Virginia Tech: When should patients' rights be sacrificed?

The controversy surrounding forced psychiatric treatment rises in the wake of last week’s massacre:

For Gambs, last week’s shootings at Virginia Tech highlight major failings in our nation’s mental health laws: Long-standing laws protecting patients’ rights make it difficult for authorities and family members to intervene and order a loved one to receive treatment.
“It absolutely breaks my heart and makes me so sad that so many people died because we, as a society, didn’t treat this man,” said Gambs, San Luis Obispo County’s president of the National Alliance on Mental Illness of California. Her son, now 34, lives in community housing and is successfully stabilized on medication.
Emerging details about Seung-Hui Cho’s interactions with the mental health system more than two years before the shootings have stirred up long-standing debate around how state and local authorities should handle mentally ill people who refuse treatment but show signs of potentially dangerous behavior.

Comments

Anonymous
The VT massacre is, as was inevitable I suppose given the lack of standards in modern political debate, becomming a vehicle for every sort of cause.
Frankly, we have not sound basis for assuming that anything happening differently surrounding his commitment two years ago would impact events now. While any human emotional experience or behavior that causes distress to themselves or others gets a diagnostic classification as a mental disorder, complete with criteria and codes, that doesn’t mean that they all have an actual treatable disease. Even among the major treatable disorders such as schizophrenia, nearly half the patients show little little response to treatment–and that is if they are compliant. At least half of involuntarily commited patients don’t take their medications after discharge anyway. Only half of the prescriptions written for Medicaid patients on discharge from psych facilities ever get filled.
So after we factor in all the ifs, (treatable disorder? comply with treatment? respond to treatment?), we see that while mental health referral offered a hope, it should have never been relied upon by VT to resolve their concerns about a person of whom they were afraid.
Psychiatric treatment is a resource for people who want to help themselves. For those who present a clear and imminent danger, involuntary assessment and treament is appropriate. But it does not provide any kind of adequately reliable solution to the delimma presented to administrators with feared individuals in their organizations.
As has been often observed before, we have evolved a legal and civic culture in which administrators, even though recieving ever greater pay differentials, fear taking responsibility for exercising actual judgement. Instread, they craft policies. Policies are blunt instruments that sweep a lot of people about like so much trash.
When multiple people (not one neurotic paranoid) are afraid of a person in your school, church, business, medical practice, whatever . . . then the person is indeed a danger, whether mentally ill or no, and should be gotten O-U-T before something happens. Judgement must be exercised and decisions made. The literature show that the best predictor of violence is not in psych assesment but is ordinary humans sense of fear in a persons presence. We have an instinct for danger that exceeds our science. Given the homicidal nature of humans, that instinct is a precondition for our ancestors’ surviving long enough to reproduce.
So pour some water on the bandwagon to change commitment laws, confidentiality laws (based on thousands of years of ethics), and gun laws–at least for a while. Let’s start with expecting our overpaid administrators at unversities, and elsewhere, to take responsibility for getting scary people off the jobsites and campuses for which they are responsible.
Don’t drag it out while their anger stews–just get them out.
Michael Rack, MD
“Let’s start with expecting our overpaid administrators at unversities, and elsewhere, to take responsibility for getting scary people off the jobsites and campuses for which they are responsible”
expelling/firing a scary person doesn’t prevent them from later coming back later with a gun.
Anonymous
Simple experiment to determine whether the mental health system ready for the task of identifying those prone to violence.
Take Cho’s file, several other killer’s files too, and put them in a stack of 20 files from creepy whacked out young adults who have never committed a violent act. Deidentify all files so that the shrinks have to go on objective data only and cannot apply the retrospectoscope. Then see if they can ‘predict’ the killers. If the psychology community had any confidence that they could, then such a study validating the worth of their predictions would already have been done.
Anonymous
Given that states are loath to fund mental health facilities and treatment, where exactly will all these people be kept?
Anonymous
Rack:
No it doesn’t prevent it, but keeping them around longer makes it more likely. Surely we don’t need to be absolutely sure something will be effective before doing it? The thing is, doing more to try to treat this sort will probably not help as most narcissistic and paranoid characters will not engage in or comply with treatment and do not respond when they do.
If you get themout or YOUR environment before their obsessive anger has totally focused itself on YOU, then YOU are less likely to be the ultimate victim.
Alternative scenario: Paranoid loser is sent home instead of being tutored (the intimacy of which was likely destabilizing). He broods, but school is hundreds of miles away. He gets a menial job working in the back of the family dry cleaning business. Eventually they become afraid of him and send him to Uncle Kim back home in the old country.

Virginia Tech: When should patients’ rights be sacrificed?

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