Melissa Keyes: So we've gotten so used to that institutional model of, let's create this divide between the public and folks who act erratically, or who due to their condition behave in a certain way that we find different or disturbing, but we're dressing it up in the trappings of access to treatment. Be honest and call it what it is, we don't know what to do with you so we're going to remove you from society. I can deal with that. I can respond to that. What is problematic is when you start to equate treatment with detention and hospitalization. If I leave a hospital AMA, Against Medical Advice, a police officer does not show up and take me back to that hospital. That's not the same for mental health. And until we acknowledge that and have a conversation about the biases that are inherent in that it's going to continue to be that way.
Jesse: This is Committable, a podcast about involuntary commitments. I'm Jesse Mangan, and in this podcast we spend a lot of time focusing on mental health laws and the systems created around those laws. Practices and processes that revolve around the state granting select groups of professionals the authority to detain and restrain based on little more than suspicion. And underlying all of those conversations is the essential question of what does it feel like to be forced into one of those systems?
Jill Edwards: It's like being wrapped in barbed wire and the more you struggle, the deeper, you know, the barbs go into your skin, the more powerless you become.
Jesse: This is Jill Edwards.
Jill Edwards: Well, my name is Jill Edwards, and I'm not currently working right now. I recently withdrew from grad school due to impairments and medical problems and symptoms from my injury from electroconvulsive therapy. That was, well, a little over 20 years ago. So right now I'm not working, but I had been working on a graduate degree in clinical mental health counseling. I have an undergraduate degree in Youth Adult and Family Services with a minor in Psychology. I do advocacy work on the side, not paid or anything, it's just a passion because I've been so harmed by the system. And because I have both education and work experience and personal experience in the system, I kind of know the ins and out and I feel like I'm in a really good position to understand the issues with the system. And, you know, my own experience and my anger about it. I view it as a justified anger, seeing the injustices, seeing how many people are being hurt. I feel like I'm in the best position to try to advocate for change.
Jesse: What was your first involvement with the system?
Jill Edwards: I'd had a lot of childhood trauma. I was being sexually abused by church leaders on a weekly basis in the sanctuary during a lights out prayer service, I'd been raped multiple times. There was just a lot of things that happened in my childhood and I was very, um, fundamentalist religion, a lot of indoctrination about women's roles. And so I get into my adult life and I just kind of, you know, had a lot of identity issues. I had a lot of trauma to deal with and struggling with an eating disorder and anxiety and depression. And basically got to the point I, um, was living on my own as a teenager, trying to support myself, trying to pay for college, trying to go to college, just feeling really overwhelmed. And I got to the point where I was suicidal and my boyfriend, who's now my husband, took me for like an evaluation in the night, like to an emergency clinic. I go in, you know, they talked to me a little bit and they're like, Hey, you know, we can't let you go. You're a danger to yourself. We can't let you go. And I'm like, well, I don't have money. I don't have insurance. You know, I'm working at fast food, I don't have an insurance plan. And at that point they're like, Oh, here, sign this paper stating you won't hurt yourself and you can go. And I know that paper had nothing to do with protecting me, and it had everything to do with covering their asses, and in a way I'm kind of glad it happened that way, because it would have introduced me to the system at an even younger age, before I had much of a solid foundation of support from family.
