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Lines In The Sand

Every relationship has ground rules, and everyone who has been in a relationship for an appreciable length of time knows what they are.

So when you’re arguing, you know that there are certain buttons you just don’t push, certain subjects that you just don’t broach.

You Just Don’t Go There.

And when you cross those boundaries, you know there will be consequences, ranging from getting the cold shoulder for the next few days, to unwilling celibacy for the foreseeable future, to having her/him toss you out on your ass.

And when your argument spills over into physical violence, expect that one or both of you will go to jail when the cops get involved.

Likewise, there are some things you Just Don’t Get To Say.

If your spouse/lover/life partner/ babydaddy chose to get the police involved, or if a third party overheard your argument and called 911…

… well, suffice it to say we don’t grant Mulligans. You don’t get to take it back.

And chief among those things You Just Don’t Get To Say in an argument is, “I’m just going to kill myself.”

Almost as bad, but without the implied threat, is, “I wish I was dead.”

Make the threat more specific, like say, threatening a specific way to do harm to yourself, just adds the element of a defined plan to your suicide threat, and makes it all the more credible.

Say those things, and I can guarantee you one outcome: You. Will. Go. To. The. Hospital.

Your only choices are whether you go restrained or unrestrained. You don’t get to say no any more.

And yes, I am perfectly willing to believe that you said it in the heat of anger and didn’t really mean it.

I also believe that someone who seriously intends to kill him/herself would be willing to tell any lie necessary to get the cops and paramedics to leave so they can get on with mixing their hemlock smoothie.

You don’t get to be that person.

And no, I don’t really give a rat’s ass if you get a mental health record or if you have class/work/social engagements in the morning that you just can’t miss.

Neither am I going to lose sleep over the fact that a 48-hour stint in the psych ward ruins your chance at that law enforcement career you’ve been so zealously pursuing, or takes you out if the running for Man Of The Year at the local Rotary Club.

Pleading with me for lenience is only going to fall on deaf ears. The only leniency you get is the ability to choose the pleasantness of the ride.

You made the threat. I don’t get to decide whether it is credible, nor do I want that responsibility. Plead your case to the ED doc and the mental health tech if you want. Sometimes, if they believe your story, they’ll cut you loose.

But it’s my job to get you there for that conversation, and get you there I will.

Fighting with me is pointless. I will win that fight, every single time, and all your struggle only guarantees that you will spend the next 48-72 hours walking around in shoes without laces and talking to psychiatrists about things you’d rather not discuss with strangers.

So, consequences.

Don’t like ‘em, then don’t say those things. Don’t cross that line in the sand.

Hugs and Kisses,
Your friendly neighborhood Ambulance Driver

Comments - Add Yours

  • Jess

    Good post, especially on the suicide threats. When it comes to such things, there’s nothing to do but call for help. If they’re sufficiently despondent to say such a thing, you never know if they’ll act on their threat and if they do, you’ll have a hard time dealing with the guilt. 

  • http://speakertweaker.blogspot.com/ Speakertweaker

    I swear, reading this reminds me of a conversation my buddy has with his three-year-old, right around the time it gets late enough for the kid to get cranky and, more importantly, whiny.  My buddy tells him every time, “Child, when you get whiny, that’s how I know it’s time for you to go to bed.  If you don’t want to go to bed, don’t get whiny in the first place.  Whining about going to bed is only going to get you there faster.”

    Course, Little Dude is only three…

    tweaker

    • http://twitter.com/tjic tjic

      > I swear, reading this reminds me of a conversation my buddy has with his three-year-old

      The difference, of course, is that three year olds don’t have a full set of God given rights that are codified in the Bill of Rights – adult human beings do.

      I fully support a father treating a three year old like an infant.

      I do NOT support a State treating an adult like an infant.

      • Plburghardt

         Isn’t holding someone accountable for their words — taking their words seriously — treating them as an adult?

        Another point: we had a suicide by semi on the highway here recently.  The semi driver didn’t have a choice about participating.  What about his freedom?

        • Dave

           Not when it boils down to “You said something naughty, now go to time out”…

        • Matt Radcliffe

           Yes, people are responsible for their own words. But they have rights.

          What happened to the semi driver is a horrible thing but we should not lock up anyone that MAY someday do something horrible.

      • http://speakertweaker.blogspot.com/ Speakertweaker

         Just for clarification, I’d like to emphasize the my last sentence:

        “Course, Little Dude is only three…”

        The implication being that treating a three-year-old like a three-year old is normal.  An adult deserves a bit more consideration.

        tweaker

  • jetfxr69

    Jeez. I started out reading and thinking you’d had a relationship fall apart over one of those lines.

    Then reading comprehension and additional detail/exposition kicked in and I got it.

    Yep, pretty much what Tweaker and Jess said. Saying it only removes the doubts I’m having if the thought has even crossed your mind. The phone is getting dialed and you will NOT be alone while waiting…

  • Old_NFO

    At least you weren’t scraping them off the front of a Semi… BTDT… (her 4th attempt was finally ‘successful’)

  • Sean Murphy

    Sorry AD, I have to dissagree with you here. The person in question is the owner of their own body, life, mind, and spirit. They have every right to desroy things they own. Their life is theirs to do with as they please. That includes ending it. You do not own their life, and have no right to force them to go anywhere, do anything, or receive any treatment that they don’t want.

    • mpatk

      FWIW, I agree that people should have the right to do whatever they want with their life, including end it, as long as it doesn’t affect another person’s freedoms.

      The problem with your approach is that society as a whole, and the governments (federal, state, local) in particular disagree.  And once the magic form is signed (5150 here in California, your numbers may vary), the paramedics DO NOT have a choice in the matter.  Since we’re not permitted to place people on involuntary holds, we can not and should not be allowed to clear people from involuntary holds.

      Personally, I don’t think that EMS should be involved with involuntary psych holds at all, since EMTs and medics aren’t permitted to place people on holds in the first place.  Too many police officers just fill out the hold form and then “turf” the patient to the ambulance to deal with.  Unless there are clear medical issues involved (OD/toxin ingestion, actual hanging/shooting/stabbing), EMS doesn’t need to be involved.

      • http://twitter.com/tjic tjic

        > paramedics DO NOT have a choice in the matter.  

        Sure they do.

        We all have free will.

        No one is forcing you to put a Jew on a train, or a free person in a psychiatric hospital.

        If you do it, be a man about it and admit that you CHOSE to do it and that your paycheck is more important to you than someone else’s freedom.

        • mpatk

          Roberta X said it best. Calling 911 or a suicide hotline is NOT the same as simply “mention[ing] it out loud”. It is either a cry for help, or a demand for attention. I am not willing to risk my livelihood and my family’s security for the freedom of someone whose actions are DESIGNED for them to have their freedom taken away.

