Recommending involuntary commitment is going too far here October 19, 2012 9:52 PM   Subscribe

I ibeg people to think twice, then think again, then think a fourth time before suggesting that an AskMe questioner get someone involuntarily committed to a mental hospital.

Here we have a question about a man who believes conspiracy theories.

-To the OP's chagrin, the man continues to believe conspiracy theories even after the OP has argued with him about them.

-A bunch of people do not want to be friends with the man due to his belief in conspiracy theories.

-The man has quit his job to study the conspiracy theories more.

Here's what didn't appear in the question:

-Any mention of the man being violent
-Any mention of the man threatening violence
-Any mention of the man talking about violence
-Any mention of the man being angry
-Any mention of the man harming himself
-Any mention of the man talking about harming himself


Now, I have no problem with saying, "hey, I have known people like that and eventually they were diagnosed with a mental illness."

Or, "hey, I have known people like that and eventually they became violent so you should keep an eye out for that / prepare for the possibility of that."

What I have a problem with is, based on the the facts as they are now, (rather than things that have happened to other people or potentially could happen at some point in the future, or illnesses that other people we've met have been diagnosed with) outrightly suggesting that the man be set up to be involuntarily committed.

Should we take it upon ourselves to decide a man shouldn't have the same civil rights as the rest of us, and should be detained and forced to have a medical evaluation, because we think his opinions are ridiculous and unrealistic?

Because he quit his job to delve more fully into his ridiculous opinions?

Because his opinions remind us of someone or other that we knew with some or another mental illness?

Even if someone is ill, should they be FORCED to be treated even if they are not harming anyone by it? Should cancer patients? Or just patients with illnesses that are mental?

Should we decide that we know better than an adult man what is good for him, and force him to take it, even if he is not harming anyone?

In the beginning I asked everyone to think several times before recommending involuntary commitment on AskMe. In addition to that, I would also ask that if you have never personally visited a mental hospital where people are involuntarily held, please visit one at least once before recommending that someone else be taken there.

This is what a great many of them are like. Imagine the waiting room at the DMV, and all the people in it. Now the doors are locked and nobody can leave. Now, the people - a great many of them are there because they have done something violent. Many of them are extremely disturbed - screaming, babbling, crying. Many act out and have to be redirected, or if they can't be redirected, have to be restrained and taken out of the room. Many of them have difficulty maintaing adequate hygiene. The man you send there to be involuntarily committed will spend most of his waking hours doing nothing but sitting in this room with these other men, maybe reading waiting room magazines, maybe watching daytime TV. The staff will often ignore them most of the time, unless they are giving out food, someone is acting up, etc. Maybe there will be a tiny little "outdoor" space, with 4 walls and a "ceiling" made out of wire mesh. At night, the man who is involuntarily committed will have to share a room with one, two, or more of these other, very disturbed men. Maybe he will spend a bit of time with a doctor at some point during the day. Maybe it will be every other day, or less.

It is essentially a holding tank, a human filing cabinet. Just being trapped there can and does traumatize people who weren't already traumatized. This is not somewhere that a person should be held against their will unless they are dangerous.

All I am asking is that people really think twice, really think about whether or not it is overkill that would seriously violate the rights of a man who has done nothing bad to anyone, before recommending things like googling the Baker Act as a "powerful search term" in a situation like the one described here.
posted by cairdeas to Etiquette/Policy at 9:52 PM (77 comments total) 20 users marked this as a favorite

By the way, in some places, a person who is involuntarily committed will be charged for the stay and for the treatment. To do that to someone could tip them from getting by into deep and serious financial trouble. One of many things to seriously consider before recommending doing that to someone.
posted by cairdeas at 10:19 PM on October 19, 2012 [9 favorites]


I see that you did comment there suggesting pretty much what you've said here, which is fine, and it's also fine to bring issues of site behavior up in Metatalk. However, Metatalk is absolutely not for prompting debates on issues that you're not allowed to argue at length in Ask Metafilter. To the extent that we can discuss specific site issues here, I'm leaving this up for now, but this is not an ad hoc space for venting about something that's basically unrelated to the site.
posted by taz (staff) at 10:22 PM on October 19, 2012 [2 favorites]


yup, agreed, cairdeas.

i don't get the moderator comment. this is about site policy, piling on, acceptable boundaries of advice-giving, yes? i don't see what's not meat-and-potatoes meta about this.
posted by facetious at 10:28 PM on October 19, 2012 [21 favorites]


Yes, I don't see how this could be more related to the site, and that thread needs a clean-up.
posted by drjimmy11 at 10:31 PM on October 19, 2012 [3 favorites]


Metatalk is absolutely not for prompting debates on issues that you're not allowed to argue at length in Ask Metafilter.

But we're not allowed to argue/chat about anything in AskMe. So where do we do it?
posted by mannequito at 10:36 PM on October 19, 2012 [6 favorites]


How does askme handle really bad advice? Like, when a parent posts a question about how they think they might have a gay child, what if someone popped in and suggested reparative therapy? Would that be deleted? Or do we rely on people to correct the bad advice in the thread? My sense is that normally bad advice is left up and it's up to other people to explain why it is bad advice in the post. Do mods normally delete any advice that might be a bad idea?

Do we have any kind of norms about certain advice that shouldn't ever be suggested? Like, if someone asks how to deal with a cat scratching up the furniture, is there social pressure against the idea of suggesting to get the cat declawed?
posted by andoatnp at 10:37 PM on October 19, 2012 [1 favorite]


I sincerely apologize for making this post the wrong way if I did, Taz. My purpose was entirely to talk about it as a site issue, along the lines of other Meta threads about AskMe answers (example, example, etc.)
posted by cairdeas at 10:39 PM on October 19, 2012 [1 favorite]


And some of us have had very different experiences with loved ones who were involuntarily committed or spent time in in-patient mental health facilities that were nothing like the places you're describing.
posted by gingerbeer at 10:40 PM on October 19, 2012 [13 favorites]


Nobody answering in that thread has the power to commit the man or violate his civil rights. The fact that psychiatric holds were mentioned does not mean the man will be subject to one without say, a judge or psychiatrist or whatever getting involved.

So even if this is bad advice, it's not like "go to your kitchen and mix these explosive chemicals" - there's a check even beyond the Asker's own common sense.

The answerers are making suggestions of things the man's friend can consider looking into; namely, that this might be a psychiatric issue rather than just a new quirky hobby, and Asker should consider all the angles there. You've also noted some things for the friend to consider; namely that involuntary psychiatric holds should really only be used as a last resort and here's why. It seems to me that this is the system working.
posted by LobsterMitten (staff) at 10:41 PM on October 19, 2012 [15 favorites]


I would respectfully point out that this MT goes very much to the heart of "site behavior" - Many AskMe's amount to requests for professional help from a totally unqualified group of people. In most cases, that doesn't much matter; when the answers run along the lines of "deprive this person of their freedom", however... We as a community need to take a huge step back and decide where that leaves us.


