I'm the author of Your Consent Is Not Required: The Rise in Psychiatric Detentions, Forced Treatment and Abusive Guardianships. My book examines how mental health laws are used to police streets, manage schools, nursing homes, and other institutio...

What you seem to be suggesting directly contradicts my personal experience trying to get help for my brother who has been diagnosed with schizophrenia and bipolar disorder, and declared 100% disabled by Social Security, as well as the experience of almost everyone at the NAMI support group meetings that Ive been attending twice a month for six years. If anything, it seems to be getting even more difficult to get a psychiatric hold on anyone who is not clearly and immediately threatening to harm themselves or another person.

The term of when they "don't know that they're ill" or are "lacking insight" is anosognosia, and it is a very real problem. There's an excellent book on the subject written by Dr Xavier Amadir called "I'm not sick and I don't need help" that goes into detail on the subject, how it affects the mentally ill and how it often leads to untreated illnesses with devastating consequences. Have you read it?

Did you spend any time interviewing advocacy groups like NAMI or family members of the severely mentally ill to help inform your point of view from the perspective of those living with these issues? Because it seems like you're focused on statistics and the enforcement side without investigating how difficult it actually is to get a person who absolutely needs help but doesn't want help to get treatment.

Yes, I read that book, and I talked with people from NAMI, I examine the issue of the role of involuntary treatment amid family conflicts at some length. And yes, I show in the book that it's often relatively easy to get people detained--and that's part of the problem, because then there aren't beds left for those who might really benefit. The whole process is very unscientific, and legally vague, and so people on all sides become frustrated. More voluntary options and supports would help a lot.

As a physician, my anecdotal experiences seem to be the opposite really. Just recently I had a patient with hepatic encephalopathy admitted, but refusing to take lactose. Traditionally, in this situation doctors would put restraints (soft limb or mittens) and place ng tube to prevent the patient from worsening encephalopathy, lose airway protection, or go into a coma.

I had a nurse just flat out refuse to place an NG tube because the patient (which is encephalopathic) is refusing (everything, might I add). This is getting ridiculous because we are swinging so far towards pro patient autonomy, the do no harm part of our oath becomes meaningless. This patient eventually was so encephalopathic that she couldn't protect her airways, got sent to the ICU where she was intubated and had an ng tube placed about 6 days after admission. Such wasted time, resources and suffering because of (in my opinion) gross misunderstanding of the limits of patient autonomy/consent.

I'm curious if you have come into situations like those, because in my personal experience they are much more common than they were even just before the pandemic.

Sorry, I'm confused -- was this a psychiatric patient, or no? Did mental health laws play into this in any way, or are you thinking maybe they should have, or...? I do have some thoughts (and example cases) on these kinds of situations, I think, but I'm just not sure exactly what you're asking...

This is hepatic encephalopathy so not psychiatric condition, but a medical condition caused by liver cirrhosis not processing ammonia which causes toxicity in the brain. So technically medicine, but the role of consent and autonomy is still very much at play.

What I'm asking is your opinion about the limitations of autonomy/consent?

Well, this is interesting, because hepatic encephalopathy is known to potentially cause serious symptoms that can also impact the brain and mimic certain mental disorder symptoms, right? So I've seen cases where the HE went undiagnosed for a long time, and the person was forcibly treated with psychiatric meds and/or ECT instead. I think that's appalling, and dangerous.

Of course we allow (and I'm all for it for me if it happens!) people who've been in car crashes to get surgery even when they're unconscious, and totally unable to consent. So when you present a challenging case like this, I think there can be what's supposed to happen -- a discussion to determine if the person does have a reasonable understanding of the situation and potential consequences and the range of options and pros and cons. And if so, then, yes, we live with that person's decision, even if it means death. The Supreme Court has upheld this right. If capacity is not there, then perhaps an intervention is warranted. You know, I might even go so far as to say there could be certain situations where giving a person a chance to try a psychotropic drug of some kind is warranted -- but if that person tries it, or has tried it repeatedly in the past, and is still refusing, at what point do we just respect and accept that? This is what's not being respected, the standard has largely become, keep forcibly treating people anyway, And more generally, the problem is, what's happened in psychiatric care is the patient-doctor relationships have been completely destroyed by this repeated force, so the standard of care is just generally not good.

How do you reconcile your position with the rising homeless populations in major cities? When provided permanent housing the vast majority have refused it. Many have drug addictions or mental problems and are left to roam the streets instead of getting care that would actually support them.

This is a complex topic, but a few issues that don't often get mentioned... Every study that looked at deinstitutionalization found that virtually none of those people ended up homeless or imprisoned. Other factors account for rising homelessness. Very few people refuse decent permanent housing. But another problem is, much housing being offered requires compliance with treatments. "Housing First" -- housing without treatment compliance, but voluntary supports, is a better approach, and more effective. "Care", unfortunately, is not what forced treatment typically involves -- it's often very aggressive and many people want to escape it.

Here's a systematic review of studies from around the world, including the US, that actually tracked what happened to deinstitutionalized patients. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/deinstitutionalised-patients-homelessness-and-imprisonment-systematic-review/B8FFC76E4454C9FB9C0DB9BCAB52308B

Very few people refuse decent permanent housing

That's just not true. At all. Here are some articles from Seattle alone:

• Report: More than half of homeless people offered shelter by city of Seattle say 'no'
• When a homeless encampment was cleared, no one went to a shelter. The reasons are complicated
• Seattle cleans up U-District homeless camp, but most there opt to stay on the streets

Side note: I do realize you carefully qualified your response with "decent," which is of course highly subjective.

Yes, this is all reinforcing my point. Shelters are often horrible, even dangerous environments. Many shelters and places of public housing also involve intensive monitoring and psychiatric coercion--you can even see it between the lines in these articles. People get driven away from them. I'm not the only one saying this -- here's a pro-force psychiatrist writing in a major psych trade journal that probably only homeless people today manage to get free from coercive psychiatry: https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2019.3b29

But also, we have to be careful about logical slippage in these conversations. I find many people discussing this issue one minute say they just want to "help" the homeless, then it's "control them for their own good", then it's lock them up forever because they're "dangerous", and it becomes hard to even discuss it clearly. What is your basic underlying intention? Make the streets nicer for well to do people? Or truly help struggling people? Or what? Tell me that honestly, what your own real goal here is, and then I can probably give a clearer response.

The “Housing First” programs are abject failures. Some politicians tout it as a solution but the evidence points to the contrary: https://freebeacon.com/latest-news/la-hotel-converted-to-homeless-housing-suffers-11-5-million-in-damages/

Homeless people, who likely have mental issues or substance abuse issues, destroy the housing they’re provided.

Sorry, while I don't know about that particular case, I can say with certainty that the article is 100% wrong that "Housing First" is "the law of the land" in California. An analysis of CA's full service partnerships found that the vast majority required treatment compliance. https://www.ahrq.gov/practiceimprovement/delivery-initiative/gilmerstudysnapshot/index.html

And actual studies have consistently found that Housing First maximizes how many people stay housed. Canada did it across five cities. The VA has instituted it. European countries have had success. I have yet to see a single "abject failure" identified in formal studies. Even knowledgeable critics often just criticize that it does not increase treatment participation a lot--but it does keep 80-90% housed.

I’m sorry did you do research for your book at all?

Have you visited housing given to mentally ill and homeless drug addicts. I have and I have watched it on the ground.

They destroy them. Or don’t live in them because they can’t do drugs in them. This has been proven over and over by the latest sweeps in San Francisco.

