Jesse: This is Committable, a podcast about involuntary commitments. I'm Jesse Mangan, and this episode is going to be a bit different. For this episode I interviewed Rob Wipond about his book Your Consent is Not Required: The Rise in Psychiatric Detentions, Forced Treatment and Abusive Guardianships. This book is a fantastic resource for anyone who wants to better understand these systems, it has concrete examples from court cases, firsthand accounts, federal investigations, lived experience, and structural analysis. Rob also brings a sense of insight from his own experiences after watching his father get pulled into one of these systems. And that's where our interview begins, and so, this is Rob Wipond.
Rob Wipond: So my name's Rob Wipond, I'm an investigative journalist and I've been researching and writing about civil rights in the mental health system for about 20 some years. And I now have a new book out called Your Consent is Not Required: The Rise in Psychiatric Detentions, Forced Treatment and Abusive Guardianships..
Jesse: So, in your book you described the story of your father, and you have this personal experience with someone you care about entering the system in this one way. Where they're asking a medical professional for help and that sort of gets them sucked into the system. As you began researching more into these systems, what other entry points did you discover and what other access points are there into systems of psychiatric detention?
Rob Wipond: There's a lot of funnels into the system, that's what I call them. And it's a big one, and it should be noted that going into the system voluntarily has become one of the predominant ways that people are ending up locked up against their will. It's very counterintuitive in some ways because there's this narrative out there that, oh, it's only if you lack insight and don't realize that you need help, that's when we forcibly treat you. But in fact, lots of people fully recognize that they're struggling in some way and they reach out for help, and of course more and more people do this, and nowadays your odds of getting locked up are actually pretty high. When I say high, of course I don't know an actual number on that, but I hear this story of a lot, of people reaching out for help and getting locked up. So that's one of the biggest ones.
The other one we've talked about before, there’s increasing media attention around it now, is calling out for help through the 988 line, the National Suicide Prevention Lifeline or other hotlines. Not all of them, but many of them do, occasionally trace calls at a disturbingly high rate and people can get taken by police to psychiatric hospitals against their will through that avenue.
Jesse: I was sort of staggered by the amount of funnels you covered in the book. You had punitive measures where someone is protesting, or someone is a whistleblower, and it becomes a political mechanism to involuntarily hospitalize them. You had systems where there were body brokers, if I'm getting this correctly, there are body brokers that go and find people to bring into a facility?
Rob Wipond: Yeah, and that's a really important one too, because, so we have really mass scale fraud going on. There was a heyday of this back in the 1980s, and there was an attempt to get it under control. Laws were passed, lawsuits were filed, governments got involved and a lot of companies shut down. Massive, like hundreds of psychiatric hospitals got shut down in the midst of these massive like hundred million dollar, billion dollar, sorts of lawsuits going on against fraudulent use of mental health laws simply to incarcerate people and bilk insurance plans. It looks like that's coming back. So it becomes a major funnel into the system, is that there's just corrupt medical professionals and people on the street working for these medical professionals, finding vulnerable people and bringing them into hospitals. Or even in some cases we've seen just advertisements like, come in for our free mental health assessment and people show up, they do a little mental health assessment and they actually get locked up.
And what's really important about this is clearly we would say, well, those are cases of extreme abuse. And they are, but the reality is it's very difficult to tell which ones those are from “legitimate” psychiatric detentions. And this is something that I discussed with the US Department of Justice, who are prosecuting some of these cases, and they acknowledged as well that even for them, even for their auditors, even for their attorneys, sometimes they're studying a hospital and they're finding it hard to figure out whether or not this hospital is engaged in systemic abuse or simply engaged in normal responsible psychiatric detentions. Because they look for all intents and purposes the same. People get restrained. They get drugged until they're barely functional. They, you know, are abused in lots of ways, what we would call abuse. And at the same time, that's considered acceptable if you're trying to “cure” a person. So it's a major problem.
Jesse: I think it's worth mentioning that when you talk about corrupt medical professionals, you spent a great deal of time in your book actually listing specific lawsuits that have occurred. You've spoken to, ah, an interagency task force on Medicare fraud. And this medical fraud, and this corruption, is well documented and it even occurs in places, or we see other access points in places like the military. The military seems to commonly use this threat of psychiatric hospitalization as a way of managing, I guess, dissent or managing people resisting or speaking out?
