Jesse: All right, let's do the intro.
Michelle: This is Committable!
(laughter)
Michelle: I did it! I win!
Jim: Did you think I was gonna try to go before you?
Michelle: Um, you didn't know the answer, Jim. I knew the answer, sooo…
Jim: You have 37 Committable points.
Michelle: That's how many I wanted.
Jesse: Jim, do you wanna do one?
Jim: This is Committable.
Jesse: Oh, nice. Elegant.
Michelle: That was elegant.
Jesse: So elegant that it can bring us straight into the music.
(intro music from Reasonable by Christopher G. Brown)
Jesse: This is Committable, a podcast about involuntary commitments. I'm Jesse Mangan and I'm here with Committable producers, Michelle Stockman.
Michelle: Hello.
Jesse: And Jim McQuaid.
Jim: Hello.
Jesse: And for this episode we are talking about mental health laws in Arizona. And to learn more about those laws I spoke with Ian Pettycrew.
Ian Pettycrew: So my name is Ian Pettycrew. I'm an attorney with the Office of the Public Advocate in Maricopa County, Arizona. I have been representing individuals in the mental health court for about six years now. Prior to that, I worked in adult criminal defense and juvenile delinquent defense, which is the same as criminal only they call it delinquent for juveniles.
Jesse: So the civil commitment process usually begins with some sort of detention for evaluation. In Arizona, how does that detention for evaluation process work?
Ian Pettycrew: The main way is either a family friend, relative, police officer, social worker, someone who has personal experience with the patient will fill out what's called a COE petition, Court Ordered Evaluation petition. But it does not need to be by a specific person, any adult with knowledge of the person and the symptoms can go and file the COE petition. It does have to be notarized, so that's kind of the only check on that system. So you do have to sign under oath and then a doctor has to review before it gets sent to the police officers, or whoever are gonna go to pick the person up. What often happens is the police, or crisis team, or someone, will be called out to a house or residential facility where the patient is and if they decide at that time, you know, this person needs to be evaluated, then they can take them to one of the three screening facilities and fill out the paperwork there. So that's how the majority of our cases start.
Jesse: Okay, so at this point we are talking about the COE/COT process. COE stands for Court Ordered Evaluation, and COT stands for Court Ordered Treatment. But there is often a precursor to the COE/COT process, which is called a pre-petition screening. So, in Arizona there is an application process where basically any adult can apply to have someone else detained for evaluation. You can get this application form online, and the only real requirements are that the application be notarized and given to a screening agency where that application will initiate the pre-petition screening process. And basically how that works is that an application is given to a screening agency, the screening agency then has two business days to investigate the allegations in the application. And if the determination from the screening agency is that court ordered evaluation is necessary, then the screening agency sends a petition to the county attorney for court ordered evaluation. If the screening agency believes that this is an emergency situation, then someone from a law enforcement agency is supposed to pick up that person, the person named in the application, within 24 hours. For a non-emergency situation, law enforcement has up to 14 days to bring that person to a facility.
Michelle: For 14 days, like, do you go to work? Because what if the cops like to go to your work? Like you're fucked. It's the difference between you maybe having the hope of still having a job and not having a job.
Jim: Oh, I wasn't even thinking that, that's such a good point. It makes it so much more insidious and menacing almost.
Jesse: Yeah, and that's all before you're detained in a facility. So take that anxiety and compound it with whatever frustration, anxiety, or trauma is brought about by actually being detained.
Michelle: Yeah, my anxiety in a psych facility would be, this person has anxiety. There would be no conscious connection between being currently in a psych ward is causing me anxiety.
Jim: I mean, that gets to, you know, a point you've made a whole bunch of times, right? That theoretically the appearance of symptoms is a manifestation of some underlying condition, but the symptoms themselves become, for all practical purposes, the condition. Right? There's no distinction between the expression of an emotion or an affect, or a mood or a behavior, and having the illness itself.
