Involuntary commitment?

By all accounts, Cho Seung-Hui's mental illness was apparent and frightening to everyone around him; but the hands of all those who could have helped him were tied by the laws that require his cooperation in getting help. When he was referred to mental health professionals, he claimed not to have any suicidal thoughts, and thus was allowed to return to his dorm and get on with his plans for mass murder.

If he would have been placed in in-patient treatment at a mental health facility, he could have been treated, or at least confined and the whole Virginia Tech tragedy would never have happened.

Is it time to bring back involuntary commitment?

Are you kidding?

Maybe we will be safe then. :sarcasm:

but they aren't easy to use. You need more than one psychiatrist, a plethora of hearings that have to have clear and convincing evidence of either insanity or willingness to use harm against him/herself or others, among other things.

I understand that laws vary from state to state, but it seems like his writings alone should have been more than enough reason to start the process. Was it necessary for him to actually harm someone before the process of involuntary commitment began?

...but when I lived in Ohio I had a naighbor who was Schizophrenic (and didn't take his meds) and legally blind. He lived alone because none of his family members wanted to be bothered with him. He put me, my family and the families of the entire neighborhood thru 8 years of sheer hell. Calling the police on everyone for his delusions (which included neighbors being on his roof, stuffing trash down his chimney, people spraying water in his open windows, people squirting hairspray and other substances in his eyes and along those lines of nonsense). He came out one Saturday morning with a shotgun, runnig around in his yard pointing that thing at everything and nothing (did I mention he was legally blind?)- I called the cops - and nothing happened.I was informed that he had to commit an actual crime before they could forcibly commit him. Well, I had three small children and yes, I got a gun. And I would have used it if necessary.

living with that threat on a day-to-day basis.

...of course, I could have moved - but I didn't see why I should since he was the one terrorizing everyone (granted, it was his illness) - I'm a bit stubborn in that way.....

The saddest thing....after a few years of this, the Police didn't bother showing up anymore when he called them. The entire neighborhood was happy when there was a day we didn't have to deal with him.
So nobody was too upset when we didn't see him for three days in a row. We just felt relieved. Until the Police broke into his house (his mother had called them to check on him because she hadn't heard from him for three days) and found him on the floor, passed out. He had had an aneurysm, they found clawmarks where he tried to claw his way to the phone - he survived but had to be put into a nursing home permanently. The sad part is, while we all felt a little shocked and sad - we felt mostly relieved that he was no longer living in the neighborhood. That may sound horrible - but that's the reality.
Even tho there are situations like this - I'm strongly against involuntary commitment unless there is sufficient evidence and absolute concrete reason. Because, especially under this Administration, how many people would be committed for less than ethical reasons?

and I don't think it was horrible.

We used to have a neighbor we called crazy, but she was more like just a natural-born troublemaker. My next door neighbor kept her dog in an outdoor kennel during the day and the crazy woman would go over and open the kennel door to let the dog out so that she could call the cops and complain that the dog was loose. I saw her do it, but when confronted she lied and played victim. The cops knew it was all about harrassment, but told us they HAD to follow through on every complaint.

Just before we moved, she got herself in a heap of trouble. She babysat and spanked one of the kids with a wooden spoon and was brought up on child abuse charges. She did some jail time, and of course was forbidden from babysitting. That was probably the best thing that ever happened to her. She had to get a job outside the home and got away from her three little kids, who were pushing her over the edge. Anyway, things calmed down significantly after that.

Springfield man is accused in plot to kidnap, rape, kill

Police say Randy Lee Rust planned the deaths of his former wife and 13 others

The handwritten plans called for three young girls, ages 4 to 9, to be kidnapped, raped and killed. Others slated for death were an ex-wife, her family and old friends.

Thanks to the actions of a housemate — who passed notes on the alleged plot to investigators — Springfield police say they were able to thwart the plans of "a dangerous kidnapper" who appeared ready to abduct, "mutilate and kill" 14 people.

http://www.ozarksnow.com/apps/pbcs.dll/article?AID=/20070419/NEWS01/704190376

As far as I can tell from reading the article this guy hadn't broken any laws YET. They took him into custody. More:

Police executed a search warrant at Rust's residence Monday afternoon, where they seized hoarded supplies similar to those he described in his notes. Rust, who was home alone at the time, was arrested on suspicion of possessing a controlled substance, although no drug-related charges had been filed at press time.