Rob Wipond: Yeah. One of the things that happened to me while I was researching this book is I was repeatedly shocked when I kind of got out of the typical people you might interview for something about psychiatric detentions, like psychiatrists and mental health agencies, and I ventured further afield to talk about psychiatric detentions. And in this case, so I started getting a hint that this was a common phenomenon. That whistleblowers were getting forced into psychiatric evaluations and sometimes locked up in psychiatric hospitals in the midst of their whistleblowing activities. But, you know, it seemed kind of crazy. I thought, oh, well maybe one, there were, you know, there are a couple cases that hit the news and I read about them and I thought, well, yeah, you assume it's rare. But then I got Tom Devine, the senior legal director with the government accountability project on the phone. And he basically told me story after story after story of whistleblowers having this happen to them. He called it a bread and butter harassment tactic. He said it's so common that when he has a new client, it's part of his standard educational first day meeting speech that he gives them. Is to tell them, look, this is something that's likely gonna happen to you, you're gonna be forced into a psychiatric evaluation. You are going to be, probably, compelled into a psychiatric hospital, potentially. Is this something that you're prepared to deal with? Because the stress of these kinds of experiences of engaging in whistleblowing, going through these very serious attempts to undermine your credibility can really wear on people.
Jesse: And you detailed how these systems are expanding, they're becoming more and more normal. They're appearing in our workplaces, they're appearing in our schools, elementary schools, universities, and it seems like these sorts of systems and mechanisms just continue to expand. What sort of justification did you find, or explanation, for the expanse of involuntary commitments? For the expanse of this tool, involuntary commitments, in all of these different ways and creating all of these different access points?
Rob Wipond: Yeah. It becomes a challenge because right now we're in the midst of this enormous expansion culturally of the notion of what mental health even i,s and what mental disorders are, and it's presumed that improving people's mental health can only be a good thing. What could possibly be wrong with me trying to help improve your mental health, right? Us trying to improve our mental health together? Yeah, we're gonna try to make everybody feel better, what's wrong with that? Everybody's gonna be a better person, what's wrong with that? Right? Well, yeah, the devil is in the details, that's the issue here. And so we have this massive expansion going on everywhere. Workplace mental health programs, school education, mental health programs, throughout our culture, in long-term care facilities. There's people that show up to help make sure everybody's mental health is okay. All these little programs and things and all that seems so good, except that who's driving it? What's their agenda? What's their notion of what it means to be mentally healthy? What's their notion of what it means to be not mentally healthy? And how aggressively do they intervene if they think you're not mentally healthy?
The other thing that's feeding into this is there's just an assumption that these treatments are helpful. It's become very vague. A lot of people do them voluntarily, they might have a good experience, they might not, they make that decision. So they don't have an association with, say, a psychiatric drug, like an antidepressant as a threatening tool. Maybe they've never even tried an antipsychotic, so that's the mass of the culture. They don't really know what this experience is like, but when you’re caught in the clutches when someone's now aggressively trying to improve your mental health, the tools are very powerful. Antipsychotic drugs can just knock people out, right? They can debilitate you. It's not like an antidepressant at all, even though some people have quite extreme reactions to antidepressants as well. But antipsychotics are an order of magnitude more powerful. They're the most common tool used in forced treatment, and a lot of people do not like the experience.
So we have these two things going on at once, and really what I wanted to say about that is that it's just, there's this assumption that what happens at a psychiatric hospital is good, is safe, is helpful. People get treated respectfully. They get all these options presented to them. They can pick and choose. They feel safe, they feel cared for. That is really not the experience that's happening for the vast majority of people out there, that are talking about what's happening to them at least. And in terms of the few studies we have looking at this, it also doesn't seem to bear out in the studies that that's what happens at an average psychiatric hospital. Rather, people feel pressured, they feel coerced, it's a very unpleasant environment. They quickly want to leave because they're like, I thought this was gonna be different. Then they're prevented from leaving.
Jesse: So the focus of your book is, really, looking at systems of psychiatric detention throughout North America, so you bring a lot of examples of the US and Canada. What differences did you find between the healthcare systems? Did you find that having a universal healthcare system prevented some sort of ttragedies, or did you find that the private system had some advantages? When looking across North America, what were the similarities in these two countries and what were the differences?