Michelle: I think this is all the more prevalent with, you know, certain non-majority communities. Like the LGBTQ community, it's like, you know what's depressing? Constantly having to engage in conversations about whether or not my life and choices matter. Weird how that's kind of a bummer all of the time. Or like, you know, if an African American person was like, I feel paranoid the cops are out to get me every single day. Well, yeah, that would be really stressful because you're right.
Jesse: Understanding the difference between identifying symptoms and identifying root causes for those symptoms is really important. Especially when those root causes aren't something that can be solved by focusing solely on the individual. All mental health laws are essentially built around the concept that when symptoms are observed there needs to be a legal mechanism for forcing that person into a facility where they will be evaluated. And all that we've been discussing so far is the precursor to someone being detained at a screening facility for a court ordered evaluation. And that evaluation is supposed to happen within 72 hours, but when does that 72 hour clock actually start?
Ian Pettycrew: It starts whenever the paperwork is actually filed with the clerk's office, is when the 72 hours starts. And, unfortunately, it doesn't include weekends, it doesn't include holidays. So yes, a lot of people get that confused. They'll say, well, I've been here five days already. Well, unfortunately, they came in on Friday afternoon. Their petition wasn't even filed until Monday, so it's almost a full week before that 72 hours expires for them. And that's even if there's no holiday or anything like that.
Jesse: At the point where the paperwork is filed, and the 72 hours starts, and a person's being evaluated. They're in a facility at that point, what determines whether or not a court order out into the community would be appropriate, or whether or not further inpatient treatment would be appropriate?
Ian Pettycrew: Usually the patient is given the option of signing in voluntarily, and if they do that then the court order process basically stops. And then that person is given the opportunity to say, okay, I'm willing to stay here 3, 5, 7, whatever time is required to get stabilized. Again, they are true screening facilities, so if someone comes in and it's clear that they, you know, were only acting that way because of substance abuse, or if they were only acting that way because they hadn't slept in three days, and once they get a chance to sleep again those symptoms go away. And so they can be released at any time. So the doctor at the screening facility can release them, or if they are brought over to Valleywise Hospital. Valleywise Hospital is the semi-government agency in Maricopa County, which provides indigent healthcare, indigent psychiatric care. There's three courts right now inside Valleywise Hospital, and they're about to add a fourth. This has just exploded over the last few years. When I started in 2015 there was one court and one judge. Now there's four already, and they're adding a fifth.
Jesse: With these mental health courts, are they exclusively civil? Or are they also criminal? Would someone who has been alleged to have committed a crime, who is believed to have a mental health condition, would they also be brought to the mental health court?
Ian Pettycrew: They will be brought to the mental health court once their criminal case is resolved, or they're out on bond while the criminal case is resolving. So our interaction between the criminal court and the civil mental health courts are actually very small. Sometimes we do get patients that are being released from the Arizona Department of Corrections, and they know the person has a mental illness, and so they wanna get the services started. When they get discharged from the prison back to the community, they want the services to already be in place. And so sometimes we get those patients. Other times we will get people that are in jail and maybe they're pending trial. And sometimes, you know, trials can be set out six months, nine, and so in the meantime they're released from the jail, brought over to one of the crisis centers, or directly to Valleywise happens a lot too. They come directly to Valleywise, and then that starts the evaluation process for them.
Jesse: Okay, so once someone reaches a screening facility for a court ordered evaluation they will be detained for up to three business days. But that 72 hour clock does not start until someone actually files the paperwork. And all of this, the pre-petition screening and the court ordered evaluation, happens before there is a hearing about court ordered treatment. And if a judge does issue a court order for treatment, then not only do you lose the right to own a firearm, but in Arizona you also lose the right to be in possession of any deadly weapons. And what qualifies as a deadly weapon in Arizona seems like it can be interpreted in some pretty broad ways.
Michelle: I hope nobody's a chef.
Jim: Puts people in a weird situation too, where if somebody is on a court order and they own some guns, or they have a knife somewhere, or they bought a sword at a Ren faire once. Do they have to frantically get rid of their, like, where do you bring all of your dangerous weapons to?