A recent re-analysis found that San Francisco detains people under mental health laws at 9 times the rate that the county officially reported to the government. It's one of the highest known psychiatric detention rates in the world that I've come across. Does it appear to be helping? Forced detentions and forced treatment is the failed model.

Did you find many cases of people with misdiagnosed non-psychiatric illnesses forced into treatment?

There was one in the Washington Post a while back about a woman normal pressure hydrocephalus whose family paid hundreds of thousands for her inpatient treatment for years:

https://www.washingtonpost.com/health/2022/02/12/medical-mystery-mental-facility-ct-scan/

I feel like there are a lot more syndromes that aren't well understood and immediately dismissed as a known psychiatric disorder. In her case, this one was easily distinguishable (well easily, but not quickly), but I feel like the thinking stops as soon as a psychiatric disorder is decided upon. The word anxiety for example is horrible—it's what Marvin Minsky called a suitcase term, in that it can encompass anything. My horrible history with psychiatry is too long for a post. But as a short example, I had a psychiatrist who told me there was no such thing as an upper limit on lorazepam if my pulse hadn't come down, which he presumed was from anxiety. And it never did come down. I had a delayed diagnosis of 10 years for POTS which is treated with a very simple, non-addictive beta blocker (heart medicine) rather than with Ativan (a medication used in twilight anesthesia and that is more difficult and dangerous to withdraw from than opioids and leaves you with memory loss).

Oh, yes, this happens A LOT. And I discuss it in my book, yes, with examples. It's so common it even has a name in the scientific literature "diagnostic overshadowing." The American Association of Emergency Physicians issued a couple of massive reports not long ago reviewing the extent of the problem, and calling for some sort of standards to ensure doctors and nurses actually test people for physical conditions before diagnosing them with mental illnesses, because many common (and uncommon) physical diseases and problems create "symptoms" like depression, extreme anxiety, hallucinations, and more, and many studies show they're missed. As in, the MAJORITY are being missed, and people are getting labeled and forcibly treated with psychiatric treatments, sometimes for years, never getting the actual physical cause identified and addressed until much too late. I have some tragic cases like these in my book, too.

Have you gained any insight as to the best course of action patients should take when their medical concerns are being dismissed as psychosomatic with 0 investigations into physical causes?

I have this happen constantly even though I'm diagnosed with dysautonomia and protesting only increases your chances of being seen as delusional... I got labelled manipulative/BPD at one point. :/

I'm so sorry. And all I can say is, it's horribly, terribly common. It's widespread. It's almost "standard of care" that anyone with a mental illness diagnosis on their medical record struggles to ever again get decent normal medical care for physical problems. It's one of the most common consequences--even without having ever been involuntarily detained--and I think everyone, especially children, should be cautioned about seeking out mental health practitioners for this reason. The lifelong consequences can be terrible. Unfortunately, so many care providers have to put down a mental disorder diagnosis to be able to bill insurers, and so it's becoming more common, not less so. You probably know better than I what helps and what doesn't, and if you have some tips I and others would be glad to hear them. My best suggestions culled from others are, interview the practitioner when you first meet them about the issue, discuss it, and see if you get the sense they are 'on the same page' with you before you even start seeing them. If you've already got a physical ailment, it's too late to discuss it neutrally for either side. Try to get into a situation where your past med records with the diagnosis are not readily accessible and appearing to the new practitioner. Don't ever berate them if they're not doing what you want/need, because you will dig the hole with them deeper, but try to seek out a second opinion. Research your symptoms well enough to know exactly what test to ask for. Have someone else come in with you who can verify that these symptoms seem real, are unusual, etc. I know someone who got his ex-wife to come with him in to the doctor and verify that, despite his depression, his current symptoms were distinctly new and different. The doc finally believed it, ordered tests, found a brain tumor and saved his life.

Is there any real legislative effort to distinguish those who are a possible harm to themselves and those who are a possible harm to others? It's never felt fair that people who simply wish to end their own life should get lumped in with those who are homicidal. The line may blur, of course, but it's obviously not every situation.

There are some jurisdictions where psychiatrists fill out a box or field to distinguish whether the person is detained for risk to self OR risk to others. There, and in testimony from many psychiatrists and attorneys, it appears that a very small percentage, like about 5%, are ever seen as a risk to others. What's really concerning is, in practice and in law, harm to self has expanded far beyond only suicidal feelings and encompasses people with poor hygiene or risky habits or overly anxious and on and on. And I think many people don't realize that people who are truly homicidal or violent, they usually get moved into the criminal forensic psychiatric system -- it's a completely different system. My book is about "civil" psychiatric detentions of generally law-abiding, non-violent people, and how they're being detained at ever higher rates.

encompasses people with poor hygiene or risky habits or overly anxious and on and on

This is an illegitimate and unfair gloss over a wide, heterogeneous range of concerns. As far as hygiene goes - only showering once a week is not the same as living in filth (caked in feces and urine) and developing horrific bedsores because of psychosis, depression, or catatonia. And as far as "risky habits" goes - I have likewise seen patients refuse food for days or weeks because of depression or paranoia (not suicidality), bang their heads at the command of auditory hallucinations, or remove eyes or jump head-first onto concrete floors for similarly nonsensical (but nonsuicidal) reasons. Your attempts to minimize risk and suffering, particularly in front of an audience who don't know better, are gravely concerning.

Basically nothing you're saying is actually inscribed in the laws. So the laws apply to those people and to a much broader spectrum as well, and it comes down to the discretion of the individual psychiatrist and individual judge what qualifies as "poor self-care" or not in any individual case. This is why and how these laws have become so dangerous--they've been deliberately designed to give broad discretion to psychiatrists. The evidence suggests, this isn't actually helping -- it's just increasing the number of people detained, and dramatically reducing resources for those who might actually want and need those resources and supports.

I experienced forced treatment through the psychiatric system for a misdiagnosis. What I endured was horrific. Few people are talking about this issue, fewer people believe me when I try to speak out about it. Since you are one of the few writing about this, my question is: what would you suggest to someone who wants to make their story known? And what wpuld you suggest for someone who wants to actively get involved in creating change? Are there any individuals or organizations you know of that I could connect with?

I'm sorry to hear that. And yes, what you say is so true. The website Mad in America is an increasingly prominent place for people to share their stories. I do journalism for MIA at times. You can also find other orgs there. But of course it's important also to reach other audiences, and that is hard. I'm trying to do it with my book. There are some groups, usually consumer or survivor-run, and orgs like NARPA or ISPS, but there's a dearth of political organizing in this whole space generally. Sorry to sound a bit negative -- it's something I'm actively talking with others about, though, too!

Thanks for your reply, I'll check those sources out.

Feel free to contact me through my website contact page to discuss more in future. I might have news, or at least be able to direct you to some others, depending on where you're located.

Three years ago I had a psychiatric break due to lithium poisoning from taking my medication regularly and my doctor failing to check my levels. I ended up in jail. I was hearing voices, and began trying to kill myself. I put myself on suicide watch. Big mistake. Before they put me on a zoom call with the judge, they placed me in a restraint chair and a lady jailer wrapped both hands around my right thumb and snapped it. The other jailer that helped was actually a friend of mine from high school. The police are not mental health authorities, and they don't care enough to try and be one. What's being done to prevent police from responding with violence when handling mental health situations?

There is growing awareness right now that most of these situations do not require police involvement, and more communities are starting to develop mobile mental health crisis teams -- usually social workers and psychiatric nurses backed by on-call staff psychiatrists. This will reduce police violence and shootings, one would assume, so that's good. Unfortunately, as far as we can tell, these teams are still getting people locked up at fairly high rates, so it's not really reducing psychiatric coercion much, and most institutions have security guards on staff, and overall a lot of violence occurs in these institutions, too.

