the involuntary admission barrier to care

I am very far away from the news cycle, these days, but even I have not missed the horror of another terrible school shooting. As it should, the topic of America’s mental health system appears to have again come up. I want to very briefly note a serious practical barrier to appropriate care, which is the involuntary admission system.

When I reached the end of my ability to cope with my illness last August, I had a dilemma. I went to the hospital because of a long string of erratic and self-destructive behaviors. But the final event that drove me to seek emergency care was that I had accused a friend of hacking into my bank account and threatened to harm them in revenge. That they didn’t have me arrested was an act of mercy. When I got to the hospital, I knew that if I revealed that I had threatened physical harm to someone, I would be at risk of a 9.13(b), New York’s involuntary admissions policy. Most other states, I believe, have similar laws. I could not risk the disruption to my life, and the total loss of control, a 72 hour stay would entail. And since I was not willing to divulge that detail, which would have made my crisis clear, the psychiatrist who treated me would not allow me a voluntary admission and I was left to pursue outpatient care. This is the lacuna into which you may find yourself when you have a psychiatric crisis: how to receive appropriately urgent care without losing control of your life. This problem was particularly acute in years past because I was hiding my condition from family and friends and was terrified of them finding out.

This dynamic, I’m sure, would not have impacted the Florida shooting. And I recognize the need for some form of involuntary admissions. But I am convinced that many people avoid seeking care entirely out of fear of involuntary admission, and something has to change.