For Whose Good

Suppose this were you on a sunny morning.

You are starting the day in the usual way when a uniformed officer of the law walks in. Without warning or explanation, you are put into a sheriff's car and taken off to jail or a hospital.

Back where you work your shocked associates gossip and speculate. Was there something in your past they didn't know about?

Why did the sheriff take you away? What crime did you commit?

Time goes by, but no doctor examines you. No friend comforts you. No one tells you why you are there or what happens next. You become more and more frightened and confused.

It's like a nightmare.

You could have done nothing at all but be yourself. A self that was sick or disturbed or unhappy or different from the people around you.

So someone, perhaps a relative or a neighbor, decided you belonged in a mental hospital. "It's for his own good," they might say.

Until 1968, something like this could have happened to you. It could have happened to anyone, and often did. Now it can't happen in the state of Minnesota.

With the enlightened Minnesota Hospitalization and Commitment Act, all of our citizen's rights are protected. "All citizens" doesn't mean only the ones who think, act, and talk, like the majority of people around them. It means everyone. Sick or well, like or unlike others in the community, those whose behavior is considered abnormal as well as those considered normal.

What is normal, anyhow?

Certainly the concept of normality changes from place to place, from country to country, from time to time. There was a period in our own early history
when it was normal to believe in witchcraft.

Some countries allow a man three wives.

In some, people mutilate their faces in ways that would cause considerable concern if they did it here.

The normal dress of women in some places is topless. A development that fashion photographs indicate might be heading this way.

At any rate, in their community, these actions are considered normal.

How do you judge who is normal? Who does the judging? And how important is it?

Outside of the courtroom, a judgement often is made out of fright, frustration, or ignorance.

A child in the neighborhood mumbles to himself, stumbles when he walks, does not know how to play with the other children, or they won't play with him. He seems peculiar. Clearly he is not normal. Obviously help is needed. But what sort of help? And for whose good?

A man has become an alcoholic. Night after night he comes home, not only drunk, but roaring drunk. He tyrannizes his wife, terrifies his children, and irritates the neighbors. What should be done about the drunken man? For whose good?

A middle-aged woman hears voices nobody else can hear. Worse, she often replies to them. Sometimes she holds loud conversations with God, or with people she has known in the past. What sort of care and treatment does this woman need? For whose good?

An elderly woman is a problem to her family. She is forgetful. Sometimes, she wanders away, and can't find her way home. Often living in the past. She is irritable and demanding. What kind of help is needed here? How much? And for whose good?

For whose good?

For the sick person's good, of course, it's easy to say. Sometimes it's not so easy to be sure of.

One key is understanding behavior, and the reason behind the behavior. Another is understanding the differences in people, personalities and lifestyles. The more we understand, the better we will be able to plan a course of action with the person who needs help.

That's another key.

With the person, not for him. Unless he is totally unable to participate, he has the right to take part in the decisions that will influence his life.

He is not a criminal, he's sick. Being sick doesn't mean you lose your civil rights, or the freedom to help determine what becomes of you.

It's a matter of what's the most effective help for the individual and what is available.

Placement in a state hospital may be best for some people at some times, but there are many alternatives to look at first. Hospitalization in a community hospital, in or out patient treatment in a mental health center, help from a social agency, public health nurse or private counseling.

County welfare departments can offer services or point the way to facilities or programs that offer alternatives to state hospitalization.

The objective is to help the sick person get well, or at least be able to function in society, with the smallest possible disruption of his life, liberty, and dignity.

Whenever possible, this is best done within his home community.

But sometimes a person needs more concentrated help than can be found outside a state hospital.

The Minnesota Hospitalization and Commitment Act is designed to make it easier for people to get into and out of mental hospitals; to insure humane, fair, and proper treatment; due process and legal protection.

The intent of the Act is to broaden the service options available and to improve operating methods. Hospitalization is not a goal in itself. Nor is it a punishment. It is part of a total plan for a patient, one step in the process of helping him with his problems.

Informal, Voluntary, Emergency or Commitment

These are the four ways a person may go into a State Hospital under the Act.

Judy went into the hospital as an informal patient. She was profoundly depressed and had been under the care of a psychiatrist for six months. But she grew progressively less able to keep house and care for her family. The doctor suggested she needed hospitalization, and Judy agreed. So her husband took her to the State Hospital, where she was admitted in the same manner as to any other hospital, for any other kind of illness.

After a few weeks of treatment, she was able to go home again.