Jesse: Yeah, I don't know what legal avenues are available for disposing of something that could be categorized as a deadly weapon, but generally speaking, disposing of everything that could be perceived that way does seem like the safest thing to do. And it gets even more complicated when you consider profession, like a chef, because in a case where someone is a culinary professional and carries specific knives for the job, or a construction worker who carries tools with blades, or if you're a security guard, or in law enforcement, or a medical professional with a scalpel or a saw, that court order could essentially destroy your career path. Because if a peace officer believes that you are in possession of something that could be classified as a deadly weapon then you can be charged with a felony. Which can bring you into the criminal process. And as Ian mentioned, if you're in the criminal process and someone thinks that you need to be detained for a court ordered evaluation, possibly in part because they see that you have been put on a court order for treatment before, then that COE hearing is not in place of the criminal process. It is in addition to the criminal process. And if you are awaiting trial for a criminal charge and then forced into the COE/COT process anything that you say at any hearing related to the COE/COT process can be used against you at your criminal trial.
Jim: Oh my God, that is just so fucked up.
Michelle: Mm-hmm.
Jesse: Okay, so at this point we've discussed the pre-petition screening and the court ordered evaluation. But if you are being detained for evaluation, and the two physicians that evaluate you determine that you do need court ordered treatment, what happens then?
Ian Pettycrew: Then what happens is a hearing gets set four to six business days from then. That's what the statutes say, it has to be between four and six business days. That gives the county attorney time to subpoena witnesses. That gives the defense some time to, you know, meet with our clients, talk about possible witnesses themselves, talk about whether they want to testify. So we have a very short period of time, but we do have some time to meet with our clients and try to prepare, you know, a defense for them in that four to six business days window. If they're placed on a court order, that really ends the judge's involvement. So at that point, if the doctors say the person needs three weeks of treatment, then they stay for three weeks. If the doctor says they need two days, they stay for two days. Typically, by the time we get to the hearing, they've already been there for a week or two, they may be taking their medications and may be getting back to baseline. However, it is their right not to take medications while they're through that process. The only time they can be forced to take medications before a COT is in place is if they're trying to hurt themselves or hurt someone else. Otherwise, through that entire two week process, it's up to them if they wanna take medications or not.
In Arizona, a court order has three prongs, three requirements if you're placed on a court order. The main one obviously is take all your medications as prescribed. That's the big one. The second one is you have to attend clinic appointments, which they set up for you, they assign to you. You know, since these are all ordered by the court the clients don't have to pay anything for these services, which is, you know, appropriate. The final consequence is they're no longer allowed to possess firearms, ammunition, or deadly weapons. They have to petition the court to get that right reinstated after they are removed from the court order for treatment.
Jesse: And so that court order basically allows the clinicians to administer the medication any way they can?
Ian Pettycrew: If the person's not willing to take oral medications, or for some reason oral medications aren't as effective, then yes, I have seen situations where they get, you know, four beefy guys and they say, okay, you're gonna take the left arm, you're gonna take the right leg, and they force inject someone. Doesn't usually get to that. Usually, if the person's been to court, has heard that the judge has made a decision, they're willing to comply without physical involvement. And they have a special board which they use for electric shock therapy. They can't just do it on their own, they have to get a higher level of approval at the hospital. I think there's like a committee they have to apply to to get permission if the individual isn't willing to do it. But for the most part it's just medications, and those are easy to administer. I've had cases where they put it in applesauce for someone, so they wouldn't know, you know, they're taking the medications. This is after they're on a court order, obviously.
Jesse: In general, if it isn't an emergency situation, for the time that someone is there before the court order is in place, can they refuse all treatment?
