Honesty in mental health services (MH) can cause involuntarily committal to psychiatric wards and even inadvertent imprisonment, a stark reality not always omnipresent.

Like saying “bomb” in an airport, there are words in therapy when spoken can & will take your freedom away, including by police force.

Understanding these risks is critical for patient safety.

Never make empty threats of dramatic harm-related nature. Don’t even joke.

Providers are required to mention this risk, but they rarely emphasize its life altering significance in much detail beyond introductory disclaimers.

So passive can be this disclaimer, it can be very easy to overlook & under appreciate its significance.

Threats of harm to self or other people-places-things allows MH providers the subjective right to have a patient involuntarily committed (laws vary by state). And it happens.

The goal is preventing harm. So it’s based in theoretical good. But it’s also a horribly flawed system that can cause more harm than good imo.

The underwhelming approach to this disclaimer speaks to the lack of risk assessment in MH in general.

This makes patient honesty in a slippery slope. I’ve never been suicidal nor joke about it, but I have discussed it naively as a therapy newbie in passing. Not anymore!

I have seen both patients & providers be harmed by this. It’s really a broken approach.

Providers don’t want death or harm on their conscience. Who can blame them. Every seasoned MH provider has at least one suicide under their belt & we’ve all heard media reports about mass-shooters raising red flags in therapy. Prevention is key.

So there is something worth attention here, but it’s a half-baked patch to a bigger problem.

Empty threats or real danger? Leaving this determination up to subjectively-driven providers is probably not fair. But giving providers this unyielding power may not be fair either.

We all know therapists are perfect, but they can cause harm intentionally & unintentionally all the same. A better system is needed imo.

True Story:

A fellow therapist friend of mine reported her psychiatric patient to the police after he openly vented harm in trusting session.

It ruined many lives, including her own. Was it justified? I couldn’t tell you. But it all backfired for everyone involved royally.

When the police arrived at patients home, he had cannabis & guns, as most Coloradans do.

They slapped him with a felony & committed him to a psych ward.

The patient subsequently lost his teaching job. This snowballed into eternal life-altering detriments impacting his entire family and friends for years.

Think the patient was angry/suicidal before? Imagine how he felt after losing everything he had, unable to work.

The patient got out of jail & was pissed. So were his friends & lover. He lost everything & became a convicted felon for things he said to a therapist in trust. It threw rocket fuel on a raging bonfire.

Patient wasn’t happy & proceeded to harass this therapist for years. Not cool either. It got bad. The whole thing was a tragedy layers thick. It became a story gossiped about in town, especially among therapists.

The therapist had to stop practicing entirely. Negative review-blasts & word of mouth ruined her practice. She was also very scared by the threats & harassment.

She had to get security cameras & a dog for protection (a single woman in her 60’s). It ruined her life for years!

I don’t side with patient or provider here. I only point out the madness & detriment caused to all.

Be very careful what you say. Consider asking therapist their historical track record on committals.

Perhaps one solution to alleviate patient & provider burden would be a middle-man system therapist can punt a problematic patient to for further independent risk assessment.

For example: an external 3rd party somewhere between therapist, hand cuffs & psych wards, preferably from another region able diffuse conflict locally unaffiliated.

Choose your words carefully! If you do want to harm someone or yourself, please be honest & ask for professional help. But understand the gravity of your statements if you don’t.

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