How do you feel about the increasingly common practice of printing information on the national suicide hotline at the bottom of news stories about suicide?

I would not mind it if they also openly disclosed: "Please be aware that, if you call this phone number, your call may be traced and you could be subjected to a police visit and forced psychiatric hospitalization. The policies and circumstances under which this might occur are unfortunately broad and vague." It bothers me even more immensely that, on the contrary, many news stories deliberately lie and mislead about this issue -- I've tried to get some corrected by contacting the journalists and editors with the evidence, but I've only rarely succeeded.

Did you do any historical research on how the psychiatric industry was weaponized against dissidents in the Soviet Union and how the current "mental health crisis" in the U.S. could be used as a pretense for similar actions by our own government in the very near future?

Yes, and I show that what happened in the USSR then, and in China today, is already happening here. Indeed, this was brought up way back in 1989 in hearings before the House Armed Services Committee, as VA and military whistleblowers testified about being locked up in psychiatric hospitals for exposing corruption.

Wow. Good on you bro, you just sold me on checking out your book! Lately, it's been feeling like Joseph McCarthy was just a little too ahead of the curve lol.

The legal director of the Government Accountability Project, which represents US whistleblowers, told me that forcing whistleblowers into psychiatric evaluations and potential psychiatric detentions is a "bread and butter" harassment tactic in this country, and gave a litany of examples. I also look at cases involving political protesters and institutional complainants.

Hey Rob, just wanted to get back and let you know I just ordered the book on Amazon. Can't wait to dive in. Thanks for doing this important work and good luck!

Thank you for your support of my work, and for your interest in how these laws affect all of society! I share people's concerns about homeless populations, obviously, but at the same time, it would help if people realized that these laws have become so broad that they can and are being used in ways that ultimately have risks for our entire society. That's what my book is about.

Do you think there should be any forced treatment in Canada?

The rates of detentions appear to be as high or even higher in Canada than in the US -- and much higher, from the data we have, of comparable European countries.
I think when we discuss this, we should separate out the policing intervention of physically stopping someone from doing something from the act of forcing someone to take psychiatric drugs or undergo electroshock therapy against their will. I think there are lots of situations where we may want to physically stop someone from doing something. I've yet to see any compelling arguments or science in support of forcing people to take tranquilizing drugs for weeks, months, years against their ongoing express wishes.

Also a victim. Gonna spare the details. My question would be, what do we do once we get away from the mental healthcare system, and we find ourselves actually needing help? What's the most careful way to go about it?

I think the assumption that one needs a mental health practitioner is often just misleading. We've over-pathologized and medicalized all this. But if you do it, when first meeting practitioners, ask them what conditions or what things you could say would make them worry and call 911 or otherwise try to get you detained. Make note of it, and avoid saying or doing that with them, and always do your best to reassure them. A lot of detentions have more to do with practitioner fears of liability or "moral responsibility", so your job is to make them feel safe.

Then, yeah, most people I talk to do better by realizing they need to teach themselves ways to better navigate their own feelings and inner worlds, to take care of their physical bodies, to learn what things make them feel more grounded again, what they enjoy doing in their lives, etc. Then to try to develop relationships with people they can really trust, so they have folks they can genuinely talk to honestly without fear of someone calling 911. There are also mentors, coaches, people we admire with other skills, spiritual leaders, artists, etc, who may all have valuable insights to offer.

so your job is to make them feel safe.

The fact that it's OUR job to make them feel safe is really the mind boggling part isn't it?

Yes. I make a point of pointing that point out pointedly in my book. :-) If you get locked up and make the mistake of thinking it's all about making you feel better, you'd be wrong; the only way you get released is when the people holding the power feel better about you and your behaviors. And that may or may not link up with how you're actually feeling inwardly yourself.

What can individuals who receive psychotherapy/psychiatry treatment, and/or taking medications for mental health, do to prevent being institutionalized against their will?

Ask the provider under what conditions they might call 911 or otherwise get someone taken against their will to hospital. Responsible ones will tell you straight up. Usually, it's if a person talks about suicidal or violent feelings in particular ways that worry the provider. Unfortunately, many people really need safe spaces to talk about such feelings. Also, have an advance directive of some kind that identifies what you might like if you go into a crisis, what might help you, who you trust -- a good supportive social network of people who care about you and also support your rights is always great.

As someone who is suicidal, I will never again ask for help because of forced institutionalization when I did.

The system is broken.

It's brutal, isn't it? I hope you find things within yourself and in connections with others. We've "overmedicalized" all of this stuff, anyway. I was what I'd call fairly actively suicidal at times in my teens, but I found engagement in inner exploration, in getting physically healthier, in friends that I could just talk with comfortably who sometimes had similar feelings (or didn't), in putting my energies into making art and meeting with others about social change, etc. It all helped!

To sort of second a point another commenter made, it feels like there's an entirely other half of this equation you're not really reconciling with. For a lot of us with lived experience as both patients and caregivers, this stuff is "undermedicalized." You can unite people around treating people humanely without making blanket statements that don't comport with the lived reality of a huge number of people.

Nobody wants to take psych meds if they don't have to, and it isn't helpful to pathologize normal variations in human behavior and emotion. It also isn't helpful to conflate situational distress with an "illness," which seems to happen a lot with diagnoses of anxiety and depressive disorders. But there are many people who suffer from severe anxiety, depression, and psychotic symptoms that are idiopathic (for lack of a better word) and for which the medical model is the best there is.

I'm glad you're around and didn't take your own life, even without taking medication. For a lot of severely depressed people though, psychiatric medication is life-saving. Ketamine can totally reverse suicidality within like an hour for some people. It can be hard to find a medication that works, and the side effects can be considerable, but sometimes medication is necessary to live a high quality of life.

Of course, this reality doesn't justify treating people cruelly or forcibly hospitalizing people unnecessarily. And it doesn't mean everyone needs psychiatric meds or will benefit from them.

I'm generally not discussing voluntary psychiatric medication use, it's not what my book is about. I support fully informed consent and choices and options. My book and my concerns are about coercion: Forcing these drugs on people who are saying, 'I don't like it, I don't think it's helping me, and I like my life better without this drug.'

One overlapping area though, which I discuss in my book, is children. Young children don't truly have the right to consent or withhold consent, and in that sense all drugging of children is forced and lacks informed consent. There, I think as a society, we have to be more honest about what the science does and does not say about the weak efficacy and substantial harms of some of these treatments, and especially how little we know about long-term impacts on children, how little studied it is.

Why do you think the hospilizations and certifications for mental health treatment have increased so highly in Canada in the past 2-3 decades?

This is the issue that my book explores in depth. To say it in brief: As a society, there's been widespread buy-in to the belief that mental distress is "biochemical", and therefore giving people drugs, whether they want them or not, and even especially if they don't want them, is a good thing. I also show at great length that governments and public institutions and corporations are increasingly finding that mental health laws are a very convenient, flexible tool for managing disruptive or distressed people who aren't breaking any actual laws. This is very evident, for example, in the staggering rates at which school and foster children are being sent to psychiatric hospitals against their will--British Columbia has good data on that, and Florida in the US.

thanks for the answer.

i guess the "biochemical imbalance" supposition is a fallacy, in that the drugs wouldn't necessarily (and haven't been proven to) sort out any so-called imbalance, even if there is any, which has yet to by systematically proven as far as i can tell.

As for using Mental Health Treatment as disciplinary measure to suppress dissent, expression of justified distress or deviance, i wonder what the ends of the "management" are, and how the lawmakers reconcile with the denial of liberty and freedom of a selected group;

Your point about people in the foster system and (in another post) indigenous people being disproportionately certified, detained in hospital are important. As an aside i couldn't find the BC source in a brief Google search.

