Involuntary Confinement Won’t Stop Gun Violence, But Patients Say This Is How It Impacts Them
Following two mass shootings in El Paso, Texas, and Dayton, Ohio, President Donald Trump has called for mental health reform, rather than gun control. In a speech on Aug. 5, Trump said that as president, he plans to increase involuntary "confinement" to psychiatric facilities to prevent domestic terrorism, the Washington Post reported.
“We must reform our mental-health laws to better identify mentally disturbed individuals who may commit acts of violence,” Trump said, “and make sure those people not only get treatment, but when necessary, involuntary confinement.”
Trump’s comments are concerning for several reasons. The American Psychological Association pushed back on this, saying in a statement released on Aug. 4 that blaming mass shootings on mental illness is “unfounded and stigmatizing.” Also, overwhelming evidence shows that mass shootings are not caused by mental illness. In fact, people with mental illness are 10 times more likely to be victims of violence — not the perpetrators of it — according to the U.S. Department of Health & Human Services.
Linking [involuntary commitment] to mass shootings can place even more stigma on this practice
It's important to stress that the symptoms of mental health issues are painful, and they can be life-threatening. For people who are at risk of harming themselves, involuntary commitment can sometimes save lives. But involuntary commitment is a process that’s highly stigmatized, and its history and current implementation can often have a traumatizing effect on patients. A study published in European Archives of Psychiatry and Clinical Neuroscience stated that often “shame and self-contempt [are] emotional reactions to involuntary hospitalization.” An article review published in Psychiatry (Edgemont) explored the carceral origins of involuntary psychiatric admittance, showing that the practice can sometimes criminalize mental illness. The most notorious example is London’s Bethlem Royal Hospital — nicknamed Bedlam — an "insane asylum" founded in 1247 that often used involuntary commitment as a tool of oppression against women and used cruel "treatments" that are now regarded as torture methods. Virginia’s Central Lunatic Asylum for Colored Insane, opened in 1862, often listed the cause of mental illness symptoms as "freedom," which pathologized emancipation from slavery.
These are old examples, and mental health care has made tremendous strides since then. But research shows that this painful history may not be completely eradicated. A 2016 survey from Mad In America, a nonprofit platform that advocates for "rethinking psychiatric care," showed more than half of the over 500 respondents described their psychiatric ward experience as “traumatic,” with 37% reporting physical abuse and forced treatment, and 7% reporting sexual abuse. Only 17% said they were “satisfied with the quality of the psychiatric treatment” they received.
Involuntary commitment is an important resource because it can sometimes save lives. However, mental health providers and legislators need to examine the ways that the practice can also be used as a tool of harm, especially against people who exist at the intersection of mental illness and other marginalized identities, like race and gender.
I've struggled with mental illness for most of my life. My first time being involuntarily admitted, when I was 20 years old, was helpful overall. I think the supervision and medication helped save my life. But I was also involuntarily admitted after a suicide attempt in my sophomore year of college due to trauma from a sexual assault. That experience was horrific. My therapist called the police to the office to come take me to the government-run hospital, and the officers handcuffed me and put in the back of a paddy wagon. At the hospital, I was grouped with men and women who were much more acutely ill than I was, and at several points I was threatened with sexual assault by other patients. Although I was released in about seven hours, that experience stayed with me for years, and I continue to have panic attacks stemming from it. Criminalizing Black women and putting them in danger of sexual assault is not healing or survivor-centered.
Clearly, involuntary commitment is not a trivial matter. And linking it to mass shootings can place even more stigma on this practice, and further criminalize people with mental illness. While involuntary commitment can be life-saving, it can also be traumatizing for patients.
That's why it's important to understand the potential effects of involuntary commitment before believing that increasing this practice will help cauterize the tragic flow of gun violence in the U.S. It won't. And increasing the practice without being critical about the flaws in the system, or having empathy for those who go through it can cause a lot of harm.
I shared my story here because I think it's important to put a face to a practice that not many people know about. Here are four other women's stories of how involuntary commitment impacted them.
Trigger warning: This story contains mentions of sexual assault, self-harm, trauma, and suicidal ideation that may be triggering.
I was first admitted voluntarily to a psych ward when I was 14 and then again when I was 18. Both of those hospitalizations helped me cope, but mostly, as someone who self-harmed, I needed to be monitored.
I was 20 when I was hospitalized involuntarily for another PTSD episode. After I posted a message on Facebook where I said I was going to end my life, one of my friends called 911 after I didn't pick up my phone. I was evaluated and was put under Section 12 in Massachusetts, which meant I was hospitalized and had to put a request three days in advance before being released.
I found [involuntary admission] to be neutral — I didn't learn any new coping skills, but I needed to be supervised due to the severity of my suicidal ideations.
I admitted myself [by going to the ER], but it was still hard. For days I was unable to easily reach out to friends, couldn't go outside, couldn't even listen to music. I did it so I could be fast tracked into better care and treatment. Getting the kind of sustained counseling one needs to get on the right medication and get on track is hard. And I'd been misdiagnosed — I was diagnosed with depression, but I'd clearly had manic episodes that my male psychiatrists over the years refused to acknowledge. Getting the kind of sustained counseling one needs to get on the right meds and get on track is hard.
