Tuesday, June 14, 2011

Time to retire "danger to self or others"

It is time to retire “danger to self or others” as the criteria for hospitalization for those with serious mental illness and replace it with a more humane “need for treatment” approach.   Danger to self or others has been a failure on all levels.  Deinstitutionalization and non-hospitalization have left hundreds of thousands of the serious mentally ill on the streets or in jail.  “Danger to self or others” has caused death and injury to thousands of the mentally ill and their families and friends, and police officers who attempt to take them into custody.  Police have become the primary providers of mental health services in the United States, threading an incomprehensible system with few guidelines for “danger to self or others”.  If they don’t take someone into custody something bad may happen, if they do, they may be tied up for an entire shift at the emergency room only to find that the hospital has discharged the person in less than 24 hours. 
If an 85 year old man with the brain disease of Alzheimer’s is found in his pajamas walking down the street in a snowstorm, no one protests when he is taken for care.  When a 25 year old man with the brain disease of schizophrenia is sleeping in a doorway during the same snowstorm, unless he is in imminent danger, he has the right to be left alone.  The curse of Freudian psychology, where we are somehow responsible for the disease that has altered our brain continues to drive policy for millions of seriously ill Americans.  Because of their illness they won’t seek help and because of our outdated view of mental illness we won’t mandate treatment.
The rights of those with serious mental illness need to be preserved:  Life, Liberty and the Pursuit of Happiness or the right to have a horrible, untreated illness that often results in poverty, incarceration and early death.

Future Posts:
Anosognosia- why patients don’t get help
 Medical judgment versus legal judgment
“Need for treatment” criteria
Objective diagnostic tests
Police/mental health partnerships
Focus on illness not behavior
Changing assisted outpatient and mental health courts to “need for treatment” model


  1. I so agree with you about this. The insurance companies won't keep patients in the hospital unless they are a danger. That doesn't mean they don't still need treatment!!!

  2. There is great incentive for the doctors and hospitals to get people out the door. There is little time to coordinate services. Research shows that the best chance of a good outcome is for the patient to connect with the outpatient service provider prior to discharge. Currently there is no chance of that. Terry Garahan

  3. Reaganomics abandoned the mentally ill time to be done with them.