acting injections of anti-psychotics to those on 72 hour holds against their basic human and legal rights, and is a strong proponent of forced ECT (electroconvulsive therapy) being reintroduced into Washington State Institutions.

How the public allows a person in charge at a county public mental health facility (Navos) to subvert and trample upon the basic rights of those he deems mentally ill goes beyond conflict of interest and is deeply disturbing.

http://www.seattlepi.com/archives/1990/9011060039.asp

This is how the sick and deeply flawed mental health system legislates from an RX pad with it's underhanded methods; while reaching all the way to the halls of justice with no one in place to hold them accountable except a free press.

Interesting that on Fuller Torrey site (those deemed mentally ill are dangerous crowd supporters) is a former judge in the mental health court in Seattle:

Honorable James Cayce, Judge - Vice President

King County Superior Court Judge
Former Presiding Judge, King County Mental Health Court
Seattle, Washington

Pretty scary stuff going on. This all has the wrenched smell of a "Eugenics 2009" movement attempting to make come back.

I gather it's unfortunately true when they say "mankind seldom learns a lasting lesson from the brutal and historical mistakes of their past".

Posted by: Ms. Piggy at September 14, 2009 06:52 AM

A journalist who had gone into a mental hospital in her late twenties decided ten years later to sign herself in to three different mental hospital to investigate the care being provided. She choose 1. a state mental hospital 2. a private mental hospital 3. an alternative mental hospitl.

Very interesting reading! Here is what SSRI Stories says:

http://www.ssristories.com/show.php?item=3625

Page seven reads [in part]: "My doc and I tried a lot of other medications along the way, and I had all the classic side effects. I went hypomanic on the Prozac, so we added mood stabilizers to even me out. I lost interest in sex, so we tried another antidepressant, Wellbutrin, to bring me back. We switched, jiggered, and recombined, looking for that perfect pickle. But if one thing didn't give me a rash or panic attacks, then it made me gobble salty junk food in the middle of the night. I tried most of the majors, and burned through their effects. I got scrawny, then fat, petrified, then out of control, sexless, then sex-obsessed."

"Eventually the dope just doesn't work the way it used to. Even Klonipin needs a boost to keep hammering you. And that's when they start referring to you in whispered tones as 'medication-resistant'."

So I ended up in the bin that first time, to do some serious recalibration. I was all used up. In the space of a few years, I went from being just another twenty-something having a good old-fashioned life crisis to being a pscyhotropic junky."

Page 280 [ 3rd paragraph] reads: "I know that when I go off medication I feel far worse than I ever felt before I took it, and I have never been able to stand the downside for more than a few months, so I don't know how long my brain might take to recalibrate, if it can."

http://www.amazon.com/Voluntary-Madness-Year-Found-Loony/dp/0670019712/ref=sr_1_1?ie=UTF8&s=books&qid=1252891043&sr=1-1

Voluntary Madness: My Year Lost and Found in the Loony Bin (Hardcover)
by Norah Vincent
Norah Vincent (Author)

Posted by: Rosie at September 14, 2009 06:59 AM

Interesting that the op ed writer doesn't want judges making medical decisions, but he's OK with the state doing so.

Posted by: Miranda at September 14, 2009 10:11 AM

That a psychiatrist would hold out a side show as a main event and then demand that the crowd ignore the reality of what was going on the Big Tent is not at all surprising. And questioning their benevolent authority--"I just don't understand what you mean by that, sir"-- makes you a paranoid, Dawdy.

@Rosie I am a medication resistant patient and damn proud of it.

Posted by: marlborojones at September 14, 2009 11:28 AM

When I read posts like this, I'm reminded of how lucky I am to have gotten away from psych treatment. The last time I left the psych hospital (AMA by the way) in 2000 or 2001?, I was worse when I left the hospital than I was when I went in. The treatment in psych hospitals is generally pretty awful. It's a very depressing environment. No friends or family coming to your room to visit, no flowers, no get well wishes. Just constant threats by staff that if I didn't go to this group or that group, if I didn't do x, y, or z then I wouldn't be able to leave. When you threaten people with the loss of their liberty, they tend to get even more stressed out. Most of the staff were pretty nasty (there were a couple who were ok).

