How do other countries handle civil commitments to mental hospitals?

Forcing someone into treatment against his/her wishes is not only controversial in our country, but in others too.  In the U.S., each state establishes its own specific criteria, but all states require someone to be a danger to themselves or others before he/she can be forced into a hospital. [Several have adopted looser language, such as  “gravely disabled” or “unable to care for self” to their criteria, but dangerousness  remains the key criteria.]

I was surprised recently when I discovered that our focus on dangerousness  is out-of-step with the rest of the world. Most other countries rely on what is called a  “need for treatment” standard.

Only one nation has more stringent rules than we do. That country is Germany and, I assume, the reason it has established so many hurdles in its civil commitment process is because of abuses in its NAZI era past.

Our checkered past also is at the root of why we adopted “dangerous” behavior as our threshold.  Before the 1970s, it was much to easy to force someone into a mental hospital and commitments were often de facto life sentences.

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The National Alliance on Mental Illness bills itself as ” the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.”  As a lifetime member of NAMI, active supporter of NAMI, and frequent speaker at NAMI groups, I greatly admire and support that goal. But I’m also curious about what that mandate encompasses.

What are NAMI’s priorities when it comes to specific mental disorders?

A recent conversation with Fred Frese and two emails from readers are responsible for my curiosity.

Fred has schizophrenia, is one of the finest speakers I’ve ever heard, and has been a tireless advocate for decades. If memory serves me correct, he has attended every NAMI convention since it was founded in 1979. In recalling NAMI’s history, Fred said that many of the women who helped found NAMI were adamant about challenging the then-commonly held belief that schizophrenia was caused by overbearing mothers.

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FROM MY FILES FRIDAY:  I first published this blog in December 2010, yet the question that it poses  is just as haunting today.

WHO IS TO BLAME FOR THIS DEATH? 

The residents of Morrisville, Pa., got an intimate look this holiday season at our troubled mental health care system. Paulette Wilkie, a homeless woman with a long history of schizophrenia, was found dead from exposure. The 56 year-old woman’s   body was discovered last week behind Ben’s Deli, a sandwich shop that she frequented.

Temperatures the night before had dropped into the mid 20s. But that was not cold enough to trigger the county’s emergency homeless plan. Temperatures must sink to 20 degrees or below for two consecutive days before teams can be dispatched to try to  persuade homeless persons to come indoors.

Reporter Ben Finley, writing in the Bucks County Courier Times, noted that people who knew Wilkie said she likely would not have gone into a shelter anyway. The owner of Ben’s Deli said Wilkie refused help from people concerned about her safety and health.Click to continue…

Information that I have on my webpage  about  Thomas Silverstein, who has been in solitary confinement longer than any other American prisoner, was posted on the front page of the Internet website REDDIT yesterday, resulting in a quarter of a million visits to my page.

Yep, that isn’t a misprint. More than 250,000 readers clicked on the link to read about Silverstein and look at his drawings. The last time I checked, the story had netted 1,200 comments on the Reddit site.

Silverstein, a major character in my book, The Hot House, was put under what unofficially was described as “no human contact” after he murdered correctional officer Merle Clutts in 1983 at what then was the federal government’s most secure prison. When I met him in the basement bowels of Leavenworth penitentiary, the federal Bureau of Prisons kept the lights in his cell on 24 hours a day. It was just one of several ways the BOP punished Silverstein, who today is being held in the government’s Super Max prison in Florence, Colorado.

When I asked him how he slept with the lights on, he replied: “Pete, I close my eyes.”

I was the only and last reporter to inteview  Silverstein face-to-face when I met with him several times between 1987 and 1989. We have kept up our correspondence. Amazingly, it is not unusual for me to get a handwritten letter more than a dozen pages long from Silverstein who sometimes apologizes for taking so long to respond because he is “busy.”

Somehow, after spending thirty years in solitary confinement, he still finds way to keep himself busy.

Zac Pogliano

Dear Pete,

     My 22 year- old son, Zac, has schizophrenia, the paranoid type. Since February, he has phoned emergency services five times to ask for help for problems that he’s imagining. Sometimes it’s a heart attack, sometimes his throat is closing, and yesterday, it was to report a gunshot wound to his head.

    He was certain he had been shot because earlier in the day, he’d heard a leader in his psychiatric rehab program say, “Who wants directions to Zac’s house?”  That comment upset him and by night time, it had translated into him thinking that he’d been shot in the head.

    He phoned 911 to report it.

    I was worried when I found out what he’d done. The police have weapons and there is no shortage of news articles about tragic encounters when police are called to intervene during a psychiatric crisis.

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