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Dr Mordrid
18th April 2007, 10:50
First a rule: no gun talk in this thread. This one is about how to prevent such incidents by intervention when people are known to be "disturbed".

As noted in the original thread about 10-15% of the adult population have serious mental disturbances, some treated and many not. Obviously Cho was largely in the "not" column, at least recently.

In this case all the signs were there; setting fires, stalking others and extremely troubled writings. It went so far that one of his processors notified the administration and the police, resulting in Cho being referred to counseling in 2005. After that the usual bureaucratic inertia set in until Monday.

Previous to the 1970's the state of the commitment laws was such that if the police, family etc. felt a person was a potential danger to themselves or others they could be easily involuntarily committed for diagnosis and treatment.

Then came some exposes of poorly managed institutions and the movie "One Flew Over the Cuckoo's Nest". After this the "reform machine" started to dismantle virtually the whole inpatient psychiatric hospital system and most of the commitment laws; basically throwing out the baby with the bath water in my opinion.

Now it's almost impossible to act preemptively in cases such as Cho. Even if some judge agrees (most won't) it's only for 3 days, and that's not enough time to do much in the way of evaluation, especially with an uncooperative patient.

What should we do? Reinstate a more aggressive involuntary commitment law? Keep on protecting individual rights in extremis then repeat the discussion?

Your turn....

Dilitante1
18th April 2007, 10:57
one snag is privacy. You can look at a person's actions and know there is an issue, but all you can do is point it out to someone. Unless they are visibly violent, even the police can do nothing. If they are visibly violent, the police can have the checked in for psychological observation iirc.

Dr Mordrid
18th April 2007, 11:06
In other words you have to wait for them blow under current conditions.

Is this where we want to be; waiting for the fuse to burn down even though all can see it's lit?

Umfriend
18th April 2007, 11:30
What should we do? Reinstate a more aggressive involuntary commitment law? Keep on protecting individual rights in extremis then repeat the discussion?

Your turn....In extremis? I'll let that one slide.

I wonder Doc, what percentage and numbers of these type of drama's do you think could be avoided by a more agressive commitment law and how many people would be involuntary commited while they would not have done anything had they not been?

Dr Mordrid
18th April 2007, 11:54
in extremis: until death, IMO appropriate to the situation :p

As for your concerns, they're mine as well. Where do we put the balancing point? I would argue the balance tipped too far towards the individual in the 70's. We certainly don't want the USSR system, but we aren't doing anyone much good by being at the other extreme are we?

ND66
18th April 2007, 12:25
What should we do? Reinstate a more aggressive involuntary commitment law? Keep on protecting individual rights in extremis then repeat the discussion?

Your turn....


If there is a will, there is a way.

Even the best law can and will be abused. There will always be someone who will find a way around those things.

Now, let’s get back to the basics. The way kids are raised lately is a Stress Free way. They are not responsible for anything, because there is no consequence of punishment.

And don’t tell me then sending them to their room is a punishment because they have everything there to keep them busy for weeks, PC’s, games, MP3’s etc… .

If they don’t learn that respect is something you have to earn, never deserve it.

Looks to me like this guy demanded respect because he deserved it, because he was poor or something like that.



.

P.S.

Don’t forget, Russia did try to make everybody equal and it didn’t work.
You just can’t have it all. S _ _ _ w the freedom to burn the flag and show the flag some respect instead.

Because as I said, respect it’s something you EARN! You want to be respected, you start showing it to those around you first!



.

cjolley
18th April 2007, 12:54
...I would argue the balance tipped too far towards the individual in the 70's.
...

So how would you draw the line?
I mean specifically.
That's the problem. The Devil is in the details.

Gurm
18th April 2007, 14:12
Too many "One Flew Over The Cuckoo's Nest", "Girl Interrupted", "Crazy People" scenarios for my liking. The problem is that ANY laws making involuntary commitment without prior action possible... WILL be abused. Not just CAN be, but WILL be. Hospitals, especially mental hospitals, are BIG on red tape. They're BIG on procedure. They're BIG on protocol. You'll NEVER get yourself the hell out of there once you're in.