Ian Pettycrew: Yes, medical treatment, psychiatric treatment, they'll be, you know, talked to. They'll say, look, this is why we think you should take this. But a lot of times we've had people that are here for the third or fourth time and it's because they don't like the medications that they're prescribed. You know, some medications unfortunately do have, you know, side effects. They include things like weight gain or, you know, restless sleep, you know, things like that can impact everybody on a day-to-day basis. But you kinda have to weigh and say, well, the medications aren't great, but when you're not on the medications, you know, you're not safe. So it's not a perfect, you know, system. It's only as good as the medication, you know, that's being ordered. Luckily, they're coming up with new treatments all the time, so hopefully in the next five years we have a more technological system where people are getting, you know, scans to see if there's some biological element that they can try to help. Or whether it's just a chemical imbalance type of issue. Which I've read some stories that say that that's really not something that exists, that the whole chemical imbalance is kind of a myth that people still use to convince people to take their medications. But I'm not a psychiatrist thankfully. But I have seen clients, you know, with new treatments and they do seem to be effective. So anything that works is great.
Michelle: We're not dogs, you should not be hiding things in peanut butter.
Jesse: Yeah. In terms of the legality of it, I think it really depends on what specific requirements are put into that court order for treatment. But generally speaking, even if there is a court order that states that physically forcing medications is legal, that person still has a right to know what they are being given. And to intentionally deny someone that right is just dehumanizing. Because protesting medication, even if a court order says that medication can be physically forced, protesting that medication can be an act of self-preservation. The potential side effects of some of these medications can range from trivial to serious, even life-threatening.
Michelle: Well, hold on a second. I also want to highlight this whole trivial versus life-threatening. Some of the side effects that most people consider trivial, you're not taking some broader context into consideration. Like restless sleep and weight gain, “Oh, mehhhh, that's the difference between your mental health and not? No!”
Well, I'm sorry, but an inability to sleep every night would completely break me down. And also weight gain? Good thing we're not in a fat phobic society in which your weight can sometimes be the determinant of whether you get a job or not. Some of these things do seem trivial, and maybe they are manifesting themselves in trivial ways, like maybe it's just a lightweight gain and maybe it's just light lack of sleep, but some of those can be more significant than they sound. And also there are a lot of societal factors that also need to be taken into consideration because constantly having to live with certain shame from certain side effects is very real.
Jesse: That is a fantastic point.
Jim: Agreed.
Michelle: That clip also really highlights what a weird and tricky relationship the concept of mental health and treatment has with medication. The average person thinking about mental health are thinking probably in terms of just medicate them. That fixes everything. And if someone isn't taking their medicine, then that is an issue. Like we just need to get them their medicine. And there are so many people who, family and friends who will talk about stories involving loved ones, where it's like, “Oh, all we needed to do was just get them on medication and then they were fine.” And there are even people with lived experiences who will say that medication has really saved them, come through for them. And so it's a challenging subject because there is something that feels very intuitive for a lot of people, like that should be the purpose of this. Just get them on medication by golly, by gum and that'll take care of it. And I don't think that we do enough public discussion about one, how little evidence that there is out there that some of these medications are viable options or that they work. I don't know, it's just this whole messy complication and I think It's challenging to talk about wanting to fight for someone's right to not have medication when so many people believe that medication is the only answer for them.
Jesse: And I think a big part of why these conversations are so complicated is because of the prevalence of the chemical imbalance theory, which can be a really complicated topic. So to learn more about the chemical imbalance theory, what it is and what evidence might support it, I spoke with Hans Schroder.
Hans Schroder: My name's Hans Schroder, I'm a clinical psychologist in the state of Michigan, and I'm a clinical assistant professor at the University of Michigan Medical School.
Jesse: And what is the chemical imbalance theory?
Hans Schroder: So the groundwork for the chemical imbalance notion, and I call it more of a notion or a narrative than a theory, really started in the 1950s and 60s when doctors started prescribing medicine for things like schizophrenia, psychosis, depression, anxiety. And scientists in the sixties said, well, we've got this medication that we know increases certain brain chemicals, and that medication also happens to alleviate some symptoms of depression. So the logic is that depression must have been caused by a lack of, or low levels of that brain chemical. And that's really the basic notion of a chemical imbalance, is that there are certain levels of brain chemicals that are too low or too high that explain a mental health problem.
