The Abuse of Psychiatric Detention and Its Complications

I've often said that Indiana's mental health laws are about 50 years behind where they need to be. Even in Indianapolis, where mental health treatment is relatively cutting-edge, there are still problems, especially when it comes to involuntary hospitalization.

Danger to Self or Others--kinda, sorta

There are two types of psychiatric detention in Indiana: a 24-hour hold, called an "immediate detention" or "ID", and a 72-hour hold, called an "emergency detention", or "ED".

Theoretically, these are done only when someone is in imminent danger. However, Indiana law allows a mental health professional generous leeway of what that danger is.

For example, I live in an apartment complex with several other individuals with mental illness. The complex is managed by a community mental health center. Recently, there was a pinkeye outbreak. At an emergency meeting, staff informed us that if we caught pinkeye, we would probably be IDed to keep the illness from spreading. If we caught pinkeye, we were technically a "danger to others".

Imagine explaining that in the paperwork. While it is extremely doubtful that we would be admitted after the ID expired, it remains disturbing to me that the ID would probably stick.

One especially problematic result is that a person with pinkeye would occupy a bed that might be needed by a person with psychosis.

When Mental Health Professionals Lie, It Creates a Loss of Trust

Psychiatrist E. Fuller Torrey once said perjury can be a practice.

"It would probably be difficult to find any American psychiatrist working with the mentally ill who has not, at a minimum, exaggerated the dangerousness of a mentally ill person's behavior to obtain a judicial order for commitment," he said. "Thus, ignoring the law, exaggerating symptoms, and outright lying by families to get care for those who need it are important reasons the mental illness system is not even worse than it is."

The problem is, this leads to a lack of trust that is vital to the therapeutic relationship.

This happened to me once. I've forgotten what led up to it, but there was a heated argument with a therapist. The psychiatrist on call, without speaking to me, ordered an emergency evaluation. After I sat in the crisis intervention unit for several hours, a social worker came to evaluate me.

She examined my arms and seemed surprised to see no fresh wounds. "[Therapist] said in your ID that you pulled out a knife and started cutting on yourself," she explained.

To say I was stunned is an understatement along the lines of describing the Arctic as "kinda chilly". I was able to prove that I hadn't done so, emptied my pockets to prove I didn't have a knife, and was allowed to leave.

One thing was severed, though--any remaining trust I had in that therapist. I later learned that she had a reputation for falsifying reports in order to get an ID to stick. To my knowledge, she has never been sanctioned for it. I requested and received a new therapist.

A Lack of Other Options

A fradulent ID is not always a negative thing.

In 2009, I became severely ill with bronchitis. While my symptoms were not severe enough to warrant hospitalization, my doctor could not see me for a month. As the illness became worse, my psychiatrist realized I needed prompt medical attention. She IDed me so I would receive that treatment.

Although understandable--and I'm grateful she did so before it went into pneumonia--it is still problematic. An ID is a difficult thing to deal with--especially the part involving the police handcuffs. An ID can save lives. It can also derail them.

We need other options. For example, what about a medical detention? What about detaining someone in need of medical attention until it can be determined if he or she is competent to refuse? What about mandatory outpatient treatment (which is legal in some states, and unusual in most)?

We need other options than ignoring the problem or abusing detention--for the sake of us patients, other people in society and for treatment professionals.