Over the weekend, I told Steve that I was very worried about Amanda Bynes. And Steve was all like, ‘who’s Amanda Bynes?” Because he reads books and shit and doesn’t watch Access Hollywood after dinner. Silly boy. I had to explain that Amanda Bynes was one of those Disney stars who is now insane. Here, you can catch up at TMZ.
She has been publically unravelling for a week or so. The gossip websites have been documenting the mess. Her parents basically had to trick her to get her to California where they get her involuntarily locked up for a few days until the anti-psychotic meds could take effect.
It’s really hard to lock up a person in a mental health facility without their consent. Do we need to rethink this policy?
Apt. 11d 
Are you suggesting we make it easier to lock up adults who have not commit crimes?
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No. I was just throwing it out. I have a friend whose younger brother suddenly came down with schizophrenia right after high school. He was out on the streets for years. The family had a terrible time trying to get him home and get him help. It was tragic. This family would have been very, very happy to have him forcibly removed from the streets. I think parents should have more tools to help their kids when things really fall apart.
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I agree that it’s troubling that so many people in need of help aren’t getting treatment. The old institutions and heavy-handed policies were wrong, but leaving people to fall into desperate straits, even death, because of mental health problems, is a horrible consequence of our policy changes over the past two generations.
Poor Amanda Bynes. It’s been hard to watch her problems emerge so publicly over the past several years.
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Even people who know they have problems and would (with some coercion) accept being in an mental health facility can’t get help because of limited facilities, incredible waiting lists, and lack of insurance. We have a problem and it is much bigger than involuntary vs voluntary seeking of treatment
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Even here in Canada it’s a challenge to find appropriate mental health services for families and kids. If you can’t afford private care, you wait at least 6 months for treatment. That’s a lifetime for a kid.
And even if you can afford private care, it’s difficult to navigate the system and find out what kind of treatment is best and who are the best practitioners.
Children’s mental health (I used to work in the field both in a public children’s mental health centre and in private practice) is not something that’s an easy “sell”.
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This is a really difficult question. Back in the 90s I worked with some women who had been involuntarily committed by their husbands back in the 70s and 80s as part of a larger pattern of abuse. It was disturbing how badly their own testimony was discounted during their experience in the system.
Fast forward to 2013 where I have a suicidal family member and am struggling with how to get them to in-patient treatment, of which they are terrified. Compound this with the shortage of beds which means that the local hospitals are only admitting 5150s. Family member becomes more afraid at the thought that they would not be able to leave. Luckily we get into a diversion program, which is kind of like a halfway house. It’s a pretty gloomy beat up old mansion. Most of the residents are homeless, with a variety of challenges. The staff are amazing – I am struck by their warmth and concern, which helps alleviate some of the fear of staying there. It’s still extraordinarily difficult to leave my loved one there to sleep in the same house as the guy mumbling about fires and guns, but the staff assures us it is safe. The 2 week program ends up being a turning point in a year long depression.
I wonder what I would have done if I had not been able to persuade my loved one to go into that program. Luckily the therapist was willing to take the responsibility for the 5150 if it came to that so as to help maintain family trust. We did very mildly use the threat of involuntary as “persuasion” which felt uncomfortable but it also made me realize my own limits, which were that I need adult family members to do what it takes to care for themselves. I realized I was willing to do something that could end the relationship if necessary.
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And we had decent insurance. After the program there were months of follow up care covered. Some of the other residents from the program went back to the streets.
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Good discussion. I was going to comment that I don’t think we’ve found the right balance yet for the legal issues with mentally incapacitated adults (a population I think is going to grow, and has grown, because we have better medical care and resources of support).
But the raising of the issue of resources made me I agree that lack of access to care is a bigger issue, and that arguing about the legal issues (and, often, with cases of outliers, like Bynes, or Lohan, . . .) can be a distraction. Not only is there no access, but what access is available often looks scary and unsafe for most (though maybe not for Bynes). Being held against your will is always scary, but its scarier if you are with people who scare you in beat up old mansions than if you’re in physically beautiful, restful spaces.
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I don’t know that it is exceptional for seriously mentally ill people.
There are lots of mildly mentally ill people who know that they are mentally ill and are good patients (in fact, I presume that Laura’s readership contains quite a number).
However, the more seriously mentally ill one is, the less likely that one is to be aware that one can’t trust one’s own judgment or to believe that treatment could in fact be helpful.
(I have to add, though, that the mental health field is a relatively young field (at least in terms of results) and that there’s a lot of failure in it. People say, “so and so is off their meds,” but that’s assuming that those were the correct meds, which isn’t really something we can assume given the state of knowledge in the field. There seems to be an awful lot of trial and error with medication. One of our mentally ill relatives has several diagnoses, and I don’t know that her psychiatry team is any closer to figuring out how to help her than they were when they started.)
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Good point. Most residential programs that insurance covers are NOT in beautify restful places. They are not necessarily unsafe, but the truth is that you will be with people who are not predictable or who may make you feel afraid. The guy who mumbled about guns and fire? He was not violent but not fun to be around either.