So my formal introduction into it was later, after I was married, you know, still struggling with a lot of emotional issues. Not really understanding how it was related to my childhood. I just knew that I hurt. I struggled. You know, I was anxious, why was I sad? You know, I didn't understand all of it. So you reach out for help and I had been on various different antidepressants from my GP, but nothing was really helping. It seemed like, you know, it was getting worse. You get referred to a psychiatrist, next thing you know you're labeled with a chemical imbalance. They're throwing drugs at you left and right. You just start spiraling. You start getting worse. And I made a suicide attempt. And looking back I really think a lot of it was related to the effects of the medicine, just this intense dysphoria. Strange thoughts and emotions that were very different in nature from what I was experiencing when I came for help. And I think it was sort of like a chemically altered state of mind, you know, but I didn't understand it. The doctors keep saying, Oh, your illness is progressing. You're getting worse. You're getting worse anyway. So I'm kind of, I think I'd had some hospitalizations, attempted suicide by overdosing, obviously that didn't work. That psychiatrist that I met while I was in the ER, of course I don't remember that, but he later said, Hey, you know, we've kind of tried a bunch of different drugs. Your depression isn't responding. Basically said, I think we should do ECT. I was kind of scared, talked to my husband too. My husband's like, you know, this is the best thing and the doctor's like, hey, you know, the meds aren't working. Yeah, this is the best thing for her. I signed myself in, you know, I mean, I was kind of reluctant, but I signed myself in. I was kind of desperate to, you know, let's make this pain stop. This is the professional. They're saying this is going to help me. Signed the consents, but shortly after treatment started I just, something inside me said, this is not right. This is not what you need. And I started fighting against the treatment saying, no, you know, I want to stop this. I want to stop this. And it just became this constant pressure and this coercion and the threats. And kind of to jump back, I do distinctly remember begging them for a phone book, begging for an attorney. I was scared to death. And I was signed in and I signed consents for treatment but I didn't know if I could leave. I mean, they were making it appear that I wasn't allowed to leave.
So after my second leave of absence I came back, I refused to remove my clothing for the strip search, which, you know, as a sexual assault and abuse survivor it's very degrading. I mean, it's very traumatizing to have to strip your clothing off, you know, with a few people in the room and then watching you and looking through all your clothing and but anyway. At that point I was just like, look, I'm done. I'm going home. I'm stopping this treatment. I'm not taking off my clothes. I'm done. I'm out of here. And, you know, so I've gotten part of my records and I saw that my decision to stop ECT triggered them to petition for an emergency detention. Now, even though I went in and I was depressed and anxious, they clearly charted throughout it denies homicidality, denies suicidality. I had been doing some surface cutting while I was in the hospital, but my understanding under Indiana law is that would not qualify as a valid reason to detain someone against their will. So they said in the chart that they didn't follow through with the court order because the patient eventually complied with treatment. So it was all about treatment compliance. It wasn't, we think she's a danger to herself, you know, she's acting irrational. She's talking about suicide, she’s talking about hurting someone, it was nothing like that. It all came down to I wasn't complying with treatment. They were going to use the court to force it, and they had even said in their notes I had good insight. But they were misinterpreting all my reactions.
So basically, sorry, I kind of jump around a bit. When I decided I'm done, I'm going home, I’m done with this treatment. A bunch of people came in a room, you know, and I don't remember exactly what happened but I knew I wasn't getting out of there without getting shocked again. Like, I just knew it, and I don't remember if they specifically said they were going to get a court order, but I know I definitely felt threatened, and I felt coerced, and I knew I was powerless in that situation. And of course, you know, they followed through, and I left the hospital completely traumatized. Just broken in spirit and, you know, I've been living with a brain injury and still dealing with the aftermath of that trauma for decades.
Jesse: Electroconvulsive therapy, or ECT, is a controversial process that uses electricity administered through different combinations of voltage, current, and duration in order to intentionally induce a seizure. The research into ECT is complicated and passionately contested from many different perspectives, but I don't think there is any reasonable dispute that the use of ECT involves a risk of memory loss and injury to the brain. And because those risks are so significant, I don't think ECT should ever be administered involuntarily. But if someone were truly, properly informed about the potential risks then I think everyone should be supported and empowered to choose which options are right for them. But in psychiatric facilities, the line between voluntary and involuntary is often blurry. At times, that line is outright obscured. So my next question for Jill was, during these hospitalizations, was she ever formally classified as involuntary?