FWIW, I think a lot of AskMes should get deleted for the simple reason that the asker really really needs to talk to a licensed professional, not post to a web forum. Of course, on the flip side of that, I also think the hive throws the phrase "talk to a therapist" around like frickin' candy to kids on Halloween; suggests that every mildly unhealthy relationship looks like a chronic wifebeater; sees every instance of odd behavior as proof of whatever paranoia the asker has.

Personally, I responded in this particular question that the dude needs meds (NOT involuntarily sending him to the loony bin) because what the asker mentions far, far exceed "conspiracy" theories. Obtaining such drugs, however, would necessarily include... seeing a licensed medical/psychiatric professional.


andoatnp : How does askme handle really bad advice?

Depends. I've personally had a number of answers deleted because I responded to the "real" question rather than the fluffy "pretend we live in a perfect world" version of the question. For the most part, though, just about any complete nonsense will remain, so long as it fits the overall site ethos.
posted by pla at 10:43 PM on October 19, 2012 [10 favorites]


Andoatnp, we don't delete answers because we think they are wrong. The system works pretty well for countering bad advice with good advice. That said, there might be situations in which we'd delete a suggestion that was dangerous. We do, however, frequently delete comments that don't answer the question. Pla, if you ever have questions about a deleted comment, hit us up on the contact form and we'll let you know why.
posted by taz (staff) at 10:46 PM on October 19, 2012


I don't think people are suggesting the man be involuntarily committed, though; they feel he needs to a psychological evaluation. What the Baker Act does is allow involuntarily examination and assessment, which is required to take place within 72 hours of the initial evaluation. It is a temporary measure. During those 72 hours, the patient has to be deemed mentally incompetent, released to outpatient treatment or released altogether. If, during that time, the patient asks to be redefined as a voluntary inpatient, that can be done, too, and the 3 days still apply. Sometimes, the Baker Act is meant to help people who don't have the money but need the diagnosis of mental illness to get help. As far as not a danger to himself or others goes, "danger" in this case can include self-neglect, and the OP made the point that the person in question has quit his job and is "ruining his life" in such a way that he, the OP, felt some drastic action needed to be taken. He knows this person better than we do; he just didn't know what action he could take.

As far as the patients sitting around 'reading waiting room magazines' all day, in my experience that is not at all the case. Inpatient programs I know of are very strictly structured, with several group therapy and activities planned out daily. That structure is seen as part of the care of the mentally ill and why they need to be in a facility in the first place, as they are being observed closely by staff for signs of self-harm or being a danger to others.

I believe that your experience with this process has been different, cairdeas, and I'm sorry that it was so bad; I'm just saying what I know of the way the process works here in Florida with the Baker Act that was brought up in the thread.

No, mental inpatient facilities are not the nicest places to be. But I don't agree that they always cause more harm than good, or that anyone is out of line in suggesting that sometimes they are not only the best choice, but the only choice we have.
posted by misha at 10:50 PM on October 19, 2012 [4 favorites]


The phrase "conspiracy theories" seems really inapt in this instance. There's a pretty wide gulf between believing in a second gunman and believing in an inter-dimensional sun portal.
posted by Bookhouse at 11:01 PM on October 19, 2012 [15 favorites]


I know it seems extreme but it might be the only correct AskMe can give. The question is What can I do that we haven't tried already, what other answers are there but somehow get a professional evaluation done.

I think the issue is what will the consequences be.

If I am lucid, not agitated, don't seem like I'm going to hurt someone would the authorities even commit me? Would they even do an evaluation on me? You can't just walk in with anyone and say "hey commit this guy, he is totally crazy I promise" can you? We don't have the resources to do batteries of tests just because people don't like our life choices.

So on one hand they decide I'm fine, and I'm pissed at my fiends and I never talk to them again. On the other hand I'm not fine, now I know and have the option of treatment.

I can always leave AMA after this initial observation period right? So they can't just treat me against my will can they?

I appreciate that this is like the nuclear option, and will likely ruin the friendships anyway, but if he is fine it will be sorted out soon no?
posted by Ad hominem at 11:02 PM on October 19, 2012 [1 favorite]


You people seem to have to got your ask jammed into my meta.
posted by PareidoliaticBoy at 11:02 PM on October 19, 2012


Yeah sorry about that, I am just thinking right now the answer they gave is the only answer AskMe is really qualified to give, which is somehow involve a professional. I'm just still wondering about how harmful it would be if OP went through with it and it was bad advice.
posted by Ad hominem at 11:06 PM on October 19, 2012


The phrase "conspiracy theories" seems really inapt in this instance. There's a pretty wide gulf between believing in a second gunman and believing in an inter-dimensional sun portal.

I don't know, I see/hear people espousing those sorts of things constantly. One of the conspiracies mentioned in the post was the guy's belief in chemtrails. There are whole groups of people in my city who consider themselves to be anti-chemtrail activists. Sometimes I think it's just my (liberal, weird) city, but then I see the things my Teapartier friends from childhood post. Tons and tons of people believe things that sound totally nuts. But I do not think that based on that alone, AskMe should be recommending they get examined, locked up, or treated against their will.
posted by cairdeas at 11:16 PM on October 19, 2012


Taz, I don't necessarily agree with Cairdeas (my motto when it comes to internet advice is "Caveat Emptor") but I don't understand why you feel this isn't acceptable for MeTa. If not here, then where?
posted by wolfdreams01 at 11:19 PM on October 19, 2012


I am just thinking right now the answer they gave is the only answer AskMe is really qualified to give, which is somehow involve a professional

I don't necessarily disagree with this. But, it's one thing to say "you should somehow involve a professional." It's quite a few leaps past that to say "you should somehow involve a professional, against his will if necessary" - especially given the particular facts of that question.
posted by cairdeas at 11:21 PM on October 19, 2012


It's an acceptable Metatalk for discussing site behavior. "How do we deal with questions like this?" is perfectly fine. What isn't great is to have a adjunct, no-holds-barred bifurcation of the Ask thread, and that's what I'd like to avoid.
posted by taz (staff) at 11:24 PM on October 19, 2012 [1 favorite]


But I don't agree that they always cause more harm than good, or that anyone is out of line in suggesting that sometimes they are not only the best choice, but the only choice we have.

It doesn't look to me like cairdeas is saying anything near to "they always cause more harm than good." Even if there were only a one in six chance of the guy ending up locked away in a traumatizing environment for the rest of his life, that's still Russian roulette odds.

Cairdeas just seems to be saying that it's an extremely grave measure and people should weight it as they would spinning the cylinder for themselves—and portray it that way in AskMe answers—rather than taking it as a "hopefully they'll give him some pills and he'll get better" nothing-ventured-nothing-gained situation.
posted by XMLicious at 11:33 PM on October 19, 2012 [4 favorites]


I think AskMe often displays a "nuke it from orbit--it's the only way to be sure" groupthink toward problems that have non-zero chances of escalating to require serious professional legal or medical expertise. The linked answer seems par for the course.