          If a person is So much of an attention whore that they must make their “suicide” a big dramatic production (or they’re too stupid to see the consequences of such attention) then they’ve brought the psych hold on themselves BY THEIR ACTIONS.

          I’ll support someone’s freedom of self determination, not their freedom to tie up valuable public safety resources with grandstanding dramatics.

          • Matt Radcliffe

             Yes that is one outlook but if you look back at the original article it is about dragging someone off if they mention the idea in a conversation with someone not about someone calling a suicide hotline. Even if they do that asking for someone to talk to is no the same as asking for the help of being locked up.

        • Matt Radcliffe

           To be fair to them the paycheck/civil liability is only one of their motivating factors. They may believe that they are doing the right thing and that this is justified in saving a life. That is a legitimate moral argument even if it does oppose what some of us believe were the principals of the founding fathers.

    • BH

       The law says otherwise, sport. 

    • Ambulance_Driver

      That’s a very nice philosophy you’ve got there, Sean, but for the fact that other people are involved.
      Kill yourself if you want to, but it’s not going to be on a day when I’m civilly liable, with my certification and livelihood at risk for allowing you to accomplish your goal.
      So once I’m in the mix, you have lost your right to self-determination until such time as a physician, the courts, or both declare you fit to make your own decisions.
      That’s my position, and the laws are on my side.

      Kelly Grayson

      • http://twitter.com/tjic tjic

        > Kill yourself if you want to, but it’s not going to be on a day when I’m civilly liable, with my certification and livelihood at risk for allowing you to accomplish your goal. 

        How does this differ from “OK, Jew, I understand that you want to leave this prison camp, and that would be OK by me, EXCEPT for the fact that I’d get written up and get three demerits if I let you, therefore I won’t let you – your actions have consequences for other people, and you have to realize this!”

        If you’re unwilling to allow other people to be free because it would give you demerits at work, maybe you’re in the wrong line of work.

        > That’s my position, and the laws are on my side.

        Ah.  “Just following orders”.

        • Kristopher

           It ain’t the police that are the real problem, tjic.

          The suicide’s relatives will sue him into poverty if he does not follow procedure and the suicide offs himself.

          • Matt Radcliffe

             The argument here is still that of someone removing the liberty of another just to protect themselves. It is one of the weaker arguments for this on here ethically  but one of the strongest to many people who are concerned with their own life.

            Removing someone else’s freedom is not justified to cover ones own ass. It may be justified on other grounds.

      • http://twitter.com/tmoreau2 ILTim

         Just one more way that we COMPLETELY forfeit all freedom instantaneously, without warning, consent, or knowledge.  How many people, knowing that they become your property subject to decisions based on your professional certifications, would EVER pick up that phone and call?  How many people are desperate to put that genie back in the bottle after learning this horrendous truth? 

        NEVER call for help.  NEVER.  Read this post and understand, you are forfeiting your free will the moment you call. 

        • Ambulance_Driver

          If the call involves threatening to kill yourself, yes you are forfeiting your free will for the next 48-72 hours, but don’t make me the bad guy here.
          If you want to kill yourself, I have no intention of interfering with your right to self-determination… unless it involves putting me at risk.
          Do it, don’t just talk about it, and don’t get me involved.

          Kelly Grayson

    • Too Old To Work

      Nice sentiment, Sean. Unfortunately there is a lot of legal precedent that puts physicians, nurses, EMS providers and others on the hook if someone says they are going to kill themself, nothing is done, and then the person kills themself.

      You can, and should, go check out Rogue Medic’s position on “patient kidnappint”. It will be instructive because he’s just about 100% wrong on the issue.

      These are never easy calls. Sure, more often than not they are just BS as the result of some lover’s quarrel. The problem is that there is absolutely no way to know when that’s the case and when the person is full of it and when they really, really, mean it.

      The only really reliable indicator is previous suicide attempts. In that case, there is no gray area, but in most of the rest of them, there is.

      In an ideal libertarian world, we’d leave people alone. In that same world, we’d be able to do that without fear of liability. I don’t know about you, but I don’t live in that world, I live in the one where people are eager to sue for any error.

      • Matt Radcliffe

        If you see something you believe to be an injustice but are coerced into it is the moral course to accept it or to oppose the coercion? Would it be better to fight the legal situation that makes you legally responsible for the actions of another?

        • Ambulance_Driver

          And if fighting it the way you’d have us do it results in us being unemployed and unable to provide for our families, and subject to various criminal and civil penalties?
          Would that be morally acceptable to you?

          There are a number of ways of fighting within the system without choosing a frontal assault doomed to fail.

          • Matt Radcliffe

             Even if you choose to go along with what is expected of you a little more understanding for people would be compassionate in the original article. The whole hauling them all off with no remorse or concern for if they are guilt thing does read a bit callus. There is no body language or tone of voice on the internet.

    • Dave

       Unfortunately, the law disagrees with you.  The state is the owner of your body, life, mind, and spirit(or so the state says).  The state reserves to itself the right to destroy those things.  In other words, you’re morally right and legally wrong.

  • Detroit EMT

    Love it. I do probably 5-7 psych transfers a week, so this hits home. Had one last week that tried every excuse in the book. Then he started making threats at me and my partner. I told him straight up, “look man, you said things last night while you were drunk. You can’t take those things back, and if you can’t control your drunk self, that’s a separate issue. Now we are taking you to the behavioral center one way or another. Yeah, you can swing at me, and you MIGHT get me, but then these 5 security guards are going to have their chance at you. Then, while they’re holding you, this cute 90 lb nurse is gonna inject you with what we call STFUSS (shut the f*** up and sit still). Then, we’re gonna tie you into an uncomfortable position and you’re STILL going to the behavioral center”.

    He sat there on the cot nice and quiet the whole 30 minute ride.

    • Matt Radcliffe

       On the questions of if we are talking about being detained this is a clear example. Someone is being threatened with being attacked by multiple security guards, tied up and injected with medication because they allegedly said something when they were drunk. Using unnecessary medical treatment as a threat to detain someone is low. If they were arguing about wanting to leave so that they could go kill themselves you would have more high ground but if they are just saying that they don’t want to be locked up against their will then it is less defensible.

      • mpatk

         While I also agree that Detroit EMT’s remarks sound unprofessional, you’re missing a very important point.

        The patient is threatened with the security guards and medication ONLY IF HE THROWS A PUNCH.  In other words, only if the patient becomes a physical threat to the EMT will he be subject to restraint by the guards and RN.

        For my part, I’ll usually explain that there is a legal piece of paper that says they will go with me.  If they’re reasonable in their arguments, then I’ll usually talk to them about how to most quickly get released and how to avoid another psych hold in the future.  However, the instant they cock their fist or take a kick at me, they get the “Sit down or be tied down” ultimatum.  I’ve had colleagues hospitalized due to assaults by patients like this; and a lot of the patients are thinking, “I’m on a psych hold, I can’t be arrested for what I do right now.”