Jill Edwards: It's spotty, you know, because when you have ECT your memory is spotty, so I remember bits and pieces. So I think part of it is the environment itself is a threat. You see people get tackled. You know, they say, do this, you don't obey, they get tackled and get injected. There was a chair sitting in the hallway that literally looked like an old electrocution chair, like a solid dark wood chair with all these thick leather straps on like every part of your body. Really looked like an old electrocution chair. So the whole environment is a threat, an unspoken threat, but then there are definitely spoken threats, you know, take this or you can't leave, take this medicine or you can't leave. There is talk of, you know, because I've had several hospitalizations, so it's just common, it's do this or else, it's not, Jill, what do you need in this situation? What do you think the issue is? What do you need? How can we help you right now? How can we best support you through the struggle you're going through? It's all about, we know what's best for you. We're going to use whatever's in our power to ensure that we can, you know, basically force this upon you. I don't know if I answered your question exactly.
Jesse: No, I think you're identifying something really important, which is that it is not a neutral environment, it is not a neutral situation. That it has to be understood by clinicians that when they say do this or else, it's not a conversation.
Jill Edwards: No.
Jesse: And this power dynamic results in you having your concerns, your desire to want to leave just sort of railroaded.
Jill Edwards: Not only railroaded, but pathologized. That's your illness talking. Your illness is telling you this treatment is hurting you. Your illness is telling you that this isn't helping you. So, yeah, I mean, that's a huge component of it, and part of it is they are controlling the environment, they're controlling the narrative, they're controlling what goes in the charts and what doesn't. Every reaction, everything you do, you say, it's all in their interpretation. And since we don't have access to the records, and we can't say, hey, you know, you wrote this down completely wrong, that wasn't what I said, that isn't what happened. It doesn't matter, the doctor's opinion takes precedence. You know, and so when I was expressing frustration, like after basically I realized I was going to be, you know, detained and shocked against my will. I kept expressing frustration to the doctors and this is in the notes, you know, that I was saying, hey, do you like the power you have over innocent people? Like, does this make you feel good? And I was calling them out on their abuse of power, and they interpreted it as, you know, that I was having paranoid delusions, I was feeling paranoid. And that they interpreted it as psychosis. And to me, it was a valid reaction to that situation, to their abuse of power. It was a very valid reaction for any person in that situation where they're being detained and somebody's doing something horrible to their body and they won't allow them to access an attorney, or an advocate. To me, it was valid, but they had the power to control the narrative and pathologize my reaction to, and really to reinforce their own power. So them taking my valid reaction and turning it into something pathological, reinforced their power to force treat me. Does that make sense? It's sort of this endless loop. It's like being wrapped in barbed wire and the more you struggle the deeper, you know, the barbs go into your skin, the more powerless you become.
Jesse: The impact of these types of hospitalizations, the impact of this type of coercion, can be unpredictable. For some, the experiences can be manageable, even viewed as part of a positive transitional phase in their life. For others, these experiences can be debilitating. They can be devastating. So I asked Jill, in what ways have these experiences impacted her life?
