On Involuntary Committments & Personal Responsibility

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I've got a few questions to ask, bear with me if you will and please respond if you can, to any part or all parts of this post.

1. In your State, is there a law that allows for involuntary committment of individuals deemed to be a danger to themselves and/or their community? If there is, are you aware of the basics of how this is accomplished?

[In Florida we have the Baker Act, which BASICALLY allows for the involuntary committment of an individual for hte purposes of mental health evaluation by a mental health expert, for not more than 3 days without further action]

Background: Young man is found to be incompetent. YM Commits several crimes and is sentenced accordingly each time. YM's family has him evaluated by a mental health physician, who's report tells the family that said YM is not sane. YM commits another offense and YM's family has him INVOLUNTARILY committed. YM's family informs the facility of previous Dr.s Evaluation and Comments and implores facility to not release him, for fear that someone will be hurt, and most likely YM's mother.

Now...are we all aware of the patient's bill of rights? It's fairly universal I think....but it's displayed prominently in medical facilities so that patients are aware of their rights. When patients can't understand these, they're explained to them.

Anyway...here's the deal: A person was found incompetent and committed to a mental health facility for evaluation & treatment, INVOLUNTARILY. Being found incompetent by the Courts, YM from above scenario is assigned a patient advocate. Assigned advocate explains YM's rights to him, who hears that he can sign himself out of the facility. It's medical treatment he's in for, it's not part of a criminal sentence.

YM releases himself and days later, murders his mother.

Would you say some responsibility of that resides with the patient advocate?

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ABSOLUTE RESPONSIBLITY LIES WITH THE MURDERER.

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I thought involuntary commitment meant that the patient could not sign himself out. And if that's the case then the institution bears some responsibility for letting him out.

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FreeDuck wrote:

I thought involuntary commitment meant that the patient could not sign himself out. And if that's the case then the institution bears some responsibility for letting him out.

As did I, but this is not the case in this instance, and I don't have any other information...I'm just wondering based on the provided information, what you guys' thoughts are.

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Well, if he had the right to sign himself out even after being recognized by a court to be a danger to himself or others, then that's a flaw in the system. The patient advocate didn't do anything wrong by explaining his rights to him. In this case it seems that he shouldn't have been able to sign himself out and shouldn't have been let out absent court approval. It is a very sad outcome.

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I've never heard of any jurisdiction where a patient advocate could release a patient from a facility. They can, and must, explain their rights to them, but they aren't responsible for the release itself.

Is there a time frame that involuntary commitment runs for in your jurisdiction?

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oh - I just saw the three days. So once the three days are up, the commitment has to be voluntary?

The advocate was doing what was required. It's a rough job at the very best of times. Horrible in examples like this.

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Re: On Involuntary Committments & Personal Responsibilit

onyxelle wrote:

Would you say some responsibility of that resides with the patient advocate?

Unless you've excluded some part of the story - no, I wouldn't. I don't see how explaining someone's rights to them makes them responsible for what might happen as a result of the person exercising those rights.

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I am not sure about Florida (even though I live here). In New York a person can be held for three days also. If he attempts to sign himself out, and the doctors think that he is a danger to himself or others, he can be taken before a judge, and if the judge agrees, he can be committed until the doctors no longer believe that he is a danger.

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Here (I am in Australia...and in South Australia) it is quite difficult to commit someone involuntarily.

After an initial 48 hours, there must be a further assessment. If the patient appeals, there is an appeals board hearing. And, I can tell you from experience, that they are, at least sometimes, very harsh indeed to the treatment team advocating further involuntary committal...ie the burden of proving that it is in the patient's/community's interest is very high.

This is an area, I think, where the balancing act for people making the decisions is a very difficult one, and will continue to be so.

The committal bar is set high, because of the abuses of the past.

There are, at least here, a number of criteria to be met.

Many people advocate easier to obtain involuntary treatment orders......and I would probably be one of them.....but the law is the law.

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Yes, I think the patient advocate bears some responsibility. If a person
is judicially declared incapacitated/incompetent, then the patient advocate
would need to notify the court prior to releasing this involuntary admitted patient.

Despite reading the bill of rights to this patient, the p.advocate has no
authority to override a judicially decision.

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CalamityJane wrote:

Yes, I think the patient advocate bears some responsibility. If a person
is judicially declared incapacitated/incompetent, then the patient advocate
would need to notify the court prior to releasing this involuntary admitted patient.

Despite reading the bill of rights to this patient, the p.advocate has no
authority to override a judicially decision.

You are reading things into the story that aren't there.

Nowhere was it stated that the Advocate overrode a court order or was the person that actually released the patient.

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I would expect that this was a case of an overzealous patient advocate, coupled with a mental health system that allows dangerous people to fall through the cracks.

In my experience, psychiatric hospitals are discharge planning before the patient warms his bed.