        That is generally every EMT/Medic’s breaking point.  Call us whatever vile name you want, shout anything to anyone in hearing; but if you become a real physical threat, the game changes.

        • Matt Radcliffe

           Taking physical action to protect yourself is completely justified unless it is established that you were wrongfully holding him and were therefore the source/cause of the conflict. As long as you are justified in holding the person you have every right to defend yourself with all necessary force.
          Problems
          1. Just because that force is justified in defense doesn’t mean it is justified in all threats you may use if you use that threat to coerce anything beyond your safety then it becomes less moral.
          2. Drugging them. Most of us view involuntary administration of drugs as being way up the ladder of force. Not only is it a potentially dangerous tool it is one of the stronger violations of a person that is possible. Altering the way someone thinks removes their self determination physically and also assaults the mind that in all other things remains involute. To use it when not absolutely necessary is nothing short of criminal, to use it as a threat is little better.

          • Ambulance_Driver

            Just to be clear here: the only people we drug are those who are CLEARLY not in possession of their mental faculties, and the state of their physiologic arousal poses a danger to themselves and the rescuers. The why’s and wherefores are long enough for a blog post in itself.

            When we sedate someone, they are almost without exception people who are violent, and I’m not talking about those who say, “I’m not suicidal, I don’t care what someone else said, and if you try to take me against my will there’s gonna be a fight.”

            For *those* people, there is only a struggle if they wish one, and the physical force is limited to restraining the patient safely. Blows may be struck, although I fervently hope not, but rarely by me or the other EMT’s. Mostly it’s done by overwhelming numbers and speed sufficient that no blows CAN be struck. And once the patient is restrained, all of that ceases.

            Obviously, I find those struggles distasteful, but I will not shrink from them if that is my only option.

            The sedation is reserved for patients in a heightened state of physiologic arousal called “excited delirium.” Most often it is caused by mental illness and a combination of stimulant and/or hallucinogenic street drugs. Sedation for THOSE patients is essential, and quickly,
            because the fight does not end once they are restrained. They fight
            against their restraints, all the way to a physiologic death spiral.
            Most of the “Tazer deaths” you read about in the papers were patients in
            excited delirium. The Tazer probably had little to do with it, but they
            don’t issue sedatives to cops because they don’t have the training to
            administer them safely.

            We do.

            In those cases, the sedation is LITERALLY to save the life of a patient
            who is obviously mentally incapacitated.

            Otherwise, we don’t sedate your garden variety psych patient – and most
            especially the ones we think were speaking in anger or the heat of the
            moment, or those accused by third parties – for one simple reason:
            psychogenic drugs make it damned hard to separate the sheep from the
            goats once we arrive at the ED. It’s impossible to reliably assess a
            depressed patient’s emotional affect if they’re sedated, and thus
            impossible to judge if the patient needs to be committed or not.

            Sedating the violently psychotic patients actually makes it *easier* to
            assess them, because once sedated it is far easier to communicate with
            them. Kind of hard to ask a patient, “So, how are you feeling?” when the
            patient’s hallucinations make the caregivers look like face-eating demons.

          • Matt Radcliffe

             Much more reasonable, and I wholeheartedly agree with necessary action for people that are obviously in such a delirious state.

            Using drugs as a threat to force compliance or on anyone that throws at punch at you in their own home that you are trying to drag them away is ethically inexcusable.

            Now there may be a few instances where this amount of confrontation to secure a patient is necessary I sure wouldn’t want to see this happen too often.

            I really can’t predict what level of force I would use if a couple of your equivalents in this state showed up and tried to haul me away for something I allegedly said. For one thing any yahoo crackpot can order a EMT uniform and as far I know there isn’t even a law to stop a burglar/home invader from doing so. I wouldn’t be happy if an EMT somewhere got shot trying to force their help on someone else but I sure wouldn’t be surprised either.

          • Ambulance_Driver

            Well, generally they have ambulances and fancy equipment that costs many thousands of dollars to go along with the spiffy uniforms, but I get your point.

            The acid test: If their uniform does not bear coffee stains, and the EMT does not look tired and slightly rumpled, he’s probably a friggin’ impostor up to no good, or a supervisor, whichever.

            Shoot those on sight. ;)

          • Matt Radcliffe

             Acknowledged.

          • mpatk

             I also won’t use chemical sedation as a threat.  If I’m using chemical sedation, it’s because the patient is violent beyond reason and neither discussion, threats or even forcible restraint will reduce their violence.  Usually there’s some drug involvement, though I’ve seen it arise from PTSD.

            As for imposters, I know of no state that allows EMS alone to take a person off the street on an involuntary psych hold; the police must ALWAYS be present and make the final decision to send the person to the ED.  From there, it’s up to the doctors and mental health professionals.

          • Matt Radcliffe

             For the first paragraph: Good.

            For the second: Shifting the responsibility to another person that is even less qualified than you to judge medical issues is a poor shield for the morality of your stance.

          • mpatk

             Matt, not shifting responsibility.  You asked how to deal with the potential for imposters; if there’s an EMT at your house trying to claim a psych hold without police to back him up, something’s wrong.

            My patient, my ambulance, my responsibility.  I take that VERY seriously.

  • Shafers38

    Well put, A.D.!

  • Nick42

     So what’s the legal standard for someone reporting a suicide threat that’s believable enough to act on?

    If an intimate partner / family member calls 911, when EMT / police respond the reporter is there and the reportee is obviously distraught, that seems pretty cut and dry.

    But what if you respond to anonymous complaint and the supposed suicidal party answers the door in a calm, collected manner?  Or more likely there’s some kind of drama, but they deny any suicidal tendencies or thoughts?

    • Ambulance_Driver

      There’s gray area and wiggle room, but when the patient herself admits to saying it, or the 911 caller who witnessed the threat is there on scene, I treat it as credible.
      In those instances where anonymous third party callers have reported a suicide threat, usually what we do is go with who we find more believable – a lucid, alert and non-distraught patient, or a shadowy 911 caller who refused to even give a name. In those cases, we’re more likely to take the patient’s word.
      We’ve also reviewed 911 tapes when the caller wasn’t on the scene, called the 911 caller back, and had them reiterate what they saw/heard specifically.
      Kelly Grayson

      • mpatk

        So can you place the person on a hold? Or do you need law enforcement to make the actual official decision?

        • Ambulance_Driver

          We don’t place them on the hold. Actually, law enforcement really doesn’t either, but they invariably support our position on the issue.
          In Louisiana, the parish coroner (an elected official, and not necessarily a physician) grants broad authority to law enforcement and EMS personnel to transport patients to the ED for a psych evaluation.
          It’s called a CEC, or coroner’s emergency certification. They can be issued directly in cases where there is no acute event or immediate threat to the patient or others, or we can act on his behalf if there is credible evidence, by word or deed, of an immediate threat.

