Why no Involuntary Commitment in DC?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You can't just indefinitely cage a person. That would be an abuse of involuntary commitment.

Dp. If they refuse to take the meds and are endangered oh yes you can confine them to a room and board. I don’t understand why it’s ok to live in encampments. It’s one of the many examples of normalizing things that aren’t normal.

Because involuntary confinement has been historically abused to atrocious ends. It is a social conundrum that through out history we have failed to address because until it hits your family, no one seems to care.

Hospitals were "closed" 40 years ago. Time to regroup? The abuse today is leaving mentally ill people to die in the streets.

[Anonymous]

I agree with you OP. I just don’t understand how it is more humane to allow someone with severe mental health issues to live in squalid conditions on the streets than to build or re-open institutions.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think the problem is that at some point living in the streets was normalized. Even from the POV of well-being of those that live there, let alone not caring how it affects healthy people around them (mostly poor and non white btw, because encampments aren’t near McMansions through in SF it can be the case now).
There needs to be a stance that it’s not normal and that their lives need to be closely monitored. Nobody wants cages, more like a nursing home. Why is it ok to “confine” the elderly but not the mentally ill?

I think that came with the defunding of mental health services. There was a big move a couple of decades ago to get mental hospitals in DC closed. But, the people don't magically disappear.

I think that the people who are posting here have no idea how limited resources are to deal with mental health issues. And, then finding someone to pay for the services can be nearly impossible. For things to change, we as a society have to decide that we want to fund mental health services and make them accessible to the masses.

To give you an example, in any given month, I spend close to $1k on mental health services for my young adult child, plus I pay for everything else that most parents are no longer paying for due to mental health issues. In prior years, when there were institutionalizations, my costs were closer to $50k. Most people that I know can't do that. We were lucky that we had savings. I am not complaining. Just sharing the reality.

Yes it started with closing the institutions.
Yes there is not enough funding. Mental health services for people whose families are taking care of them is a separate topic imo - there needs to be reforms but it’s just a different area of concern.
People on the streets need to be put into housing on cheaper land with round the clock medical care. It’s ok if they only have a bed and not a room, let alone a house to themselves. Someone needs to monitor their medications. They should not be allowed to camp out on city streets.

[Anonymous]

Anonymous wrote:I agree with you OP. I just don’t understand how it is more humane to allow someone with severe mental health issues to live in squalid conditions on the streets than to build or re-open institutions.

Let alone those who have to endure the encampments in their backyards

[Anonymous]

Yes it started with closing the institutions.
Yes there is not enough funding. Mental health services for people whose families are taking care of them is a separate topic imo - there needs to be reforms but it’s just a different area of concern.
People on the streets need to be put into housing on cheaper land with round the clock medical care. It’s ok if they only have a bed and not a room, let alone a house to themselves. Someone needs to monitor their medications. They should not be allowed to camp out on city streets.

Your suggestion is to target the end point and not the crises and problems that get people to that end point. Also, you are talking about taking away free will. At least some people on the streets are choosing their fate. Not everyone wants housing and medical care and even less what institutional living. If that were the case, people would be going to homeless shelters instead of staying on the streets.

I don't think that either suggestion is the answer to the problem. If you intervene at an earlier point, then maybe you can avoid reaching the point where someone ends up on the streets.

And, yeah, I am taking care of my child. But, I'm going to die and the street is a very real possibility. And, it wouldn't be the first time because even though we are willing to do everything we can, people have free will.

[Anonymous]

It’s not a “DC” problem. It’s a national problem, based on decades of political decisions. Some people genuinely believed that psychotropic medications and community clinics would be “enough”. And even community based clinics haven’t been adequately funded. Others saw this as part of larger efforts to use tax dollars to support corporations while encouraging the rest of us to tug up our bootstraps — not easy without health insurance or boots, even as housing costs have soared astronomically.

As others have said, DC, like most places, can hospitalize people for short periods of time when they are deemed a danger to themselves or others. But then what? As with many things, the people who already have resources might get their needs adequately addressed. The people without resources probably will not get their needs adequately addressed. That, as you’ve noticed, has consequences for the well-being of the entire community.

Check out the stats on the percentages of people imprisoned who have diagnosable mental health issues and/ or learning issues. Then think about who we are as a society and what our country has prioritized.

At the risk of going all John Lennon, Imagine if approved treatment options were available— and people got them. Imagine if such options included case management and other support services to ensure that people continued to get needed supports beyond the immediate crisis.


- Someone who provided community based services for kids and families for many years — until the funding got cut.

[Anonymous]

Anonymous wrote:

Yes it started with closing the institutions.
Yes there is not enough funding. Mental health services for people whose families are taking care of them is a separate topic imo - there needs to be reforms but it’s just a different area of concern.
People on the streets need to be put into housing on cheaper land with round the clock medical care. It’s ok if they only have a bed and not a room, let alone a house to themselves. Someone needs to monitor their medications. They should not be allowed to camp out on city streets.

Your suggestion is to target the end point and not the crises and problems that get people to that end point. Also, you are talking about taking away free will. At least some people on the streets are choosing their fate. Not everyone wants housing and medical care and even less what institutional living. If that were the case, people would be going to homeless shelters instead of staying on the streets.