A person enters the hospital as an informal patient at his own request and without written application. Generally, this is arranged through his physician. If he changes his mind about staying in the hospital, he is free to leave again within a matter of hours.

John entered the hospital as a voluntary patient, the designation used in admission for alcoholism or drug addiction. John had a serious drinking problem. His evenings passed in an alcoholic blur, and often he was so hung over, his wife had to drive him to work in the morning. Sometimes, he didn't get to work at all. His long-suffering boss finally threatened to fire him. His wife said she would take the children and leave if he didn't stop drinking. John tried to stop on his own, but without success. So he went into the hospital as a voluntary patient.

A voluntary patient, inebriant or drug addict, signs an application for admission.

If he wishes to leave the hospital before his treatment is complete, his demand for release must be in writing. Then he can gain release in a matter of days.

Mildred was placed in a hospital on an emergency basis, after she tried to commit suicide. Her neighbor found her unconscious and called police, who arranged for her to be taken to a hospital, where she regained consciousness. A doctor examined her and had her admitted. Mildred was not grateful, but angry. She still wanted to die.

Under emergency hospitalization, a person may be held in a hospital up to three days without a court order but with a written statement from a licensed physician that the person has been examined, that he is mentally ill or inebriate, and may cause injury to himself or others.

If a person needs emergency hospitalization, the law required that he be place in a treatment facility, not a jail. At his own request, and with the consent of the medical director of the hospital, such a person may later become an informal or voluntary patient.

Norman went into the hospital under commitment proceedings. He had been in a mental hospital in another state. He often talked of mysterious things
that interfered with him and he thought the walls of his room moved in and out. He was bothered by mind waves he felt were inside him, calling him names, and he worried about his hidden subconscious breaking through. He lived with an aunt who became more and more concerned about him, his delusions, and his uncontrollable temper. Finally, she petitioned the court for commitment.

At the hearing, the finding of two medical examiners was that Norman was unable to function and take care of himself. He was committed to a State Hospital. After treatment, Norman was provisionally discharged. A committed patient is hospitalized by order of the Probate Court. He is present at the hearing, represented by a lawyer, his own or one appointed by the court, and by an interested person who may be a member of his family or a friend. Two qualified examiners provide expert opinions on whether or not commitment is indicated.

Under the Minnesota Hospitalization and Commitment Act, the fact that a person is a patient in a mental hospital does not mean he loses his legal rights, whether he enters the hospital on his own, or is committed by the court.

Unless there is a specific finding of incompetency, determined through a special hearing, he will continue to have the following rights: The right to vote and hold a driver's license, to enter into a contract, sign legal documents, sue and be sued, make purchases and sell property.

He has the right to communicate with a reasonable number of people at reasonable hours, and to meet privately with his attorney, personal physician, minister, and at least one member of his family without interference or censorship.

He has the right to correspond with the Governor, Commissioner of the State Department of Welfare, the court, and other official agencies, his physician, attorney, and at least one other person outside the hospital.

He will be furnished with paper and stamped envelopes.

Correspondence will be mailed promptly.

Incoming or outgoing mail will not be read or censored.

The patient has a right to practice his religion.

He will have physical and mental examinations at least once a year.

His consent must be asked for surgical operations.

Review boards visit each hospital at least once every sixth months to evaluate patient admissions and retention. When the patient goes into a hospital, he is notified of the next date the review board will visit. He has the right to appear before this board whenever he wishes. He can do so by telling any member of the hospital staff he wants to. The request does not have to be made in writing and the staff must see that the request is honored.

From the time a person enters a State Hospital, sometimes even before, his County Welfare Department has a legal and ongoing responsibility for him. When a patient is about to be discharged or placed on provisional discharge the Welfare Department is involved with hospital staff in planning so that they will be prepared to offer all possible assistance.

Assistance takes many forms. It may be medical or continued psychiatric treatment on an outpatient basis nursing care, vocational training.

Perhaps the former patient needs help finding work or a place to live. The Welfare Department, with access to other agencies, stands ready to help.

These are the major provisions of the recently enacted Minnesota Hospitalization and Commitment Act.

A giant step forward in helping people who are mentally ill, retarded, or inebriated. But an act is only as good as the people who implement it; the careful, concerned professionals who make it come alive; the people who, because they are able to function adequately, and appropriately, have the responsibility for helping those who are not.

It's a heavy responsibility.

Any sensitive person must sometimes have doubts about his decision. When in doubt, it may be helpful to go back to the primary question.

For whose good?