Rob Wipond: They're very similar, so to me that's an important part of the story because it is easy to slip down into sort of a rabbit hole of blaming it all on money and power and profit, and if only we get that under control, it'll be fine. But in Canada, in most of these areas, there's far less profit to be made. We have some degree of privatization in the mental health system in Canada, but nowhere near the extent of the United States. Nevertheless, very much we see the same trends as are happening, both this narrative about deinstitutionalization, the narrative about underfunding, and these dramatic increases in the numbers of people who are being forcibly detained and forcibly treated. So the only difference I found, really there was a few, but one of the main ones was simply, it's worse in Canada. And one of the reasons for that is your insurance never runs out. So if they wanna come after you, if they wanna “provide you with services”, they can keep doing that. Whereas in America, I did talk with a lot of people who managed to kind of escape an involuntary commitment situation simply because their insurance would no longer pay and they got thrown out on the street, or back home, or wherever they went. In Canada they can be very aggressive and keep people under their thumb and often do, and that happens in the United States too, don't get me wrong, especially with the poorest of the poor. That's the ironic aspect of this whole thing. So you kind of get two different groups getting more often caught in the system, people with really good insurance or people with no insurance, because then the public system will pay for it.
Jesse: There was one case that you covered in your book which I found astonishing, which seemed to result in the Canadian government suing about 30 private facilities in the US for fraud after a series of, I guess, recruitment efforts? Cross-border recruitment efforts?
Rob Wipond: Yeah, the first time I heard about this, somebody called me, said, Hey, this happened to me. I was like, yeaahhh, you know? Because you're hearing such wacky stories so you can't help but come with a certain degree of skepticism, you know? As a responsible journalist you have to. And it just sounded so scary and unbelievable, you know, even though this person themselves didn't sound that way. They, you know, they presented the story in a way that seemed very credible to me, but I couldn't help but, I had to force myself to kind of doubt her and doubt it.
Nevertheless, she then forwarded me some of the evidence and I started to look into it and discovered that yes, in fact this was a well documented heyday of fraudulent Mental health treatment back in the 1980s and early nineties where US psychiatric hospitals were paying people to either come up here, or hiring people in Canada to go to different kinds of meetings of Alcoholics Anonymous, or mental health support groups, wherever vulnerable people were meeting. Offer them free sunbelt retreats and you know, like spa-like settings down in Florida or other nice places in the US. And all this is gonna be paid for by Canadian public health insurance. It's gonna be so wonderful, and even your flight is paid, come on down. And people would, and a large percentage of them subsequently got immediately detained in psychiatric hospitals, declared to be dangerous to themselves. And then the Ontario Health Insurance Plan, in this particular case where I found lots of evidence, was being bilked for millions of dollars. Like, ultimately the Ontario government sued these 25 hospitals for about 150 million as I recall, and laid it out in these court documents. And they ultimately settled out of court.
And then I discovered that this was just part of a much huger trend between the two countries, and also within the United States itself.
Jesse: One thing I really appreciated was how you framed the increasing prevalence of people being given a psychiatric diagnosis. Because you framed it as, that a diagnosis is essentially the first step towards a commitment, because you have to find that the person has a mental illness in order to justify the detention. So as that rate increases so does the number of people who have met that first step in the criteria towards psychiatric detention.
Rob Wipond: It's important for people to realize that the way civil mental health laws are written is that the first step is that you're diagnosed with a mental disorder. If you're not diagnosed with a mental disorder, mental health law does not apply to you. So this means the first step one criterion in potentially getting involuntarily committed is that you get diagnosed with having a mental disorder. Well, the latest numbers around this suggest that by the time they're 18 years old, 50% of American children will have had a clinical mental disorder. The latest numbers from a study in the Journal of the American Medical Association suggest that 86% of people at some point in their lives will meet the criteria for clinical mental disorder. So in effect, that means 86% of the population will at some point meet the step one criteria for getting involuntarily committed.
The other piece of the puzzle is that step two and step three and step four of mental health laws have all broadened out substantially. So this notion that you have to be some sort of really threatening, dangerous person, that's ancient history. Yes, if you are that you can be detained, but those are not predominantly the people that are getting detained. Most experts that I talked to said maybe 5% of people who are getting detained at psychiatric hospitals meet those criteria, the dangerousness criteria as laid out by the US Supreme Court. Most people are meeting these other criteria that are, you might be at risk of not being able to take care of your own personal needs, or you might be at risk of mental or physical deterioration. These are the actual wording, they're vague, they're amorphous. They can potentially apply to anyone in any way, just sort of judges and psychiatrists kind of make their own ad hoc decisions. And you would say, well, if all that's true, Rob, surely the consequences of that would be that the number of people getting detained would probably be going up and up and up? But we have this dominant narrative out there that they're going down, down, down. But no, they're actually going up, up, up, the problem is no one's ever really studied it in a formal way before.