The interesting thing is I was admitted because I was deeply depressed and stopped taking care of myself(not showering, that sort of thing), but they didn't provide any hygiene products even when I asked. Another patient found some toothpaste and a toothbrush that had not been opened and gave them to me a few days later.

They didn't wean me off of any of the meds I was on when I was admitted. They just stopped them all and started new ones. There were so many other problems there that I won't even go into. Is it any wonder why people aren't improving? Does it make any sense to put depressed people in a depressing environment, treat them like crap, and expect them to get better?

I shudder to think of where I would have ended up if the laws had been more stringent and I was not permitted to leave. I have not been hospitalized once since leaving psych care AMA years ago. However, while I was under psych treatment I was repeatedly hospitalized. The treatment was definitely a big part of my problem.

If they're going to change laws, then how about focusing on providing compassionate, humane treatment to patients. I know, I know it's a part of every psych hospital mission statement - but it's not reality. An interesting thing I noticed is that homeless people don't fight to get out of regular hospitals. In fact, it's hard to get them to leave. But, so many people fight to get out of psych hospitals. Does anyone ever ask why? It's because they suck. If they were truly, compassionate places people wouldn't fight so hard to get out. In a regular hospital you're an adult and a human being. In a psych hospital you're a child who needs to be put in her place. Patients know the difference.

Unfortunately, the only way people like Dr. Skolnick will ever understand what it feels like to be an inmate in a psych hospital is when they're in a nursing home one day and at the complete mercy of the staff. Then, they'll get it.

Posted by: Lisa at September 14, 2009 09:37 PM

Forced treatment is torture. Beware the therapeutic state.

Posted by: george ebert at September 15, 2009 04:11 AM

Sure, we should all just offer psychotic people a pleasant little garden-side asylum room, and serve some chamomile tea. forcing psych meds is purely a sociaological construction developed by state hosp employees to esure job stability. Yeah, right.

People - there are real problems out here in the real world. Whiel I probab ly disagree with clinical recommendations with every psychiatrist mentioned in this post, the truth is that some ppl quit taking their psych meds, and begin acting dangerously - and there is a clear line when their civil rights can be violated for teh purposes of safety: generally "imminent harm" to self or others. In over-crowded, understaffed cities, the criteria to do a civil commitment get very, very extreme - it is not enough to be talkign to ppl who are not there, urinating on yourself, etc. - you must be a danger - physical violence-type danger -AND a family member or neighbor MUST communicate this well enough for an authority to agree, while juggling several potential civil commitments and limited psych bed space.

Here is a clip from a news story from Houston, which I came across by a link in in someone's blog:
"Earlier this month, SWAT officers surround the home of mentally ill man in the Woodland Heights subdivision. Police were called when Michael Gable threw a brick through one of his neighbor's windows.

After hours of stalemate negotiations and using a motorized ram breaking out windows to get the Gable's attention, officers finally lobbed tear gas into the home. Within minutes Gable surrendered and was taken away in an ambulance. He spent his 54th birthday in the county's Neuro-Psychiatric Center.

"It had to come to this with the SWAT team," said Gable's sister, Rosemarie Barnes. "I mean this is ridiculous."

Barnes wasn't angry with police. She was angry it took this use of force to finally get her brother help.

"He needs it. We've been trying to do this for a long time," said Barnes.

Volumes of indecipherable manifestos found inside Gable's home show years of mental illness. Since 2002, police have been called to Gable's home 17 times for a range of petty crimes. Before this incident, Gable records show Gable has been to the Harris County jail, the Neuro-Psychiatric center, twice to the Harris County Psychiatric Center and twice to Rusk State Hospital. Each time, he was stabilized, then released with no follow-up care, only to drift back into psychosis.

"The last social worker, whoever it was at the hospital, told my brother he's surprised that (the doctor) is letting him go," said Barnes.

"I think he's an example of a system that's broken," said Lt. Michael Lee, head of HPD's Mental Health Unit.