I wonder about class and detention in hospitals in BC; there's been data to show income quartiles, and there's alot of wealthy people certified, but in my experience (over a year in interior BC psych wards) i scarcely meant anyone with financial means or any higher education...

I think "class" is definitely a major bias, too -- poor people are more likely to be targeted. The evidence is pretty strong on that, especially in the US where the Dept of Justice has been forcing hospitals to release people (by the thousands in multiple states) who don't meet detention criteria but are being held mainly because they don't have homes to go to and psychiatrists believe they'll "decompensate" in future.

The BC Rep. for Children and Youth did a study of child detentions a few years back. Powerful read! If you don't find it, let me know, I have the link around.

Holding someone 'because they might decompensated' sounds like a recipe for permanent confinement as it is impossible to argue against the possibility that something might happen.

Yes. Some of the legal challenges taking place in certain states are literally focused on that, the circular logic. It's really plain in some of the laws, like almost literally saying, 'if you might be committable in future, that makes you committable now'. I think more of these laws would fall in court challenges, but they rarely get challenged because it's become clear govts will just rewrite something even more egregious and wait another 20 years before it gets challenged. I hate to sound cynical, but I've seen it happen, and some lawyers tell me this is why they don't bother challenging the constitutionality of mental health laws any more and are just trying to use other leverages to get people freed.

Sounds like there really needs to be a legal mechanism such as an injunction for stopping government bodies from passing similar unconstitutional laws after a law gets struck down on the basis of being unconstitutional. Such a law would be able to be applied to any law that is substantially similar to a law that was struck down as unconstitutional and then the government bodies would have to fight against the induction to show otherwise.

Very true, great idea. I'd guess there maybe are some jurisdictions that have processes for doing something like that with laws generally. And I think many judges would sneer at it and make quicker decisions when shown an example. I want to ask some lawyers about this! But I think another problem is, govts can be clever enough in how they do it to sort of make the process more complicated, anyway... But you've got me intrigued... Maybe govts don't do it in jurisdictions where such protections exist.

Definitely raise the issue. There is nothing to lose from not raising it. Regardless, another strategy that could be considered would be for if a lawyer has multiple clients be subjected being subjected to an unconstitutional law would be encourage class lawsuits.

Strength in numbers is good for fighting the system and could provide the lawyers involved a good amount of income that would allow them to focus on the case. If there are continuous class lawsuits to challenge the constitutionality of law, it may increase the chance the government may give up trying certain things.

There are some good class actions going on, many done by the state P&A "Disability Rights" groups in the federal NDRN network. And the DOJ Civil Rights Division is active in this space. They focus often on standards of care in institutions or on getting people out of institutions who don't need to be in them. I know a few lawyers at state levels testing other types of challenges to due process in the mental health laws, and things like that. So it's a hodgepodge. The core problem is, the US Supreme Court, and the Canadian one too, waded into it and set clear standards--but states have simply gone far beyond that--so no matter how we look at it, there's an 'enforcement of the law' problem at the heart of all of this that is perplexing to figure out. How do you ensure govts, lawyers, judges and lower courts actually follow the law, when they are the ones who are supposed to be following it but are not?

Yea, it goes to show how preventable societal problems, like the housing crisis, can cause people to have their basic human rights of freedom of movement denied based on the supposition being (even temporarily) homeless increases the liklihood of deterioration.

maybe this is TMI, but that was one of the arguments doctors seem to have made to keep me in hospital for so long, before, even though i had means to go to temporary housing like a hostel or air bnb, or a shelter, before finding more stable housing. It's can be hard to find housing in a hospital in another city.

it's shocking so many more young people are being detained now compared to before... I found that report and will look thru it today

Yes. Glad to hear you're free now. The reports out of Florida are even more worrisome -- I think they are the best portrait we have of what is likely occurring everywhere, they are the only place with detailed data.

i'm not free, i'm on "extended leave", and will have to leave the province for a period of time, essentially in exile (while experiencing migraines), and potentially forgo PWD payments, or find a doctor who thinks my hypothesis involving EMF pusles into people's bodies is rational and not a symptom of a serious mental illness.

I just saw a report that says 17% of floridians have been diagnosed with a mental illness...

If there's revolving-door hospitilazions, or if there's permanent detainment, people can't get or keep jobs to pay for housing; and there's no disability benefit or payments to the so-called disabled patients in florida.

I looked into going to florida recently and housing is fairly expensive.

Oh, I'm sorry!

Florida may be the North American capital of involuntary interventions, including fraud, so I wouldn't advise going there.

fair enough, i think the climate and multicultural atmosphere of the south might be interesting to experience.

I'm fairly confident i won't get detained elsewhere, lest i speak to a psychiatrist and challenge their epistemology.

Do you have a position on Canada's new Disability Benefit to be effective within the next year?

I don't know much of anything about the new Benefit.

Recently in California they passed the Care Act which allows a first responder to file a petition to summon you in court to take forced medication. You can refuse this but they could then file again another petition into a conservatorship. If you lose the hearing for conservatorship then it's possible they will put you in a outpatient forced medication program where police come to your house if you don't take the injection.

I was misdiagnosed with schizophrenia and put on Abilify. I have worked with my psychiatrist to slowly lower the dose and I'm almost off. I'm scared once I get off the psychiatrist will files a petition and summon me to court.

My question is what advice do you have for someone in the situation. I do have a good psychologist who believes I don't have mental illness and I have been going to him for 2 years. He could potentially testify for me. But how do you win these kind of hearings in a pro psychiatry legal system?

I was even considering contacting disability rights California who was against the care act in the first place.

I do feel much better after reducing the dose but would hate to be forced back on medication and this time it would be injections instead of the pill.

Could you say the psychiatrist is lieing and try to get a perjury case against it? What is the best strategy?

These kinds of situations are very difficult. And what your specific 'legal strategies' can be depend a lot on the jurisdiction, the laws in your state. As it happens, I've been studying the laws in California more lately with everything going on there, so I can say that you're generally right to have this concern. The fact you've been collaborating with the psychiatrist is strong evidence in your favor generally. But as you say, if the psychiatrist disagrees with you on next steps, that could become risky. Having the psychologist in your court is a great asset, no doubt. Having a family doctor on your side could be good, too. Rallying others to your side can be helpful -- family or friends or colleagues who fully support your rights. If you can afford a lawyer, that's good. DRCA is unlikely to be able to offer much practical support, though perhaps tips. There are some peer-run groups in CA that might have tips. I've never seen any kind of direct attack on the credibility of a psychiatrist or the diagnoses or treatments work unless he/she has blatantly, egregiously lied or deviated from the normal standards in ways that are extremely, obviously abusive. Best thing, too, is avoid going into any crisis yourself -- stay calm, clear, firm, not angry, just measured in what you want.

I'm new to your work but am aware of similar problems in the UK.

Simply put, what changes could potentially stop these practices or at least make the process more fair overall?

The system is so unregulated, so unaccountable, that there are a hundred places where one could at least easily make simple reforms that would improve it a lot. Make psychiatric institutions accountable to truly independent regulators with order-making powers. End self-regulating in the health professions. Track and monitor outcomes of forced treatment, so we actually have reports on whether people are improving or worsening as a result. De-medicalize mental health laws so psychiatrists don't always have the absolute power. And on... I discuss these in my book...

That's fair. Trouble is that I'm yet to see much truly independent regulation in any domain. Too often the revolving door maxim rings true.

