Psychiatric detentions rise in first year of 988 hotline
madinamerica.com
madinamerica.com
My primary complaint was in the organizational changes made by the non-profit. The amount of funding increased significantly, and while some of it was spent on non-volunteer responders the majority of the funding was spent on new bureaucrats. With the funding, the amount of external organizations we were answerable increased. I was suddenly scolded for behaviors I had been doing for years before. Things like calls taking longer than fifteen minutes (when we had lines open, and I am talking to a person in crisis), or me failing to collect enough demographic information from distressed individuals. I didn't want to adapt, and they were more than happy to pay someone $12/hr that will follow orders more closely.
There were a lot of great things that came from the 988 transition. For one, cell phone calls are now routed based on the location of the cell phone, where previous they were routed by the area code of the cellphone number. Another thing, is it did lead to increased call volume. I bet the combination of increased calls, with all calls routing to centers familiar with local resources, drastically increased the amount of detentions coming from suicide hotlines.
There was a core of highly skilled volunteers that is now entirely gone over the last 2 years. She still volunteers because she wants to be there if a teen calls.
This is emotionally draining work when done right and it shouldn’t be done full time by 20 year olds.
> Who are “your people”?
This seemed (to me at least, but it wasn't entirely clear) to be reading a comment to be race based when it obviously wasn't.
> Should every person consider people with the same citizenship as “their people” and treat them better than others? Is it really uncivilized and inhumane to not follow that norm?
Really? This just completely misinterprets the comment it replied to.
> There are no logistics issues with residents and tourists.
This assumes that a system aiming to provide universal healthcare to the citizens of a nation will refuse to help non-citizens within the nation.
It seemed so to you because you tried to read something imaginary between the lines. It is ironic that it is exactly what you accuse me of.
> Really? This just completely misinterprets the comment it replied to.
I don't think it misinterprets anything. If you think it does, provide a better interpretation.
> This assumes that a system aiming to provide universal healthcare to the citizens of a nation will refuse to help non-citizens within the nation.
No, I didn't assume anything. OP said "Keeping your people healthy should just be a given". Following basic language pragmatics, it means that keeping not your people healthy is not a given. I asked who are "your people" and was given an answer that it means citizens.
Then perhaps that's the problem - as per the guidelines "assume good faith".
> "Keeping your people healthy should just be a given".
> Following basic language pragmatics
Quite frankly, that's rubbish; here you are taking the least charitable interpretation of the parent comment.
Most people would have interpreted that as excluding those outside of a country's borders - its region of direct control.
You misinterpreted my comment, where I said "citizens" in much the same way.
> In every comment you made in the thread, you seem to have taken minor issues of phrasing and used them to wildly misinterpret comments in the least charitable way imaginable.
My previous comment hits the nail on the head, and you've done the same damned thing with your latest response.
Life, liberty, and the pursuit of happiness—so long as you have a premium healthcare plan brought to you by Blue Aetna Cigna Humana Kaiser(tm)!
https://www.propublica.org/article/cigna-pxdx-medical-health...
If you factor in insurance, Americans pay more as their percentage of income. In the US there is more private and public bureaucracy in the healthcare system, higher wages for doctors (because they often have to repay their student debt and prices are on average higher in the US) and overall higher prices for equipment and drugs (often due to (often lobbied) laws that favor some US businesses). In Europe health care is treated more as a public service (although there is also for profit health care there). The high profits for US companies in the medical sector have to come from somewhere and they often come from the pacients and the taxpayer, because the US also subsidizes their health care system by taxes. In fact the US government spends more per capita than other governments in the world on health care. https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...
Besides that the taxes in the US are more inefficiently spend than in many western European countries. I could write a long essay about that, but this is just a comment to a hn comment and I already spent to much time on writing it.
People absolutely should not be subjected to bankruptcy in order to get adequate health care, but there's an aspect of personal responsibility that needs to be considered.
In NZ we have ACC, ACC is a universal insurance plan that covers injuries only (we don't have universal healthcare) so some dickhead can shatter his knees jumping of the roof of a three story building and be fully covered, but my little cousin with a disintegrating hipbone got no help from the state.
I think we should expand to universal healthcare (no chance), and failing that ACC should not be abolished (no need to throw ambulance chasers and insurance fraud into the mix) but I do think that the state should have the power to recoup the costs in the case of grossly negligent behaviour that leads to predictable outcomes.
Beyond momentary acts of idiocy, there are also lifestyle choices that have a significant impact on the health - for example, my morbidly obese aunty has had damned near every one of her non essential organs removed - I firmly believe that tax payers should not be on the hook for her (or anyone else's) wilful self-neglect.
https://www.madinamerica.com/2019/06/involuntary-hospitaliza...
