EPISODE TRANSCRIPT
KAREN OWEN TALLEY: Section 12 can happen to anybody.
BOB FLEISCHNER: Ultimately the authority to sign these pink slips is absolute.
KAREN OWEN TALLEY: Most people who are not familiar with it are quite honestly shocked at what kind of liberties can be taken from somebody.
STEVE SCHWARTZ: But when it comes down to,
“I wasn't really dangerous, I wasn't really mentally ill, they thought I was.”
You're going to lose.
JESSE: This is Committable.
JESSE: this is Committable, a podcast about involuntary commitments. I'm Jesse Mangan.
For over 20 years, I've been trying to process a series of events that began with me making an appointment with a nutritionist and spiraled into three years in and out of psych wards.
When all of this began, I had just started as a student at the University of Massachusetts at Amherst and I knew something was wrong. I was constantly cold and exhausted, having trouble sleeping, having trouble concentrating, and I was losing weight that I did not intend to lose. So I made an appointment with a nutritionist at UMass health services.
The appointment started at 9:00 AM on a Wednesday and within 15 minutes, I was crying.
I was crying because I felt just overwhelmed with...everything. Seeing my reaction, the nutritionist went to get a physician, Dr. Webber. Dr. Webber weighed me, ran some tests and diagnosed me with anorexia.
At the time, I didn't really know what anorexia was. All I knew was that I had just been told that my weight was so low that if I moved too much I might have a heart attack. If I moved too much, I might die.
I was frightened.
After that Dr. Weber referred me to a psychologist, Dr. Bynum. Dr. Bynum brought me into an office and he asked if I was willing to gain weight.
I was.
He asked if I was willing to go to a hospital.
I was.
He asked if I was willing to speak to a psychiatrist at the hospital.
I told him that as long as he got me to a place where the, “if you move too much you might die” thing was being taken care of, I would speak to whoever he wanted me to.
He asked if I wanted my parents involved.
I did.
Bynum called my parents and we all agreed that I should wait at health services until a hospital bed opened up.
My parents asked Tom, my older brother, to come wait with me. Here's what Tom remembers from that day.
TOM: I remember sitting there with you for a long time. I remember seeing a nurse once, maybe twice tops. You had asked for apple juice or something and I remember asking her myself,
“Hey, what happened to that request?”
Because you had said you weren't sure they were listening to you, but I remember coming out of that room and being greeted by a gurney with two not frail looking fellas. As well as Bynum, Bynum was there saying,
“Okay, we're ready to take you to the hospital.”
And us going,
“Okay, well, the car's out here.”
And then proceeded this very odd conversation that at the time I had no basis for comparison. So I didn't, I certainly didn't put two and two together for what was happening, but them insisting that we had to take the gurney and we were like,
“I've got a car.”
Well, even before, cause they asked before we went out there, there had been some conversation about something and I said,
“Yeah, I'll just drive him over.”
And they were like,
“Well, let us check into that.”
And “...check into that.” turned into us walking out into this gurney and them insisting that for insurance purposes they had to have you on gurney. You had to go in the ambulance. We had some more conversation because that seemed shifty. And they're like,
“No, you have to go on the gurney to get to the hospital.”
I was like,
“What are you talking about?”
And then they basically just kind of steamrolled us into,
“No, this is the way it has to be for insurance purposes. This is the only way we can get you into that bed to have them, you know, take a look at you. The only way this works is if you get in this gurney and sign this piece of paper.”
There was no request, it was do this or...it was do this or and it was bad.”
JESSE: Strapped into a gurney I was brought by ambulance to a hospital. EMTs switched the gurney to a vertical position to get me onto an elevator. I was then wheeled directly out of that elevator and onto a psych ward where I heard the distinct “click” of magnetically locked doors shutting behind me.
A nurse approached and asked for my belt and anything else that might be unsafe.
“What? Like my shoelaces?” I joked.