It's funny what tools of cultural hegemony many of us turn out to be when there's perceived risk. Relative to MeFi, I'd have guessed the political tenor of the site would be slightly more anarchic: noting genuine risks cautiously, noting the inadequacies of the respondents, etc., but not so often urging so many querents directly into the arms of the state and/or incredibly expensive hired professionals without at least a few more "You know, maybe you don't need to worry about this so much ... maybe you can just chill and let the world be sort of woolly and imperfect, like it is" kinds of comments.

Naturally, I sympathize with the impulse to get the worst-case scenario under control, but it's not the right thing to aim for.

And yes, I sometimes wonder if my handle is a joke I played on myself but forgot.
posted by Monsieur Caution at 11:35 PM on October 19, 2012 [21 favorites]


I agree askme answers can easily overstep and often do.

Suggestion: new flag for "this advice goes beyond the principle of do-no-harm"?
posted by ead at 11:38 PM on October 19, 2012 [2 favorites]


you should somehow involve a professional, against his will if necessary

Point taken. Even having to talk to a guy for an hour to show he is lucid and not going to hurt anyone may be uncalled for unless it is clear his life is in danger. And you guys are right, who knows what will happen.Personally, I don't think quitting your job for a dumb reason proves much, but what do I know.

I guess my question here, and for AskMe in general is how do we evaluate the risk of following the advice. Are some answers just too risky? Even if they seem to be a correct answer?
posted by Ad hominem at 11:39 PM on October 19, 2012


Someone's experience in an involuntary commitment facility largely depends on which one they go to. I was in one at one point and the staff was very in-your-face with activities, group sessions, etc. I didn't like it, but it wasn't a place where the staff didn't care about me or my wellbeing. I was only there for three days and was released on the contingent that I continue therapy and update them on my progress or I'd be committed again. I never did any of that and never heard from them again. I hated the experience but it wasn't the end of the world.

From what the OP from that thread posted, it doesn't sound like the person in question could be committed anyway. He may be making poor life decisions but it doesn't sound like he's a danger to himself or others.
posted by Autumn at 11:40 PM on October 19, 2012 [1 favorite]


I guess my question here, and for AskMe in general is how do we evaluate the risk of following the advice. Are some answers just too risky? Even if they seem to be a correct answer?

We have definitely made that determination for suicide-related questions and they are now disallowed because we think it is too risky. There's room to discuss whether questions of mental health might fall into a similar category... but it's such a wide expanse, I'm not sure how that would be narrowed down.

Also, I always think about this: if the person does not ask about such a question here, where do they ask? A more informed venue would be good, but will they find that? Asking friends on Facebook (for example) is probably going to be worse. It might be a good idea to actually brainstorm alternative sites for more informed answers to these sorts of questions, if such places exist, and maybe even make a list on the Wiki. Maybe it would be good for answerers to be able say, "most people here can only give you our off-the-cuff, non-professional opinion, but on X site, they actually have people who are knowledgeable about Y."
posted by taz (staff) at 12:07 AM on October 20, 2012 [4 favorites]


Is it really that easy to have someone involuntarily committed in Florida? I don't really see the issue here because where I'm from, it is not at all easy so I'm not sure what the danger is of suggesting it in AskMe.

I've gone through the process of having someone put on an involuntary hold and then a hearing to extend that commitment, and it took evidence of danger. Multiple interviews, testifying before a judge with a lawyer present for the patient, hours in hospitals trying to get the temporary hold in the first place. I was turned away repeatedly. Professionals tried to dissuade me at every turn because it would be hard, but it was needed and that's why it happened.

And I don't think the process should be any easier at all, but since it's not something a friend can so easily do I'm not really getting the danger as in "this is dangerously bad advice".
posted by Danila at 12:09 AM on October 20, 2012 [2 favorites]


Who did people ask before the internet?
posted by Ad hominem at 12:37 AM on October 20, 2012 [4 favorites]


Some of us are opposed to any lay medical advice on askme. Which is what we are really talking about here.
posted by spitbull at 12:41 AM on October 20, 2012


Daniela is correct. You can't just "have someone committed" as easily as the OP suggests here.
posted by spitbull at 12:43 AM on October 20, 2012 [5 favorites]


Take someone's 95-year-old grandmother who might have dementia and is talking about these nice people who keep visiting her house asking for donations. She's getting mailings offering to help her refinance her house to get money to give to this group. You offer to take her to the doctor, she says no. Is it irresponsible to suggest that perhaps she needs help anyway, just because there are terrible nursing homes and caregivers out there? Some people have problems where you can't just advise that only voluntary solutions be recommended.

Yes, there are sometimes bad outcomes of those involuntary solutions, and that's why friends and family should stay involved in the whole process, and I think it's definitely good that those were brought up, too. But if you suggest offering only the help the person wants, then what happens when they aren't rational enough to say yes to the help they need? I think it's entirely appropriate to make suggestions that make the asker aware that there are involuntary measures available. Which are in no way confined to commitment, or even things that have anything to do with medical treatment. Suggesting that a friend tell someone's family even though they don't want them to. Suggesting that a family member look into guardianship and power of attorney. Etc. These can be things people don't like to do without being nudged. "Mental hospitals suck" is not a reason to avoid giving the advice that a person may need help they don't want to accept.
posted by gracedissolved at 12:46 AM on October 20, 2012 [6 favorites]


ead: "Suggestion: new flag for "this advice goes beyond the principle of do-no-harm"?"

I think that's a "It Breaks the Guidelines", with a possible follow up with the contact form depending on the severity.
posted by radwolf76 at 1:01 AM on October 20, 2012


Yeah, sorry I didn't address that. We're not thinking of adding any super-specific flagging-for-this-reason flags, and that's part of why we have "Other." If you are concerned about something, do flag it, and contact us if you think it needs more explanation.
posted by taz (staff) at 1:16 AM on October 20, 2012


I don't often indulge in whining about having my own advice deleted, and I'm not about to do so now. That said: fairly early on in that thread I made a suggestion about using the friend's belief in conspiracies to generate motivation for a shared session watching a three hour video of solidly researched and well presented debunking.

I still think that's a good idea, and the kind of thing that would have given me pause for thought had somebody done it for me before I'd fully disappeared down my own mental rabbit hole, so I'm curious about how many flags it got. I'm also curious about the reasoning of those who did flag it, either here or via memail, if anybody feels like letting me know. Because if it was e.g. a tone issue, I wouldn't mind figuring out how to reword it so it sticks.
posted by flabdablet at 2:30 AM on October 20, 2012 [5 favorites]


All I am asking is that people really think twice, really think about whether or not it is overkill that would seriously violate the rights of a man who has done nothing bad to anyone, before recommending things like googling the Baker Act as a "powerful search term" in a situation like the one described here.