Will look into your book for additional insight

That's right. The system is out of control in many ways, from what I've seen, and that's why it's concerning that, with a hyper focus on homelessness, so many people are advocating for expanding it even more. They are not realizing all the other uses these laws get put to. Also, it's odd to blame the "revolving door" on patients, when in fact they're constantly encouraged to "seek help."

We may have our wires crossed. I refer to the revolving door between regulatory bodies and industry. The deliberate headhunting of the main people from a regulator to then earn better money in private corporations by stifling what they once protected etc.

There's probably a negative knock on effect with the resulting brain drain from these poaching schemes

Ah! Yes, thanks for the clarification. We have clear evidence of that at the FDA, but I'm not sure, I haven't seen any studies of, say,,hospital safety regulatory bodies. But there are inherent conflicts of interest, anyway. Govt is monitoring its own facilities, or facilities join the Joint Commission to hide the results of investigations from the public and govt allows that, and so on.

Do you know of any journalists/other professionals who are investigating or trying to help people with this in the UK?

A friend of mine is being subject to some of the worst of what you've described and I haven't been able to find any help for her.

There's much more prominence of critical views in the UK, and especially prominent critical practitioners and researchers like James Davies, John Read, Joanna Moncrieff, Jay Watts etc. MIND UK has some critical survivors involved, doesn't it? Their magazine has critical views in it. And we see some good reporting coming out of the UK. But I don't know if there are any journalists who regularly look at civil rights issues in mental health there, sorry. If you ask one of those people, like at the Council for Evidence-based Psychiatry in UK, they might know. I'd look for consumer-survivor run groups there as a good starting point for general tips on what to do.

Have you written anything about the involvement of the child welfare/family policing system in mental health coercion? I feel like this often gets missed, particularly in the age of "send social workers rather than cops" and would love your take on it.

To be clear, I am not referring to cases in which this system is employed to assist minors with reluctant parents in accessing services; I am referring to cases in which a child's or parent's providers call in reports when there is not true abuse or neglect essentially to get someone involved who has a lot of power over the family.

Where I am a court clinician in Massachusetts, which is one of the states with the highest rates of CPS overreach, providers seeing minors with MH issues and supportive parents will frequently call DCF, often stating they are not alleging abuse or neglect but "want to make sure appropriate services are in place." Of course, DCF doesn't provide any such thing, but will typically rubber-stamp concerns from professionals and will make a neglect finding stating "well, a provider was concerned." I also see things like ER providers seeing that MH providers have a long waitlist but DCF comes within 24-72 hours, so they call DCF when they send the kid home so that someone is following up rather than no one, honestly believing they are doing the right thing (by sending cops and cop-adjacent folks to visit a supportive family). I have had a few where the ER believes that DCF reports are "making a referral since they're the ones who will come to the home and do safety planning" when there is nothing suggesting the family can't remove medications from the home on their own. I have also seen cases where a child's ongoing team doesn't believe hospitalization is necessary and an ER physician who always hospitalizes in the event of suicidal ideation calls DCF to "let them decide."

Some of this I see from programs that have statements about not using police/crisis team except as an absolute last resort, but for whatever reason they see the family police as something different. Thoughts?

I do discuss this in my book, and come at it from different angles -- as it sounds like you'd well know, often these cases get intertwined with child institutionalization, divorce proceedings, domestic abuse and family conflict etc. However, I don't fully flesh it out in the way you're describing -- I as I recall wrote something like "another book could be filled with..." this topic! But I saw a strong, long report come out of New York recently on this, did you see it? If not, DM me and I'll dig up the link. I'd like to talk with you more about your experiences and perspectives sometime, too. This report I mention had a focus specifically on how family and child services use mental health laws among other tools in racist-influenced family control efforts of Black families especially. But it was clear the approaches would apply to others as well.

And yes, I see the angle with parents as well. Typically DCF’s take is that any parent who has any history or signs of any mental health issue must be engaged in extensive medical-model treatment all their life. It’s disproportionately applied to Black and brown parents and poorer parents for sure.

Yes, exactly what I've seen, too.

Awesome. I look forward to reading it.

Yes, I know the article you’re talking about. Good stuff.

Happy to DM you and speak on these things. Thanks for being here and shining light on these important issues.

Thank you! Look forward to chatting more.

First of all, congratulations for your amazing work which has supported many psychiatry survivors recovering their human rights and their right of refusing treatment. Which improvements do you suggest for the new WHO draft about mental health rights?

Thank you! The WHO released a lot of great guides for ways to reduce coercion across the entire system of care from hospitals to communities. I see they've just released a new guide today, so I don't know if you're asking about that one -- I haven't read it yet. But there's pressure on them to back away from their recommendations about reducing coercion, so I think it'd be great if they can stay with it.

Hey Rob, I'm running for mayor of Boise and this is the only issue I care about. What can I do to help this cause?

https://boisedev.com/news/2023/10/03/right-to-die-bodily-autonomy-supporter-running-for-boise-mayor/

You are the only mayor I know who is putting these important issues on the public agenda in this way! And I wholeheartedly agree that, "It is no measure of health to be well adjusted to a profoundly sick society." I've learned a lot from reading J. Krishnamurti.

Does the Ronald K. Davis Pennsylvania case fall similar to cases in your research?

Yes, it's absolutely, shockingly, frighteningly common and typical. Based on my own research, the only thing that seemed unusual to me about that case was that the police officer involved was the one fabricating the dubious story about someone he was involved with. The only other case off-hand like that I know of was when NYC police officers went after their fellow officer, Adrian Schoolcraft. But I've seen countless cases where spouses make up stories about each other to get each other detained, or family members about each other, etc.

I have not yet read your book, but the book description says that psychiatric coercion is increasingly used to resolve workplace disagreements. Could you provide some examples of your investigations here? I have heard about cases where employers, to avoid legal consequences of workplace bullying, try to get the bullied person labeled as mentally unstable.

Yes, that's a good example. I include a number of interviews in the book with people who work in human resources, workplace insurance, etc, who talk about it as a broader phenomenon. And I include a few cases--for example, a man argues with the human resources manager, who calls 911, and a SWAT-like team surrounds his house. He gets taken to the psych ward -- they knock him out with drugs because he's demanding to know his rights -- and then they just let him go in the morning. But one really big, systemic area this is happening is in, for example, "Physician Health Programs". These have become extremely controversial, and rightly so. I interviewed psychiatrist Kernan Manion extensively for my book, and here's a little about him and his work in this area:
https://www.physicianrights.net/

https://www.medscape.com/viewarticle/904696?form=fpf

Thank you very much for the reply. I have heard about a cases where people who have complained about workplace bullying were forcibly taken to psych ward. ”Mental health crisis” is a manufactured crisis, employers use draconian methods to silence people who have suffered abuse in the workplace. This is happening in western democracies that are suppose to be safeguarding human rights.

You're welcome! Yes, it's a problem, and it's one of a whole slew of ways that mental health laws are being used and abused across society that I'm trying to raise public concerns about with my book. And I think we only know a small portion of it -- so much is shrouded in secrecy.

Hi Rob, thank you for your book. I have seen nursing home abuse first hand. It is deplorable. Conditions in facilities whether they be nursing or psych or scarily similar. My question is... Why is there silence from Psychiatrists and Nurses (who are aware of the abuse?) It seems like most are complacent with are very abusive system.