After my shoelaces were taken I was escorted to a simple room with a bed, a locked bathroom, a camera, and a door kept open so that every 15 minutes a staff member could look in to see if I had attempted suicide.
I started that day as a student with health concerns speaking to a nutritionist. I ended that day on suicide watch in a locked psychiatric facility because of a form that Dr. Bynum had signed something called a Section 12.
So what is a Section 12?
STEVE SCHWARTZ: Bob, you want to answer?
BOB FLEISCHNER: Yeah, sure.
JESSE: This is Steve Schwartz and Bob Fleischner from the Center for Public Representation.
STEVE SCHWARTZ: Hi, I'm Steve Schwartz, I'm the legal director of the Center for Public Representation. The Center is a national and local training and technical assistance center, providing representation to people with disabilities all across the United States. And we particularly focused on people who are in facilities like state hospitals, or jails, juvenile justice facilities, nursing facilities, and our mission is to try to bring them home. Bring them back to the community and give them the supports that they would need to live fully productive lives.
BOB FLEISCHNER: Hi, I’m Bob. I worked at the Center for about 40 something years and retired a couple of years ago. Currently, I’m doing special projects for the Center and I'm doing work internationally on access to justice issues for people with disabilities and in Massachusetts on solitary confinement in prisons.
JESSE: So, specifically I wanted to ask what is a Section 12?
BOB FLEISCHNER: A Section 12 is not a simple question. It's not a one sentence answer. There are different kinds of Section 12s. There's several subsections.
Most generally a Section 12 is an order of emergency commitment signed by someone and it could be a doctor, it could be a police officer, it could be some other mental health clinician, or it could be a judge, that finds that there's reason to believe that if the person's not hospitalized they'll be dangerous to themselves or others. And it authorizes transportation to a hospital or authorized facility for three days for evaluation to see whether the person needs to stay longer.
STEVE SCHWARTZ: Just to make sure, there is a three day time period, during that three day time period you can request a lawyer and your lawyer can request an immediate hearing. The court will do their best to schedule the hearing within 24 hours. So, if you really know how to work the system. which people who are sometimes confused might not know how to do.
In fact, there aren't many lawyers besides Bob and I who know how to work the system. But if you know how to work the system the minute you're thrown into a place you get a name of a lawyer. You call that lawyer and say,
“Get me out of here as quickly as possible.”
The best they'll be able to do for you, short of convincing the doctor to release you voluntarily, the best they can do for you is get a hearing in 24 hours. That's the best you can do.
JESSE: Do you need to have a diagnosis in order to keep someone beyond that 72 hours?
STEVE SCHWARTZ: You need to have a diagnosis to get the person in in the first place. The standards in this whole process are relatively the same, although they are interpreted a little more loosely on the front end because people have less information on the front end, but the standards are the same.
The standards are;
You must have a serious mental illness, that is someone must believe you have a serious mental illness. They must believe that you would present a danger to yourself or someone else if you were not hospitalized and they must have exhausted alternatives to hospitalization. Now, whether they really do, it's really some of the information that happens at the hearing.
Sometimes clinicians and police officers will do this with some real fidelity. Sometimes they say,
“I don't know where else the person goes. They look kind of crazy to me. I feel real bad for them to be on the street. They might do something. So if they did something (whatever that is) somebody could get hurt.”
Maybe themselves, maybe somebody else let's not take a chance, whisk them off.
JESSE: Is there a specific reason why it's three days and not one day or two days?
BOB FLEISCHNER: There's a balance. There is a substantial loss of liberty that's involved for the person who's being put into the hospital or being held for the three days.
So it should be on the short end in order not to interfere with the person's liberty. On the other hand, it has to be long enough for the psychiatrist at the hospital to make an evaluation of whether the person needs to be held for a longer period of time, which takes a court order. So there's a balancing of the practical application and the Liberty interest that's involved.
JESSE: Steve emphasized how important it is to understand the history of commitment laws as we start to look at ways in which those laws are still being challenged today.