For what it's worth, cairdeas, I think the comment you wrote in-thread was exactly the kind of thing that would make somebody really think twice before doing anything forcible. I'm very glad you did write that and I'm inclined to agree with LobsterMitten that your contribution has indeed helped AskMe function as it should.
posted by flabdablet at 2:35 AM on October 20, 2012 [6 favorites]


flabdablet, you gave great advice in that thread, and you can repost that comment with a bit of explanation. It got a couple of flags, and it was the first thing I saw in that thread. It seemed like either a joke, or something that didn't answer the question because it was about convincing the OP's friend that there aren't really aliens visiting earth. It wasn't until after I saw your other comments that followed that I understood what you were getting at. I'm actually willing to undelete, but I think it would be more helpful coming after your other comments, with a bit of explanation about what something like that might accomplish.
posted by taz (staff) at 2:47 AM on October 20, 2012 [2 favorites]


If the delusional person in question is not at risk of harming himself or others, then the OP of the question probably wouldn't even be able to get the person involuntarily committed, especially if the OP is not related to the person.
posted by IndigoRain at 3:35 AM on October 20, 2012 [1 favorite]


I guess that people who have in some way witnessed how voluntary or involuntary some commitments to mental hospitals really are, and what consequences that can have for the individual, get a little twitchy around the issue, making it in fact into something quite related to "go to your kitchen and mix these explosive chemicals".

That said, I don't believe misguided advice on Ask can be discussed as a site policy thing, while pointing it out may:
I'd use a 'derail' flag, or in dangerous, time-sensitive or otherwise agonizing cases the contact form. We've got all the tools...
posted by Namlit at 4:21 AM on October 20, 2012 [1 favorite]


Hi. That's my comment you linked to.

I think people in that thread were very consistent in saying not that the OP's friend needs to be committed, but that the OP's friend needs to be assessed. Neither the OP or his friends appear to be psychiatric professionals capable of making that assessment. Neither the OP or his friends have the authority to Baker Act anyone at all.

My suggestions were aimed at getting the friend assessed or ("I guess there's an inbuilt doubt when you encounter the suggestion that someone you know might be mentally ill, and that's where I am now. I'd like to be very sure before I do this.") more confident about the need to have the friend assessed if that is the best thing for him.

On reflection, the friend may be totally open to working with psychiatric professionals, and I should have gone there first. I am not a mental health worker, I made it clear I was speaking from my own experience, and my own experience is so dramatically far from that particular possibility I literally didn't consider it. Again, I hope the OP's situation works out very differently than ours.
posted by DarlingBri at 4:47 AM on October 20, 2012 [5 favorites]


There are whole groups of people in my city who consider themselves to be anti-chemtrail activists.

Oh, lord. They aren't making orgone chembusters and tossing them around in places and then claiming they saw winged elemental creatures flying in the air eating the chemtrails, are they?

I feel down that rabbit hole a couple of years ago online and was appalled at the woo and nonsense. Pretty pictures of clouds, however.
posted by hippybear at 6:14 AM on October 20, 2012


I feel down that rabbit hole a couple of years ago online and was appalled at the woo and nonsense.

I put a rabbit in my woo-hole once.



Just sayin'.
posted by the quidnunc kid at 6:33 AM on October 20, 2012 [3 favorites]


My daughter got Baker-acted by an over-zealous counselor's aide who asked leading questions about whether she felt like she might harm herself during her first week at college in Florida. She called me to say that they wanted her to go in for an evaluation, thinking it would be for a few hours or perhaps overnight, then she just... disappeared for 48 hours. No one was at liberty to tell me where she was due to HIPPA regulations, and no one thought to ask her whether she would authorize them to speak to me on her behalf for almost 2 days. The whole experience was utterly traumatic for her, she lost her faith & trust in the mental health profession almost utterly, and missed the first 2 days of classes.

When they say that they can keep a person for "up to" 3 days for evaluation, you can be absolutely guaranteed they're going to keep you the entire three days, even if their case is utterly without merit or substance, because of an "abundance of caution." She was in there with all sorts of people who had been remanded under baker act abuses, like a woman whose separated husband had called a baker act in on her out of sheer meanness, because he could get her tossed in the clink for 3 days. It's a horrid law that had its roots in a good idea - that no one could be held against their will for longer than three days without an evaluation, that has been turned utterly on its head.

I'm with the OP in that people really need to think twice about the idea of remanding folks into custody against their will.
posted by Devils Rancher at 6:39 AM on October 20, 2012 [23 favorites]


Is it really that easy to have someone involuntarily committed in Florida?

It's not a matter of "getting someone committed", but usually how this happens in Florida is if you are acting in such a way that the police show up (not necessarily criminal behavior, but out-of-sorts enough to draw attention), and they decide you pose a risk to yourself or others, they can take you for 72-hour observation. It's a common enough procedure that I know people who have been "Baker Acted" and acquaintances will mention their friends getting held under the Act more often than you might expect. The comment in the AskMe thread seemed to be recommending that the OP arrange for their friend to get an "assessment" through a clever ruse, which I think is really bad advice.
posted by mediated self at 6:54 AM on October 20, 2012 [5 favorites]


I have no problem with saying, "hey, I have known people like that and eventually they were diagnosed with a mental illness."

I am sorry this topic pushes buttons for you cairdeas. Like other people in this thread I know people with better and worse experiences with commitment, chosen and involuntary. We assume the OP in any given thread will evaluate and assess the information that they are given and this is why answers like "Maybe you should at least know this option is available" are allowed to stand. The OP was already asking "What do you do when you think someone is mentally ill?" and people were responding to that.
posted by jessamyn (staff) at 7:02 AM on October 20, 2012 [1 favorite]


One of the things I have really come to value about Metafilter over the years is its ability to help me identify my own buttons and react less poorly to having them pushed.

My own experiences with involuntary commitment, both at first and second hand, have been poor. Which is pretty much to be expected, given the state a person needs to be in before depriving them of their liberty becomes the appropriate thing to do.

Here's hoping the OP's friend doesn't ever reach such a state.
posted by flabdablet at 7:25 AM on October 20, 2012 [1 favorite]


an inter-dimensional sun portal

TEACH THE CONTROVERSY
posted by Egg Shen at 8:25 AM on October 20, 2012 [6 favorites]


"Also, I always think about this: if the person does not ask about such a question here, where do they ask? "

I think another implicit question people are often actually asking when they ask questions that clearly need to be posed to a doctor (or a lawyer, or a fireplace professional, or whatever) is, "I have never dealt with a situation like this before, I do not know of anyone I can talk to about this situation, please put me in a ballpark." I think a lot of times people ask "help! what's this festering sore on my arm?" but the tone of their followups makes clear they're actually asking, "I have never been to an arm doctor before and I am intimidated and I need to know a little bit about what to expect so I feel like I have a little control before I go into this strange situation." Those people never come back and say, "You idiots, it wasn't an alien baby growing in my arm!" They say, "Thanks for the help, guys; I saw the doctor and it was just a poison ivy rash. It wasn't any of the things you guys suggested, but seeing an arm doctor was definitely the right thing and the exam went just like you said and ruled out all these insane internet diagnoses, and now I'm better. Yay!"