I don't think that either suggestion is the answer to the problem. If you intervene at an earlier point, then maybe you can avoid reaching the point where someone ends up on the streets.

And, yeah, I am taking care of my child. But, I'm going to die and the street is a very real possibility. And, it wouldn't be the first time because even though we are willing to do everything we can, people have free will.

I don't want to disregard you or your experience, but I disagree that free will applies to impaired judgment. That is where society steps in. I also agree with a PP that solutions on public dime should be humane and cost effective. People who are incapacitated and need care do not need a full house. They need a bed, care and supervision. 100% There are ways to reimagine this that are humane and realistic.

[Anonymous]

Anonymous wrote:

Anonymous wrote:DC has involuntary commitment. But a person has to meet the standard. I will agree with you that mental health services are sorely lacking. And, it is also tough because if a person is considered competent, they are in charge of their treatment and family gets no say.

Many people stop taking medications that would give them a better quality of life. Some do for financial reasons (and this is not only a mental health issue). Others stop because they feel better and don't understand that if they stop the medication they will decompensate. Others stop because of the side effects. And, some even stop because they like how they feel without the medication - like the manic phase of bipolar disorder if their manic is positive and energetic. It's really complicated.

I get that. However, how is it that Britney Spears has conservatorship, but we can't as a society look out for other people unable to make sound decisions? The mental health / and or addiction fiasco in our countryleads to so many unintended consequences... If someone says they want to remain in the streets during hypothermia conditions for example, why isn't that evidence they are not of sound mind and a ticket to the mental health treatment facility?

This comparison is not helpful because the reason Britney Spears is in the situation that she's in is that she is a wealthy woman who had not exhausted her earning potential. Most people under conservatorship are not wealthy and being the conservator is not lucrative the way it is for the Spears family.

I used to work in community mental healthcare in DC, and I knew Angela. I am sad that she died but I am not at all surprised. If anything, I am surprised she survived as long as she did. She was extremely resistant to help of any kind. One time we tried to bring her water during a heatwave in the summer and she literally threw the bottle back at me.

Hospitalization is intended to stabilize people. It is not a destination so much as a transitional point between crisis and maintenance. There are a lot of people who would really benefit from halfway houses and group homes, and nowhere near enough of those types of facilities to accommodate everyone who would benefit from living in one. Additionally, opening that kind of facility is expensive and frequently opposed by the neighborhoods around the facility. It is also worth noting that among homeless folks and people at risk of homelessness, almost any option is better than going to a shelter. There are a lot of reasons for this, some of them legit and some much less so, but at the end of the day, shelters (in DC specifically and also other places I've lived and worked) are not viewed as safe options. In shelters, people's stuff gets stolen. They're assaulted by other shelter residents. Staff at shelters are not always kind and respectful, particularly if there is some kind of conflict between a resident and staff over a rule. Everyone I've spoken to who has spent time in DC shelters as a resident likens it to jail in terms of the restrictions. I don't disagree that it's a bad decision, but people are allowed to make all kinds of bad decisions without having their self-determination taken away from them. You guys might not think of things like psychiatric hospitals as "not like cages" but I promise you that the majority of the people who I had taken to psychiatric hospitals against their will very much thought of it as jail.

As for the idea of criminalizing homelessness, until society is also able to fully commit to preventing homelessness in the form of providing housing to people who can't provide it themselves, in a sustainable way, criminalizing homelessness is cruel. Until society (and a lot of people on this thread) is able to fully commit to the idea that homeless people are PEOPLE, not gross objects to be stashed in "day stations", there is not going to be any real progress in this area. The people y'all are talking about understand how they are perceived, and frankly, that alone dissuades people from wanting to "seek services."

When Britney Spears was put under conservatorship, I thought, "Wow, look how fast the system can move to protect a wealthy white woman and her wealthy white kids from the effects of mental illness." When she stayed under conservatorship for this long, I thought, "Those people would evaporate if it was no longer financially worth it for them." I saw an awful lot of Black families destroyed by the effects of mental illness and addiction. Kids who didn't have relatives riding in to the rescue because their relatives were not in a better position than their parents. The system is quick enough to say, "This parent is not fit" and take kids away, but as someone who has also worked in child welfare, so many of the things that people consider to be parenting problems are actually poverty problems. People living in generational poverty have a really hard time in DC even with all the services that are available. I worked with so many families who were in trouble with CPS for making the best of really bad choices - e.g., leave your 6yo to get to school on her own at 8am because you have to get on three buses to get to your job across town or else you'll lose your housing. In many of these situations, there are obvious solutions - e.g., provide entirely subsidized housing until families are able to meet situation-specific benchmarks related to savings, education, certifications, etc. - but there isn't the political will to institute those solutions, and there certainly isn't the social will to fund them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You can't just indefinitely cage a person. That would be an abuse of involuntary commitment.

I don't think of mental health facilities as cages, and you are correct --it is very difficult to commit someone in this country against their will. However, if people were committed and treated likely they would not die in this horrible manner. If they stop taking medication, re commit them and treat them again.