Lee said months before SWAT officer were called, he and his officers tried to peacefully lure Gable out of his red and black fortress to serve him with a mental health warrant. Lee said the problem is mental health warrants are civil, not criminal, and the law doesn't give police clear-cut permission to go into someone's house to serve one."

Do you see? This person is a ticking time bomb. Because of existing civil liberty standards, no one can do anything except wait until the eventual brick is thrown.

Forced medication? No.

Forced hospitalization to contain the likelihood of someone getting gravely harmed or killed? Yes.

If you disagree with me, sure, 1. call me names, etc., plus 2. go talk with the mother or father of someone with a psychotic disorder - ask how tese episodes goes i.e., person goes OFF meds, declines, gets violent, everyone scrambles to find a cop or judge to act, and hopefully no one gets hurt; or go with a peace officer on a civil commitment warrant. Come up with your own answers, adjusting chamomile to taste. Enjoy.

Posted by: medsvstherapy at September 16, 2009 01:14 PM

MvT,

This is the problem. Going off meds doesn't make people more dangerous. Treating them violently and medicating them and imprisoning them in psych hospitals when they've committed no crimes makes people dangerous. There's no clear criteria for what a psychotic disorder is. If you throw a brick through a window and you're not "sick" you don't go to prison, if you throw one and you're labeled diseased you do. Are you suggesting that all "brick throwing through windows is psychotic behavior?"

Forced confinement is simply always wrong unless a crime has been committed.

Are you seriously suggesting that forced commitment without medication will improve any situation? If so then why not subject the guy to the criminal sanctions for throwing a brick. What exactly is the argument that throwing a brick indicates imprisonment as punishment? That imprisonment makes a person less likely to throw more bricks, that throwing a brick makes one likely to become more violent

Taking away his civil rights is unconscionable and won't help anyone.

Posted by: Sally at September 16, 2009 04:00 PM

Medsvstherapy said:

"Forced medication? No.
Forced hospitalization to contain the likelihood of someone getting gravely harmed or killed? Yes"

I happen to disagree with you!

Because you don't trample of civil liberties in broad brush strokes because there are rare exceptions. The example you used is not the norm and an exception and not the rule.

Psychiatry has abused the privilege of forced treatment and incarceration for far to long (you say NO to forced medication, yet you know as well as I this is exactly what will happen under forced commitment).

Do they actually treat the people in their charge as it stands today? I say they do not!

Do the people in their charge get well or recover by the medical modality? I say they do not!

Does the damaged caused by forced incarceration and inhumane medication worth or outweigh the risk of the few that will act out while in the throws of "madness"

I say with this system's track record; I will take the risk, and error on the side of freedom and civil rights.

Before you want anyone to buy this bill of bad goods; as in taking away further rights from those deemed "Mad"; the system has to earn this right by providing proven effective and humane treatment first and foremost. Then we can discuss chipping away at our constitutional rights.

Proven and effective is far from the case in today's institutional and psychiatric modality.

Civil liberties are there for a purpose, and for everyone. Once you take away the rights from one segment of the population, another segment of the population also runs this very slippery slope risk at the loss or degradation of their humane civil rights and liberty.

We don't lock up criminals because they have a propensity to commit another crime. They serve their time or earn probation while being given the opportunity to succeed or fail on their own accord (with the exception of civilly committed sexual predators in-which there is some reasonable debate).

This is because when you place that type of power over others in the hands of an institution (in this case psychiatry) that stands to gain both monetarily and with unbridled influence; the situation becomes ripe for the exact kinds of problems we have with the pharmaceutical and other powerful industries abusing their influence for greed and gain.

I would hope no one here wants to see crimes and harm inflicted upon others by the hands of anyone; yet in a free society there is a risk and price we all must pay for civil rights and freedoms.

You make a good argument medsvstherapy; I just don't happen to agree with your basis or conclusions.

Opinion are opinions after-all.

Posted by: Ms. Piggy at September 16, 2009 04:57 PM

meds vs therapy:

Wrong: any one person can commit another: police, doctors, friends, anyone who brings someone to an ER for an eval. not always family. Family is not always told this has happened to someone, until they telephone or someone else contacts them.