I interviewed a psychiatric nurse for my book who was very insightful on these issues. And other staff as well talked about the career implications and potential blowback of speaking out against the "standard of care." Many do believe in it, too. Also, they are heavily indoctrinated in their schooling and training to administer force and believe in it. I use that word "indoctrinated" deliberately, it is truly like military training, in that you simply cannot graduate as a psychiatric nurse or a psychiatrist without being extensively practiced in administering force. And it changes a person. But I say all this, and I still have the same question as you. Why aren't more of these people speaking out? The Buzzfeed stories about Universal Health Services are interesting, because they do interview staff about their perspectives, and there were ultimately some whistleblowers that talked to the DOJ. I'm surprised there isn't more whistleblowing in nursing home care -- in the US you can actually make money whistleblowing.

Thank you for your thoughtful response. It is really SCARY how that indoctrination works. It even goes against the WHO... I STRONGLY believe that all patients should fill out advanced medical directives and try to have a designated person of their CHOICE to be their advocate. I would never want to be a patient myself in those places nor would I want it for my loved one's.

Yes, I discussed the advance directive issue in another thread here earlier if you want to see my comments on that. They're great -- if they're not simply ignored by medical staff.

I will def. take a look! I bet its easy for medical staff to ignore them... thats why you need an aggressive friend or family member that will push for YOUR RIGHTS to be respected whether that be to get you discharged ASAP or to respect your medication preferences (should you stay)

I know Yukon at one point put this kind of process directly into their mental health laws, but I think they may have backed off since and made it more 'voluntary' to comply with someone's previously stated wishes. I'm not sure how it's all played out there.

I would be interested in seeing more about this. I am in the U.S. but I think that everyone should have the convo with a loved one about what they would do should they be incapacitated in any manner. I think that Advanced medical directives should be easily accessible to fill out and I think that there should be medicare/medicaid fines if they are ignored. I also think that every patient should be offered to have a representative OF THEIR CHOICE. Friends don't let friend's go to the doc. alone. everyone needs an advocate.

I agree. I think this would help a lot, and it concerns me that medical staff generally are not more encouraging and supportive of it. But I encourage people to do these advance directives regardless, because they can always help one way or another. It's shared understanding between the people involved, and good judges will take it seriously even if not "required" to, and so on.

Sooo... You wrote what Foucault wrote? :))

JK, however, as you have cultural studies background, I would be interested what is the "new" thing you found that Foucault didnt/couldnt.

I think Foucault was pretty smart. :-) He had no idea of the scope and reach of the modern mental health system across communities today, though, he just saw asylums in his day. That is what my book explores--though he certainly had a prophetic sense of what was coming, I think. But my book is journalism, not philosophy, about community developments.

Do you find that detentions and forced treatments cause people to not seek out help?

Absolutely. Sometimes the detention is only nominal -- the person still feels respected and gets into a collaborative relationship with the doctor, and things like that. They make decisions together, the person finds the treatment helpful and gets to help decide on optimal dosage level, etc. That does happen, and that's obviously much better. But the many people who end up threatened, pressured, forced, forced even after they've tried the treatment and hate it, restrained, locked in seclusion, injected etc, most of these people become terrified of health services forever after. I've talked to many -- you can see some even here in other threads -- who say they feel they do want and might benefit from help, but are now too afraid to seek it after such experiences.

Damn! Didn't realize how crazy some of those stats were 0_0

I guess more than anything, I'm curious to know how things like involuntary medical holds intersect with race, class, and the prison industrial complex.

Also, what do you think the turning point was? you said the per capita rate has increased, was there legislation or something to that effect that caused this rise?

Good questions! Caveat: There's no good national data on this. But because the criteria for diagnosing mental disorders and detaining people have become so broad and vague, studies often find that the dominant prejudices in particular places or cultures have strong influences. So for example we know that Black people are far more likely in the US to be labeled as schizophrenic and violent than white people with the same characteristics. Even American Psychiatric Association testing of their own members found this happening. Indigenous people are disproportionately targeted, too.

I wish we had the studies and data to say definitively, but I think the turning point was around the 1990s. After the rebellions of the 1960s, the US Supreme Court made mental health laws very strict around actual, real, physical danger, and large institutions were being replaced with smaller community ones. But with the economic setbacks of the 1980s, and the rise of "biochemical imbalance" theories with Prozac, there were moves to re-expand forced treatment criteria again. Where I found data, I could show the detention rates have been rising since the 1990s at least.

What do you think is the solution to the mental health crisis in cities like San Francisco or Los Angeles? Lots of people here actually want there to be increased involuntary asylum detainment due to the high volume of severely mentally ill people addicted to drugs and living on the streets. It really does lower the quality of life for everyone, makes places a more dangerous environment, and (arguably) is inhumane.

Many Californians think it’s more inhumane to allow a severely mentally ill person to rot and suffer on the streets than it would be to force them into tratment.

People who say that kind of stuff have never personally been surrounded by security guards, restrained, forcibly injected with a heavy tranquilizer until they can barely think, started developing severe motor dysfunction from the antipsychotic, and so on. This is not an extreme case I'm describing -- if a person resists involuntary "care", that's exactly what happens next. Threats and force that feel like ongoing torture to many. If more people understood that, I think they'd speak differently.
What's the solution? Well, it's clear that rising detentions and widespread coercive drugging aren't working. Why double down further on that approach? Lots of homeless people, in fact, are taking psychiatric medications. It doesn't miraculously produce a home. The problem is affordability of homes, and getting voluntary supports of different kinds to those who really need them. As soon as we're coercing and forcing those people, many will even deliberately flee to life on the streets to escape. I discuss this with respect to homeless youth -- most are actually runaways, fleeing abusive and coercive environments.

I have a sneaking suspicion that many unhoused people have had terrible encounters with the mental health system in the past -- they were treated against their will, traumatized, belittled, made to take psych drugs that potentially caused permanent damage to their health and cognitive abilities, given ECT, and then either went into hiding from the system or were spit out by it. I often imagine that many people who are living on the street are simply terrified of the prospect of being force treated again -- more afraid of that than of the dangers presented by their current situation.

Do you know if any statistics exist that would prove or disprove my hunch?

Thanks for all you do to fight for those of us who were labelled.

It's appalling that we don't have any formal studies of what you're asking, as far as I've seen. But I have little doubt that you are right, because I hear people saying this all the time for themselves, and many experts who work with homeless people say they hear it all the time. A Disability Rights Oregon study found that more homeless people had been arrested (directed to jails or psychiatric hospitals) in one year in Portland than the federal homelessness count even found in the city! So that tells you, the vast majority of these people know exactly what sorts of 'care' exists for them out there.

I feel it’s necessary to point out that the length of detentions need to be clarified. A 3 day detention won’t do anything. That’s what they have in California and nothing is being solved

The data in California is abysmal and likely far, far higher across the board for all lengths of detentions, and the govt acknowledged the unreliable data to me when I pointed out serious errors that others had found in the official reporting. And I've discussed this in another thread at more length, but long-term, ongoing coercive treatment has also risen a lot. The best numbers for understanding that are in my article, linked in my initial post, about psychiatric bed numbers. As you'll see, I got some good data particularly for California, where long-term beds in nursing homes, group homes, supportive housing etc have risen a lot, and an independent study found the majority of their "full service partnerships", their most intensive supports for about 70,000 people, mainly require treatment compliance even when, officially, they're not supposed to involve coercive treatment. References in that above-mentioned article. So the whole "we're hardly forcibly treating anyone long term like in the 1950s" just does not match the best data we have -- it looks like coercion, short and long term, have both increased a lot per capita. Adjusted for inflation and population growth, America is spending about 30 times what it spent on mental health in the 1950s -- a lot of that is going into coercive care.

What would be your advice for anyone facing hospitalisation against their will? What are the options for fighting it if it does happen and what are some options for preventing it from happening in the first place?