But horrible things have also happened in mental health facilities.

Here's a review that shows that according to various studies, 7 - 8 % of inpatient psychiatric patients experience sexual assault, and that's in an era of brief hospitalizations. The longer term hospitalizations you seem to be proposing would send that number up.

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202000038

[Anonymous]

The lack of affordable and accessible mental health care in this country is a travesty. Even parents who want to help their young children with burgeoning problems often cannot get the help they need unless they can afford $250/appointment. We need transformative thinking from the ground up.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Yes it started with closing the institutions.
Yes there is not enough funding. Mental health services for people whose families are taking care of them is a separate topic imo - there needs to be reforms but it’s just a different area of concern.
People on the streets need to be put into housing on cheaper land with round the clock medical care. It’s ok if they only have a bed and not a room, let alone a house to themselves. Someone needs to monitor their medications. They should not be allowed to camp out on city streets.

Your suggestion is to target the end point and not the crises and problems that get people to that end point. Also, you are talking about taking away free will. At least some people on the streets are choosing their fate. Not everyone wants housing and medical care and even less what institutional living. If that were the case, people would be going to homeless shelters instead of staying on the streets.

I don't think that either suggestion is the answer to the problem. If you intervene at an earlier point, then maybe you can avoid reaching the point where someone ends up on the streets.

And, yeah, I am taking care of my child. But, I'm going to die and the street is a very real possibility. And, it wouldn't be the first time because even though we are willing to do everything we can, people have free will.

I don't want to disregard you or your experience, but I disagree that free will applies to impaired judgment. That is where society steps in. I also agree with a PP that solutions on public dime should be humane and cost effective. People who are incapacitated and need care do not need a full house. They need a bed, care and supervision. 100% There are ways to reimagine this that are humane and realistic.

Impaired judgment is just not the standard for taking away free will - and really, we wouldn't want that in our country. You have to be certified as incompetent by two doctors. There are many people with impaired judgment who carry on just fine in life, probably due to a lot of good luck.

Also, can you really imagine institutions to be humane and better than prisons? Imagine a large room with 50 or so beds, large cafeteria areas, and large common areas filled with people who may be paranoid or violent or who may have weird behaviors or be loud mouths. Imagine that all they have going on in their day is sleep, eating a few meals a day and watching TV - because by your standard, all they need is a bed and by your standard, due to impaired judgment they would require supervision so could not leave. Then imagine the fights that would break out and the chaos that would erupt when someone's PTSD kicks in or when someone hogs the remote. I've worked in these settings and honestly, it seems as though you have on rose colored glasses if you think just a bed, care and supervision are enough.

Regardless, even if our country does start to tackle mental health care, I just don't see it reaching the people you are concerned about. The cost would be staggering and no one has the stomach for that right now, especially when there is not a significant financial cost to the country to allow them to stay on the streets-that's why institutions were closed in the first place. What we might see is some early intervention given all of the attention that mental health issues has received during the pandemic, which just might result in people getting the care they need to stop the cycle.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You can't just indefinitely cage a person. That would be an abuse of involuntary commitment.

I don't think of mental health facilities as cages, and you are correct --it is very difficult to commit someone in this country against their will. However, if people were committed and treated likely they would not die in this horrible manner. If they stop taking medication, re commit them and treat them again.

But horrible things have also happened in mental health facilities.

Here's a review that shows that according to various studies, 7 - 8 % of inpatient psychiatric patients experience sexual assault, and that's in an era of brief hospitalizations. The longer term hospitalizations you seem to be proposing would send that number up.

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202000038

But freezing to death under a bridge was safer? You can't make the argument that because facilities are unsafe, we can't have them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You can't just indefinitely cage a person. That would be an abuse of involuntary commitment.

I don't think of mental health facilities as cages, and you are correct --it is very difficult to commit someone in this country against their will. However, if people were committed and treated likely they would not die in this horrible manner. If they stop taking medication, re commit them and treat them again.

But horrible things have also happened in mental health facilities.

Here's a review that shows that according to various studies, 7 - 8 % of inpatient psychiatric patients experience sexual assault, and that's in an era of brief hospitalizations. The longer term hospitalizations you seem to be proposing would send that number up.

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202000038

And there have been multiple studies that mentally ill homeless people are sexually assaulted on the streets at alarming rate. Rates that are two to three times the 7-8% that you cite. Many homeless women have been repeatedly sexually assaulted. Add to that living in squalid conditions. It is just so cruel that we have normalized this.

[Anonymous]

I just watched "I care a lot " with my spouse. Apparently easy to get elders institutionalized and seize their assets, but not commit and treat mentally ill. No profit?

[Anonymous]

Anonymous wrote:The lack of affordable and accessible mental health care in this country is a travesty. Even parents who want to help their young children with burgeoning problems often cannot get the help they need unless they can afford $250/appointment. We need transformative thinking from the ground up.

It varies. There are programs that provide school and community based mental health services and prevention services that are covered by Medicaid and other types of insurance. There should be more programs like this. Prioritizing funding for mental health and case management services would be a start.