I am a parent of someone severely and chronically psychotic, and I have witnessed my loved one the same way on meds and off meds.

As a matter of fact, the inpatient doctor in this article prescribes vitamins, and chamomile tea along with the neuroleptics. I know the doctor.

Posted by: anon at September 16, 2009 05:34 PM

One problem is with who gets to define "imminent harm" to self or others. The therapist who took me to the hospital has since lost his license to practice. Guess which opinion carried more weight when I was in the ER? Not mine. I never committed a crime not before psych treatment, not during psych treatment, and not years after leaving psych treatment.

People assume that "imminent harm" means the patients are threatening to hurt themselves or others. Not necessarily true. It may mean they're not taking care of themselves physically. The mental health professional is the one who gets to define imminent harm to self, not the patient. And in my case that mental health professional doesn't even have a license anymore.

I was always a "voluntary" patient, though. Here's why. One thing they did was say if you don't sign in voluntarily we'll sign you in involuntarily and then it will be harder for you to get out. That's what I was told once. Now, maybe they wouldn't have been able to do that legally and were just bluffing, I don't know. But, I sure believed them. So, I did sign in "voluntarily." It's not voluntary treatment when someone signs in under threats and coercion. That's like saying, "If you don't sign this consent form for surgery then we're going to do the surgery anyway." Kind of defeats the whole purpose of informed consent, doesn't it?

There are many voluntary patients who are not there voluntarily. They were pressured to sign in or they were threatened. Let's not pretend that doesn't happen.

The majority of patients who were in the psych hospital when I was there were either depressed and/or had substance abuse problems. Those who were psychotic were in the minority. Making the laws more stringent will not only affect those who are psychotic.

I get it force is quicker. It's quicker to get results when you can surround a person and drag them by their limbs to their room. Why try to connect with people if you don't have to?

If psych hospitals were places of refuge and healing you wouldn't have so many people fighting to leave. That's the bottom line.

Posted by: Lisa at September 16, 2009 08:47 PM

Meds vs. Therapy, why the sarcasm? To be honest, that greatly surprised me since your posts are usually very reasonable.

One issue you and many professionals keep ignoring is that cold turkeying any med greatly increases the chances of causing the symptoms that you described. Of course, when someone is being threatening and menacing, you can't say to the person, "Uh, don't cold turkey your meds".

But the problem is psychiatry makes this an either or situation. They say, bad bad patient, you must stay on meds for life. Meanwhile, patient is saying, why do I have to stay on meds that destroy my fabric as a human being. The cycle repeats itself and god knows how many more people get harmed..

Imagine if the psychiatrist said to the patient, ok, you don't like meds, don't cold turkey them but I will help you taper them very slowly to keep you safe. I will work with you to find other means. My guess is the incidents of violence would go way down.

I know I am living in fantasy land but heck, I didn't sleep so my brain is going wild.

Anyway, I also agree with the previous posters about the other points they made.

Posted by: AA at September 17, 2009 04:08 AM

The thing about psych hospitals that I'm sure all of us have observed is that if you want to leave they force you to stay and if you want to stay they force you to leave. It's about breaking the patient as we've seen in the blog where January Schofield writes about brutalizing and torturing his six year old daughter.

The sane response to being forcibly confined is violence, is depression, anger, a desire to escape. These normal human emotions are labeled as symptoms resulting in a dreaded conviction of non compliant being written in one's chart, and yet, if someone is quiet, polite and compliant (as my chart indicated I was), they get written up for "hiding their anger" and/or being manipulative. So there's no way to win.

I'm trying to get out from under the trauma I still experience from my involuntary treatment 6 years ago, to work again, (and I have worked for most of the time I've been out and supported myself the entire time) but the sheer terror of knowing that I could be locked up again at any time keeps me at home a lot, afraid to interact with anyone.

Psychiatry destroys people, it's cruel and ruthless and evil in every instance.