I do discuss this in the book. My best tips come from watching it happen to my father, and then from interviewing many people on all sides over many years. Some of the best strategies include, social connections with people who support you and your rights, being willing to rally around you -- help a bit when you're in crisis, show up at the hospital to let them know people out there know you as a decent person and care about you, come to a hearing to say, hey, I believe in this person and I'm going to be there if they need me, that kind of stuff. Huge. Just knowing what you need, like good food, getting outside for walks, exercise, whatever, the things that help you feel grounded, many people say that was enough to prevent crises. I also point out to people often: You only get locked up if you're interacting with others. No one can truly read your mind. So if you're managing to keep your crisis to yourself, confide in people you truly trust, and don't spin out in social situations in obvious ways, then usually no one's going to call 911 on you for quietly listening to music in your apartment. Find some other socially accepted way of expressing your feelings, like arts. If you run out into the street demanding people agree with you on something they don't really understand or help you in some way, it's likely to end badly. Obviously I don't know you and I don't mean "you" when I say "you" here, I'm just generalizing!

What can the average person do to help?

What can/should the average person do to protect themselves?

What can/should the average person do to realize that/help protect someone they know who may be especially vulnerable?

For starters, let's all just be more honest with each other, and when we speak publicly, about how for many people involuntary treatment can be unhelpful, brutal and traumatizing. Let's not whitewash what we're talking about.

I've discussed this a lot in other threads, but briefly, simply being aware and mindful about what things trigger you and can cause crises and what things ground you, and trying to generally take better care of oneself physically and mentally-emotionally. And reminding others to do the same. Social connections, trusted networks really can make a difference, people you can really talk to when in crisis without someone calling 911 -- and offering that same, safe open ear to others. I suggest other strategies in the book for if one actually gets detained, too.

Interesting, I'll look into your book. If forced treatment doesn't help people, what are your thoughts on what should be done about mentally ill people who reject treatment? I'm thinking specifically of Eugenia Cooney, a young and popular youtuber who suffers from ED and is seemingly reaching the end of a long and very public spiral to her death. Nobody thinks there is much hope now or that the end can be very far away. It's very sad, but there is seemingly nothing that can or will be done under the law currently to get her help or treatment. The ethics of allowing her to die, people watching her die, and the inability of anyone involved to get her medical and psychiatric help have been on my mind the past few weeks.

I don't know her case, so I cannot comment on that specifically. But of course, it's not uncommon that some people go through serious troubles of different kinds, and there are others around who wish they could help. Not to be trite about it, but this is part of the human condition. People make extremely bad choices that have terrible consequences, have self-destructive habits etc. What do we do when it's a friend of ours, someone we care about? We reach out, we try to build bridges, we ask them what they feel might help them or make them feel better, etc, we show we truly care, and we hope that love and affection are felt and appreciated and have at least some small positive effect. And they often are, and do. Maybe not miracles over night, but human connections make real differences every day. Calling 911 on someone and getting them locked up and threatened by security guards and forcibly drugged -- it's often just not a helpful approach.

Have you ever looked into how thr soviet union institutionalized political dissidents? Do you have any insight into how they used allegations of mental illness for political repression?

Yes. I discussed this in more detail in another thread if you can find it. But briefly, the topic is in my book, and I show how Soviet psychiatrists basically diagnosed dissidents pretty much the same way that US psychiatrists then and today diagnose people. That is why, as I recount, the World Psychiatric Association went years without sanctioning the USSR psychiatrists--there was disagreement as to whether it really was abusive. But news media in the West kept hammering away at it and embarrassing the psychiatrists into taking action. Then I proceed to show examples of politicized pathologization and detentions in the US and Canada today that look in many ways very similar.

Can I ask what your majors were? Everything you just detailed is why I found sociology so interesting in college but didn’t need up finishing the class.

I did "cultural studies" which overlaps with sociology and many other disciplines. I do think having cross-disciplinary interests helps understand society a lot!

How much overlap does this have with the troubled teen industry- or is it just a big circle?

I love the name "troubled teen industry", very catchy, but unfortunately it's created some confusion in the public, too. Many people now don't realize that the troubled teen industry is, or includes in large part, the ordinary mental health system for children and youth. There's really no difference at all. Some of these institutions are more like psychological wilderness boot camps, and others like standard hospitals, and everything in between, but it's all part of the long-term care mental-behavioral health care system for youth. Foster kids and rich kids like Paris Hilton were, and still are, often held in the same facilities.

How do you find out or get rid of guardianships especially if they won’t tell you?

If you're on a guardianship yourself, as the ward, I believe you have the right to know. I would ask a lawyer specialized in guardianship law in your location about this -- it's the kind of question they can answer easily, it shouldn't cost much if anything. It's something your local Disability Rights P&A would likely be able to answer. Then likely just a letter to the suspected guardian saying 'please inform me if' would be enough.

If this is about someone else, it's a much more challenging conundrum, because no one else holds rights except the ward and more so the guardian. If people won't answer your questions straight up, then you have to likely get it into court.

But I'm not an expert in guardianship laws.

You state that tens of thousands of people get the cops called on them by 988, but Lifeline's/988's website states that they received about 2.4 million calls in 2020. (See https://988lifeline.org/by-the-numbers/) If we're generous and interpret your number as 50,000 people who get the cops called on them, this is roughly only 2% of callers. It sounds like a big number, but practically speaking, it's proportionally quite small.

I am not in favor of involving law enforcement in crisis calls. It's traumatic, the person often ends up with an arrest on their record, and involving the police there's always at least a small risk of injury or perhaps even death. However, there are almost certainly instances where the caller is an immediate danger to themselves or others and the situation can't be deescalated over the phone. My question here is: Of these tens of thousands that you mention, for what proportion is it actually appropriate for law enforcement to get involved? Yes, there will invariably be peers who are bad at their job and call in police unnecessarily, but that's unavoidable given 988's policies. Broadly speaking, 2% seems like a reasonable figure. (ETA: I don't mean to sound combative--my question is in the context of how 988 operates. IMO police should not be involved in handling mental health crisis situations.)

For people in crisis who are concerned about this, are there any other suicide prevention hotlines, warm lines, etc., that never involve law enforcement, no matter what the circumstances?

If one in every 50 airline passengers were detained as "risky" every day, would you or anyone dismiss that as "rare" and not worthy of concern? But the real problem here is, I had to fight for about 18 months to get even that data, and 988 administrators appear to be not answering even for themselves the very reasonable questions you're asking, let alone for the public. But their "imminent risk" policy is very broad, far far broader than those who might actually be in the midst of trying to take their own lives. So my concern here is, they advertise as "confidential", people confide their deepest darkest feelings -- and that worries call-responders and they call police. People report profound betrayal. Also, suicide rates rise dramatically after hospitalization, even among those who weren't suicidal. So is this good policy?

Btw to your other question, yes, Samaritans NYC has a "no call tracing ever" policy declared on their website, and Wildflower Alliance has one, and there are others around the country. It's unclear how many -- no one has ever studied it.

Trans Lifeline as well. They have a great section on their page about the dangers of nonconsensual rescue and a pledge never to enact it.

Yes, thanks for mentioning! I've actually been talking with them and consulting now and again on a report they are developing about non-consensual call tracing.

what Country are you talking about?
and what institutions might prevent such abuse?

I personally am a hardliner for sovereignty.
It's super simple: everybody has complete absolute sovereignty on their person.
People shall be free to kill themselves however they like, and this shall be even facilitated so that they don't have to find gruesome methods for not having access to peaceful ones.
If they don't want medical or psychological care, NOFUCKINGBODY, not even their family, has the right to say otherwise, PERIOD.
To prevent a situation where someone e.g. gets Alzheimer or something else that makes them allegedly unable to decide by themselves, everybody at 18 should fill a mandatory paper to decide if in such cases the doctor should listen to them, even if they seem not in their "right" mind, or a given person or familiar should intervene.
And it should be mandatory to update such paper tot x years.
Problem solved.