STEVE SCHWARTZ: So it's important Jesse, when we started our work, which was in the early seventies, many States had no provision at all for what’s called emergency detention.
In fact, they even had no serious protections for long-term commitment. But as a result of some civil rights cases that were brought in the late sixties and the early seventies that held that you could not deprive a person with psychiatric disabilities of their Liberty without a hearing, without a good reason, without the right to a lawyer, States began to reform their laws.
Massachusetts was one of the first to do so and when it did it, it actually required a fairly in-depth process and a pretty rigorous standard for long-term commitment. Long-term commitment was for six months or a year, or longer, which was novel across the country, because there were no protections in many, many States.
So Massachusetts was one of the States that set up these more rigorous standards and procedures to safeguard the inappropriate deprivation of freedom. At the same time, it allowed a wide exception. What's often known as the front door and allowed someone to be held for 10 days, as Bob said, under a provision called emergency detention.
And at that time, when this statute was first enacted in the early seventies, the emergency detention provisions, section 12, had no requirement for a hearing. And in fact, the hearing would happen sometime after the 10 days expired because of court delays and so on. So if you were brought to a state hospital in let's say 1975, You could have been brought to the hospital for 10 days with no hearing, no safeguards, no lawyers, no due process.
And by the time you got that, it could have been been another 10 days. So you could be there really 20 days before anything began to happen gradually over time. CPR led by much bogs work began both litigating and trying to legislate improvements or more safe guards to this emergency detention process.
And at some point the 10 days became five days and the five days became, I think four days and the four days became three days. And then people ran out of steam. And so that's what it is now. And recently there became a question that went to the Supreme Judicial Court in a case that Bob and I wrote a friend of the court brief of whether the emergency detention timelines, the three-day time period, could be circumvented.
If you were sent to an emergency room, like at Mass General Hospital, and kept in the emergency room for a week before you were sent to the mental health facility, because you could only stay there three days. And so this issue of length of time, your question, has changed very dramatically from no days, from a hundred thousand days in 1960 to 10 days to five days, to four days, to three days.
But even then those days only begin to count, you only start the three-day period, once you arrive at a mental health facility. And if you are first brought by a police officer to an emergency room and kept there for a week, you're three days don't start until the emergency room sends you to the psych facility.
JESSE: This case that Steve was referring to is called Massachusetts General Hospital vs. CR.
KAREN OWEN TALLEY: It's Massachusetts General Hospital vs. CR, which was decided in April, which was a case I did both in the BMC appellate division, where we prevailed, and then in the SJC where we did not prevail. They thought that the legislature should address this issue of what happens under 12a.
JESSE: this is Karen Owen Talley from the Committee for Public Counsel Services.
KAREN OWEN TALLEY: I’m Karen Owen Tally, I've been an attorney for around 25 years now, a little over 25 years, and for all that time have been practicing exclusively in the area of mental health law on the side of respondents or people who are in institutions.
It's been about the last 11 years in total I've worked for CPCS, which is the state public defender organization. And that's where I work currently. My current position is as the Director of Mental Health Appeals, so I'm responsible for either assigning counsel and handling a small number of appeals myself that arise out of mental health cases. Which is generally commitments and also some guardianship cases.
And when I say commitments that also often includes an order for forced medication that's part of the commitment order.
JESSE: This case, Massachusetts General Hospital vs. CR, focuses on the space between two parts of a section 12; a 12a and a 12b. I asked Karen to help me understand exactly what...that...means...
KAREN OWEN TALLEY: So the person is initially under 12 as a clinician, or in emergencies it can be a police officer, has reason to believe that the person might have a mental illness that may create a likelihood of serious harm to self or others. That authorizes them to physically restrain the person or take them into custody for lack of a better word.
It's usually an ambulance and then the way the statute is written my interpretation, most other people that you've already spoken to; Steven Schwartz, Bob Fleischner, people who have been around doing this for a long time, would argue that the way the statute was originally drafted the intent was the ambulance picks them up and drives them directly to the door of a psychiatric hospital.