Jill Edwards: It's basically altered the course of my life in every way, both physically, mentally, emotionally, how I see the world, how I react to the world. I'm terrified of doctors, of going to hospitals, of medical procedures, of having it happen to me again. I know the laws surrounding ECT, and this can be done to me again. You know, I live with the effects of brain and electrical injury. Fortunately, after over 20 years of looking for answers on all these physical problems I've developed. I’m researching, going from doctor to doctor, trying to figure out what all these physical and neurological problems I was having. Had tons of testing, you know, and things were showing, but nobody really understood the root of my symptoms. And I started saying, now wait a minute, these are all neurological. And I did have a bunch of electricity pulse through my body and gosh, I didn't seem to have these problems before then. And, um, I ended up going, well, first of all, trying to get brain injury treatment centers, brain injury specialists to see me to do an evaluation and, oh yeah sure let’s get you signed up. Now what was the nature of your injury? I said, well, it's from electroconvulsive therapy. Sorry, we can't help you “click”. You know, and I'm literally calling clinic after clinic, doctor after doctor trying to get somebody to help me and they're either like, well, ECT doesn't cause injury, or we can't help you. And finally found a clinic out of state and I did an eval and they said, you know, you have classic brain injury symptoms. And I went in and I had a specialized brain scan and a bunch of other brain injury assessments and yeah, I had a profound brain injury. My biggest fear when I went there was that they were going to say your brain is normal. That there's nothing wrong and that it would come back to, Oh Jill, it was all in your head. Just like the doctor said. It was just your depression that was causing all the memory, and all the issues. And when I saw the scan and saw what a profound brain injury had, I cried tears of joy because I had validation of what they'd done to me and now I understood why life was so hard. Why cognitive tasks were so hard for me. Why daily functioning was so hard for me, so it was like tears of joy. I mean, that sounds odd to be thrilled that you find out you have a brain injury, but it was an answer. It answered why I had lost so many abilities and so many things over the years and why I had struggled so much. So to have that injustice and that injury validated was profound for me.
Jesse: In recent years, Jill has been involved in advocacy work. She has spoken at state congressional hearings, including in Indiana, where she spoke in opposition to HB 1006. A bill that has since been signed into law and significantly alters that state's commitment process. And for me, whenever I review mental health laws, there is a looming sense of dread crawling up the back of my mind. A fear of what I might find and of what this law might say about people like me. To process that fear, I try to focus on understanding the law, on untangling semantic complexities in the hope that I might be able to fully unravel this legal tapestry and figure out which threads I need to avoid. And looking at this new law in Indiana was no different. So to better understand HB 1006, to better untangle this tapestry, I spoke with Melissa Keyes.
Melissa Keyes: My name is Melissa Keyes. I'm the Executive Director for Indiana Disability Rights. We are the state's protection and advocacy organization. I have a master's in clinical psychology, and a law degree. I also have ADHD.
Jesse: Every mental health law in every state has some form of initial detention for evaluation process. So I asked Melissa, in Indiana how does that detention for evaluation process work? And in what ways has this new law changed that process?
Melissa Keyes: The initial process can really start with any avenue that somebody might seek treatment. Whether you're going somewhere voluntarily, whether a concerned family member or friend might seek out treatment on your behalf. Law enforcement as part of this bill can detain somebody if they, you know, have reason to believe that they are in need of mental health treatment. And so one of the things that this new law changed was kind of that definition of who qualifies. Historically, it's been a person with a mental illness and either dangerous or gravely disabled and in need of treatment. For the purposes of this new change in the law that just went into effect, there was an amendment made to the definition of mental illness. To add in, just for the purposes of the emergency detention piece, temporary impairment as a result of alcohol or drug use. That's really kind of been a significant shift in this new law. So again, really there's multiple entry points. It could be seeking out treatment yourself, having somebody seek out treatment on your behalf, calls from law enforcement, a provider can initiate, a court can initiate. There's really a number of ways that somebody could get introduced into this system.
Jesse: So, my understanding of the previous law was that if someone is brought to a psych facility for that detention for evaluation phase, there was previously a probable cause type of hearing that would take place within a few days. But that seems to have been removed. So now, however you get there, once you reach a psych facility where you're being detained for evaluation, what happens?
Melissa Keyes: So the preliminary hearing under the new law has gone away, and so when somebody comes to a facility and the facility says, Hey, we think you are in need of treatment. The facility within the first 48 hours is required to submit an application to the court stating that they have probable cause believing that you are in need of treatment. Submitting that application raises that number to 72 hours. So once that application is filed, then the court either agrees and sets it for a hearing within 14 days, or the court denies and the person has to be released within that 72 hour period. Historically, it used to be a 10 day period that was expanded to 14 days. And so there's a little bit of an extra added time that a facility can detain the person. The process now really streamlines, for lack of a better word, that initial period of getting the court's approval to be able to continue to hold somebody.