And before you ask, doing nothing does work, or at least it beats this option. Yes there are yet better options, actual interested attention from an actual human being, but literally leaving the person on the street works better than any mandatory treatment, and is a lot better than involuntary detention.
https://pubmed.ncbi.nlm.nih.gov/1023455/
And frankly, find a local Psychiatrist and ask them this question "Who is best of: a person committing suicide, or a person in involuntary detention NOT committing suicide for 6 months". They will illuminate what causes this problem.
So why are we doing this? Well, this gets done to those people to give Police an option to deal with people who've done nothing wrong but are judged to be "at risk" and generally being a nuisance, or the police judges they're "at risk" of doing serious damage by killing themselves, slowly getting worse but not actually having done anything wrong.
Lastly, some people are doing this because they see it as a form of euthanasia. They are ill, or have destroyed their lives (for example with medical bills) beyond repair and they just want out. It takes a long time for them to actually do something about this. Needless to say, any form of "treatment" for this will only (sometimes rapidly) make things worse. In fact most old people die not from old age but from starving or dehydrating themselves to death (this gets a lot easier once you're past 70 or so. Energy/calorie shortage causes cascading organ failure, which ironically feels good, and you fall asleep as your blood poisons itself. Obviously doctors do not make a habit out of telling next-of-kin this is what happened, nor do they try to prevent this by for example force-feeding them). But, there is sadly no age limit on this. For example, in one famous case a 15 year old kid relapsed into Cancer after a very intense and destructive cancer. She'd had chemo from 5 to 9 years old, which handicapped her phsysically and mentally, permanently. She caused a lot of damage killing herself by putting a certain person in a position where the police could indict her for murder, a hospital was involved, psychiatrists, she got people to cover up her earlier attempts at suicide, psychiatrists lied to her parents, her parents got divorced and partially remarried, youth services got involved because the parents did not agree on what to do ...
Note that this is independent of the actual health care system. The same problems manifest in Europe with public systems. The problem is that psychiatric help ... well, somewhere between doesn't help and actually destroys people.
Who pays for this is beside the point because mostly, of course, these people are homeless, very ill and/or (ex-)criminals. You can charge them all you want, but as the expression goes "you can't get blood from a stone".
The sad part is that parents and children can be held liable if a suicide (attempt) does damage, which then causes more problems. This is done to "protect" society against psychiatric patients and to redirect as much of the cost of totally rejecting people to those people and their families as possible.
Comment threads often branch down different rabbit holes - the issue of how health care is paid for is generally orthogonal to the question of the nature of the care (although industrial lobbying makes this far less true than it should be).
You don't really have to convince me of anything regarding the utterly useless nature of western models of mental health - I've been depressed for over 20 years.
The first thing they did "for" me was put my on SSRIs - which turned me into an asexual robot (fuck you pfizer) the effects only reversed in the last couple of years due to this bad boy - https://en.wikipedia.org/wiki/Bupropion (thanks GSK).
I've gotten more help from fists full of illegal mushrooms than I ever have from the system (but at least they stopped drilling holes in people's heads).
Because hospitalization takes a lot of expensive resources. The bill has to go somewhere.
> Keeping your people healthy should just be a given.
For the entirety of human history, up to and including this point, it hasn't been.
> How many hundreds of years will it take before universal healthcare is finally accepted as the basic standard of a humane civilization?
Realistically? When they have AI doctors that can treat the plebs for very little cost.
Until then, we're talking about at least 10-15% of GDP of a rich country, which is a massive amount of money. Even places with "universal healthcare" make tradeoffs (e.g. IIRC, healthcare waiting lists for many things are absurdly long in Canada compared to the US).
It was part of living in that village.
So no, under modern less-personal systems this hasn’t been the case.
>> For the entirety of human history, up to and including this point, it hasn't been.
> For the majority of human history, health care was done by village shamans etc (that did actually treat most ailments they could) for free.
Would you be OK with universal shamanistic healthcare? Because I don't think that would count as succeeding at "keeping your people healthy" by any reasonable definition. My strong hunch is that village shamans could successfully treat far, far fewer aliments than you could with OTC medications and first aid supplies.
Things start getting expensive once you try to be more effective than that.
And the shamans almost certainly weren't doing it "for free," but a village like that almost certainly is primarily a non-market economy, so their compensation could be obscure to modern eyes (e.g. for a more modern example and easy-to-understand example, Jewish priests were compensated by being entitled to a portion of religious sacrifices).
If we have resource constraints (not enough doctors, hospitals, medications) then one of our top priorities should be to solve the shortages.
