mheslep said:
Where are you getting this from? Using the phrase "in practice" implies first hand knowledge of many such instances. Is that the case? There's no mention of "imminent" in the legal standard I referenced. Nor does it say a doctor must witness first hand a threat. The standard is "poses a substantial risk of harm", the word "substantial" implying a subjective judgement call by a professional.
I don't expect to convince you; there are others on this site you'll trust who will tell you the same thing, I'm sure. Feel free not to take my word for it; as for firsthand experience, yes, it's the case, although I'm not psychotic nor do I have any relatives with a psychotic disorder.
Each state has variations on a theme, but you would be AMAZED at just how blatantly someone needs to be ill to be held. For better or worse, this country has powerful laws protecting privacy and the right to be free, and really, it's a common nightmare for many that they could be derailed from society and placed "away" as ill without due process. Instead of improving our system, we gutted it, and in it s place we use the penal system as a means of control.
Here's an example for the state of Massachusetts
http://www.apa.org/about/offices/ogc/amicus/mills.aspx
APA Position said:
APA's Position: APA submitted another brief in support of the plaintiffs to the Supreme Judicial Court of Massachusetts. The brief argued that: (1) the law of Massachusetts guarantees a right of personal autonomy and freedom from unauthorized bodily intrusions, a right offended by the involuntary administration of psychotropic drugs to (a) a person competent to make treatment decisions for himself, and (b) an incompetent person who would choose not to be medicated with such drugs if he were competent; (2) the civil commitment decision in Massachusetts is not equivalent to a judicial determination of incompetence to make treatment decisions, and that the civil commitment decision is different from a determination that the Commonwealth may forcibly medicate an involuntarily committed person with psychotropic drugs; (3) a person competent to make treatment decisions should have an absolute right to refuse such medications, and (4) the question of competency can be made only by a court, not by hospital personnel, except (a) where a patient presents an imminent threat of physical harm to himself or others or (b) where the patient's mental condition would suddenly and irreversibly deteriorate without administration of the drugs. In that case, they may be administered on an interim basis until a court could make a determination of incompetence and a substituted judgment decision.
That is GOSPEL for any psychiatrist practicing in MA, and you'll find something like it in most or all states (not 100% on all 50).
Read some of those, and tell me how we can reconcile THAT level of freedom, which I believe in... with the need to provide care? The only sane solution is to provide a higher standard of care; a proper standard of care. Properly treated and maintained mental illness is NOT generally a threat to anyone, including the sufferer. Group homes for those with no family left or able to care for them, and ones that aren't Texas fight-clubs so understaffed as to be a joke... are needed. Other solutions are also needed, and have been outlined in paper after study after paper...
Nobody seems to care until its them, their loved one, or a tragedy occurs.
Oh, and yes, it's a subjective call, but do some research into how narrow the guidelines are to MAKE that call. Compare with actual rates of psychotic disorders in the population and despair.
edit: In practice, "4b" is just not done, but you can walk through Boston, or NYC, or SF, etc... and know that. You see, "4b" is in direct conflict with "3". You're probably thinking I'm an idiot saying that... after all you've doubtless seen people on the street who CAN'T make decisions about their medication. Fair enough, but what do you think happens when that medication begins to work?... 3. Refusal... often refusal. Antipsychotic drugs don't cure anything, they diminish symptoms and can do their own long-term damage... nasty damage too. Plenty of people can't stand the adverse effects; drooling, tardive dyskinesia, drowsiness, stop... and then pretty soon they're back in place where they can't seek help again, or won't. Often, and this is a problem with Bipolar disorders as well, illegal drug use practically goes hand in hand with some many untreated psychiatric disorders. If the choice we're giving them is an unbearable non-life with medications, or a familiar life on drugs... too many choose drugs and the streets.
edit2: Note: in cases where 4b is an issue, you're talking about such a crisis that it's simply not required; a court would do the work anyway.
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