Jesse: To clarify, whether we're talking about 48, 72, or 10 days, those are business days, not counting weekends and holidays, is that right?
Melissa Keyes: Correct.
Jesse: So someone's in the facility within the 48 hours, first 48 hours they're there. The facility has to decide whether or not to take this further. If they decide to take it further, they submit an application to a court and there's a 24 hour period where the court has to respond to that, essentially.
Melissa Keyes: Right, merely submitting that gives them up to 72 hours. So if they don't submit it within 48, the person can be discharged.
Jesse: In almost every episode of this podcast, we inevitably ask some version of the question, do weekends and holidays count? This question can be essential to understanding the practical realities of the process because in Indiana, under this new law, a person can be detained for up to 14 business days without ever actually getting the opportunity to appear at a hearing. Without ever getting a chance to explain their situation to the court. So my next question for Melissa was, if this 14 day detention does not include weekends or holidays, does that mean that the person is actually being detained without a hearing for up to, at the very least, 18 days?
Melissa Keyes: Correct. And in fact, we kind of were playing around with that magical holiday time where there's a lot of family drama and conflict between Thanksgiving and the Christmas holiday where, depending on where you fell, it could be almost a month, really. That 14 days based on, you know, holidays and weekends and things like that. And so, yeah, the other interesting language and something that hasn't really been clarified is that timing starts from admission to the facility. And so trying to really figure out what admission to the facility means because if you go to an emergency room, is that when you're considered admitted? Or is it the actual admitting process where the hospital says, Hey, we are admitting you to this facility, because that can be different. You can stay in an emergency room for hours, depending on where you are, and so where does that time clock start? There's that provision in our law that says that if a patient is admitted to a facility after midnight, but before 8 a. m, the time period begins to run at 8 a. m. that following day. And so that's something that I think would do well to be clarified as to what they mean by admission. Is it when you walk in the door? Is it when they put your name in the system? Or is it when they actually say, Hey, we're gonna admit you for treatment?
The other change that happened in that process is that the information provided to the court in that initial report, it used to be called a report, but that initial what's now being called an application used to vary county by county. And now court services have established a standardized form, so all facilities are supposed to use kind of the same form. That is supposed to help create some consistency across the different courts in what they are reviewing. It's taken that pre hearing and distilled it down to this checkbox application. In an effort to streamline we have lost the individuality of being able to get that information to the court and that to me as an advocate is one of the most troublesome aspects of this, is just the one sidedness of this whole process. All of the power, all of the authority rests with the facility. And I'm not trying to impute any ill will on facilities in general, right? But you have a facility where they are the arbiters of whether or not you need treatment. They are the arbiters of whether or not there is probable cause that you are a danger to yourself or gravely disabled. And the information that the court gets at that initial application is so one sided. And then you have this up to 14 day period, and the person who may want to challenge the sufficiency of the evidence used to make that determination or challenge whether or not a full civil commitment is appropriate, they are so far behind the eight ball at that point, with their ability to connect to counsel, with their ability to gather evidence and information, or seek out witnesses that could testify on their behalf. It is such a David and Goliath at that point, because you're talking about the process of detaining somebody who hasn't committed a crime, who hasn't done anything other than need help for a medical condition. And that to me just really, we should be erring on the side of protecting somebody's rights over streamlining a process to get them access to treatment. There's always got to be that balancing and it's got to be that individualized real examination of it.
Jesse: It is important to remember that at this point in the process, any allegation that a person is mentally ill, or a danger to themselves, or temporarily impaired by substances, any claim like that at this point in the process has yet to be proven at a hearing. So when that application is reviewed by the court, it should be viewed as a series of allegations that only represent one perspective on the situation. But with this new law, simply submitting those allegations is all that is required to authorize over two weeks of involuntary detention, which is particularly concerning because if that application is approved it can include authorization from the court allowing the facility to implement a treatment plan. And there are a myriad of potential entirely justifiable reasons why it might be a matter of self preservation for a person to refuse to participate in a treatment plan. So exactly how far can the facility go to implement that plan? Does this new law place any clearly defined limitations on the scope of that authority?