I went completely broke as a result of my 5150 [California's involuntary commitment law]. I was a freelancer, and had to forego two weeks of work completely, then work a reduced load while I went through extended therapy. I still haven't paid all my medical bills from that point. I was living off of credit card debt. I didn't realize one of my cards was set to pay off in full, and when my account paid it automatically, my entire checking got wiped.
Overall, the experience was a total cascade. Because I went in voluntarily, I was able to plan ahead and tell clients I was having "health issues" and would need to take time away from projects. If commitment had been [totally] involuntary, I have no idea what would have happened to my finances. I'm so lucky I was already in therapy, and had supportive friends who helped me figure it all out.
I was admitted to a psychiatric hospital almost exactly 10 years ago. I was in my sophomore year of college, and every day was an intense battle just to will myself out bed. I had been struggling with manic depression and post-traumatic stress disorder since my mid-teens. While I had had suicidal ideations in the past, there was something about the particular thoughts and plan that developed that night that was different — teetering on the edge of intention and action.
Instead, I called my therapist. Even though I surrendered myself and told my therapist about my plans, I had no idea that I would be confined for the next three days. I didn't know that my secret years of therapy on campus and the true nature of my illness would be revealed to my conservative father. I didn't know how truly powerless and out of control I'd feel at the mercy of a random ward in upstate New York. If I had known these things prior to going to my therapist, I'm not so sure I would have [disclosed my suicidal ideation], and I really don't know where I'd be today.
When I arrived, I was stripped, searched, given several meds to take, and escorted to my room, which was shared by an older woman. It wasn't until the next morning that I learned I'd actually be there for the next three days instead of overnight like I'd been told. Understandably, I freaked out and had a breakdown. To the staff's credit, no one restrained or sedated me as I wailed and started tearing up the room, but at the same time, it was so cruel because after that, I knew nothing I was capable of would have any effect on my being trapped there.
Most of the time was unstructured — men and women of various levels of psychiatric need wandered the circular halls freely. Most of the folks there had needs much more acute than my own.
There was another patient there, a boy approximately my age, who wrote me love notes and drew me pictures. I was terrified of him. Part of the root of my PTSD was my childhood sexual abuse and later sexual assault when I was in high school. He was large and I didn't know how stable he was. There were no locks anywhere in the facility, not even on the showers, so I refused to change clothes or bathe for my entire time there out of fear. The staff told me they had talked to him, but he continued to pursue me the entire time I was there. It may not have been fair for me to be so afraid of him, but I was extremely vulnerable and no one helped me in this regard.
Though the experience itself was highly traumatic, it kept me from making a very permanent mistake. All in all, I guess I would say the action of being admitted was incredibly helpful. But my actual experience was incredibly traumatic. A year or two later, I saw one of the other patients at the local mall and I had an anxiety attack. On the other hand, I don't know what else could have been done to keep me from carrying out the worst.
I have shared this experience with only a handful of people — even my own sister doesn't know I was admitted. It's not difficult for me to hide it, but I do sometimes feel an immense guilt around hiding it. I don't know why.
My first admittance was November 2009. The second was a few months later in February 2010. I was 302ed [Pennsylvania's involuntary commitment code] both times and sent to two mental hospitals that had children/teen wards. The state threatened my parents with criminal charges and removing me from their care the first time. Teen wards in short term in patient care are extremely dangerous and overwhelmed with patients. Riots and fights between other patients happened several times a day. I felt like I was in prison.
Going to one on one and group therapy was mandatory, but I didn’t feel like I was healing. I wasn’t immediately put on medication and the first time you enter a hospital that’s not always the intention. They do want to get you out of short term and that depends on a variety of factors. I didn’t find either space particularly helpful, except that my social worker at my second one became my therapist at my outpatient practice. She was a wonderful therapist but she was overwhelmed with her volume of cases at the hospital and at her outpatient. There’s a lot of things I cannot do for myself because I was [involuntarily committed] and that’s fine, but the idea of being [involuntarily committed] is messed up.
What Providers and Legislators Can Do To Help
Involuntary commitment to psychiatric facilities can be life-saving, but they can also cause a lot of trauma, particularly for people who already marginalized because of their identity, like I was. That's why advocating for increased involuntary admittance to psychiatric hospitals won't help mentally ill people or stop gun violence. However, being critical about the current system help people with mental illness. Legislators should take time to listen to mentally ill people, who have been quite vocal about why increasing involuntary commitment or starting a government-run database of people with mental illnesses would be destructive.
And mental health care providers should listen to their patients about what their needs are. Misha tells Bustle that "honesty about what would actually be happening to me upfront would have been the best. There was also the matter of feeling so incredibly dehumanized."
"But it was also because of the way the staff interacted with us, all smiles and nods with no attention behind their eyes. I felt like a fragile object, shuffling around staring out one dirty barred window after another. But nobody there made me feel like they'd care if I broke."
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.
*Names have been changed
Interviews have been edited for length and clarity