  • http://mymountaintopblog.com/ Blog

    My favorite is suicide by Internet….saying good bye to 400 Facebook friends….then sending out a broadcast text message to another 100 people….then telling the army of EMS, police, and fire that show up that they were ‘just upset at the time and didn’t really mean it.’

  • Matt

    Yeah, you take  people who are asking for help and subject them to massive abuse and exploitation.  The system claims to want to help, but it’s nothing but a lie, they just want your money and to abuse the hell out of you.  There is no help available and asking for help is probably the most self-destructive thing a person can do.

    • Ambulance_Driver

      You lost me. Want to explain that one?

      • apotatofarmer

         I think what the other person was saying is that it makes no sense to take a desperate despondent person and put them into the hands of the incompetent and mentally ill “experts” who are after money, power, and above all else, feeding their ego and pretensions of serving a useful function in society. A suicidal person has a problem, psychiatrists and psychologists ARE a problem.

        • Ambulance_Driver

          I don’t think psychiatrists are a problem, per se, but our revolving door mental health system is.
          Psychiatric care is an essential and legitimate specialty, but sadly, for too many of our mentally ill, what passes for adequate psychiatric care is institutionalization, medication, stabilization, release, and…
          … very little follow up outpatient care.

          Lather, rinse, repeat.

          Complicating matters is that a large portion of our mentally ill have conditions that were caused by, or exacerbated by, substance abuse.
          The problem as I see it isn’t that psychiatrists are too blame, only that a) there are too few if them willing to provide comprehensive psychiatric care to the unstable mentally I’ll, and b) consequently too many of them resort to over medication without any real psychiatric services.
          Kelly Grayson

          • apotatofarmer

             Thanks for the intelligent response.

            As a young man I saw 18+ psychiatrists and psychologists, almost all were incompetent and insane. One was a psychopath, and two were paranoid and delusional (they later got some national press for one of their witchhunts, it turned out the recovered memories of ritual satanic abuse were actually implanted by these two nuts).

            I’d like to think my personal experiences are just anecdotal, a bad run of bad luck, mere exceptions to the rule, but having talked to more than a few patients, and having read more than a few books and theories by many of the movers and shakers of the field, my conclusion is that they are a problem, per se.

            The incompetence of the majority is what seems to concern you, and it is a major problem, but I think an even bigger issue is that so many psychiatrists and psychologists and their leaders are lunatics. YMMV.

  • Nick42

    Thanks for the response AD.  As I am security geek / libertarian instead of  legal or medical professional, I tend to look at how these things can be abused.  I guess the involuntary commitment procedure is a lot less likely to result in permanent harm than swatting.

    I do find it interesting that the Corner is responsible for this determination.  Corners seem to have a lot of powers that I wouldn’t expect – In several jurisdicitons they are responsible for arresting the sheriff if need be. 

    • Ambulance_Driver

      Louisiana’s system is kind of jacked up. In most states, coroner is not an elected office, but in Louisiana it is.

      Here, you don’t even have to be a physician to be elected coroner, but if a non-physician runs against a physician, the physician wins by default. In the parish I used to live in, the local florist was our coroner for years, and he was MUCH better than the physician who took his place.

      In the parish I work in now, the director of one of the funeral homes is the parish coroner, and has been for twenty years or more. He does a good enough job that nobody, not even a physician, ever bothers to run against him.

  • http://twitter.com/tjic tjic

    This seems like a remarkable – and disgustingly – fascist stance.

    You’re not only willing to stand by while someone is imprisoned based on words that he says, you’re willing to actively restrain a free human being who has given zero evidence of intending to harm another and hand them over to other people who will cage them while they are restrained, observed, and given God knows what drugs against their will…all without a court order, a jury of their peers, or any other sort of warrant.

    …and you don’t try to justify this through argument.  You just assert it as fact “I will be a willing tool of the State and lock you up, because I’m Just Following Orders”.

    I find it hard to understand such a mindset.

    • Stevedschultz

      tjic….we ae not free people….we are wards of the state.  An officer of the state can do anything he wants as long as he deems it neccesary to protect the wards of the state.

      Steve

      • http://twitter.com/tjic tjic

        > tjic….we ae not free people….we are wards of the state.  

        In practice, true. 

        I’m trying to argue with one agent of the State that he should not be so blithe about oppressing people.

        I assume that Ambulance Driver has free will, may be a good person, may care about liberty, and may be persuaded to not be a tool of the government.

        • Kristopher

           It ain’t the government that would sue him for failing to intervene.

          The suicide’s relatives will sue him in poverty.

          Deal with this first, before you expect others to uphold an idiot’s right to idiocy. Said idiot could have just bought an N2 tank and plastic bag and played spaceman spiff in the bathroom.

          He decided to attention whore and put EMS on the lawsuit hotseat.

          That little attention whore can screw himself. If he wants to own his body, then he should own it, and not expect EMS persons to put themselves at any liability risks while he ends it.

    • borepatch

       I’m pretty comfortable with this for minors.  Adults have better impulse control, and so it seems a lot less risky to let a Drama Llama say what they want.

  • http://profiles.google.com/yrrosimyarin Yrro Simyarin

    I in no way blame you for enforcing the law as written. It isn’t your duty to throw your career away and the good you do otherwise as a political protest.

    But man, that law is messed up. I think the real takeaway here is “never call 911 if someone you love says they’re going to kill him/herself, because you’re just about destroying their life.” Talk to them, try to get them help, but make damn sure it is all voluntary and not involving the authorities.

    • http://twitter.com/tjic tjic

      > I in no way blame you for enforcing the law as written. It isn’t your duty 

      You’ve got a very small and legalistic understanding of duty.

      • Ambulance_Driver

        And you’ve got a very broad and distorted view of fascism.

      • http://profiles.google.com/yrrosimyarin Yrro Simyarin

        It’s a lot easier saying that when it’s one issue, and it isn’t your life. Of course, that cuts both ways. But given that we are talking about ostensibly medical treatment, not death camps…

        What good does he do getting fired, I guess, is my question. That isn’t going to change the law. Go start a movement and write pamphlets and picket or something.

        One prison guard refusing to be a prison guard just results in a job posting.

  • http://twitter.com/tmoreau2 ILTim

    Who the fuck are you to decide that a person should be dragged against their will to gitmo/ fluffy bunny land/ wherever you please? That type of personal violence could and should be resisted in every way available and necessary including lethal force. 

    • BH

       Don’t like the law, change the law- unless you’re just a tough talker, of which we see many.  Advocating lethal force against those bound by said law is irresponsible, stupid, and trollish. 

      • http://twitter.com/tmoreau2 ILTim

         The law is no excuse, only cowards hide behind it.