Melissa Keyes: There does not appear to be other than there's language in the form the facility is allowed to begin a treatment plan using clinically acceptable standards of care. And the court as part of its review of the application can order continuing that continuing treatment. The unfortunate thing is the application that the facility uses now, that standardized application, really doesn't give a whole lot of room for detail and it's unclear at this point what information a court's going to get in this application to be able to make that determination. Now, that's not to say that as part of that 14 day hearing that somebody couldn't challenge the treatment plan, but there isn't anything that allows that process to happen before the treatment plan is started, before it's initiated.
Jesse: I guess one of the things I'm trying to figure out about these changes is It doesn't seem like there's very clear guidance for the facility about what they can and can't force. And when we're talking about force that might involve heavy coercion, or that might involve being physically restrained and injected with something. So is there anything in these changes to the law that specifically spell out what sort of guardrails are in place before that commitment hearing? Which is supposed to be your legal check. It's supposed to be the judicial check to make sure that all of this is supposed to happen. Are there clear guardrails during that 14 day period?
Melissa Keyes: No, other than that it's gotta be using accepted clinical care guidelines, but there's no limitation on medication, or therapy, or treatment plan that is expressly stated in the statute.
Jesse: During the times when I was detained inpatient it was deemed clinically acceptable to tell patients that there would be repercussions if they consumed any amount of caffeine, but perfectly fine iIf they wanted to smoke cigarettes. It was deemed clinically acceptable to confine a patient to a wheelchair and make them watch as their feces was strained and collected from a toilet. And it was clinically acceptable to tell a group of patients with eating disorders to sit in a circle and watch as one of them would be forced to eat a cookie. They were all then, as part of their treatment, forbidden from talking about it.
Clinically acceptable practices can be bizarre, they can be counterproductive, and far too often, like with forced medication and ECT, they can be dangerous. So I can understand why this term, clinically acceptable, might provide legislators with confidence that this process will involve rigorously tested methods of treatment that have proven therapeutic value. I can understand why this term might make people feel like this process is going to be safe. But there is a frighteningly broad range of trauma within the scope of clinically acceptable. And all of this is before that person gets a hearing but after that 14, actually more like 18, days of involuntary detention, there is supposed to be a civil commitment hearing. So my next question for Melissa was, what happens at that civil commitment hearing?
Melissa Keyes: So it's supposed to function as a fairly standard hearing. The person is entitled to representation. If they can't afford representation the court is able to appoint a public defender in this case. They are allowed to bring witnesses, give testimony, kind of the whole trappings of what you would think of in a typical court scenario. The issue becomes, from a practical perspective, outside of our large metropolitan areas where we do have more of a deeper bench of attorneys available. If you think about that 14 day period and first off how the person is going to be able to proactively access counsel, if they don't have somebody able to help facilitate meetings or connecting with an attorney. And then the time that it might take to get that attorney on board and able to review materials and evaluations, or seek out witnesses, or whomever on their own. You can see that there's kind of a lopsided ability. And that's nothing to say, our public defenders are tremendous. They do the best they can with the resources that they have. But it's, you know, starting the race two miles back.
Jesse: Those are all of my questions. Is there anything I haven't asked about relating to these changes that you think is important to know?