(Much like Walter Reed, where our distinguished servicemen get to ROT for years waiting to be "processed" even though their injuries have long since healed...)

I see no way to go about this without generating a HUGE and unacceptable number of false commitments.

Dr Mordrid
18th April 2007, 15:23
My bet is that he was put on meds in 2005 after the involuntary committal, took them a while and got better allowing the court to vacate its jurisdiction. After that he went off them and the result we know.

If so then perhaps better communications between doctor, court and police is in order.

To that end; should we make it a civil infraction for a seriously ill psychiatric patient to go off their meds without a physicians order so the court can re-claim jurisdiction?

I'd say yes, but these cases should only be heard judges trained in such matters. Inexperienced/untrained judges should not hear these cases.

cjolley
18th April 2007, 15:41
...
To that end; should we make it a civil infraction for a seriously ill psychiatric patient to go off their meds without a physicians order so the court can re-claim jurisdiction?
...


Currently that is not constitutionally possible.
You can't sentence someone to something if they haven't been convicted of something.

Not that I think it wouldn't be desirable, but it would take a restructuring of the commitment process that would allow a sort of "parole" for commitees.

Not sure SCOTUS would go for that.

Also not sure the cure wouldn't wind up worse than the disease.
After all, we have an Attorney General right now who thinks there is no "right" of Habeas Corpus.
Think of the truck some future AG could drive through that loop hole.

Dr Mordrid
18th April 2007, 15:51
Currently that is not constitutionally possible.
You can't sentence someone to something if they haven't been convicted of something.
That's why I specified it as a civil infraction and not a criminal act.

They would be charged for going off their meds, then if the court finds them guilty the committal order gets reinstated and the judge takes it from there.

cjolley
18th April 2007, 16:41
...guilty the committal order gets reinstated and the judge takes it from there.

That's the problem.
Guilty of what?
SCOTUS is never going to be fooled by a slight of hand that transforms civil commitment into guilt.
Guilt is a property of CRIMES.

On the other hand, can there be a crime of ignoring a civil judgment?

Dr Mordrid
18th April 2007, 16:54
Yes, contempt of a court order. If you don't go to court on a ticket for long grass they'll issue an arrest warrant.

Gurm
18th April 2007, 17:34
To that end; should we make it a civil infraction for a seriously ill psychiatric patient to go off their meds without a physicians order so the court can re-claim jurisdiction?

I'd say yes, but these cases should only be heard judges trained in such matters. Inexperienced/untrained judges should not hear these cases.

This is something I can get behind. I can't COUNT the number of people of whom I've heard who have "gotten better" and stopped taking their meds, and then gotten far worse and killed themselves or hurt someone else.

It's almost a truism now.

But yes, have the judges be trained - much like family court judges are trained to make rulings about kids - and it should only be if the doctor thinks the person is a threat when unmedicated. I mean, lots of people get put on antidepressants at one point or another by doctors jumping the gun, wouldn't want them to get busted for not refilling their Paxil.

Dr Mordrid
18th April 2007, 18:04
I'm more concerned with schizophrenics and others who have to take antipsychotics, but yes...there are some people who turn into basilisks if they miss their prozac/paxil etc.

Gurm
18th April 2007, 20:45
I'm more concerned with schizophrenics and others who have to take antipsychotics, but yes...there are some people who turn into basilisks if they miss their prozac/paxil etc.


Well right, that's what I'm saying. There would have to be a doctor involved saying "this person's condition is serious enough that..."

Umfriend
7th May 2007, 11:20
It seems, Doc, the laws in place are suffiecient but that actual enforcement, tracking or whatever is lacking.
http://news.yahoo.com/s/ap/20070507/ap_on_re_us/virginia_tech_cho