Those days it was probably a state psychiatric hospital. Now they're mostly privately run psychiatric hospitals. So that initial 12a period was supposed to be a very brief period of restraint just for the purposes of getting them to the psychiatric facility, where they would then be evaluated by a designated physician under 12b, to see if they actually met the test of posing an actual likelihood of serious harm.
Also at that psychiatric facility, that's where they're given the opportunity to sign in on a conditional voluntary. So hopefully to avoid the need for an involuntary commitment. So the period under 12a has grown into this situation where most people are brought to an emergency department and sort of parked there while they look for an available psychiatric bed.
The issue in CR was there's no time limit on that 12a portion of the statute. And yet the person is being held and restrained and deprived of their liberty without counsel, without judicial review, for a potentially indefinite period of time. That was the issue that we tried to litigate to say that, you know, this can't be what the legislature intended.
The court agreed with us that that cannot be what the legislature intended, but thought that the legislature should address this issue of what happens under 12a. To try and figure out what's an appropriate time limit on that 12a detention. So, 12a is involuntary but it's meant to be a very brief period of just, kind of assessing the person to get them to the psychiatric facility involuntarily. But number one, there’s supposed to be an actual determination by a designated physician who is now personally examining the person that they meet the criteria of presenting a likelihood of serious harm by reason of mental illness.
And they have declined or refused to sign themselves in voluntarily. So, in a typical scenario, you have someone picked up and restrained under 12a, brought to the emergency room most likely, instead of being brought directly to a psychiatric facility, and then the 12b period, if they don't sign themselves in voluntarily, is a three business day time period. At the end of that 12b time period the hospital has to either discharge them or file a petition for their commitment.
Or what we would argue should happen is that the person declines to sign a conditional voluntary at the door of the psych hospital, they could do it later on as well when they do have an opportunity to consult with counsel, but setting that aside, if the person doesn't sign a conditional voluntary the 12b psychiatric hospitalization for three business days is involuntary.
That three business day limit is intended to prevent somebody from being housed involuntarily without a court hearing. Because at that point it's really just the say so of a designated physician. There hasn't been a court review.
JESSE: when Dr. Bynum ordered that I be strapped into a gurney and wheeled onto a psych ward.
That was a 12a.
Then when I arrived at that psych ward, the law provided them two hours to accomplish two things. One, to evaluate whether or not I needed to be held for up to three business days under a 12b. And to offer me a chance to sign myself in under a conditional voluntary.
Okay. So one, I was told there was no one there who could evaluate me for a 12b. That everyone qualified to do so had already left and gone home.
And two, I entered that psych ward on a Wednesday and was told that my best chance for getting out some time on Monday would be to sign myself in under a conditional voluntary.
How does something referred to as voluntary keep a person confined for five days?
What is a conditional voluntary?
KAREN OWEN TALLEY: A conditional voluntary, when I say you are waiving legal rights, it's not often perceived in that way or described in that way, but it is a waiver of legal rights. Because if you sign in on a conditional voluntary you're no longer there on voluntary status. So you lose your right to appointed counsel. Okay. Because now you're considered to be there voluntarily.
And there's no right to counsel if you are just voluntarily in the hospital. So that's the first right that is waived. The second right that is waived is if you're in the hospital on an involuntary three day admission under section 12b, you have a right to counsel.
You have to request it though. It's not something that is automatic, but you have a right to be informed that you can request the council through CPCS. You have a right to have that council appointed to come and meet with you. And you have a right to what's called a 12b emergency hearing to see if there has been some abuse or misuse of the section 12 process.
So there are some legal protections that are available to you in that sort of emergency, three day section 12, temporary commitment or admission. However you want to term it. But number one, you waive all those rights if you sign a conditional voluntary and number two, it's not entirely clear what the scope of relief is that can be afforded at that 12b hearing. Abuse or misuse of the section 12 process is still sort of in the process of being defined.