Posted by: Sally at September 17, 2009 06:19 AM

"Unfortunately, the only way people like Dr. Skolnick will ever understand what it feels like to be an inmate in a psych hospital is when they're in a nursing home one day and at the complete mercy of the staff. Then, they'll get it."

Alas, no they won't. Why? Because they will have made enough money off our misery in their highly lucrative profession to afford top-notch care. I am a former geriatric social worker and trust me, the rich continue to live in their dotage in an entirely different world from the rest of us.

Lisa,
Every one of my 12 hospitalizations (which all occurred when I was in "treatment" but never since I terminated my relationship with psychiatrists) were "voluntary" in the manner you described. So were those of most of my fellow patients. We were almost all there under threat of involuntary incarceration in the state hospital.

There are two ways to get out of a psych hospital quickly:
1) lose your insurance coverage
2) decompensate.

With #1 you'll be deemed "improved" and out the door so fast it'll make your head spin.

#2 isn't always foolproof but more often than not the hospitals I was in would toss out anyone who was decompensating. They knew it was a dead end--they really had nothing to offer or any means of stopping the progression. So they'd toss them out, usually after trumping up some charge against them. It's an old game.

On the other hand, you do NOT want to be in a psych environment when you are decompensating. You'll end up in four-point restraints (interestingly, the very kind of restraint we know is favoured by rapists--I have been in one hospital that had an entirely different, highly effective system), forceably drugged, etc. With luck you might survive--one woman I knew did not. She died after being in restraints for four days. Her psych "doctor" abruptly withdrew a med known to cause heart attacks during withdrawal and she (surprise) died alone and in restraints. I wouldn't treat a dog that way.

Oddly, the peer advocates in my state informed me that we have one of the best systems in the country for checking on patients in restraints--why, we check on them (or say we do) every two hours! I was flabbergasted. IMO, NO ONE should be left alone in restraints. Ever. Not for one moment. The local peer advocates ("consumers"--boy do I hate that label) were too busy congratulating themselves for this enlightened policy to become involved in changing it.

If anyone wonders why mentally ill people become violent, I certainly have developed a "they'll never take me alive" mentality about forced contact with the mental health system.

Posted by: Sherry at September 17, 2009 07:50 AM

Considering how people with mental illness are treated by the system that's supposed to be "helping" them, it's amazing that more people don't turn to violence. And a testament to the human spirit.

Posted by: kimbriel at September 17, 2009 11:55 AM

http://awakenyourbrain.net/

"Dr. Skolnick is an MD psychiatrist, PhD in Natural Health, with advanced training in Neuropsychology and almost 30 years as a Zen meditation practitioner.

His journey to understand his own meditation practice coincided with his studies of the brain and human behavior. The result was the creation of a full-spectrum model of how the mind and brain work –from the most primitive and abnormal states to the highest most Awakened states. Continuing his self-exploration within his Zen practice, he then developed the set of skills of Neural Inshifting."

Wanting to remove rights from people, lock them up, drug them with neuroleptics, and the OWNER of this business(SatoriWest Center) at the same time feels so contradictory.

Posted by: anon at September 17, 2009 05:39 PM

Another opinion letter, in the Sea Times

http://seattletimes.nwsource.com/html/opinion/2010155560_guest29johnson.html

Discusses the ITA (involuntary treatment) and lack of willingness to commit people to care and lack of beds if needed, and men's shelter.
---------------------------------------------
My Opinion, as a parent

The lack of funding and housing is in a crisis in the state of Washington, currently the state is considering closing several long term care facilities.

When people discharge from an involuntary commitment, there are little, few to no choices for housing, many just get shipped to Western State Hospital.

When we have people in mental health crisis and can only provide inpatient acute crisis care based on medications for stabilization, we create an endless cycle of readmitting patients, over and over again.

Without the tools necessary to learn to live with extreme (for example)mental illness symptoms, such as hearing voices, all that is relied upon are medications which have been proven to be less than efficacious or the hospitals would see far fewer returning patients for care.

The "gravely disabled" term is actually a broad use currently, which can assess a person for self-care (showers, eating and drinking meals, and medication compliance) along with safety concerns all can be used together for that term and reason to detain someone.