        • Ambulance_Driver

          A fine theory, out in that libertarian utopia that doesn’t exist.

          A fine *theory*, most especially when you’re not the subject of the theoretical exercise.

          • Matt Radcliffe

            One may well ask: “How can you advocate breaking some laws and
            obeying
            others?” The answer lies in the fact that there are two types of laws: just and unjust. I
            would be the first
            to advocate obeying just laws. One has not only a legal but a moral responsibility to obey
            just laws.
            Conversely, one has a moral responsibility to disobey unjust laws. I would agree with St.
            Augustine
            that “an unjust law is no law at all.”
            Martin Luther King Junior

            You are responsible for choosing the morality of your own actions.  You may be doing so but ILTtim is correct that law does not define morality even though morality “should” limit law.

          • Ambulance_Driver

            I can’t disagree with any of that statement.

            I guess the difference is that the times I feel my actions are morally justified in following that law far outweigh the times I feel it is an injustice, and I see no point in sacrificing the good I do for a protest doomed to fail.
            Kelly Grayson

      • http://twitter.com/tmoreau2 ILTim

         What really grates me here is not the person who dials 911 and threatens suicide, or the person who’s locked in a bathroom threatening the swallow the whole medicine cabinet while someone else calls…. its the bold statement that if I mumble “I’d be better off dead” in my front yard then walk inside, the G-man will come and take me away.  No explanations, no assessment of the situation, simply “Your only choices are whether you go restrained or unrestrained.”

        A rational person now lives with the awareness that the right buzzwords or catch phrases will bring your friendly Hugs and Kisses neighborhood Ambulance Driver to take you away.  Not the national guard, swat, or even local police.  Whats next, a mailmen with tasers and handcuffs?

        Beware while your BS’ing with friends over a few too many beers on the patio, say the wrong thing and poof you’ll be swept off “restrained or unrestrained”.  Lethal defensive force is the LEAST I can offer, and the most I’ll publicly advocate.  

        I absolutely don’t give a rats ass what the law says about any of this. 

        • Ambulance_Driver

          1. I’m never doing it by myself. The police are always with me. In some jurisdictions, the police transport. In ours, the EMT’s do. But the police are almost always involved.
          2. You neglected to read that whole comment thread about where we DO assess the situation. I’m likely to take the word of a calm and lucid patient over some vague and shadowy 911 callers who is not on the scene and didn’t give a name. However, if the patient admits to saying it, my hands are tied. I’m not the one who gets to decide whether it was a valid threat or not. The ED doctor is.
          3. In the context of “coming to take you away,” I’m more like the guy who gets to take you to the embarkation point where you *might* get taken away if the doctor is convinced you are a danger to yourself, and…
          4. Your only choices in that matter ARE restrained or unrestrained. The majority go unrestrained and we have a pleasant ride and a conversation on how to best convince the ED doc that you’re not a danger to yourself, but I can and will restrain you if that is the only way to accomplish that transport.
          But let’s not confuse my “fish or cut bait” speech, often given an hour or more on scene AFTER I have assessed the patient and the situation, with me throwing my weight around and being overly authoritarian. I work a 911 ambulance, and emergency calls are holding while I’m trying to convince the drama queen why she shouldn’t threaten to kill herself if she didn’t really mean it.
          5. As for “who the fuck gives me the right” to do all this, it’s your friendly neighborhood Congresscritter, via the Baker Act, but I don’t look at it as a right, more like a dirty job I’d rather not have.
          6. There is a simple way to keep from even needing deadly force to resist such things: don’t open your mouth and threaten suicide, even jokingly. I’d much rather not be on scene when the liberty-loving dude gets gunned down over his principles because it was his right to get good cops and medics involved in his drama play.

          • Matt Radcliffe

             In response to #2 that is much more reasonable but it is the opposite of what you said in the original post where it was “Say those things, and I can guarantee you one outcome: You. Will. Go. To. The. Hospital.”In response to #3 you are physically detaining someone without probable cause to believe a crime has been committed. You may only have the legal authority for a limited time span but you are taking someone away from where they choose to be. In response to #5 California may not like it but their laws are limited by the US constitution and the supreme court was well as human rights. We are not arguing that the law of California doesn’t approve of your actions but that its approval doesn’t necessarily make it legally right and it has no bearing on its being morally correct or not. How long has it been since homosexuality was a disease that needed treating by mental health professionals? #6 is good advice but then again keeping ones mouth shut about racial equality in 1960s Florida would have been safer too. The safe and easy road is not necessarily the easy one. Don’t anyone think that I approve of deadly force in such a situation, civil and peaceful resistance to these actions are by far more preferable and more effective but however peaceful the resistance to injustice and tyranny is a American ideal.

          • Ambulance_Driver

            No, it’s not the opposite of what I said in the original post. I said, as you directly quoted, “Say those things, and I can guarantee you one outcome: You. Will. Go. To. The. Hospital.”
            If you DO say those things, then that is exactly what will happen.

            If you are ALLEGED to have said those things, then I looks for corroboration and weigh the patient’s words against the callers.
            In regards to #3, it’s not about a crime at all. It’s about a presumption that an imminent threat to life and safety of the patient and others exists, based upon available evidence, including the words, actions and physical evidence of the patient and credible witnesses. You can be taken in for questioning as a material witness or suspect in a crime, without being formally charged. You have rights during that questioning, as outlined in Miranda and other established legal doctrine, but it is not “depriving you of your liberty.”
            As for the rest of your reply, I can appreciate your sentiments, but let me ask you one simple question: Have you never, not even once, obeyed a law that you felt was wrong, silly, or even unjust?
            If you’re telling me you’ve been able to remain morally in compromised in all your years on this Earth, then I applaud you for accomplishing something virtually no other human being has.

          • Matt Radcliffe

            Choosing to follow a law that is wrong, silly or unjust to yourself is a personal choice. Following a law that is an injustice to others is morally wrong. I can’t think of any time that I have imposed an injustice on another under cover of law.

            Whenever someone is detained against their will they are being deprived of liberty. This is allowed under many laws and it is morally acceptable only somewhat less often then it is legal but to claim that liberty has not been deprived when you lock someone where they do not choose to be is a prima facie fallacy.

            Anytime you do not hear the words yourself but still judge them to have been said you are acting in place of a jury.

  • http://twitter.com/tmoreau2 ILTim

    “I think the real takeaway here is “never call 911″”

    And That’s all, folks.  Nothing more to be said.  I’ve learned this lesson myself, and someday, you’ll all learn it too. 

  • http://twitter.com/tjic tjic

    > You made the threat. I don’t get to decide whether it is credible, nor do I want that responsibility. 