JESSE: Is there an advantage to the patient if they sign a voluntary versus an involuntary?
KAREN OWEN TALLEY: Important thing to note before I answer that is that they are supposed to have an opportunity to consult with a lawyer, or a paralegal working under the supervision of a lawyer, about the legal effects of signing themselves in voluntarily before they sign it.
That's a huge issue in Massachusetts and it's an area where there needs to be some reform because the reality is when people get to the door of the psych facility they may be presented with this paperwork and not informed, by whoever is giving it to them, about the rights that they're giving up by signing in voluntarily, or that they have a right to consult with counsel, or they may understand it completely differently.
And they may be given inaccurate information about the advantages, or disadvantages, or implications, of signing that. And there sometimes can be what appears to be a fairly high level of coercion because it's easier for the psychiatric facilities to admit somebody on a conditional voluntary.
JESSE: In the years, since my initial diagnosis, I've been faced with a conditional voluntary three times. And I don't remember ever being told that I had the right to speak to an attorney before I signed it. Here's Karen again.
KAREN OWEN TALLEY: So to get back to your initial question, which is a good one, you know, are there advantages? Are there disadvantages? The legislature provides that people are required to be given the opportunity to sign in voluntarily because there's a preference for voluntary treatment.
And I think. You know, I'm not a clinician, but my understanding is that in the clinical literature as well, there's just a preference for people to get treatment voluntarily. It forges, you know, in theory, a better alliance between the person and the doctor or treatment staff. It gives the individual a greater sense of agency. Then, you know, having something done to them involuntarily. There is a sort of societal, legislative and clinical preference for voluntary treatment. The main sort of, you know, rubber meets the road difference to an individual is if they sign in on a conditional voluntary, remain as a conditional voluntary, the hospital cannot get an order for forcible medication because the order for forcible medication is only considered if the person is committed.
So, from a very practical what are the advantages/disadvantages to an individual, if they remain on a conditional voluntary, and they’re competent to remain on a conditional voluntary, and stay on that legal status, the hospital can't get an order for forced medication.
JESSE: So, you mentioned “...if they're competent to remain on a conditional voluntary…” Is there a legal definition of competency that has to be established?
KAREN OWEN TALLEY: Yeah. And it's found in the statute and in the regulations and it's meant to be a very low standard. So, the person basically just has to understand that, you know, they're at a facility, it's a facility for psychiatric treatment, they desire to get treatment, and then they also have to understand that if they want to leave, they have to execute what's called a three-day notice. And that's the conditional part of conditional voluntary. If it was a true voluntary, you could leave against medical advice without giving three-day written notice. The conditional part is that if you sign yourself in you’re acknowledging that if you want to leave you have to, in writing, give the hospital three days notice of your intention to leave.
And that gives the hospital three days to decide whether to discharge you or whether they're going to petition for your involuntary commitment.
JESSE: Okay. So a 12a can involuntarily confine someone for transport to a place where they will, at some point, be evaluated for a 12b.
A 12b can commit someone to a psychiatric facility for up to 72 hours, or more specifically three business days, of observation.
And the conditional voluntary seems to be a form of self commitment which far too often includes elements of coercion and confusion, which can result in it being voluntary in name only. But this is all intended to help someone who has been diagnosed with a mental illness. And every time I have been diagnosed with something the criteria used to reach that diagnosis was listed in the DSM.
The Diagnostic and Statistical Manual of mental disorders.
So, if the DSM is what psychiatrists and psychologists are using to diagnose people, and that diagnosis can be used to confine someone against their will, then the criteria in the DSM must be legally binding in some way.
STEVE SCHWARTZ: I mean, the DSM has criteria.
And one of the things Bob and I used to do many years ago was when we did these civil commitment hearings, we would cross examine the doctor and we would cross examine them on all three of these points; mental illness, dangerousness, alternatives, and they had a little more, you know, professional knowledge about the mental illness than they had about the alternatives.