The people who walk free are generally able to speak for themselves at the 72 hour hold hearing.

Until the state takes care of the vulnerable citizens and stops treating this as a topic of lesser value, only then will we see positive results in care happen.

If in fact professionals are tired of working in a broken system that holds even them in a position to do little based on what they are given, nothing will change.

Demanding higher standards, increased funding, and serious ground breaking for housing, is just the beginning.

Inpatient hospitals need to add serious therapy beyond "art group". Social workers need case managers assigned to each patient, a multi-tiered system where the patient exits a hospital stay with case manager in place, several practice runs (day passes) and visits to the housing facility will make transition work cohesively.

Most importantly, ALL entities, doctors and staff will have visited where the client/patient will be residing if it is state/county housing, so they can see for themselves if it will/is working or not.

Far too many staff, and doctors do not know how the other person's job works and a team work atmosphere just is not happening in most hospitals.

Treating the patient as a whole person, with individual needs and care is of utmost importance for full recovery and transition back into society.

Until we, as a society begin to care for our most vulnerable populations we truly have failed.

People with mental illness labels, and issues have the right to reside in the least restrictive environments, based on their personal and individual needs.

They have rights as an adult to choose to live independently from family and I dare say that family has a right to not become a mental health agency of it's own.

Families that are broken by this illness are actually families broken apart by a failing system. A system, that if working properly, would ensure quality care for the patient/client and leave the family to enjoy each other as a family.

The patient benefits greatly from being independent, the same as anyone else as an adult.

When will we, as a society stop looking the other way, stop blaming a underfunded and inadequate system, and when will we be willing to take action to change the system?

I believe we should not question if we are willing to lock people away for care, I challenge our state to take steps to prevent institutionalization in a locked down ward.

Take steps to open in each city, a Soteria based program, where there are houses and apartments that can be used as step-down to hospitals.

Staff on site, medications are by choice and need based on efficacy and individual choice, is just the beginning of the road to success.

The system we have in place is not working, this we know.

Let's change it, and I mean aggressively.

Start with letters to these people:

Victor Moore, Director
Washington State Office of Financial Management
P.O. Box 43113
Olympia, WA 98504-3113

Governor Christine Gregoire
P.O. Box 40002
Olympia, WA 98504-0002

House Speaker Frank Chopp
P.O. Box 40600
Olympia, WA 98504-0600

Senate Majority Leader Lisa Brown
P.O. Box 40403
Olympia, WA 98504-0403

Time is of the essence!

Posted by: anon at October 28, 2009 10:01 PM

I live in a 10-unit condo building, and we have a resident homeowner that threatens and harrasses the other homeowners and renters on a regular basis. I have been told that he is a Vietnam war vet with PTSD, and I know from personal interactions with him that he drinks heavily and smokes medical marijuana. I have also been told that he sees a counselor regularay.

Several of us have standing restraining orders against him, but he is making our lives miserable and affecting the income of people that rent their units because he harasses their tenants. His behaviour includes pushing an older latdy down (she suffered a broken hip), turning off people's power, putting super-glue in the locks, threatening phone calls, throwing things at our windows, and threatening our personal safety verbally (the list goes on). The police have been out numerous times, but since there are rarely witnesses to his actions, they refuse to do anything for us. Our legal counsel tells us it is virtually impossible to evict someone from a home that they own.

I realize he most likely has mental problems of unknown variety, but there is a feeling of total powerlessness for the rest of us that are being terrorized and unable to sell our homes in this housing market. And frankly, I am unwilling to put the next unwitting owner in the same position. I would rather solve the problem.

I found this page because I was looking into how to have him involuntary committed. After reading all of your posts, I understand that that's not the answer for everyone, but what are our options here??? I am very stressed out and am looking for answers. Please help.

Posted by: Alissa at November 5, 2009 11:27 AM

Alissa, call me crazy (heh) but I seriously doubt the psych hospital is going to help your neighbor. He needs to be in jail for pushing a woman down causing her to break her hip.

Posted by: Lisa at November 5, 2009 06:51 PM