Jesse: With this notion, how would you define normal? If you're saying there is an imbalance, if someone has an imbalance, how would you define their normal?
Hans Schroder: Excellent question. This is the sticky point, so that logic of a treatment fixing an imbalance breaks down pretty quickly. I'll give you an example, the same notion would be if I have a headache and I take Aspirin, is my headache caused by not enough Aspirin? That's basically the same logic. And the idea that there's normal or abnormal levels of chemicals, a lot of science has been looking at that, especially in the 60s and 70s. We really don't have levels. The problem is we can't measure these things, it's really, really hard to measure someone's serotonin, or dopamine, for instance. There is no normal. Studies that look at brain differences between people who have a diagnosis and people who don't tend to find, if anything, very, very slight differences on average, but most of the time there's really no concrete differences.
Jesse: If there are no concrete differences, but people are being given medication and sometimes that medication corresponds with some reduction or change in symptoms, is it understood what is happening there?
Hans Schroder: No, we actually don't know the mechanisms here. One kind of fly in the ointment with all of this chemical imbalance narrative is that antidepressants have a notoriously large placebo effect. So in studies that, they're called randomized controlled trials, where some people are given the real medication, some people are given a placebo, and you're not told which medication you receive. People that are taking placebo also improve a great deal, that are not taking any active compounds. So we know that it's not simply that an antidepressant is working on a particular brain chemical, and that causes or explains all of the antidepressant effect.
Jesse: So most of the things, the theories that we rely on nowadays, started at some point as a notion that became tested and evolved into a theory. Was this chemical imbalance notion then tested and evolved over decades?
Hans Schroder: The narrative of a chemical imbalance has not been in step with any advances in scientific discovery. Again, there's no objective tests for measuring a normal level of dopamine, let alone measuring someone who's experiencing depression or psychosis and saying, “There's your schizophrenia” or “ There's your depression right there, I can see it on the graph.”
We don't have that yet. So I mentioned before that in the 50s and 60s this idea started coming around. In the 80s and 90s and 2000s this idea exploded in popular culture with the advent of SSRI, Selective Serotonin Reuptake Inhibitors. These are medications that do increase levels of serotonin and pharmaceutical companies really grabbed onto this idea of the chemical imbalance. In my mind the notion, the phrase chemical imbalance is really a pharmaceutical term. It's been popularized with TV commercials, in education for medical students, in psychiatry, certainly also primary care. This notion is everywhere. But it wasn't developed on strong, strong science, definitive science, that we can tell what diagnosis is being considered by a brain chemical test.
Jesse: So the chemical imbalance notion is pervasive throughout our society, but there doesn't seem to have ever been any strong evidence to support it. So why is it so pervasive? And how far reaching is this concept?
Hans Schroder: Everywhere, It has reached everywhere. And, in my mind, this is the most brilliant marketing campaign in history because it explains suffering not from human experience, but from something inside you, inside the brain. A chemical, a neurotransmitter. So it takes away the blame for the person, and there's some appeal to this notion obviously. It's not my fault, it's my chemical's fault, it's my gene's fault, it's my brain's fault. There's a lot of appeal to that.
We actually just did a survey of college students and asked them, have you ever heard of the chemical imbalance theory? And where did you hear it? And we expected people would say, well, I heard about it on TV, or I saw a YouTube video on it, or my healthcare provider told me. But the number one answer was in the classroom. People heard about the chemical imbalance theory from their professors that were teaching psychology courses. So it is permeated everywhere, even in the institutions of learning. And these notions that, again, haven't been predicated on any scientific discoveries, but this cultural narrative is so ingrained that students are learning about it in the classroom.
Jesse: Do you have a sense of how the idea of distress, or diagnosis, coming from biology or coming from a chemical imbalance, do you have a sense of how that affects the person diagnosed? How they're perceived?