But if they diagnose the person with a certain type of mental illness that has a certain classification in the DSM-V, and the person didn't have symptoms that matched what the DSM-V said, we would try to convince the judge that the doctor doesn’t know what he's talking about.
BOB FLEISCHNER: The legal standard is not the DSM.
The legal standard is the definition of mental illness that is written by the Department of Mental Health and appears in their regulation.
JESSE: Here is committable contributor Michelle Stockman with the Section 12 criteria for mental illness.
MICHELLE STOCKMAN: For purposes of admission to an inpatient facility under Section 12;
Mental illness means a substantial disorder of thought, mood, perception, orientation or memory, which grossly impairs judgment, behavior, or capacity to recognize reality or ability to meet the ordinary demands of life.
Symptoms caused solely by alcohol or drug intake, organic brain damage, or mental retardation, do not constitute a serious mental illness.
JESSE: Is there any way to avoid being sent for an evaluation. I mean, if a psychiatrist, or if anyone, has an opinion of you that you seem off, you seem like you could be a danger, whether or not you are. Is there any way to avoid ever being sent for evaluation?
BOB FLEISCHNER: Section 12, which is often called a pink slip here. Ultimately the authority to sign these pink slips is absolute within the bounds of what the legal standards are.
So you can't prevent anybody from signing them.
STEVE SCHWARTZ: If someone's after you, unless you can run faster, there's no way legally to prevent them from being able to at least initially detain you. You can try to trigger the process quickly like we mentioned. You can, after you're released, try to sue them for what's known as false imprisonment. But given the discretion that is involved, it's very, very difficult to win that case.
You know, if someone was doing this in bad faith, you know, they were doing it because of the color of your skin, because of the party you vote for, stuff like that. And you could prove that was the reason.
Like someone said,
“We're going to lock up black people.”
Regardless of whether we have any evidence about it, you might be able to win false imprisonment on that.
But when it comes down to,
“I wasn't really dangerous. I wasn't really mentally ill. They thought I was.”
You're going to lose
JESSE: And there’s immunity?
BOB FLEISCHNER: The statute provides immunity to anyone who signs, anyone who is authorized to sign, a section 12 and signs it in good faith is immune from damages.
JESSE: The state must recognize that this is sort of an awesome power that they're giving to some people. So, these facilities must be safe. If you're saying I can put you in this facility for 72 hours to be evaluated, these facilities would presumably be safe. Is that the case?
STEVE SCHWARTZ: So, there's two kinds of safety, you know, are you going to get killed or beaten up or so on? Like safety the way we think of jails as being unsafe from outright intentional violence.
Probably most, if not all, psychiatric facilities are safe in that way. It would not be impossible, but it would be very, very rare that you would have deliberate violence coming from staff or other residents. There's another kind of safety though, which really has to do with, are you going to be overmedicated?
Are you going to be kept in the facility way longer than necessary and actually become institutionalized?
Are you going to be restrained when you don't need it or excessively for a long time?
And as a result of the restraint, you get hurt because they do a take down?
So, there's a lot of other types of consequences of involuntary hospitalization that aren't in the category of intentional violence but they are in a category of likely serious risks.
And those happen a lot.
BOB FLEISCHNER: The two most dangerous and potentially harmful times in this process are one, when you're restrained, which Steve's talked about. And usually when someone's brought into an emergency room, the emergency room restrains them to a gurney until somebody can see them.
So that's one place. Restraint, restraint is a violent act.
The second actually comes before that. And that's when the person is restrained to be taken to the hospital. And if in the course of your podcast you talk to people who've been sectioned 12’d you will inevitably hear about the violence that's perpetrated by police officers when they restrain people. They've got an order that says, this is an authorization to get this person in an ambulance and bring them to a hospital and you will hear about people who have been seriously, seriously, harmed during that process.