The UK has a famously stingy system which costs 7.5% of GDP, however the UK has better infant mortality than the state with the best infant mortality, Massachusetts. The worst states have infant mortality 2-3 times that of the UK. (Note that the poorest states in the US, LA and AL, still have GDP higher than the UK. So the 7.5% is of a much lower per capita GDP.)
The average EU country spends a little more than the UK, as a % of GDP. But has health outcomes well ahead of the UK, and considerably far ahead of the best-performing US states.
It seems kind of distorted not to point out that around half of the US spend goes either on luxury healthcare for the rich, or emergency healthcare to those who can't afford proper healthcare, or simple rent-seeking by entrenched players (pharma, doctors, insurance companies) and that none of these improves health outcomes by very much.
The US uses a different definition for infant mortality than the UK or any other European country. (One major difference is whether a borderline-nonviable birth gets counted in the infant mortality or stillbirth column.) The raw numbers are not directly comparable. Correcting for the expected effect of difference in definitions, the UK still has lower infant mortality than the US overall, but by a far smaller factor.
I've commented here about my efforts to extract my friend from her psychiatric misdiagnosis. tl/dr: she has the genetic condition where she can't turn the food fortification folic acid into a methylated form of Vitamin B-9 (MTHFR), which results in her being harmed by fortified food. Folate-deficiency is known to be behind problematic alcohol consumption.
She told me about how adding L-Methyl-Folate to her routine was like flipping a switch from 'depressed' to 'not-depressed'. But the doctors had already decided her substance-associated psychosis required tranquilizers ('antipsychotics') in perpetuity, and only added the vitamin to their forced prescriptions. The latest news is that she escaped from her court-ordered guardian and involuntary mental health treatments, sometime in February 2023. The antipsychotics have worn off, and she's been able to stay sober. She sounds like she's doing well.
Mad in America has published two of my blog posts. The second one was called Cargo Cult Psychiatry: https://www.madinamerica.com/2022/06/cargo-cult-psychiatry/
SCOTUS dismissed my latest petition without comment, as if to say it's perfectly fine for the mental health industry to perpetrate fraud on the United States Court. Still thinking about how to proceed.
A book - Brain Energy by Chris Palmer - was published in 2022. All the old approaches to forced psychiatric drugging have been obsolete for decades, now they're indefensible. There's nothing new in the book, Dr. Palmer just compiled 50+ years of research into his book.
Try to find someone very powerful, or very rich, who has a son or a daughter with the same disease. Then convince that person to spend some energy in public awareness and lobbying.
Other than that, drink a lot of patience. Making too much noise can get you in trouble.
Someone explained this to me once, in another way: "missionaries get eaten by cannibals." Thanks for the reminder.
Little did I know, my school had its own psychiatric hospital, which I found myself in: the door locked behind me, I was never told that entering that building might lead to me being committed, I was only interested in outpatient programs. But I didn't get much choice in the matter: after telling my story, I was told that either I "voluntarily" committed, or they would go and get a court order and have me forced to come back within 72 hours. Now if I was at all intelligent, I would've told them to let me go, and I would've gtfo of the state for about a week and gotten a lawyer. But as a young college student I didn't know any better--and I also didn't realize how much money they made off of voluntary patients like myself (my insurance never paid for the say, by the way). Well a week later, after taking medication that didn't work but gave me terrible side-effects and me telling more than enough lies about how I was feeling better, they got me out of there (since its not there job to keep people there forever anyway), and I was on my way. It wasn't so terrible except for the forced medication, the constant threat of being moved essentially to jail in the form of involuntary commitment, and the basic dehumanization you experience.
Though it wasn't so simple: my university decided that I needed to go into an outpatient program or else they wouldn't "approve" me going back to class. That is why I say you should never go to your schools counselors: they will always use it against you. I was forced into an outpatient program, which my insurance also wouldn't pay for (or else I wouldn't be able to go back to school), but thankfully I was able to convince someone in there to move me to a less intensive program. I'd also, by then, stopped taking my medication (and haven't taken a single psychiatric drug since).
Well, long story short at this new program I was getting bullied by one of the members of the staff, but instead of taking my complaint seriously the head of the program (which was quite small) simply ejected me before I could talk to anyone higher up. And from the university's perspective, I was done with my treatment. You think that this would be the end of the story, but the school kept their eye on me for years after; the amount of run-ins I had with the police over supposed alarms about my "mental health" was both horrifying and shocking. Thankfully, I eventually learned just to tell them I wouldn't talk without a lawyer, and they stopped bothering me after. But its very scary feeling like you're being constantly surveilled all the time, and fearing that if you ever talk to the police they'll try to take you in to a psychiatric facility.
