The Perfect Storm of Psychiatric Safety Dilemmas

A just published article caught my eye, or rather one of my targeting search bots for topics for blogging. It involves that dilemma of what to do with a ‘mental patient’ in Canada who has been ‘detained,’ i.e., involuntarily committed/hospitalized in a public [read “state hospital” in the United States] psychiatric hospital for nineteen (19) years with virtually no treatment.

He has the near perfect combination of unfortunate frightening [to the public] denominators of: 1) possible intellectual deficit and consequently, 2) lessened capacity to take in, utilize, internalize, understand and retain change from mental health treatment other than use of psychotropic medications, 4) deafness with poor knowledge, facility and use of sign language, making the enterprise of conveying concepts of treatment based healthy change and knowledge of the “wrongness” or inappropriate nature of his socially unacceptable behaviors almost impossible, and worst of all the history of and baggage of being a pedophile!

He is now is in his 50’s and has spent 19 years of his adult life in an institution under legal constraints that I assume from my own experience with just such patients as legally preventing him from “re-socialization” into the community on a long term basis to prepare for re-entry into society. Most of these patients are under near perpetual court orders keeping them under lock and key inside state hospitals as “a danger to the community.” Why, even when they go to specialty medical centers for sophisticated medical care [as they DO develop chronic medical problems just like the rest of us] they have to go in police custody. Never mind that they often have the minds of children and almost never would the capacity to escape, rob banks, kidnap persons, pull off sophisticated white collar crime scams or make an attempt on the President’s life! Unlike obviously dangerous sociopathic savvy career criminals they would not have a clue as to where and to whom to go to for purchasing an automatic rifle and even a Saturday night special cheap pistol.

So they languish in ‘interminate’ lengths of stay in hospitals ill equipped to meet their complex social, rehabilitative and psychiatric needs. And forget community speciality based supervised structured based housing for them outside the secure hospitals. Such exist only in rare enlightened communities and largely not in my bailiwick of practice. With all these ‘barriers to discharge’ as they are called in inpatient mental health jargon, they are often adjudicated “incompetent to proceed,” to trial on their charges, because they are “non-restorable” [to competency to stand trial] and no professional is going to stake their license on releasing them with the thin possibility of an adverse event of such an impaired person, say for instance, approaching a child on a school playground.

So now in Canada, comes a judicial ruling that puts a six month cap on such detaining hospitalizations altogether. As this ruling comes to be cited in the near inevitable and expectable wave of advocacy attorneys in Canada and in the US citing this as binding precedent, we could see a revolution in forced discharges for such impaired patients into the public world of communities large and small that have no place, no staff, no infrastructure, no funding, to accommodate them. Perhaps they will all end up in bankrupt empty motels and flophouse abandoned hotels as we have seen in large cities where the chronically mentally ill are housed in convenient never-ending, stopgap solutions, a contradiction in terms if I ever heard one. I sincerely doubt that our unenlightened legislatures across the country will rise to the need with the billions of dollars in funding to house and care for these very impaired, needy patients with vast multiplicity of care needs. Or will they  just dumped onto their families, abandoned military bases or sent to the other great current dumping grounds, the nation’s jails, already overflowing with disturbed mental patients.

For the report on this little noticed but potentially revolutionary, if not cataclysmic article on this ruling, please read: “Court places six-month cap on involuntary detention of mental health patients,” by Sean Fine, Justice Writer, The Globe and Mail, Published Tuesday, Dec. 24, 2014.


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