And if you read testimonials from people who've been section 12’d, it's pretty stunning what happens to people. They're often cuffed. If they're in an ambulance they're restrained on a gurney in an ambulance, and this is all to get them help.
The section 12 process for many people is a violent piece of action.
JESSE: When I was restrained to a gurney and told that this was all necessary, that this was the only way that I could get help.
The harm for me was not how tight the restraints were. It wasn't the physical abuse. The harm was that it took every last shred of willpower that I had left to ask for help and to trust the people who said they were going to help me.
Internally it all felt wrong but I was being told that it was for my own good. I was being told that I had to trust them and not trust me.
So the harm is that I trusted them and that trust led to me being strapped down and wheeled into a psych ward where in one instant everything that I depended upon was ripped away.
But all of this took place in Massachusetts. What about the rest of the country?
STEVE SCHWARTZ: So at a high level, the fact that you have emergency detentions, then you have a court hearing for what's called civil commitment, and then you can have repeated hearings for longer and longer terms of commitment. At that high level most States look the same. If you drill down. And say,
“What's the period for emergency detention?”
In some State’s it’s three days. Some States are five days. Some States are 14 days. So, while they'll have an emergency detention concept, it could be considerably longer. Many States don't have, for instance, the provision that you get the name of a lawyer when you walk in, you call that lawyer and you can get a hearing right away.
Very few States have the ability to have a hearing as quickly as you now can have in Massachusetts. Again, most States have the standards for commitment, which is that the person has to have a mental illness, there has to be some risk, and the facility needs to be necessary in light of other community alternatives.
What's often called there's no less restrictive alternative.
So, those three concepts exist in most States, not every state, but most. But how they define a danger, how they define alternatives, and how they define mental illness varies.
Some States allow commitments for not only mental illness but for having an intellectual disability, or developmental disabilities.
Massachusetts allows commitments for having a mental illness or having a substance use condition.
BOB FLEISCHNER: Probably about half the States have commitment for substance use disorder, but Massachusetts is the only state who puts people in prison.
STEVE SCHWARTZ: The one other thing to say is that when you asked
“How is Massachusetts compared to other States?”
Many States have, in addition to the civil commitment provisions that you're looking at, which I hear from your questions Jesse, they are about being committed to a hospital or a facility. Some brick and mortar place. Many States have a second kind of commitment called outpatient commitment. Which means you are brought to a court, there has to be some evidence along the lines that we talked about, but there's a lower standard.
That the hospital, or the doctors, have to prove not so much dangerousness. The test often is that you're not willing to comply with the treatment requirements from your doctor. And if you're not, the judge enters what's called an outpatient commitment order. So you're committed, you're under the control of a court, you're subject to punishment and fines and institutionalization if you don't comply, but you're not in a hospital.
You're required to take medication and to go to a therapist or show up at a place. There can be different conditions. Massachusetts does not have outpatient commitment much because of the work of CPR and others who have opposed it here in the Commonwealth.
But many other States do.
JESSE: it's a lot, right?
Section 12, 12a, 12b, DSM, outpatient commitments.
It is a lot to process all at once.
Now imagine on your worst day, the day where everything feels like it's falling apart. Imagine on that day, asking for help and getting an abridged, incomplete explanation of all of this in between being told that you need treatment now, and this form here, this is the only way you get it.
Would you sign it?
Would you read it?
Would you understand it?
Next time on committable.
SUSAN MANGAN: I remember you crying on the floor for so long. And I just remember, like, you were so broken...
STEVE BROWN: The muscle was gone. His face was almost skeletal.
JEAN FORWARD: When the whole thing fell apart and they strapped you into that ambulance and took you off to a locked place they changed your behavior. You came in that house that night and you were rigid.
JESSE: Committable is produced by Jim McQuaid and Michelle Stockman.
This episode was written, edited and hosted by me, Jesse Mangan.
All music is from the song Reasonable by Christopher G. Brown.
Additional production for this episode by Brian Patrick Williams.