Years later and I'm very happy: but not on account of any help from contemporary psychiatric institutions, modern psychology, therapy, or anything (though I did get a therapist who wasn't affiliated with my university), but from my readings. God you couldn't know how much Nietzsche and Freud can help someone like me, but they certainly put me through, and I'd have to guess that as their influence waned in American psychology, so did the quality of treatment--but what can you do when all their readers say that the system is the problem, and it just so happens the functionaries of power control the purses of psych programs! Everything radical, actually life-affirming and helpful was shunted from mental health and the whole thing was turned into some sort of pseudo-scientifical escapade for extracting as much money as possible from a socially dissatisfied population: they made a whole business out of ennui--what else is "positive psychology?"
Anyway I'm on the other side of things and all I can say is this: stay the fuck away from mentally ill people, they will ruin your life and only make you feel worse. Also, get exercise, eat decently, and stay hydrated, that usually helps. And never, ever, trust your run of the mill, CBT practicing psych: they either didn't do very well in med-school and became a psychiatrist; or, they studied psychology because they didn't know what else to do and they ended up practicing. There are people out there that can help, who aren't scam artist or just mindless NPCs; but there aren't a whole lot of them, and its almost impossible to differentiate the good from the bad until you get to the other side of things. I would recommend just doing some reading on your own: read Nietzsche, read Camus, read Kierkegaard (I haven't read him but I hear he is good): there is freedom, joy, and affirmation of life to be discovered here--which is nothing that our current mode of organizing society wants for you!
I could see how a lot of well-meaning people could individually decide that it's better to treat than to ignore, but when you add it all up it becomes a nightmare for the patient.
Don’t ring the hotline, go to a priest. He will listen, offer some guidance that may help, and won’t put you in a system from which you may never escape. People need someone they can talk to knowing that they are still in some control of the outcome. Or they just won’t call.
Not particularly. It's typical of any organization where the people in charge don't have a sufficient understanding of the people and the problem area, and try to make up for that by focusing on easy metrics and CYA. The causes for that can be as diverse as simple incompetence to arrogance.
Also, it's probably time to amend the standard language about this hotline when suicide comes up to use a burner phone at a place away from your home.
How many suicides were prevented?
How many people were saved from harm by another person?
Has general mental health improved?
People involuntarily detained is a negative result, but it’s not the only important one.
Given that involuntary detention increases the risk of suicide, this caused suicides rather than prevent them. Especially by using deception to involuntarily detain someone, which is known to have a devastating effect. So a negative number.
https://www.madinamerica.com/2019/06/involuntary-hospitaliza...
In general it is the amount of psychiatric help a person gets, not their problems, that predicts the odds of a successful suicide.
This even applies to children.
And yes, the corollary does apply: refusing help does reduce the risk significantly.
https://pubmed.ncbi.nlm.nih.gov/1023455/
Suicide prevention is about reducing the risk for others, specifically the psychiatry industry (but also school, work, government, ...). Not about reducing the risk for the victims or their families. It is about hiding the problem of suicide, not about actually preventing it or helping families. And sure, not because they don't want to help, but because they can't, due to a combination of not knowing how, not caring, and help needed (e.g. housing) not being available.
> How many people were saved from harm by another person?
This is not 911, is this even an option? I suppose I don't know.
> Has general mental health improved?
No it's gotten worse.
https://www.psychiatry.org/news-room/news-releases/americans...
If someone called 998, then yes, please listen to them. Listen attentively, validate their feelings, but soothe and comfort and reassure them. There are systematic ways to do this and they can get results.
But never ever call 998. Beware if someone offers to do so. Your hospital incarceration will be more traumatic, damaging, and expensive than any other alternative.
Get help before it gets to that point. Seek out good therapists and support groups when you're sane and calm, and stick to your treatment. Do it in-person, face-to-face. There is no substitute.
This is weak enough that it will happen many times for people who are not in a significant risk, but for whom such an intervention can be seriously detrimental to their life. Note that suicidal thoughts are most of the time just thoughts and not acted upon.
If nothing else, it should be made clear to the person calling what risks they are taking. Many people might believe that they have confidentiality and that they can talk freely without risk of consequence.
Some people who call a suicide prevention hotline will go on to kill themself. That by itself is not evidence of a flaw in the hotline or its policies.
Many times ordinary people have suicidal thoughts and don't carry out it at all. Subjecting those people to coercive treatments would be extremely harmful as doing so will further traumatize them. And it's also an affront to individual liberty, including the freedom to have negative thoughts. Sometimes such thoughts, if not interfered with by a meddling "nanny state", are an opportunity for growth and recovery.
And this hotline can also be used as yet another means of coercive control by a partner with Narcissistic Personality Disorder, or other personality disorders. Where the partner can threaten to report the victim as suicidal or mentally unstable. Yes that happens, and it's surprisingly common. That's why here in the UK we passed laws against coercive control.