    Unfortunately, part of being an adult is being responsible for your actions.  You DO have the responsibility to decide whether the orders you’re following are moral, legal, and legitimate. You DO have the responsibility of deciding whether you want to be complicit in caging a free adult and handing him over to a mental hospital.

    Being an adult isn’t easy, but saying that “you don’t want the responsibility” while choosing to follow orders is a cop-out.

    • Wing and a Whim

      If part of being an adult is being responsible for your own actions, and the repercussions of those actions, then shouldn’t this criticism be aimed at the person who took the action of stating a suicide threat? AD isn’t exactly showing up out of the blue on slow Thursday to haul some completely unsuspecting blameless citizen off to the gulag; he and the police are there precisely because threats of harm were made by the person who now doesn’t want to deal with the consequences of their actions.

      Trying to get him to shirk his own duties, responsibilities, and legal obligations, and suffer all the consequences thereof, is a damn poor way of trying to get some other person out of the consequences of their own actions.

      tl;dr summary: That’s not a dragon you’re tilting at, sir, it’s a windmill.

  • http://www.twowheeledmadwoman.blogspot.in/ Roberta X

     Killing yourself: a legitimate exercise of the right of self-ownership.

    Threatening to kill yourself: Extortion.  It is exactly the same as threatening to kill a hostage.

         The threatener is initiating force-by-proxy on those with whom he shares his threats.

         Dammit, this isn’t rocket science.

    • Ambulance_Driver

      Bravo.

      You distilled the whole issue into two simple sentences.

    • http://www.facebook.com/profile.php?id=100000783801772 S Andrew Nicol

       Yup, if you’re gonna do it, then do it… quietly and alone.

    • http://twitter.com/tjic tjic

      > Threatening to kill yourself: Extortion.  It is exactly the same as threatening to kill a hostage.

      I find the logic whereby one has the right to do a thing, but one does not have the right to mention out loud the plan to do a thing confusing.

       

      • http://www.twowheeledmadwoman.blogspot.in/ Roberta X

         No, no — “Do not have the right to mention your suicidal intent out loud to EMTs/Cops/Firefighters/concerned clueless and expect them to reply, ‘Well, okay then, can I loan you a can of gas and a Zippo? Hypo of air?  Sidearm?'”

             Genuine suicides go and do it; or go and don’t do it, all by themselves.  They don’t send out a press release unless they’re Buddhist monks protesting the War.  (Please note, in that case there was both a desire to compel an action AND follow-through).

             This could be an elephant you’ve never seen first-hand.  I hope you never do, damn thing is ugly.  And depressing.

        • Tom

          ‘Genuine suicides go and do it… all by themselves’

          Bull.
          I have read the studies. The people who talk about it are the people who kill themselves, and the people who kill themselves are the people who talk about it.
          Also, there is a high correlation between ineffectual attempts at suicide and later completed suicide.
          Further, suicide is almost always a result of serious mental illness. Joking about it is like making fun of the handicapped.

      • Matt Radcliffe

         If someone charges you with a knife and you shoot him it is self defense. If someone charges you with a knife and you draw your gun and tell him to give you his wallet or you will shoot him it is extortion.

        If you are a cop and you arrest a burglar it is good. If you tell him to strip naked and run down the street or you will arrest him it is extortion (and abuse of authority).

        If you tell your wife goodby you are going to jump off a bridge it is announcing your intent to commit suicide (in my opinion ethical ok but likely not legal). If your wife is talking about leaving you and you say you will jump off a bridge if she does that is clear extortion. If she says she is leaving and you immediately say you are going to kill yourself it could be argued that it is implied extortion to try and make her stay but to me it is less clear.

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  • Duke

    Another example why you NEVER give police any more info than you legally have to. 

  • Anonymous, for various reasons

    Well, you stirred ‘em up good this time, didn’t you Kelly? Bunch of wannabe libertarians who can’t think their way out of a wet paper bag and have absolutely no idea that our founding fathers understood the relationship between rights and responsibility very well. Somehow, these guys seem to have read the Bill of Rights and not the whole constitution, which is a wonderful balance between one branch of government and another, the federal governments and the states, and any government as against the individual. Thomas Jefferson is shaking his head and saying, “No, fool, rights don’t mean you can do whatever you want so long as you don’t think anyone else will get hurt. There are obligations to citizenship as well.”

    So, let’s get down to brass tacks. First, AD is absolutely right. There is nothing in this blogpost with which any well-informed, reasonably intelligent person would argue. 

    There are a couple of posts from well-informed, reasonably intelligent people. The rest are deficient on one side or another of that equation.

    Maybe it’s bona fides time. I am a social worker with 35 years experience. Doctoral level. I’ve worked in public and private settings, rural and urban, child protection and mental health. I’ve seen all of this from all sides: as a professional and a part of the system, as someone who has family members with serious mental health problems, and as a 24-year recovering alcoholic with infrequent bouts of depression and panic attacks (hence the efforts at self-medication, early on, which eventually led to this truly wonderful life of recovery.) 

    The poster who talked about his experience with psychiatrists was right on both grounds: there really are those crooks and wackos out there, and it really is anecdotal evidence. There are far more well-meaning and competent mental health workers (not just MDs, but psychologists, nurses, social workers, counselors, etc.) The well-meaning and competent far outnumber the crooks and wackos. The crooks and wackos, unfortunately, cause negative effects way out of proportion to their numbers. Here’s the thing: even if you are brought to the goony roost on an involuntary commitment, you have the right to ask for a doctor you can work with. You don’t have to take the first Joe or Jane who comes along. If they seem hinky to you for any reason, get another. Keep trying. 

    AD is right, that all too often the MDs over-rely on medication. I have helped people get off ridiculous amounts of meds. Just this month, I encountered a 12 y.o. boy whose doctor had him on Ritalin and Adderal. No kid needs two different stimulants, no matter how ADHD they may really be. I will point out that this gaffe was caused by a pediatrician, not a psychiatrist, but that is no guarantee that it couldn’t have been. I’ve seen some crazy stuff.

    Without offering phony excuses, I have to say this: there are not nearly enough well-meaning, competent psychiatrists to handle the load. They do get rushed. They just don’t have the time, way too often, to really get to know the patient. That’s where people like me come in. I have good relationships with the docs in town. They know I get to spend tons more time with our patients than they do. I don’t try to tell them how to practice medicine, and they don’t try to tell me how to do psychotherapy. But we listen to each other, and when they have bungled it, they will correct it. You can’t ask for more, because you can’t suddenly concoct a huge new supply of well-meaning, competent psychiatrists.

