Wednesday, July 4, 2012

Independence Day Edition: How Psychologists Can Take Away A Client's Civil Rights (Temporarily)

On this Independence Day, I thought it might be interesting to discuss the power psychologists have to take away a person's civil rights.

Every state has laws in place that allow psychologists, psychiatrists, masters level licensed clinicians, EMTs, and police officers to place an individual on an involuntary mental health hold. Most state laws are similar to those in Colorado, where I live. In Colorado, an individual needs to be deemed a danger to self, danger to others, or "gravely disabled." Danger to self/others is typically considered to be a risk of committing suicide or homicide. "Gravely disabled" is defined as a person being unable to maintain basic activities of daily living, which places him/her at risk of severe harm (for example, a psychotic person running naked through the streets in the winter).

Once the clinician determines that the person is a danger to self or others or gravely disabled, that person can be placed on a 72-hour mental health hold. For those three days, the person can be held in a hospital involuntarily. If there is a concern the person may leave early, it is considered reasonable to place him/her on a locked unit. The person is in a hospital, but there is another word for a locked building that houses people who are not allowed to leave--jail.

In these cases, we are essentially incarcerating these individuals against their will for up to 72 hours. What follows are the civil rights people lose during that time:

1. Due Process (Fifth Amendment): For three days at least, they are arguably being deprived of "life, liberty, or property" without due process of law.

2. Trial by Jury, Habeas Corpus, Confrontation of Accuser, Right to Counsel (Sixth Amendment): These people can be locked on an inpatient psychiatric unit with no trial and no explanation of the evidence that led to the mental health hold. For those three days, they have no right to have an attorney and are not allowed to confront their accusers in court.

These loss of civil rights need to be put into perspective, however. Assuming a person is mentally incapacitated to the point of being a danger to self or others or being gravely disabled, mental health clinicians have an ethical obligation to act in the best interest of the client and the public. Also, these rights are only temporarily lost--although a person can be held for a maximum of 72 hours, he/she can be released early if the danger or disability improves. If the person remains a danger or gravely disabled after 72 hours, the hospital needs to apply for short-term certification for treatment through a civil court, at which point the client regains all Constitutional Rights and can fight the involuntary hospitalization and treatment in court.
Anti-psychiatry activist clearly upset over
forcing individuals to undergo mental
health treatment

It does not happen often, but I have placed a handful of clients on 72-hour mental health holds over the years. In each instance, I have taken that responsibility very seriously. I understand the ramifications of taking away a person's decision-making ability and civil rights, even for a short period of time. In each instance, I weighed the cost of involuntarily "incarcerating" the individual with the benefit he/she would receive in treatment. I also weighed the potential danger to the public in my decision. It is never easy to make this decision, but sometimes it is important to do so.

Thanks for reading-- Max Wachtel, Ph.D.


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