Handcuffs & commitment standards

Being committed to a psychiatric facility can rescue a person from the uncontrolled symptoms of a severe mental illness. Involuntary treatment, at the same time, should not be used if voluntary care is a viable alternative. No one wants to unnecessarily invoke a measure that, by its very nature, is laced with restriction.

Yet, the coercive tone of an inpatient commitment can be muted.

For too long, for instance, a trip to a hospital has automatically included a police car and handcuffs for people being committed to treatment. Vermont has ended the mandatory use of restraints in that situation. A recent law in the state requires that mechanical restraints not be used unless circumstances dictate that such methods are necessary. Restraints are still used if required to maintain safety, but the justifications for their use must be documented.

Thus in Vermont, patients can be brought in for psychiatric evaluations by mental health professionals and without handcuffs. To the advocates in many other states, the adoption of a similar policy would be frustratingly fruitless. For Vermont allows individuals to be placed in treatment for reasons other than immediate danger. The state’s commitment standard encompasses those who are “receiving adequate treatment, and who, if such treatment is discontinued” will likely become a danger to themselves or others.

As they do not present a current risk, no handcuffs are required for those patients in Vermont. In those states where actual danger is the sole trigger for commitment, there is and will remain no option but law enforcement officers and restraints.

Children deserve protection

It was a bad week all around.

In Ohio, a man bludgeoned his 13-year old daughter to death – he was not taking his medication for bipolar disorder.

In California, a woman threw her three young children off a pier to their death – she was hearing voices.

By comparison, these stories make this mother from Vermont look lucky – her son was only arrested. But her plea is too familiar.

"I have been trying desperately to get him some medical help but he has been deemed not dangerous enough to be admitted against his will … In the past, when he got appropriate treatment and followed his care plan, he was not having a lot of problems."

Treatment embraced voluntarily is always preferred - but in some cases, the disease may not make that possible. It is time for us to realize that it is just and humane to intervene long before something devastating happens. Did we learn nothing from the Andrea Yates case?

Averting tragedy is not always politically correct. It is not simple, or easy. It often requires family members to petition the court for intervention, and people who are desperately ill to be treated despite refusing treatment. But it works.

MORE: what is it like to hear voices? * help for overwhelmed family members * state laws