    So, you’ve got different groups of people who Kelly is talking about. You’ve got the truly depressed, who are truly having suicidal ideation, who may not want to go the psych unit, but who are so glad they did when the depression lifts enough that they are no longer suicidal. Genuine suicidal ideation is not the planned suicide Dr. Kavorkian talked about (and this is not about my opinion of Dr. Kavorkian’s effectiveness as an advocate.) Genuine suicidal ideation is irrational. It makes no sense to anyone except the person who’s got it. It is a symptom of an often deadly illness. If someone suddenly started slurring their words, couldn’t raise both arms equally, and passed out, you wouldn’t argue that they ought to have given informed consent before being transported to the ER. You get that stroke treated. Same here. People in that condition are not capable — let me emphasize that, NOT CAPABLE — of giving informed consent. Those who have not seen enough of this, have no idea how powerful and compelling irrationality can be. Shut the hell up and listen to people who do know. Period.

    Then you’ve got the maladroit, of both genders. They don’t know how to handle a conflict or a bad situation, and they start to wish they didn’t have to. Or, worse, they use threats (to self or others, as the legal language goes) to force their preferred outcome on someone else. Libertarians of all stripes, get this and get it right: emotional blackmail is no more defensible than physical coercion. You wouldn’t stand by while the guy beat up his girl friend, would you? (If you would, then you have no standing in this discussion at all.)

    In both of those cases, Kelly does not have the competence to decide. He knows this. He knows that I am not slamming him. I don’t do what he does, he doesn’t do what I do. With my Red Cross certification and my Scout training (kept constantly up to date as an asst. scoutmaster, training new Scouts), I know damn well when I want Kelly or his brothers/sisters there beside me. And Kelly knows when he wants me on his side. Even if he had a choice, which he doesn’t, because both the law and his licensure don’t give him that option.

    The last category is the one that others have referred to: the person who really means to kill themselves. Tomorrow, my wife and I will observe the anniversary of the suicide of her son by a previous marriage. He didn’t tell anyone. He went off by himself and shot himself. How I wish someone could have man-handled him into an ambulance and taken him somewhere, where he would have had a chance of getting over to that other side where they say “thank God I didn’t succeed.” And that’s all I am going to say about that. The rest is between my wife and me.

    • Matt Radcliffe

       You have your three categories.
      1. Suicidal and incompetent (by your claim)
      2. Criminal and manipulative
      3. Actively attempting suicide.

      Even if we agree with you that the first category need immediate psychiatric help and are not competent to make decisions any other patient would have the right to have their family make decisions about their care. How do we impose a permanent legal harm on them before we know if they fall in that category? Unless the person admits to being suicidal we are talking about removing the vast majority of a persons civil rights and their liberty with no trial based only on one statement by one witness with no guarantee that they don’t have an axe to grind. You make a reasonable argument for commitment for the people that need it but fail to address how to determine those people. Remember that this has lifelong consequences like removing the right for them ever to buy a gun even if it is later shown that they never said anything suicidal in the first place.
      How is it that the same medical profession that honors DNR paperwork believes that they have the right to force their help on others in all cases?

      For the second group they deserve a full jury trial. By your own account they are criminals that are harming someone else but you are not the judge or jury to punish them even though you obviously want to be. Again, even if they fit your description you are ignoring the issue of if they said it or not. I will not claim that it is in any way defensible to emotionally manipulate another in such a cruel way but we still have to prove that even those accused of the most vile acts are guilty before we lock them away. That whole “Innocent until proven guilty” thing is inconvenient but vital to a free society.

      There are three things to address in the third category:
          1. The original post was concerning verbal statements
          2. If they don’t give it away in the first place this never becomes a question
          3. There are considerably less question on proof when an active attempt is interrupted than when someone claims that a threat was made
      I am genuinely sorry for your loss but that doesn’t mean that I will agree with your conclusions. There is too much potential for abuse when anyone can have anyone else locked up just by lying about them being suicidal.

      My personal opinion is that in any case where a person contests involuntary commitment they should have a chance for a jury trial even if they have to be held under suicide watch until they are committed by a jury. It appears to have the best safeguards for due process on one side while still being likely to stop a suicidal person and get them help. There are some difficult questions about bail in such a situation but it is better than giving away all civil rights anytime it is “for our own good”.

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  • Chaplain Tim

    BTDT. The wife, in the middle of an argument, started talking about suicide. A third party called 911 on her. 48 hour hold because I told the cops what she had said as well as her reactions to the police and ER doctor. All of my medical training has taught that if you’re dealing with someone who A) has a family history of suicide, B) is full of rage or anger, and C) starts listing methods they could use to end their life then you have someone who is in need of psychiatric evaluation.
    Somehow, I am at fault in her mind. My marriage is pretty much over, but I stand by my decision to send her to the “loony bin” for a couple of days rather than having to call the ambulance to drag her corpse out of my house. Words DO have consequences, and all your philosophical musings about individual rights mean absolutely nothing if you have to deal with someone who has crossed the line.

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  • Matt Radcliffe

    You are advocating detaining someone who has not necessarily committed any crime, without due process of law (a trial), for expressing an opinion (that they are better off dead/ wish they were dead), based only on hearsay.

    If they had tried to bargain with a suicide threat they deserve to have a trial for what I presume to be extortion under the law.

    If they announce to you that they plan to jump off a bridge tomorrow morning you may have an argument for civil commitment but expressing the opinion that they are better off dead is no more proof of suicide than telling your mother in law to “drop dead” is proof of attempted murder.

    1st 5th and 6th amendments seem to be fairly clearly trounced on in your description.

    This is of course skipping over the moral questions of a right to self determination (do people have the right to off themselves), and the basic human right to choices in healthcare and a system that often drugs people against their will.

    From your comments below I do not believe that you are as extreme as the article makes it sound but I think that you are still very far removed from the morality of a free society. I think you are trying to help people but don’t agree with how. I am equally sure that most of the people involved in the soviet revolution were trying to help the workers, and most of the English people in the colonial days thought that the British Empire was helpful to the savages.

    As a fair hint to freedom: If anyone is pleading with you to not ruin their professional life and lock them up without a trial and with no proof you need to look closely at what you are doing especially when you are just doing what someone told you to. Like others have said: you are responsible for the morality of your own actions even if it is “legal” in your state.

    To wrap this up, it may be morally better to choose safety over freedom. There are plenty of countries that choose that path but ours is not yet one of them. You are entitled to the opinion that our country should move to that, I recommend you try to have a constitutional amendment grant all sorts of exceptions to the bill of rights so you can lock people up “for their own good. Right now we have a constitution and history of placing individual rights over what is most “safe”.

    • mpatk

       First of all, the EMTs and medics are not detaining anyone.  We have a say; but the police are doing the detaining (police must fill out the involuntary hold form, not the EMTs), and even they are not “locking them up”.  The involuntary hold must be approved by a licensed doctor or psychiatric professional; i.e. someone who IS qualified to place the person into one of the three categories.  When AD talks about taking someone in, he’s talking about taking someone FOR EVALUATION, not for the hold itself.