It boils down to the presidng judge/magistrate's subjective opinion of what is "enough" evidence to incarcerate a defendant, subject to confirmation by a panel of appeals judges.

In one jurisdiction, it could be someone not opening their mouth for "a spell" and in another years of angry, abusive threats with unreported assaults and stalking (and sometimes, even that isn't enough).

It just seems sad that all of this could have been prevented if the concerns of people who knew him and were alarmed by his behavior had been heeded.

either poses a substantial risk of harm to themselves or to others (under criteria developed in Lessard v. Schmidt). The cops the investigate the situation and decide whether they think the risk to self or others exists. They either let the person go or transport him/her to a locked psych ward.

The person can be held on the locked unit for up to 72 hours, during which time 2 shrinks (psychiatrists and/or psychologists) determine whether there is probable cause for further examination. If they convince the court there is probable cause, the person can be held for up to 2 weeks for observation. By the end of that time, a decision is made on whether to recommend for commitment. The detainee has a right to an attorney, and can have a full-blown trial in front of a jury if they wish.

In order for a commitment to be ordered, the court has to find the person both dangerous and treatable. If treatability can't be established, a recommendation can be made for guardianship and protective placement. The initial commitment, if granted, is for 6 months. It may be inpatient or outpatient, based on a criterion of least-restrictive placement consistent with safety for the individual and society. The commitment must be reviewed every year, with a new examination conducted by at least one doctor (psychologist or psychiatrist).

Overall, it is very hard to get anyone committed because the responsibility for paying for the whole process falls on the counties, and the counties have very little money for this sort of thing. As a psychologist, I'm sometimes engaged by counties to do commitment and protective placement evaluations and have testified in a large number of these cases over the last 20 years. (I used to do a lot more commitment evaluations years ago when I worked on an inpatient unit). It's never fun to lock someone away, but it is often the best available alternative, and all too often the decision is made purely on basis of the immediate cost to the county of taking action.

It sounds like a lengthy and complicated process. Sounds like there are safeguards for the rights of the individual in place. If Cho Seung-Hui had been referred for confinement under these laws, how do you think he would have fared? As a professional, do you think he could have "fooled" the psych pros and been released?

(BTW, I am graduated from U.W.-Oshkosh in the '70's, so we often had aides from Winnebago in our classes, and one of my fellow students did an internship there, and actually spoke to Ed Gein.)

and especially not from a clinical perspective. In general, the issue of "fooling" professionals boils down to how much information they have upon which to base the judgment. Generally, a decompensated paranoid schizophrenic will reveal him/herself during the course of a 1-hour interview, especially if you have their MMPI data. Other disorders can be trickier. I have evaluated people who seem totally normal, but who have had brief, homicidal psychotic episodes. I think people should be observed in an inpatient setting for at least a week or 2 before the decision on commitment is made. Generally it's not necessary to establish the exact diagnosis in order to commit. In fact, I'll be testifying in a couple of weeks in a case where I don't independently have enough information to give a definitive Dx, but I'm confident that she poses a sufficient risk to herself to require outpatient commitment. This is actually a recommitment case; she is currently committed, and my recommendation is to extend the commitment for another year.

I used to get to Oshkosh fairly ften because of all the prisons in the area, plus Winnebago and the Wisconsin Resource Center.

I'd like to see some real information.

and it would take hours to actually get the links, so I'm sure you could look them up faster, if you chose to do so.

However, the day after one of his writings was presented, only 7 out of a class of 70 showed up. Sounds like they were possibly concerned for their safety.

When he was kicked out of one of his classes and privately tutored, the professor tutoring him arranged with her assistant to have a "code word" which meant the assistant would call security. I think she understood that he could pose a danger.

There were complaints about him stalking women on campus.

One professor repeatedly requested that he seek help, and offered to take him to counseling herself.

When the news broke that an Asian student had committed this crime, one of his professors knew "instantly" that it was this particular student.

