I'm not sure I see a better solution to this that doesn't come with its own set of risks and downsides (involuntary commitment or counseling of someone against their will is not something to be taken lightly in any event, even if their reality diverges from your own).
In my friend’s case, he had actually set up permissions for the doctor, his family, and I to initiate such a thing, but after his episode started, he fired his doctor and was quiet for a month, which nullified the paperwork he had done to create a safety net for himself.
The law has a list of things that have to happen before the psychiatric hold if there is not such an arrangement.
Basically, the mental illness has to affect some number of life areas. I think this is the list, I might be remembering wrong:
- work - finances - shelter - self care (eating, etc) - family life / marriage.
It used to be that one thing on the list was sufficient. I think the current law is that a total of three are necessary, but not sufficient.
Risk of immediate self harm or harming others is a different path, but the person basically has to say “yes, I do plan to kill myself, or that fellow over there, officer” on camera for that to count.
Anyway, my friend ticked all six of these boxes, and that wasn’t sufficient. If the person is borderline coherent, don’t think anything really is.
(Nothing in this message should be considered medical or legal advice. Go talk to a doctor and a lawyer if you might need to know any of this stuff, especially if everyone is healthy at the moment.)
(Edit: upvoted sokoloff because this is exactly what everyone with any power to provide care says.)
We have a history of using this policy in multiple countries, and in each one the system was abused to torment and commit minorities, people (including children) who were deemed an inconvenience, and political enemies.
I say this as someone with a family member who went through a very similar experience as your friend. I know just how scary and frustrating it is, and the immense burden of care and worrying it puts on people who care about someone going through mental breakdown like that.
I wish there was a solution to this problem, but I don't know what it would look like.
Rosenhan's paper itself ("On Being Sane In Insane Places") also makes for fascinating reading and is very readable even for laypeople.
You then provide free legal advice, and access to mental health act tribunals where people can challenge their detention.
You have independent regulators who provide some oversight, the rpess can report on it all, and of course the courts provide a final backstop.
There are problems with this, but it's pretty good.
We have short detentions for assessment. We have longer detentions for treatment. We have police powers to take someone from a public place to a place of safety for assessment. There's another police power where the police can take someone from their home to a place of safety for assessment, but only if they have a valid warrant.
- healthcare not linked to employment
- a housing-first homeless policy
- a compassionate aid policy that presumes that people who are asking for help need help, and starts providing help as soon as it is asked for rather than after a year or more.
Those don't seem like they have any major risks other than monetary.
Threat of homelessness is basically the only remaining lever the law allows in these situations.
The other two points are spot on.
The one place I know of where a housing-first policy has been implemented, Salt Lake City (or maybe all of Utah?), doesn't just give homeless people a set of keys. They do assign everyone a social worker at the same time. The goal is to minimize the risk of what happened to your friend; that isn't good for anyone, including the person spiraling.
It's key, though, to start with a home (and a social worker). The wealthiest country in the world can do that for its people -- and it shouldn't be on private citizens, though that was generous of you.
My ex was schizo-affective (had traits of both schizophrenia and bipolar disorder). He was on disability. His doctors did not want him living by himself. Some things were simply too stressful and he couldn't do all of it. He'd only cook instant food. He wasn't good at budgeting money. And so on. For a while after we split up, he had a social worker coming to his house for wellness checks. My friend worked a similar job for another hospital: SHe'd visit mentally ill patients and help them, sometimes shopping and whatnot.
There was no recovery for him, only meds. That's it. Only meds.
I cannot fathom how stressful it would be to have your housing and your safe space be dependent on taking your meds, especially when your meds need adjustment... and paranoia strikes up again. Every stressor simply complicates things.
In so many ways, America needs to start understanding that solutions to these problems have been explored and, just possibly, greater progress achieved in other countries... progress can be gleaned by studying outcomes from those countries.
It's easy to dismiss suggestions as having "its own set of risks and downsides", but in critical areas, America is significantly underperforming other first world countries and we need to get past the Not Invented Here syndrome.
It's Indoctrinated That Anything Socialized Is For Weak Moochers And Cannot Succeed Because It's Not Capitalism syndrome.
Describing psychotic delusions as 'reality diverges' is something or other, I have to say.
Of course we need to respect the rights of individuals, but it shouldn't be the case that family and friends are the first, second, third, fourth and so on interventions, there can be professional resources available.
Most cities & states just try to fix the symptoms of homelessness (& crime), and not the actual root of the problem. There needs to be a federal mental health program to handle this, and maybe states & cities will stop playing 'hot potato', shipping them back and forth to be someone else's problem
Reagan was elected governor over FIFTY YEARS AGO.
Why not blame Julius Caesar, or George Washington, instead?
A friend that has been certified mentally ill stopped taking his meds and was fantasizing about killing himself, a family member and shooting up religious organizations. His doctor, family, employer and friends all called the police, talked to lawyers, mental health professionals, etc.
The end result was that he was facing sleeping in a car that was about to repossessed, and eating in homeless shelters. At that point he decided to accept free housing in exchange for seeking help.
His family’s only other recourse would have been to pay tens of thousands of dollars in legal fees to petition the court to force the police to uphold the law. This would have had a medium to low chance of succeeding.
Of course, during the months this dragged on, he missed an insurance payment or two (he had also been fired, divorced and evicted), so it lapsed.
There is a 12 (6?) month wait to get government disability insurance to kick in for this sort of thing, and the clock starts after the mentally ill person goes in for scary interviews with the government to establish they’re actually crazy.
The law used to handle this sort of thing properly in California, but Regan repealed the lions share of it as governor, and loopholes that accidentally allowed people like my friend to get health care have been progressively closed since them.
Nurses at the intake office of the appropriate mental health facility in Santa Cruz told me that most of the homeless people in the Boardwalk area there are in exactly the same situation as my friend was in, except they’ve been trapped in it for years.