People often even say in the question, "I'm seeing my doctor on Tuesday ..." or "I've got an appointment with a lawyer next week ..." but they clearly want to feel less overwhelmed and like they have at least a little handle on what to expect. Like, it's less scary to have known unknowns than unknown unknowns.

Anyway, I think Ask Me does a pretty good job helping those people, though I know some people don't like it when AskMe gives professional "advice." But even wildly different answers can help those sorts of questions because they're at least bounding the situation for the asker so they've got an idea of the range of things that might happen and it's no longer a terrifying, totally unbounded universe.
posted by Eyebrows McGee at 9:24 AM on October 20, 2012 [42 favorites]


In the beginning I asked everyone to think several times before recommending involuntary commitment on AskMe. In addition to that, I would also ask that if you have never personally visited a mental hospital where people are involuntarily held, please visit one at least once before recommending that someone else be taken there . . . It is essentially a holding tank, a human filing cabinet. Just being trapped there can and does traumatize people who weren't already traumatized. This is not somewhere that a person should be held against their will unless they are dangerous.

You're not the only one who's been to that rodeo. Having seen what you're describing, sometimes it is the only place to keep someone safe. And often, people are turned away at emergency rooms when it is clear that they are not a danger to themselves. To make the suggestion, even to follow it--those things don't mean that the outcome is an involuntary hold.
posted by liketitanic at 9:53 AM on October 20, 2012 [1 favorite]


cairdeas, I absolutely respect where you're coming from with your request.

I feel as if you made the point well in the thread and gave the OP (and anyone else in their position) excellent food for thought.

And Devils Rancher, I'm glad you shared your daughter's experience here, as a strong example of some of the heavy-human-toll weak points of this type of law.

Posters with related life experience in the original thread were making good points, too, though, and I think the question was put in such a way - especially with follow-up - where having a full set of potential approaches is extremely valuable. I don't think the discussion deserves to be shut down and never happen again, which it seems is what you want.

I also don't think that any possible conversation about medical issues should be restricted from AskMe. People can ask anyone. People can look anywhere on the internet. Putting a worry, idea, or situation before the variety of people who tend to take the time to answer on AskMe has a higher rate of encouragement to use reason, access valuable resources, and leverage professionals than anywhere else on the web and gives access to professionals many don't have in their offline lives. It also yields a rich mine of personal experience and encounters that help people consider their scenario more fully. That's invaluable, and should not be silenced.

This individual has quit their job and is losing their friends. For many who reach this point from whatever origin, the next step is the street. Inside nearly any behavioural care facility is statistically more likely to be safer and more rehabilitating than the street. I've lived on the street and have been familiar with many individuals who ended up there because of things like the OP's friend, and getting an evaluation or into care before they were cemented in by the stresses of homelessness would have saved them. Many of them are out there because they couldn't get care when it would have still made a difference.

The Baker Act - and related mental health laws in other states - was created to ensure a finite window for individuals thought (or accused) of being at risk for harm or harming others. Yes, 3 days is serious business, but it is 3 days and not forever, which is a great improvement from the past and allows many people to get the help they need while respecting their essential freedom. Yes, it can be abused. But the toll of the alternative - not permitting people to be evaluated or being able to hold people indefinitely - makes it an overall benefit. There is no finite window on the street.

And if they end up being in a position where they can't ever hold a job again, a hold and the care that should follow starts the clock for SSDI.

I hope the OP's friend gets the help they need, one way or the other. I hope they are able to remain safe.

I'm still sorry that one of the best resources we had left because of their strong feelings about these types of questions and the fact that anyone could answer, and I understand that they felt their ethical obligations were being compromised. But I still think, especially as an under-served healthcare consumer, that access to the far more reasonable overall advice from AskMe is far better than the various alternatives available online or in most social circles.
posted by batmonkey at 10:14 AM on October 20, 2012 [1 favorite]


cairdeas' depiction of a mental health ward struck a chord with me - one that I had not heard for quite a few years. Six years ago I had to take a chemo medication which had a side effect on some people of depression and suicidal ideation. Apparently I was one of those people and I became increasingly depressed and started thinking about ways to end that misery. But a part of me realized that I had no real reason to feel that way and so I went to the V.A. to tell them what was going through my head and if I could get some anti-depressants. They asked me if I was feeling that I wanted to kill myself and I told them yes I was but I knew that it was an improper way of thinking and thought it was a side effect of the medication

15 minutes later I am placed into the psych E.R. ward for evaluation. I was only there 40 minutes waiting while a doctor was to speak to me. The only doorway out was steel it was locked and and the window was grated. I was the only woman in that waiting room and there were several men in there who were variously mumbling to themselves, shouting at the walls and occasionally leering at me as well. The ones near me smelled bad and I was very afraid that any one of them would jump me at any moment. I was severely depressed but I was also scared out of mind in that place. I wanted to yell out the grated window "Let me the F*** out of here!" but has enough sense to realize that would be a really bad idea. After talking to a doctor for 10 minutes I conveyed the point that I had these feelings, knew that they were improper, thought they were a side effect and eventually got Zoloft which cleared things up in a few days time.

But I will NEVER EVER admit again to having such an issue should it ever happen again because I would never want to be in such a hell hole again. Frankly I had not thought of this in six years - it was an awful experience . So maybe I see where cairdeas is coming from in recommending that people think twice about putting someone completely harmless to themselves and others into commitment.
posted by Podkayne of Pasadena at 10:51 AM on October 20, 2012 [10 favorites]


Those people never come back and say, "You idiots, it wasn't an alien baby growing in my arm!"

I think it's more that the ones which have an alien baby growing in their arm actually just never come back.
posted by hippybear at 10:51 AM on October 20, 2012 [6 favorites]


The phrase "conspiracy theories" seems really inapt in this instance. There's a pretty wide gulf between believing in a second gunman and believing in an inter-dimensional sun portal.

Do not hang too much on the employment of that term. You are failing to recognize the gap between its literal meaning and its common usage.

It is rare that you get to witness a total change in the usage of a phrase in the course of a single generation, but it happens. When Geoffrey Chaucer wrote The Legend of Good Women, in the section on Ariadne he mentions Theseus and the Minotaur; describing Theseus' escape from the Labyrinth, he writes about his ball of twine: "with a clew of good tweyne,/ he fond his way out ageyne*" -- people six hundred years before us would have seen the word "clew" shift gradually from being a ball of thread to being the metaphorical small thing that gives you guidance through a larger difficult situation to being an abstract noun meaning something that serves to guide one in solving a problem or mystery.