And we finally got a good national study a couple years ago out of UCLA that found that although most states hide these numbers, don't show these numbers, don't collect these numbers very well, where they could find numbers they showed that pretty consistently, across the nation as a whole, the numbers are going up and they're going up dramatically. And that's true for Canada as well. And by dramatically I mean, in many places, doubling over the course of 5 to 10 years. I think this study concluded, over one 5 year period at about three times the rate of population growth, overall. So the numbers of people detained are really going up a lot.
Jesse: One of the things that's really sort of mind blowing to me about a statistic like 86% is that, even if we take that statistic at face value, it's a complicated thing to really figure out how you can determine that, it's a serious indication, like whether or not it's exact, it's an indication that the number is rising, the number of people eligible to receive a psychiatric diagnosis. But that's also not actually the criteria. The criteria is reasonable belief that this person probably has a diagnosable mental illness. And then you see the expansion of these laws to expand to like, I'm in New York City, the Mayor just announced a policy proposal to expand the dangerousness criteria to inability to meet your basic needs for food, clothing, healthcare, or shelter. It's just expanding to include poverty. And when you look at it that way, I don't see a way to view it other than just as a mechanism for social control.
Rob Wipond: It's very interesting because if you use that term, if you say the mental health system’s purpose is social control, it can sound to many people very, you know, inflammatory, or sensationalist, an off base conspiracy theory, that sort of thing. And yet if you ask anyone, pretty much, what is the purpose of the mental health laws? Of forced treatment? They immediately describe it in social control terms. They'll immediately say, well, the purpose is essentially we don't think this person is living their life in an appropriate way, is behaving in an appropriate way, and okay, they may not be breaking laws, but we still don't think it's appropriate and therefore we are going to lock them up, we're gonna forcibly treat 'em. That's social control. That's what it is, right? And so this is like some strange form of cognitive dissonance we as a culture live in. Where we kind of don't really want to admit what we're doing, what the purpose of this is. If the purpose was truly to heal people, to make people feel better, well, guess what? Almost nobody likes to have all their rights taken away, and they don't like it before, and they don't like it after, and they don't like it during. So that's not what's happening, and it's pretty easy to show that.
And so, yeah, I think that's the issue. We somehow cannot come to terms as a culture with what we're actually doing and as a result we're not making very reasonable decisions about how to improve the system. We're not being honest about the problems within it because we don't even wanna look at it. There's something right now where we just want to turn away from it, kind of let someone else control those people. I don't want to see, like, it's astonishing if you talk about this, how quickly people will come up with some example, like, yeah, but yesterday I was on the street and some crazy person yelled at me and, you know, kind of scared me. What are we gonna do with those people? Like that's the story they'll tell, and then they'll send you a link to an article of some person that pushed someone into a railroad tracks and they'll kind of, like, link all this together like, that's it, that's what we're talking about. And in their minds, that's what they are talking about. And then I try to say, okay, you gotta realize that's not what we're talking about. That person who pushed somebody off the tracks, they're in the criminal system anyway. That's not what civil commitments are for, that's not what it's about, so back up now. The person that you ran into the street? Yeah, what do you want to do there? And you're just assuming you're gonna help him when you lock him up? Like is that assumption correct? Let's think this through, maybe there's another approach. And that's what we're not doing right now, right now there's some strange assumption that if we lock them up and forcibly drug them, we will have solved this. And yet there's no evidence that that solution actually works. And it also raises the question like, well, if we're gonna talk solutions, what's a good approach? What's a potentially better approach? Right now, it's the only one that's being put forth. I mean, only one being put forth often in the mainstream, but it doesn't take that long for people to at least raise the question around, well, what about more affordable housing? What about simply Housing First support? People getting voluntary support to help them stay in their homes? Well, that would be a huge solution for that segment of the population, absolutely.
But we also need to understand that right now, involuntary commitment is affecting a much broader segment of the population than that. Those people that we're talking about on the street are almost like, they're becoming caricatured in our portrayal of them. They're really just serving a symbolic purpose in formulating an argument and not really what we should be talking about. We should be talking about more concretely, who really is being forcibly treated? What's happening to them?
Jesse: You speak to a significant number of people with personal experience having gone through some aspect of this system, having been pushed into some access point, or funnel. Do you have a sense of what people who have been traumatized by these systems are looking for? Do you have a sense of whether or not they're looking for accountability? Are they looking for change? Are they looking for acknowledgement? What sense did you have of what people need after they've been traumatized by this system?