The nice places you see in the movies? Private pay.
As it was, we still paid a lot out of pocket for co pays on out patient follow up and months of private therapy. It is criminal that you need an upper middle class salary for this.
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Now the question of child stars and what happens to them. That’s a Bynes specific issue. I usually explain to my kids that its a combination and money and access to drugs. But is there more?
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A superfluity of free time probably doesn’t help.
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And no one to say “no” to you. Too many hangers-on along for the ride who have no skin in the game in how you turn out.
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“the Devil finds work for idle hands”
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The previous minister of my mother’s church was raised by very hardcore, unrepentant Nazis, who fled to the US in the 50s. They had his sister involuntarily committed in the 60s for befriending an African-American girl. She managed to escape and was killed shortly after running away. He pretty much sees it as his parents murdered his sister. I don’t think this is a very helpful anecdote for deciding public policy, but it certainly is dramatic.
Mental health law seems like child protective services in that each case is different, it’s hard to predict the outcome ahead of time, the stakes of failure in either direction are incredibly high, and we mainly only find out about the failures. Eliot Rodger seems like another case where the family knew their kid was in lots of trouble and tried to do what they could, but their efforts weren’t enough to prevent tragedy.
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Sooo, presumably in the absence of the possibility of involuntary commitment, the minister’s parents would have gone straight to Plan B (“kill sister”)?
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Well, the sister ran away and lived on the streets, where she was murdered by someone random, so the parents didn’t directly kill her. They were directly responsible for her death, and I don’t know if they felt remorse. Presumably they wouldn’t have straight up killed her though. With their son (the future minister) they kicked him out of the house when they found out he wasn’t a Nazi.
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Sorry, I misunderstood the story.
We have a relative who is on a sort of merry-go-round with the mental health people. She checks herself in, she checks herself out, she threatens or commits self-harm, she checks herself in, she checks herself out, she threatens or commits self-harm, etc. It’s exhausting for her family. She finds the hospital a safe and comforting environment, but she eventually gets bored and wants out. She’s had substance abuse issues in the past, so that’s presumably something that make her eager to leave. There’s probably a sort of seesaw between on the one hand her need for safety and comfort, and on the other hand her desire for stimulation, freedom and whatever her current substance of choice is.
When she’s checked in, there’s peace and quiet for her parents, but we haven’t seen any actual progress over well over half a decade. The commitment does provide peace of mind to the family and a safe environment for the patient (in her case–I’m sure there are less nice mental hospitals), but the mental health system as currently constituted (this is not in the US, but in another Anglo-Saxon country with relatively good mental health) simply doesn’t know enough yet to be able to help her.
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I just realized I used both a merry go round and a seesaw analogy in that paragraph.
Worst playground ever.
It’s not currently my problem, but mentally ill relative manages not to kill herself over the next 10 years (and that is an ever-present possibility, at least when she’s not checked in), she will eventually be my and my husband’s problem.
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There has to be a way to find a middle ground, right? Between my friend with mentally incompacitated brother and the abusive crazy parents of B.I.’s story. Couldn’t objective psychiatrists and medical professionals tell the difference?
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There is – and children’s mental health has come a LONG way since those days. There is definitely a judgment/pendulum swing involved – in the past it’s been in vogue to remove children from their families and then it swings back to keeping the family together at all costs, for example.
However, having worked in the field, increased funding and access to mental health services would go a long way to nipping many of these situations in the bud. It’s just not a “sexy” thing for fundraising like pink ribbons, though. No one wants to see a children suffering from mental health issues on a tshirt or a poster. And it’s an easy service to cut since there is still a LOT of stigma around mental health – even depression is often seen as a character issue.
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My wife has paranoid sz. From our experience, it was hard to get her hospitalized the first couple of times. Since then, not a problem. This might be because they ‘know’ her, or maybe just that I have a better sense of when it’s time to go in. Admission has never been voluntary. (That is, she does not consent to be admitted; she’s never been forcibly taken to the ER.)
She usually is admitted on a “2-PC”. The (NY) law for that says “substantial threat of harm may encompass (i) the person’s refusal or nability to meet his or her essential need for food, shelter, clothing, or heath care, or (ii) the person’s history of dangerous conduct associated with non-compliance with mental health treatment programs.” That can be read pretty broadly.
Two or three times, she’s run out the 60-day limit, and hospitals have gone to court for an ‘order of retention’. Again, the basis seems to include the ‘unable to meet essential needs’ criterion. The state provides a Mental Health Legal Services attorney for these cases, but the process seems to be pretty pro-forma. Likewise, when they’ve gone to court for Treatment Over Objection.
It might matter that there are two state hospitals here (one a psych facility), and two of the other hospitals have psych units. Plus, a separate ‘psych ER’ (CPEP) attached to one hospital, that’s supposed to handle all psych intake for the area. There are also at least a couple of ancillary organizations solely providing housing and support for clients with MH issues. It doesn’t all work seamlessly, but I gather this is not the norm everywhere.
Insurance is … another matter. Their rule for medical necessity seems to be “have you tried to kill yourself today?”
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