Anyway, all this to say that (as I have written here before) the connotations and denotations of the phrase "conspiracy theory" have drifted so far apart that they don't even write to each other much any more. "Conspiracy theory" first entered common usage when people disputed the Warren Commission's conclusion of aone assassin. Some of the criticisms and alternate explanations were so extravagantly farfetched that the phrase quickly diverged from its literal meaning of "a speculative or conjectural explanation of events that requires several people to have worked together in secret" to being shorthand for "harebrained idea."

In the most infamous modern example, believing in nineteen people acting together to bring down four airliners is, of course, a conspiracy theory. If you refer to it as a conspiracy theory, listeners are likely to take you as not-so-subtly aligning yourselves with the people who believe the events were best explained by shaped charges, holograms, cruise missiles, and so forth.

Anyway, I tend to think that gently suggesting that the person involved speak to a therapist is a far better choice than trying to have him involuntarily incarcerated and having persons of unknown competence altering his brain chemistry against his will.

*May not be exact Middle English -- I have no copy before me and it has been a long time since I read it.
posted by ricochet biscuit at 11:14 AM on October 20, 2012 [4 favorites]


I just want to say I think this has been an extremely good discussion so far and I really appreciate everyone who has posted for taking the time to seriously think/talk about this here.
posted by cairdeas at 11:49 AM on October 20, 2012 [7 favorites]


I was severely depressed but I was also scared out of mind in that place. I wanted to yell out the grated window "Let me the F*** out of here!" but has enough sense to realize that would be a really bad idea.

I wish I'd had that sense when I was in the mental hospital.
posted by Danila at 1:00 PM on October 20, 2012


I was severely depressed but I was also scared out of mind in that place. I wanted to yell out the grated window "Let me the F*** out of here!" but has enough sense to realize that would be a really bad idea.

That is definitely something else worth considering, if you're wondering, "well, if they examine him, and he's acting normal, they wouldn't keep him there right?"

The answer to that question varies extremely widely anyway depending on the location and the hospital, but one thing to take into account is that the stress and fear that the person experiences, which is caused by the circumstances themselves, can cause them to act out in a way that they normally never would.
posted by cairdeas at 1:21 PM on October 20, 2012 [5 favorites]


I would also ask that if you have never personally visited a mental hospital where people are involuntarily held, please visit one at least once before recommending that someone else be taken there.

I ask this in all sincerity; I wondered it to myself when I saw your (or someone's) suggestion along those lines in the original thread: Is it actually possible to arrange a visit to a place like this? If so, what would it be called or how would you go about doing so? I can see myself calling a hospital switchboard and asking if I can visit "the part of your hospital where you keep mental patients who are being involuntarily held," and it seems like that might not get me too far.

It's not that I am thinking about trying to get someone committed - but it does seem like it might be an interesting lesson in how part of the world works.
posted by Juffo-Wup at 4:14 PM on October 20, 2012 [1 favorite]


Is it actually possible to arrange a visit to a place like this?

It's one thing to visit such a place and quite another to be locked in there against your will. I only spent 3/4ths of an hour there but it certainly changed my perspective.

I suspect such a visit would be akin to visiting a homeless shelter in order to get a feel for what homelessness is like.
posted by Podkayne of Pasadena at 4:48 PM on October 20, 2012 [2 favorites]


I can see myself calling a hospital switchboard and asking if I can visit "the part of your hospital where you keep mental patients who are being involuntarily held," and it seems like that might not get me too far.

You can often visit specific people, if they agree. And there are lots of people there who have no friends or family and would appreciate a visitor. I would suggest contacting the volunteer coordinator for the hospital, or an organization in your city that advocates for the mentally ill and/or incarcerated and/or homeless population, and see if they know of any patient who would like a visitor.
posted by cairdeas at 4:55 PM on October 20, 2012


If the delusional person in question is not at risk of harming himself or others

Or gravely disabled. In the involuntary commitments I've been involved with and have knowledge of, gravely disabled is usually the standard (the self-referring involuntary people I know (yes, some people want to go in because they are lonely or feel unsafe) was a suicide threatener, but that's because he knew it would work).

The standards for each change over time as well. When I started at my job, "said they might kill themselves" was often a high enough leap. Currently, with the clients where we have discussed them getting themselves committed, we've worked with the "has plans and means" level, and depending on how many inpatients there are in the Psychiatric Hospital, the officials might hold to that standard as well.

A good way to find out more about mental health and the mental illness aspects of society is to get in touch with NAMI and be a volunteer.
posted by Deoridhe at 5:44 PM on October 20, 2012 [2 favorites]


3 things I forgot to mention, because I'd spent too long on the previous thing:

1) I have personal experience with being held. I was given the choice of taking myself or being taken, so it was just shy of involuntary. 72hrs became 10 days. The first 4hrs were...non-ideal. But after I started getting the help I needed, I was beyond grateful.

2) I have close experience with others who have been through this, 2 of them to facilities that were rougher than where I was able to go. Not great, no, but that's more because we have so much work to do on improving the treatment of mental and emotional health (not just the US - most of the world needs to do better in this arena). They were still kept safe, taken seriously, and given access to further care.

3) NAMI, yes! A thousand times "YES!" - they are doing the good work and the hard work, both. They can help, they need help, and they can help you be helpful. All of it.
posted by batmonkey at 7:00 PM on October 20, 2012 [2 favorites]


Oooh Devils Rancher, I was somewhat your daughter once, except in North Carolina. I had developed severe anxiety attacks, and had gone a few days without really sleeping. A school nurse send me to the counselling center, and a overzealous school psychiatrist, indeed, wheedled me into going to the regional hospital's psychiatric ward for evaluation. It wasn't that hard -- I was a sleep-deprived throbbing raw nerve. So she didn't have to involuntarily commit me, because she just goaded me into it. She told me she would come by the hospital to evaluate me, and that they would figure out how to stop my anxiety attacks.

She never came. No evaluation was done. I was just locked up for three days, with people who were clearly dangerous, and some of the saddest, most horribly treated cases I have ever seen. (A nurse and a security guard told a schizophrenic girl that she was really pretty, and if she would just stop Acting This Way, she could land a real man). After three days, they took me to a room of people holding clipboards and sitting around a desk, and made me promise-cross-my-heart-pinky-swear that I would Act Better From Now On.

I had never given any indication I was suicidal, and certainly not that I would hurt anyone else. So it's beyond me what this school psychiatrist got out of this experience. I was very young and sick of being so anxious, and I believed her when she said they would help me. It was quite traumatizing, and if I ever were suicidal, I bet I would hesitate to tell anyone, lest I ever end up in one of those places again.

Recently, I dropped a therapist because she thought I was making this up.
posted by Coatlicue at 7:23 PM on October 20, 2012 [4 favorites]


I would suggest contacting the volunteer coordinator for the hospital, or an organization in your city that advocates for the mentally ill and/or incarcerated and/or homeless population, and see if they know of any patient who would like a visitor.