Melissa Keyes: So, you know, one of the things that we're really trying to do is to help make this law better. I mean, we recognize that we're not going to be able to get rid of this type of process altogether. And so what can we do to help make sure that the process is respectful of people's dignity and rights? And that it supports policies of self determination and least restrictive options. You know, when we talk about the timeline that folks are held, previously it was 10 days, it was expanded to 14 days. However, previously when it was 10 days and there was this initial hearing, that gave a little bit better protection to make sure that somebody's rights were being protected earlier in the process. And so with the removal of really any information from the person themselves in that process until that 14 day hearing happens, that to me is, I think, where one of the concerns comes from. It's not necessarily the addition of four extra days, it's the inability of the person to raise issues, raise alarm, have an independent note taken of what's happening until that 14 day hearing happens. And a lot can happen in 14 days. People can lose their houses, their jobs, they have kids to take care of, and pets, and all kinds of things that can happen. And when the court only gets one side of the story and limited information from that one side of the story, and the court does not have the training or expertise to be able to make a decision as to whether or not that is accurate. I mean, that to me is kind of where the crux of the problem is, that in the absence of being able to look at that whole picture where you're just getting information from the facility, you're not getting information from the person about, um, what do I have in my psychiatric advanced directive? If I have one. Who do I have as my support system that, Hey, maybe once I get access to my medication that ran out In a couple days, I'm golden. Or hey, if you detain me, I'm going to lose my house, my job, my kids, and that's going to throw things into an even bigger tailspin. Without the court having that information and only getting very limited information from the facility, it strikes me as a real disservice to that court oversight piece that's supposed to be there. So we've gotten so used to that institutional model of, let's create this divide between, you know, the public and folks who act erratically, or who due to their condition behave in a certain way that we find different or disturbing. And we're still focused on that, but we're dressing it up in the trappings of access to treatment. And I think that does a real disservice because a lot of the mechanisms that happen in that process are not very therapeutic. And can even be more traumatizing. And so I think until we start flipping the conversation and the perspective towards that focus on treatment and access to treatment, we're really not going to make a whole lot of change.
Jesse: I mean, that gets to one of the underlying, uh, it's not even a secret, really, it's just one of the underlying realities about it. An involuntary hospitalization, whether it's initial detention or whether it's a civil commitment, that decision says more about the emotional state of the clinician and the judge. I'm not saying that in a disparaging way, I'm not saying that they're unreasonable, but it says more about their state of mind than it does about the person. Because of that fear. Because the default is, well, it's easier, I know where you're going to be, and I know you're going to be watched. That decision is easier for me to make, because I'm not going to be worried about you going out there and doing something. I get that, but we need to acknowledge that is about you, that is not about me. I need you to own that side of it.
Melissa Keyes: Yeah. It's like what I said earlier, just be honest and call it what it is, we don't know what to do with you so we're going to remove you from society. I can deal with that. I can respond to that. What is problematic is when you start to equate treatment, this is how we're going to access treatment, oh, we're going to give you treatment. When you start to conflate that with detention and hospitalization, that's when I start to have the problem because it's not meaningful then. Because if it were really about access to treatment you would make sure that I had access to the full spectrum of treatment that might be available. And that me as a self determined individual in consultation with my treating team, we decide what's best and what's, you know, the proper course of action. But you're saying, oh, this person needs treatment. Here you go. This is the magical treatment access place that happens to be a detention place that you can't leave. If I leave a hospital, AMA, Against Medical Advice, a police officer does not show up and take me back to that hospital. That's not the same for mental health. And until we acknowledge that and have a conversation about the biases that are inherent in that, it's going to continue to be that way.
Jesse: Right now, throughout the United States, there are ongoing legislative efforts focused on expanding commitment laws. Focused on making it easier to force someone into that process. And when I see policymakers discussing these expansions it feels to me like someone in a position of authority is looking me straight in the eyes as they slowly unravel more barbed wire. I don't know how to feel safe with these laws. I don't know how to convince legislators that the people being detained matter, that their time matters, their voices matter. I don't know how to feel safe with these laws, I just know that I need to understand. I need to know how to avoid these systems because I don't know if I survive being committed again. And so, we continue to investigate, state by state, all of these ever expanding systems of commitment. And next time, on Committable, we'll be looking at mental health laws in Mississippi.
Jesse: Committable is produced by Jim McQuaid. Michelle Stockman and me, Jesse Mangan. All music is from the song Reasonable by Christopher G. Brown.