Why Involuntary Commitment?

Anecdotal evidence does not make good science. It does not make good policy, either.

When addressing Norman Ornstein’s account of having his adult son committed to a mental health facility involuntarily we must consider that we are dealing with anecdotal evidence and with grieving parents.

When Ornstein was informed that his adult son was behaving erratically and seemed to be dangerous, he flew to Sarasota, FL where the young man was living. He filled out the forms to have him committed. Apparently, it was a very easy process… which leads us to ask why no one did it for Nikolas Cruz.

Ornstein tells us that his son’s illness began suddenly when the young man was 24. It is a little late for the onset of schizophrenia, but one suspects that Ornstein’s son was suffering from psychosis. The Times column does not provide us with a diagnosis, but we know that the young man was held for seventy two hours and released.

An earlier column, also written by Ornstein, offers more details:

At age 24, Matthew had a sudden psychotic break, and that began a difficult decade-long journey for him and for his family and friends. Whatever his illness — his condition was never formally diagnosed, but he probably suffered from bipolar disorder — Matthew was particularly afflicted by one component of his illness: anosognosia, the inability of a person to recognize that he or she is ill. Since Matthew was over 18, neither family members nor professionals had any legal authority to get him treatment for the symptoms that kept him from living a stable life.

Astonishingly, Matthew was never diagnosed. Whatever do psychiatrists do if they cannot diagnose a case of schizophrenia. He might have suffered from bipolar disorder but sudden psychotic breaks are more often associated with schizophrenia. Dare we say that both conditions are treatable? And that, as Ornstein importantly notices, if the young man did not recognize that he was ill, then shouldn’t the proper authorities be allowed to do what is best for him.

In today’s column, Ornstein describes what happened after he signed the commitment papers. He blames the police and the system for traumatizing his son:

In a panic, we flew to Sarasota, went to the courthouse and filled out the forms to invoke the Baker Act. It was surprisingly easy.

When we got to the condo, Matthew was already gone.

We later learned what had happened next. He had just emerged from the shower when police officers cuffed him — without letting him dress or pick up his cellphone, or even explaining what was happening. He was transported to a county mental health facility.

We followed, desperate to see our son. But the staff members wouldn’t let us in. In fact, they said privacy rules meant that they could not even confirm that he was there.

Worst of all, we found out we had been duped. The condo manager who had called us had concocted the story as a pretext to get our son off the property. Because Matthew had long hair and a beard, smoked and tended to wander on the beach at 3 a.m., the manager thought he might scare away those renting other units — and he just wanted Matthew out.

The Baker Act allows 72 hours of involuntary observation to see whether someone is in fact an imminent danger to himself or others. Matthew was not, and after three awful days, he was put in a taxi and sent home. We were not informed when he was released.

Evidently, three days is not sufficient to offer any treatment. Psychopharmaceutical treatments of psychosis are far from perfect, but they are far more effective than they have ever been. True enough, seventy-two hours is hardly sufficient. Leaving the young man untreated was medically and judicially irresponsible.

Ornstein blames the police and the mental health system for having driven a wedge between him and his son:

Our relationship with our son was deeply damaged by this incident, making any further efforts by us to help him infinitely more difficult. It did nothing to help him deal with his condition and only increased his sense of being stigmatized and hounded. He moved out of Florida and died in an accident at age 34.

Clearly, treatment should have been administered, even if the young man did not want it. And yet, the standard of “imminent danger” did not allow the mental health system to hold him for more than three days. One remarks in passing that if Nikolas Cruz was not an “imminent danger” the term has no meaning.

All things considered, the trauma of being picked up by police was the least of this young man’s problems.

Besides, how much confidence should we have in the psychiatric system and its ability to judge imminent danger? One suspects that simple minded professionals ask patients whether they want to kill themselves or anyone else and mark their word down as definitive.

Ornstein adds that we do not hold patients with psychiatric illnesses for very long because we do not have the beds to do it. He does not mention the advocacy groups that worked to empty out the psychiatric hospitals several decades ago and who defend the rights of psychotics to walk free in our communities. Blaming the NRA or guns is far easier than casting a cold eye on the consequences of the disastrous work of the ACLU in this field.

He sees the consequences of the failed mental health policies, but does not affix responsibility:

We have far too few beds in mental health facilities, so most people who have a serious illness and are picked up for offenses like vagrancy from homelessness or drug possession (many people with mental illness self-medicate with drugs) end up in jails, where they lack treatment and almost invariably deteriorate.

The fault lays with the system, for failing to treat people who are clearly ill and who do not know they are ill. I would have preferred that Ornstein affix some of the responsibility to those who were the authors of the new policy and who have militated for decades to ensure that psychotics not receive treatment.

Refusing to treat a treatable illness in the name of an ideal is cruel.

[See also Walter Williams' column, link here. Via Maggie's Farm)