If you're thinking of doing this, the kind and responsible thing to do before you begin would be to make sure your schedule has enough time in it to allow for multiple follow-up visits.

Mentally ill people, especially involuntarily confined mentally ill people, are often very vulnerable and don't need the stress of dealing with fly-in fly-out never-to-be-seen-again experience tourists. So if you do plan to go visiting, please bear in mind that you might become important to the person you visit, that you might have completely disproportionate and quite unreasonable emotional demands placed on you by that person, and that even if such demands are unreasonable, failure to live up to them might cause quite real damage.

You might also find yourself feeling morally compelled to take on a role as somebody's advocate. This puts you in a very tricky position because most of us have nowhere near the qualifications or experience necessary to judge what treatment, beyond basic human respect and kindness, is in a mentally ill person's best interests. The last thing a decent care team needs is distraction and interference from a well-meaning but fundamentally ignorant white knight.

The upside of all this is the chance of making a lifelong friend of somebody really interesting.
posted by flabdablet at 2:35 AM on October 21, 2012 [3 favorites]


This thread answered a question that I tried to post to askme a while ago, but was deleted (not sure why it was deleted because I asked it anonymously and I didn't contact the moderators to ask). We had been finding what I considered to be suspicious objects in the park where I work and law enforcement had let us know that they were associated with a cult, but didn't know the specific cult. I wanted to know what the cult was and what the objects were for. The mention of Orgone chembusters, mentioned above, sounded like a good candidate and now I know that the objects we've been finding are Orgone Tower Busters.

Imagine finding resin objects containing coils of copper wire and various pieces of metal shrapnel in a public place where large numbers of people assemble.

Yeah, that was fun.

So I just wanted to thank those of you who helped to explain what these crazy things we've been finding are.
posted by sciencegeek at 3:21 AM on October 21, 2012 [4 favorites]


Again, regarding "having someone committed" - Outside of Florida, since I don't know anything about Florida, it does not seem to me that you can call the police and say "My friend Jimmy said he's gonna kill himself, please lock him up," and actually have that occur It actually requires petitioning the court and a note from a physician (or having the physician himself petition the court), according to Googling the laws in my own state. It looks like you need a judge's order for an emergency detainment.

I had a friend who was a prescription drug addict, and her niece, who lives in another state, begged me to have my friend committed. As I understood it at the time, it would have had to be her husband who petitioned the court for this. Perhaps I was misinformed; I didn't get an attorney. But I felt this was not my place and that if her niece felt this strongly about it, she should probably do it herself, since she was actually related to my friend. (It's not that I didn't care about my friend - she most definitely did need rehab - but there was enough drama in that situation already. They wanted me to do it so my friend would hate me and not them.)

Perhaps the is the real issue is people who are committed for 72 hours without the appropriate physician examination and/or emergency court order. In that case I would highly recommend an attorney.
posted by IndigoRain at 5:11 AM on October 21, 2012


Mentally ill people, especially involuntarily confined mentally ill people, are often very vulnerable and don't need the stress of dealing with fly-in fly-out never-to-be-seen-again experience tourists.

Yeah, I don't imagine they do, either. However, I wanted to explore the feasibility of following cairdeas' plea.
posted by Juffo-Wup at 2:39 PM on October 21, 2012


Yea, I answered that with some helpful search terms. I feel like people aren't considering that the OP can't simply have his friend committed by saying the words "Baker Act" right? I feel like people are viewing this like all it takes is for someone to declare something for it to be true.
posted by RolandOfEld at 4:33 PM on October 21, 2012 [1 favorite]


...or basically what DarlingBri said in the answer itself in a nicer way. She wins because her presentation was better.
posted by RolandOfEld at 5:13 PM on October 21, 2012


I feel like people aren't considering that the OP can't simply have his friend committed by saying the words "Baker Act" right?


No, the point was to ask people to think twice before making suggestions that questioners try to get other people forcibly examined or held regardless of how easy or difficult that would be. But, to this point -

I feel like people are viewing this like all it takes is for someone to declare something for it to be true.

You would be surprised how little it takes in some places. You would really be surprised. People have posted quite a few personal experiences with this upthread. It depends on where you are and who you are dealing with, and we don't know the OP's location in the question that this is about.
posted by cairdeas at 6:05 PM on October 21, 2012


All that's valid, but lets assume people did think twice and assumed the OP was able to parse answers and, like the mods said, were responding to the OPs question. Otherwise couldn't you say this about every question ever? It's not too far from that to telling people to think twice before they tell someone how to go about teaching someone else how to drive a manual transmission because they could end up going over a cliff or into traffic and seriously injured. Or saying someone shouldn't recommend homemade thermite to someone wanting to destroy their hated printer. Worth thinking twice about? Sure. Valid answer? I hope so.

You would be surprised how little it takes in some places. You would really be surprised. People have posted quite a few personal experiences with this upthread.

I wouldn't be surprised necessarily, I'm downstairs from someone who has nearly had to Baker Act someone before on more than one occasion and it was something she was trained to not take lightly in the least. Are there bad apples on the evaluation side and bad experiences on the commitment side? Shit yes, I wouldn't doubt that in the least. As you mentioned there also people in this thread saying that they were involuntarily committed. Some of which were negative experiences, but at least one that I saw was thankful they had been committed involuntarily.* So again, worth considering but aren't we really just getting a little bogged down in the "what if" potentially endless aspect of analyzing answers to AskMe questions.

The OP stated that they had tried X, Y, and Z things and asked for other ideas that they "haven't tried already." People responded. Mentioning that we don't know all the facts and that there might be some evaluator or some 'care' system in place that is subpar or downright negative is all well and good but it that logic cuts both ways. Maybe the OP didn't want to mention that his friend was cutting themselves or engaging in some other, potentially more serious, behavior. I guess I just don't see the benefit to the OP, or the friend for that matter, of limiting the scope of responses based upon that "unknown", or worse yet "personal bad experience carried over into site policy", factor. Maybe I'm over simplifying or reacting but it seems like you're making a bit of a Public Service Announcement that could have been better handled via MeMail to the OP or in your answer, which by the way I think is completely appropriate and helpful as it stands. ... along with most, if not all, of the other answers I'm seeing there at the moment.

*Props to everyone that had the courage to relate that sort of thing here. Metafilter is a great place. Stories and openness like that are one of the reasons why.

posted by RolandOfEld at 6:54 PM on October 21, 2012


So, on reread of my response, if that was confrontational (and I see where it looks that way), it really wasn't meant to be, I'm sure you're acting in the best interest of people, be they askme users or targets of questions put forth by askme users, as I feel like I am.