Rob Wipond: That's such an important question, you know, and I wish to God everybody would ask that question more and more throughout our culture. The first answer that comes from my heart around this is they want to be heard. They want people to hear their stories, hear their perspectives, hear their experiences, to be heard and validated in that really first and foremost. And then in my experience, many of these people are extremely knowledgeable, because they are experienced, and as a result of this very traumatizing, frightening experience they've had, they've done their research. They've looked into these issues and they know what's going on, and they're very articulate in proposing what kinds of changes are needed. And so that's where I would go further.
So there's a whole battery of things that get proposed, and I think really everyone in this area is struggling to figure out what might work, right? I mean, a lot of people start from the premise of, this just needs to be absolutely abolished, it should not be happening. There may be an argument made for certain people at certain times, to detain them, to control them, but that's very different than dropping biochemical drugs into their brains. Which are super toxic and can really alter your consciousness. Like, why are we doing that? What justifies that? So, a lot of people would say we need to abolish forced treatment altogether. And I think there are very strong arguments to be made there. And then there's people who just think, that's just not gonna work because look at where our culture's at right now. And so they try to figure out more practical, immediate, possible solutions that might work at their local hospital, you know? Where they say, look, you know, or within their state, you know, how can we change the law to at least make sure that there are stronger, more robust, rights protections for people? People should have appropriate legal representation because right now in many states you can't even get decent legal representation in this kind of a situation. So there's a battery of things that people will bring to bear around changing laws, making sure people get representation, actually just following what the US Supreme Court has laid out should be laws. Most state, and provincial laws actually in Canada as well, are not in alignment with what the Supreme Courts in either country have said should be the criteria. Because those criteria were quite strict around true imminent immediate danger, and almost no one is applying that strictness of the law anywhere anymore.
Jesse: How long have you been researching this particular field, like psychiatric commitments?
Rob Wipond: 25 years.
Jesse: So, from the point when you first started this 25 year journey to the point you're at now, what has changed about the way you think about involuntary commitments?
Rob Wipond: It's just far more broadly used than I had any idea at the beginning. I knew right away it looked abusive to me, and dangerous, and then I started to have a vision of sort of the wide array of situations this very extraordinary legal tool is used in. But even in my worst imaginings, I did not imagine what I found when I looked deeper and deeper. And still today, each day, I hear a yet more shocking story. Something that I go, I should have known that, or, yeah, maybe I got a hint of that now that I think about it, but I never really followed up on it 10 years ago. Now somebody's really laying it out for me and I'm realizing, oh my God, it's happening here too.
It's just the extent to which this tool is reshaping people's lives and reshaping our entire society like, you know, the latest for me is talking with more and more people that work in group homes. And out in communities where just the day-to-day life of a person, everything they do from the moment they get up, to the moment they go to sleep, to how long they sleep, right? And what drug they're taking before they go to sleep, all of these things are being acutely monitored. There's a level of surveillance and policing going on, of a vast sector of our society, that almost no one knows about. It's much more intense than probation for criminal offenders, which itself can be fairly aggressive. But here in the mental health world, just an average person who's been labeled with severe mental illness and has ended up in a group home because maybe they're struggling in some ways to meet some of their own daily needs, and maybe they do need some level of support. Instead of getting voluntary support, they're getting involuntary control. And it's the sheer extent of that I am still just learning about it, and to me it's quite frightening. So that's one of the big things that's changed. I just never really had a sense, I think, of the level of detail, of the control mechanisms that are taking place out there in terms of people's individual lives.
And then the other piece of it is just the sheer scope of it across the culture in all these different places in our society. Where pregnant women are getting locked up, you know, to try to control them and their fetuses, and whistleblowers are getting caught and people in workplaces, just a performance evaluation can suddenly turn into a recommendation for you to get psychiatric help, and then it turns into pressure for you to take psychiatric medications. Again, something I really didn't know the scope of that when I began.
Jesse: Well, Rob, thank you so much for the interview, thank you for the book, I really appreciate the work you're doing.
Rob Wipond: Oh, great.
Jesse: So, thank you.
Rob Wipond: Okay, thanks, take care.
Jesse: Committable is produced by Jim McQuaid. Michelle Stockman and me, Jesse Mangan. All music is from the Song Reasonable by Christopher G. Brown.