The criminalization of suicidality

One of the foundations of medical care is that when someone's life is in danger you do what you have to do to help them. Someone coming into the hospital for a heart attack is not told, "We're full. Try the place down the road.... or Go home, we'll call you when we get space...."

But in Tennessee and many other places the burden to provide care is no longer sacred if someone is suicidal and in danger of killing themselves. Care is mandated, but only if economically feasible.

The law in Tennessee is Title 33. It is the law that governs the terms of commitment when you pose a threat of harm to yourself or others. In Tennesse it now says that you can only be placed if "suitable accomadations" (ie- a bed) are availible. If they are not availible then you will be locked in an emergency room or jail until they are. North Carolina is farther along in that process than Tennessee. Recently they had someone handcuffed to a hospital bed for 8 days awaiting "suitable accomadations." One can only wonder at the effect that had on his mental health.

The basic effect is to criminalize suicidality. People can now be locked up without trial until "suitable accomadations" are availible. There crime is to be inconvenient and cost too much at a time where virtually everything costs too much. Nobody wants these detentions to be a long term affair, but what defines long? 8 days for someone who is suicidal and whose mental health is in danger of slipping to the point of no return sounds like a long time to me. Already mental health consumers distrust the system. How many people will refuse to go the hospital or lie and cover up their problems for fear they may be handcuffed to a bed. Who can blame them? How many people will die, because they were afraid to seek the help they so badly needed. It does not matter how many "detentions" happen. The perception that it is possible or likely will be enough to substantially effect people's decision to seek help.

And this does not even consider the effect on the hospital trying to do things it is not equipped to do or police officials having to guard people whose only crime is to be sick when "the house is full." Officials in North Carolina report this "brief detentions" as being extremely expensive, taking time, energy, resources, and money away from areas it could have been used much more fruitfully.

But the implications go even far past what happens to any specific individual. It further fuels an attitude already present and already growing that mental illness is an "elective disease" and that needed treatment need not be provided when it is "financially inconvenient." All over the country advocates have been fighting to save mental health budgets and the services needed for people to have any chance of a decent life. If the services needed to save life are conditional then what does that mean for other services. What does it say about us when we say some people are disposable and others are not? The answers I believe are scary.