      For my part, I do a lot more of what you’re accusing AD of: I do a lot of transfers from EDs to lock-down psych facilities for the actual hold (or longer).  In my experience, the people brought in by police/ambulance are always either significantly altered (i.e. hallucinating or psychotic) or have physical evidence of a suicide attempt (lacerated wrists, overdose, or setting their hair on fire).  Neither police nor ambulance people want to put someone on an involuntary psychiatric hold; from a cynical perspective, the hold paperwork is a huge pain in the ass, and it’s easier to just drop someone at the ED (or in a holding cell) and pass the buck to someone else.

      Yes, people get put on involuntary holds that shouldn’t be; but in my experience they fall into two categories. The first are people who voluntary walk into the ED who somehow convince the experts that they’re a danger to themselves (e.g. make a credible threat).  The second, and most infuriating IMHO, are children being committed at the parents’ request.

      I know the plural of anecdote isn’t data; but I’ve done a lot of those transfers and, at least out here in California, the system seems to work properly.  The ones police and ambulance bring in for involuntary holds are either seeking help (suicidal gesture vs. serious attempt) or truly are not competent to make decisions on their own welfare.

  • Matt Radcliffe

    Also remember that as soon as a person is committed into a mental institution they loose their rights to poses a gun or ammunition permanently without any jury or trial and without any criminal act being necessary nor any permanent defect being (necessarily) present.

    • Ambulance_Driver

      That is patently untrue, Matt.

      You need to read your laws and the AtF form 4473 closer, because you’re way off the mark. I just wrote a post debunking that myth yesterday.

      • Matt Radcliffe

         And you are evidently a lawful authority involuntarily taking someone to a mental health facility because you judge them to be a danger to themselves. A person would have to dig into legal precedent to argue if you are a legal authority or not.

        • Ambulance_Driver

          No, all you need to do is read the instructions on Form 4473 and learn the legal distinction between a PEC/ psych hold and an actual commitment and/or adjudication in court.
          It spells it out pretty clearly, and in this case, you are wrong.

          Kelly Grayson

  • Ambulance_Driver

    Actually, the 4473 also makes exceptions for voluntary commitments. Per the written instructions by ATF, if you voluntarily committed yourself to a mental institution, you may answer NO to line 11f.

  • Matt Radcliffe

    I have found that some of my opinions on the comments taking place here and on two following posts don’t really have a good place or fit into a specific reply.
    http://ambulancedriverfiles.com/2012/05/21/and-on-the-subject-of-lines-in-the-sand-and-wookie-suits/
     http://ambulancedriverfiles.com/2012/05/16/in-which-a-bunch-of-libertarian-types-go-full-wookie/

    In modern society terms get bandied about like, ADHD, bi-polar, Asperger’s and half a dozen loosely defined “personality disorders”. I
    think that it is wonderful that modern medicine can make these people’s
    lives easier. But you have to admit that these are often subtle
    descriptions that leave HUGE amounts of interpretation by the
    professional. We all look at the Russian Psikhuska history with their
    “sluggishly progressing schizophrenia” and think that it was an
    obviously grievous injustice but we see no problem when people are
    defined as mentally ill for not being attentive or agreeable. With terms
    like “Oppositional defiant disorder”, “Conduct disorder”, and “Antisocial
    personality disorder” it is simple to define troublemakers as mentally
    ill. It is not common but it does happen and could happen more. They are useful terms for guiding therapy and counseling but they
    are also useful jargon, to label the undesirable parts of society out of
    credibility and show that they are a danger to others. To say that it is
    a slippery slope would be putting it a bit gently.Maybe some of these concerns are based on some of the stories about the local mental health facility near where I grew up. It was a place called Fairfax right up the road in Kirkland. Or maybe I read “one flew over the cuckoo’s nest” one too many times. Maybe I didn’t like seeing classmates that were too excitable and distractible coerced into taking stimulants so they would be better students regardless of their desires. http://www.leagle.com/xmlResult.aspx?xmldoc=19961415918P2d497_11407.xml&docbase=CSLWAR2-1986-2006http://crazymer1.wordpress.com/tag/involuntary-committment/http://www.seattlepi.com/local/article/Verdict-delivered-in-rape-of-sedated-woman-at-2284580.phpMaybe I just don’t trust people to know what is sane and what isn’t.

  • Ambulance_Driver

    Personally, I hate psychiatry’s current trend of labeling every little character quirk a disease. It has gotten to the point that people who are simply shy can be labeled with autism spectrum disorder, or kids tagged with ADHD or oppositional defiant disorder who really only have Chronic Hickory Deficiency. Everything’s a disease now, so people don’t have to take responsibility for their own behavior.

    • Matt Radcliffe

      While that is a small problem as it exists now can you see the potential for more and more of these borderline issues being regarded as reason for commitment. The potential for those who refuse treatment for ADHD being defined as a danger to others? Or the danger of any political radical to be defined as Antisocial or any of the other labels and shown to be a danger to others. It is not the biggest danger to liberty and free speech in this country but it is certainly something to be watched very closely.

      • Ambulance_Driver

        Oh, I totally agree.

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  • Tom

    I know it’s sort of internet-rude to comment on year old blog, but most of the comments here don’t get it.

    I am a psych patient; major depressive. This ambulance driver is 100% right. Forget the talk about ‘the right to kill yourself'; studies have shown that 90% of the people who kill themselves are irrationally mentally ill, with a diagnosis usually of major depression, bipolar disorder, or schizophrenia. Anyone who says ‘I want to kill myself’ and isn’t joking probably falls into this category.

    Suicidal thoughts are a medical emergency. I am in my 50s, so when I went into an emergency room a few months ago complaining of severe chest pains I was bumped up the triage line and they dealt with me immediately. Right call. Many times, I have walked into the emergency room and announced, ‘I am a major depressive and I am having problems with suicidal ideation.’ Every time I was also bumped up the triage line and dealt with immediately. Also the right call; suicidal ideation is a life threatening medical condition requiring immediate intervention, just like severe chest pains.

    Ambulance driver is not declaring a personal preference here. He is following public policy, and a wise one at that. In most jurisdictions, if you declare an intent to hurt yourself to the police they are required by law to get you to the hospital.

    If this happens to you: 1) It is possible the psych evaluation at the hospital will let you go if you clearly aren’t at risk, but this is very unlikely if you physically resisted the ambulance ride; 2) If they don’t want to let you go, agree to sign yourself into the psych ward voluntarily. This has good consequences: a) It usually means you can get out easier, since involuntary commitments usually involve minimum stays. b) It usually means you retain your right to own a firearm, since state law is likely to revoke that right if you’ve been involuntarily committed.

    Whether you like it or not, this is the way the world works. Casually saying you want to hurt yourself when first responders are around is as stupid as joking with the TSA at the airport about having a bomb. In both cases they are required to take you seriously.