Hans Schroder: Yes. So a lot of research has looked at these, what we call biogenetic beliefs and narratives, on aspects of stigma. So there was a summary paper a couple of years ago that found these biogenetic narratives do decrease blame. So people who are exposed to these narratives feel less blame for themselves. They blame people less if a mental health problem is construed in biological terms. However, other aspects of stigma are increased. So when genetics or neurobiology are invoked people perceive individuals with mental health problems as more dangerous. They want to get more distance from them, and they have a sense of othering. They feel like they're very different from me, if something is faulty in their genetics or biology.
Jesse: Is there any research validating the idea that someone with a diagnosis is more dangerous than anyone else?
Hans Schroder: No. That data has been out for a while that people with mental health problems are no more dangerous than anyone else.
Jesse: Is there any other way of framing it that could see the symptoms and the diagnosis recognized, and taken seriously, without framing it as a chemical imbalance?
Hans Schroder: My research right now is focused on coming up with alternative narratives, and the one that I've kind of landed on is seeing depression as a signal that something in life is not working, that something in life needs more attention. The idea is that depression is telling you, it's functional, it's telling you something really important. And I lead groups at the partial hospital program here, where we talk about depression is telling us that maybe we need to look at our relationships, intimate relationships, family relationships, friendships, work relationships. Maybe we need to look at traumas that we've experienced to understand them. Maybe we need to look back to childhood, what was going on there? What messages were received about emotion? About ourselves? It's trying to spark curiosity about why this came to be. I view this narrative as an alternative to this chemical imbalance idea because again, the information processing kind of stops at chemical. Oh, it's biological, don't need to be curious about that anymore. Whereas if it's a signal, let's figure out what the signal is telling us about our lives.
I think for me, it's not downplaying that there are genetic or biological components to these things. It's more about the narrative. So for patients I would say, keep in mind that all of these things are complex, that there is really no simplistic explanation for what you're experiencing. And I would say for providers, be very mindful of language, because language really matters. I spoke with a primary care doctor last year who said she has one minute to convince people that mental health is worth talking about, and 30 seconds to explain why medications might be helpful, so she's using chemical imbalance narrative to do that. That is really unfortunate to me because those messages, the data are consistently showing, are not helpful for recovery.
Michelle: If I was going to consider going to a mental health professional again, I would consider Dr. Schroder.
Jesse: That's high praise.
Michelle: That is very high praise.
Jim: I had a similar reaction. So, I really liked a lot of what Dr. Schroder was saying there, in terms of emphasizing the importance of narratives and shaping the way people think about mental illness. The implications of narratives are hugely important. But there was one thing that seemed to be really missing from the thought process or the narratives that he was describing, which are the social and structural factors that are massively important, right? So the things that he was talking about were still really focused at either the individual level, or individual and their kind of like small social context. So their own individual relationships. But you know what was left out are these broader structural factors like capitalism, like the fact that we are social animals that evolved to live in tight-knit groups of people that we knew closely and we were constantly surrounded by. And so, I'm a big fan of the push and the shift in the narrative there, but until we start thinking about these things in more structural terms, the shifts in thought and the shifts in narrative end up reinforcing the idea that the problems are at the individual, or a really small group, level.
Michelle: I think that you're raising a fair point that sometimes these pushbacks and solutions to things then just create their own problems. Because we have the same foundational problem, which is like we're trying to find just good marketing to combat this previous marketing campaign. Which means we're finding simplicity and we're trying to, you know, simplify things. You know, from, like, the LGBTQIA community kind of standpoint, there are a lot of people who have problems with like, “born this way”, or “It's not a choice”. Because some of those things were really important things to get across to people, so that they would understand some sort of concept going on here, but it did actually create its own problems. Which is, well, born this way implies I have a gene that's the gay gene, or it's not a choice provides its own erasure of people who are, you know, bisexual, or fluid, or change their minds on these things, or aren't sure who they are. Sometimes these much needed, and much applauded, solutions then create their own problems.