I understand your concern, I just think that the way this is supposed to work is by putting the cards on the table in the question itself and letting the OP sort it out as best they can or letting them come back to ask for clarification.
posted by RolandOfEld at 7:49 PM on October 21, 2012


I definitely didn't feel like it was confrontational at all, in fact I thought to myself as I was reading it that it was really measured. Even if I agree with some parts of that post and not others, I am glad you wrote it.
posted by cairdeas at 8:34 PM on October 21, 2012 [2 favorites]


*fist bump*

Yea, thanks, it's touchy and open to interpretation and discussion. If I could withdraw the bit about the PSA I would because it's obvious from your comments here that you're bringing up something that concerns you about site policy and how things are handled. The fact that you seem to have a firm viewpoint/stance on involuntary forces acting on an individual has been kept at arms length and that's appreciated.

Reason number eighty-two thousand, six hundred, and one that I'm glad I'm not a mod here. Just figuring out how to run Askme without being part in getting folks killed, blown up, or just ragequitting the site en masse is more than I'd like to even think about.
posted by RolandOfEld at 8:49 PM on October 21, 2012 [1 favorite]


The fact that you seem to have a firm viewpoint/stance on involuntary forces acting on an individual has been kept at arms length and that's appreciated.

Oddly enough, I think that in the case of my own relative who was involuntarily held (and involuntarily medicated), that his being held was absolutely the best, necessary, and only thing to be done. He did something so crazy that it made the NYC nightly news, and my relatives only found out about it by turning on the TV and seeing video of him getting hauled off by the police. So, even I don't always think involuntary forces should always be avoided.
posted by cairdeas at 9:01 PM on October 21, 2012


As an ER doctor I see patients sent in on psychiatric holds every single shift, just about. So I think I can answer a few things for folks about the process because it is very routine to me.

- If you are concerned about a friend or relative or whoever, a guy you see on the street who you think looks like he needs an eval, you can call the police/EMS. Those people have been trained to evaluate others and judge whether they need to have a hold placed to be transported for evaluation. The police and EMS tend to be VERY liberal with placing holds on people. They will place a hold on everyone from a 7 year old who punches their teacher at school to a drunk dude in the park who says "if you don't leave me alone I'm gonna hurt someone!"
- However, the hold being placed does not mean the person in question will be held for 3 days! Sometimes, unfortunately, it does take far too long to get someone assessed, even overnight, but in my experience that is quite rare. If the case is very cut and dried and clearly the person does not need a psychiatric evaluation, much less a hold, the ER doctor can usually clear the hold. So for example, in the cases above, I toss the hold on the little kid and call his mom to pick him up, or let the drunk guy sleep it off for a few hours and when he's clinically sober and can tell me he just said something stupid because he was mad at the cops, I let him go.
- If the case seems a little trickier, either a social worker or a psychiatrist/resident may evaluate the patient to see whether a hold is justified. It doesn't take much evidence of trickiness for us to want this, mostly because an ER doctor doesn't have time to sit down with patients and have complex chats with them about what's going on in their lives, and we don't want to miss a psychiatric emergency. So sometimes, even if the person seems to have capacity for reason and is clearly telling me that they do not want to hurt themselves or anyone else, I'll make them stay for the psych assessment. This generally takes a few hours at the most, sometimes only a few minutes depending on how busy the psych staff is. Sometimes I just don't trust what people say, which is why I do this. People lie frequently - usually they hide the fact that they did say they might kill or hurt themself to someone because they are afraid of being held. But even if they did say such things, if it was in the heat of the moment during an argument or because they were intoxicated or just wanted to manipulate someone or whatever, they are generally released. The psych staff often gathers corroborating evidence from the patient's family and/or friends if necessary, if the patient seems to be unreliable.

Perhaps there are other places where the process is quite different, but I've practiced in 3 different states and this has been the way it is in all of those locations. I just wanted to clear up the fact that a lay person does not have the ability to evaluate whether someone is a danger to themselves or others and needs involuntary commitment, but they do typically have the ability to try to bring about a forced psychiatric assessment, which usually happens within a few hours of going to the ER, and this is often a very good thing for the patient. Therefore I don't think we need to be too concerned about this issue, even if people do make what seem to be extreme recommendations about how questions suggest a need for involuntary psychiatric holds, I do not think it is typical (and hopefully actually not possible, although I can't speak for every state since rules differ) that anyone could be held for any period of time against their will without at least a pending evaluation by a mental health professional.

You might have noticed that I commented early on in the thread and did not advise forcing the assessment, only suggested that getting the friend assessed was key to addressing his problems, and that it might take some degree of deception to do so. I did not think that there was enough information in the question to advise whether he needed an emergent psychiatric assessment to be forced upon him. I do agree with other answers that suggest his beliefs and behaviors suggest paranoia and possibly psychosis, and I was glad that others did bring that up, although I think they ran pretty far with it.

I do want to end by saying (and someone else may have already stated this above) that a person does not have to be violent or actively threatening to hurt themselves or others to be held against his or her will, meaning for a psychiatric assessment or an actual admission to a psychiatric inpatient unit. As noted above, there is a standard used to judge risk for self harm when self harm ideation might be denied by the patient, for example, a 15 year old girl who texted her boyfriend that she would kill herself if they broke up is different from a 65 year old man who owns a gun at home and has a history of past suicide attempts, even if both deny a wish to harm themselves on their assessment.

Another reason to have someone assessed or admitted would be that the person is psychotic or otherwise has such a severely deranged thought process that they no longer have capacity for reason and cannot adequately care for themselves because of it. There is a small chance that is the situation described in this question, and at least a risk that this is the way the person being described might end up if things keep worsening. So again, I think it is a reasonable discussion point to bring up in answers, although I would also agree that there is a parallel to other medical questions where I am frustrated reading the answers because so many people who are not medical professionals don't know what they're talking about. But I realize that everyone probably feels that way about questions that are asked in their particular realm of expertise.
posted by treehorn+bunny at 10:17 PM on October 21, 2012 [5 favorites]


p.s. I've had a few unusual cases where people's delusions are of having a medical issue and I evaluate them medically first. Their behavior and story usually clues me in to the fact that there is something fishy going on, and the workup turns up nothing so I call for a psychiatric assessment in the ER. For example, a patient experiencing paranoia and delusions that his/her house is infested with bugs and that there are bugs crawling all over him/her and biting her or causing various symptoms ("formication"). Interestingly, I've had people with varying degrees of this type of problem and at least one of them ended up with a psychiatric admission directly from the emergency department, although others were released for outpatient follow-up.
posted by treehorn+bunny at 10:25 PM on October 21, 2012


RolandOfEld: " I feel like people aren't considering that the OP can't simply have his friend committed by saying the words "Baker Act" right? I feel like people are viewing this like all it takes is for someone to declare yt something for it to be true."

THANK YOU. This is exactly what I was trying to say. It's like I was speaking to a brick wall.
posted by IndigoRain at 8:24 AM on October 23, 2012


In Michigan at least, an adult must be adjudged (in the opinion of a licensed professional) to be an immediate danger to oneself or others to be involuntarily committed.
posted by quonsar II: smock fishpants and the temple of foon at 10:35 AM on October 23, 2012


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