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fishin wrote:

CalamityJane wrote:
Yes, I think the patient advocate bears some responsibility. If a person
is judicially declared incapacitated/incompetent, then the patient advocate
would need to notify the court prior to releasing this involuntary admitted patient.

Despite reading the bill of rights to this patient, the p.advocate has no
authority to override a judicially decision.

You are reading things into the story that aren't there.

Nowhere was it stated that the Advocate overrode a court order or was the person that actually released the patient.

This is what oxynelle wrote:

Quote:

Being found incompetent by the Courts, YM from above scenario is assigned a patient advocate. Assigned advocate explains YM's rights to him, who hears that he can sign himself out of the facility. It's medical treatment he's in for, it's not part of a criminal sentence.

fishin', I can't find a passage where it says that the advocate has indeed
notified the courts. Had he done so prior to the patient releasing himself,
in all probability the courts would have intervened.

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I have it from a former district attorney in 1991 that a mental patient cannot be held beyond the point where he cannot respond to treatment.
Sounds a bit loony, and maybe that's been changed in the past 15 years.

If the patient advocate has the responsibility of advising patients of their rights, how can he or she be held responsible, legally or morally? Maybe it is time to look beyond those rights and see if they are well founded?

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CalamityJane wrote:

fishin wrote:
CalamityJane wrote:
Yes, I think the patient advocate bears some responsibility. If a person
is judicially declared incapacitated/incompetent, then the patient advocate
would need to notify the court prior to releasing this involuntary admitted patient.

Despite reading the bill of rights to this patient, the p.advocate has no
authority to override a judicially decision.

You are reading things into the story that aren't there.

Nowhere was it stated that the Advocate overrode a court order or was the person that actually released the patient.

This is what oxynelle wrote:

Quote:
Being found incompetent by the Courts, YM from above scenario is assigned a patient advocate. Assigned advocate explains YM's rights to him, who hears that he can sign himself out of the facility. It's medical treatment he's in for, it's not part of a criminal sentence.

fishin', I can't find a passage where it says that the advocate has indeed
notified the courts. Had he done so prior to the patient releasing himself,
in all probability the courts would have intervened.

But there isn't any statement that the Advocate DIDN'T notify the court either. (But court notification isn't really relevant in the grand scheme of things. The Advocate isn't the person that would notify the court.)

onynelle has left quite a few relevant parts of the FL Baker Act out of the storyline.

So let's catch up on a few things.

She did state that his family had him involuntarily committed and she also stated that he was there for medical treatment and NOT as a criminal issue.

So if you take those points and read the Baker Act you'd find that a person involuntarily committed isn't sent there for 3 days. They are sent "for evaluation" which must be completed within 3 days (72 hours). They can do that evaluation during the first hour of they have the manpower available. At whatever point the evaluation takes place, the court order has been complied with (whether it is within an hour or the full 72 hours).

A mandatory item under the Baker Act is that someone who is there involuntarily must be given the option of switching to voluntary status during the evaluation. If they opt to switch then they are (by law!) no longer involuntarily committed. (Nice eh! A crazy person gets to decide if they want to be there involuntarily or not...) The only time the facility can notify the court is if the patient is determined to be a danger to himself or others (the story as told, doesn't say anything about what the results of the evaluation are...) or if they were committed for criminal reasons (which doesn't apply here).

So at that point the patient is there in voluntary status and the patient has the legal right to terminate treatment and leave at any time. All of that can legally happen in under an hour under FL law.

The Advocate has nothing to do with any of this other than explaining to the patient what their rights are. They don't conduct the evaluation, they don't ask the patient if they want to move to voluntary status, they don't do admissions or discharges, etc... They also aren't there as an advocate for the state. They are there as a PATIENT advocate. They are there to ensure the patient's legal rights aren't trampled on.

So how would the Advocate be responsible here?

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I haven't paid attention to all this in some years, so wallow in confusion.

On the 48 hr/72 hour hold thing, can or cannot a person sign out? (I had been thinking not...)

I seem to remember that if med staff believe the person should stay past that, then there is a hearing regarding commitment, and then that one cannot sign out if the judge deems agreement. As Dlowan has said, I bet that has gotten substantially, if not across the board, tougher over the years, and I am supposing there are review systems built in (maybe I'm whistling in the dark.)

Thus I'm confused on when the signout can happen...

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I agree with Roger... The patient advocate was doing her job.

A patient advocate is an advocate for the patients. Patient Advocates exist because a fair system needs someone whose job it is to speak up for the rights of patients.

Stories like this are (albeit tragic) examples of hindsight being 20/20.

There are also stories of people who are involuntarily commited against their will when it is unnecessary. These stories, where people who could live funcational lives are stigmatized and locked up in an institution are also tragic.

This is why you need both... people who are looking out for the safety of society... and people who stick up for the wishes and rights of the patients.

If you hold the people who stick up for the rights of patients accountable for the occasional time when rights have tragic consequences... you are in essence taking away rights from everyone.

It is perhaps the people whose job it was to investigate her danger to society who should be held accountable.

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