Jesse: Those are all really important things to consider. Being aware of the societal and structural factors that may be contributing to the distress experienced by an individual is incredibly important. But I don't think the signal narrative actually excludes that. My understanding of the signal narrative is that it is meant to encourage curiosity about where the signal is coming. So that curiosity may lead some people to question the larger societal factors contributing to whatever it is that they're experiencing. And I think one reason that this could be a step in the right direction is that the current dominant narrative, the chemical imbalance notion, is often internalized as meaning that the source of the distress is in the individual. So providing an alternative narrative which reframes the source of the distress as a question to be explored, rather than a biological certainty, feels to me like a positive change. A change that is necessary, because you can see this idea of a biological or chemical origin to the symptoms of mental illness influencing policy makers who are actively pushing to find new ways to strip people of their rights.
Michelle: My ultimate point is that Dr. Schroder is doing, I think, excellent work. I commend them on it, and also I do think it is important to embrace that great work with a bit of caution and keeping larger context in mind. And that's it.
Jim: Yeah, I'm not coming after the Schroder.
Jesse: And I'm sure “The Schroder” appreciates that.
Michelle: Great. (laughter)
Jesse: Okay, so I wanted to end this episode by returning to the end of the interview with Ian Pettycrew, where I asked if there's anything else about the commitment process in Arizona that is important to know.
Ian Pettycrew: It's an unfortunate process. Obviously it's just like anything else the government provides, more money would equal better service. I've had personal experience where I've filled out the COE form to have a family member go into the system. And it was something obviously I thought about very hard and you know, I was not happy to do it, but I was just in a situation where I didn't have a choice I felt, for the safety of the family member, and they went to one of the three screening facilities. Each facility is a little different, but most of them have a large room with about 20 to 30 barcaloungers, so chairs that can flatten out and turn into uncomfortable beds. But they're just in like a high school cafeteria and there's no separation between the men and the women usually. At least not a physical separation. You know, they may have a men's section and a women's section, and that's, you know, where people sometimes spend three to four to seven days. And I don't know how they can sleep in that situation. I don't think I could. They're given like a blanket and that's it. Maybe a pillow if they ask for a pillow, but they wanna make it as safe an environment as possible. So pillows are sometimes not deemed to be safe. It's not a pleasant thing for anybody, but sometimes it is necessary. Again, nothing's gonna change unless they get more funding and they can build better facilities, because that's what it is, it's basically just the facility itself is set up this way.
Jesse: I have great empathy for anyone who sees someone that they love experiencing acute distress and feels that forcing that person into one of these facilities is the only option. Because these facilities, this entire process, inherently brings a significant risk of trauma to the person being forced into it. But more funding isn't going to prevent that trauma, not really. It might mitigate some of the discomfort, but any system that strips people of their rights and uses coercion, force, and violence as tools for treatment is inherently going to be traumatic.
Michelle: I mean, it reminds me of one of the conversations that's been going on in Massachusetts while they try to build a new women's prison, even though we have one of the smallest incarceration rates of women in the entire country, but we need to build a new one that's bigger and has more units. But a lot of the conversation around building this is like how it's going to be trauma informed. Like, that's this phrase that they love. Like, it's gonna be trauma informed, like we're gonna be able to find a way so that when we strip these people of their rights and force them into this place, they'll get treatment for trauma and we'll be cautious about trauma. Like, completely ignoring the first half of that sentence. There is no way to make incarceration not traumatic. There is no way to make this not traumatic. So yeah, more funding because I assure you I alone need like minimum eight blankets, so I'm gonna need more than one. But yeah, having more blankets is just going to make me warmer while I'm having a complete breakdown because I have just been stripped of all of my rights and I'm freaking out. Jesse: Okay, so next time on Committable, we'll be talking about mental health laws in Connecticut.
Jesse: Committable is produced by Jim McQueen. Michelle Stockman and me, Jesse Mangan. All music is from the Song Reasonable by Christopher G. Brown.