If there are particular cases where this is not possible, I can't say now, but this should imo be the BASIC, and the rest can be seen step by step or case by case, with ABSOLUTE priority to the respect for the individual's sovereignty.

Most of my research is in the US and Canada. It sounds like you're talking about an "advance directive" for health care, and I agree, they could be a fantastic tool. People could say 'if i'm ever in a mental health crisis, here's what I want or don't want' etc. These are common in ordinary health care, and govts encourage them and courts have upheld them. But for psychiatric care, some jurisdictions allow them, some have flatly illegalized them and said mental health laws trump them regardless, and in nearly all places they are overwhelmingly largely ignored by medical staff. Our culture seems to really want the power to forcibly sedate people, and until it happens to one personally, people often don't realize the scope of the powers that elected govts have given to doctors on these issues.

Have you also examined mental health laws in Europe, as in, are these kind of laws in general the same, perhaps around the world even?

Yes, the laws are very similar everywhere. A fascinating study that looked at 22 mainly "Western" countries in the European area found that the letters of the laws and criteria and detention standards in each country had no bearing at all on the number and types of people being detained. Basically, everywhere, psychiatrists seem to just do what they want or think is right or best, regardless of what the laws say. I discuss this in my book in more detail, with examples of psychiatrists literally advising each other in their research journals to just ignore the laws.

Rob, I have one major question on my mind a lot. As someone whose mother and I both received months of forced hospitalizations largely as the result of psychiatric drugs (for me, mostly as a minor), which completely destroyed my family, I want to know this:

How much is "making things worse for profit" intentional on behalf of providers and legislators (i.e. creating additional trauma and awful medicine purposely to make people into long term patients)?

It seems to me clear as day the interventions are designed to make a substantial number of people worse, like the suicide/self harm and psychosis causing drugs to the solid evidence of forced commitment increasing suicide attempt rates (while the APA also takes away guns so attempts get the victim forcibly readmitted). There is so much evidence against forced "treatment", so much data indicating it makes things worse and yet these cruel psychs seem to conveniently push more intervention to line their pockets.

Also, I don't expect you to read this but you can if you'd like. It's my story for anyone who wants to read; tw SA/CSA, child abuse, nutritional deprivation, suicidal/child suicidal behavior: https://docs.google.com/document/d/1r3kl167g93D8_fJX9MUXKqAZJ93xi4jctK0p187rXCY/edit?usp=drivesdk edit: replaced linn.

I'm sorry it tore your family apart, I've seen that a lot.
I grapple with this question a lot, and it informed the book a lot. I think there are a number of answers. The key one for me is, the practices are nearly all exactly the same, even when and where there's very little profit to be made -- even fraudulent, clearly illegal detentions. So I think there are often multiple motives at work, and sometimes even within the same institution or staff member. Wish to help, not really caring just making good money doing my job, exploiting, abusing, trying to change the system from within and be the good guy, naively having no idea what's really going on, taking out my own frustrations on others, Munchausen syndrome (seeing you as sick makes me feel healthier) etc. etc.
btw that link went to a list of resources and quotes?...

All this apply to Canada as well?

There are some differences that I discuss in the book. But generally, yes. A couple differences: Mass-scale fraud for profit appears to be a bigger trend in the U.S.--much harder to make big $$ in Canada's mainly public health care system. Longer detentions and unending outpatient commitment appear to be more common in Canada, because no one's public insurance ever runs out. But detention rates, bed numbers, etc all trending in the same ways.

Do you know cases like what happened in the movie "I Care a Lot" specially with old people who can't defend themselves easily?

I haven't seen the movie but have heard and read a bit about it, and so generally, I would say, absolutely, yes, I have a couple chapters in my book about these kinds of cases. Nursing homes are notorious, and the way they are collaborating in helping get guardianships imposed that they then profit from is a really worrying aspect of it. Mental health laws, capacity laws, and guardianships are routinely used to forcibly tranquilize and control older people. Sometimes, if they're wealthy, their finances get raided as part of it, but even poor people can be extremely lucrative for dubious Medicare billing.

That's scary, because only a percentage of people have mental problems but everyone will get old eventually. And when that time arrives they will put you in a "prison" and you can't take care of your life, your rights, your money and sometimes even your children or younger family relatives can't see what these people are doing is really a scam and a bad thing, even if you try to speak, no one will take you seriously because "You're just an old grampa who doesn't think right and what's best for you, just let them do it ok? And just take the meds !"

It is one of the scenarios I am most concerned about for me personally because, as you say, no matter what, there's no escaping that we all will age, and aging makes one vulnerable in multiple ways. Where I am, the rates of antipsychotics in seniors in long-term care is reaching 50%, and some 80% or more on at least one psychotropic. In my book, I quote from Human Rights Watch interviews with state Ombudspersons who oversee some of these facilities, explicitly saying that it's often to shut people up who know what their rights are.

Given the ACE study (which, among others, concluded that the more difficult childhood experiences someone had, the more they are at risk for experiencing mental illness, among others): Do you think it makes sense to call mental health a privilege? And to say that people who are born into families with less intergenerational trauma and more access to support are privileged, basically?

I’ve been wondering whether it makes sense to understand mental illness as a systemic societal issue instead of an isolated „disorder“ that mysteriously befalls individuals.

Generally, I dislike the term "mental health" because it implies that there's some sort of known "healthy" state of the mind, and medicalization seems built into the concept.

But I basically agree with you, in the sense that, poverty, abuse in childhood, victimization by race, etc, all are more likely to lead to people having mental-emotional struggles. It's clearly easier for me to feel relatively content and safe and not too afraid or anxious or deluded if I have a roof over my head, a bit of money in the bank, some prospects for future work, etc. The moment I seriously think about how I might end up homeless, there's a lot of stress that moves in that can precipitate all sorts of other inner crises.

I definitely think we need to understand "mental illness" as a social phenomenon, something that often emerges "in relationships" between people and as caused by economics, culture etc. This is why I also think the "Open Dialogue" method is interesting, because it brings everyone in the patients social network together, and they all share and openly discuss how they are triggering each other, it's not all about the patient being the only one with a problem.

Are mental health acts legal in Canada?

Every province has mental health laws that allow for people to be detained and treated against their will. Some experts argue -- and I agree -- that some of these laws would not stand a legal challenge under Canada's Charter of Rights and Freedoms. Unfortunately, the BC govt has fought tooth and nail for 6 years to prevent a court challenge from even making it into court. Alberta's mental health law was thrown out by a judge as unconstitutional in about 2019, but the govt simply revised it trivially and did not address the real problems. It could be a long time before someone else has the time and resources to challenge the law in court -- it can take years.

Can we talk? Can I pm you?

I am 31F in Ontario, Canada. I can tell you things I've been through with the "mental health," system in various parts of Ontario. And Yukon. I'm grown up originally in the far north, Whitehorse so I can give you insight into my experiences with the mental health system in some...northern Canadian experiences from me I guess.

I've been failed, involving involuntary holds I didn't agree to or want because I was seeking help from a newly graduated family doctor who I absolutely resented. The county failed me, I was promised all sorts of support in Lanark County, in the Brockville area and ottawa. I have so much to tell and I have no one to ... share with. I need to get it off my chest somehow and I would so love to get in touch with you somehow.. 🤞

With nothing but respect, ... cheers

I'm sorry to hear this! You can contact me through the contact page on my website, that's the best way. Email address is there, too.