The warning signs were there, obviously, but there was little anyone could do.

I can see where this might sound like a good idea (loosening the requirements for involuntary commitment) but I can see this becoming an area for significant abuse not only by private citizens (kid's a bit to rambunctious and you can't be bothered? pop him into the mental health ward.) but also by our government (remember many Soviet dissidents where sent away due to "mental illness")

But we used to have involuntary commitment, until the 60's or 70's, and I'm not sure it was discontinued due to abuses like that, but more because it _seemed_ inhumane to lock up people against their will.

If someone collapses unconscious in the street due to a heart attack or a stroke we don't require that person's permission to take him to the hospital or begin treatment because it is understood that he is unable to make such decisions for himself. In the same way, I believe that people who are suffering delusion cannot make rational decisions about their own treatment.

A large number of mental hospitals in the 60s and 70s were little better than prisons.

I know this isn't a popular opinion here, but one of the side effects of the ending of involuntary commitment was the rise (and visibility) of homelessness in the major cities.

I remember the videos of the institutions. (Wasn't that what propelled Geraldo to fame and fortune?) I think the abuses could have been eliminated; but instead the baby was thrown out with the bathwater.

I agree with you about the homeless issue. Sadly, the people who are least able to protect themselves from all sorts of ills were made vulnerable to everything from crime to the weather.

how many millions of people would you like to lock up for being quiet types who write disturbing fiction?

you would punish millions w. lack of freedom and a future of closed doors and financial ruin because ONE quiet man who wrote some disturbing crap ONE time shot some people

if the kid was stalking, there are already laws on the books against stalking -- put him in jail for stalking the women instead of winking at it

that is where the system fell down, it doesn't give a fuck about women being stalked and often colleges are motivated to conceal how much crime/stalking there really is on campus, even after the first shooting, they were going to sweep this under the rug as a domestic matter

if the kid had been in jail or an institution for the stalking offenses previously reported, the mass murder couldn't have happened -- and all that would have been required would be for campus authorities and police to take stalking seriously instead of as a trivial matter, women's reports of being stalked are not taken seriously

there would be no need for new rules about involuntary commitment, simply ENFORCE THE DAMN LAWS AGAINST STALKING AND TERRORISTIC THREATS ALREADY ON THE BOOKS!!!!

If they were to involuntarily commit everyone who had suicidal/homicidal thoughts/fantasies, there wouldn't be enough prisons to hold them. Most people consider suicide sometime in their lives. Many consider murder. Obviously, most people never act on either impulse but deciding who might actually do such a thing is extremely difficult, at best.

The door for abuse and/or mistakes would be wide open.

A three-day hold if testing were part of the equation. Of course, it's hard to test scared or pissed off people. I like Tahiti Nut's idea of universal preventive mental hygiene.

The poor guy pushing a shopping cart down the street and jabbering may need help, he certainly needs assistance, but my fear is that he could be imprisoned for what is essentially harmless behavior as an excuse for ridding the street of a nuisance, not a threat.

Or, frustrated housewives screaming at their kids, "I'm gonna kill you!!"

When I was a counselor, dealing with violent, or suicidal clients, I found the best way of "evaluating" a threat was through my guts rather than relying on what the person said. Only 15% of what a person communicates is verbal. The rest is non-verbal. And, I learned that my "guts" picked up a lot more of that kind of communication than my ears did.

that incorporates the family is so valuable. I learn to predict very accurately when my ex was having a hard time that could lead to a decompensation. And, I didn't do it by reading books, but by observing everything from my own jaw tension to how he interacted with his palm pilot.

Here's to better, finer tools.

Currently, we stigmatize mental health care to the point that people avoid it - where the first contact, if any, that many have with mental health care professionals is career-threatening and and possibly life-threatening.

We need a far more comprehensive mental health care system, preferably (imho) incoporated into our public education system. EVERYONE should receive mental health care as ubiquitously as people access OTC cold remedies. Then and only then can it both be de-stigmatized and thorough enough to be preventative care instead of too little and too late.

As I said in another post ...

"Let he who is without sin cast the first stone."