Mandated services are a difficult topic in the mental health community. There are differing views on when, if, and how often they should be used. Some people see them as an essential part of managing situations in which people are experiencing difficult symptoms and poor decision-making. Some people feel it is cruel to allow a person in the throes of a serious illnesses to refuse treatment. However, on the whole, consumer survivors have made clear that rights protections, dignity, respect, choice and control is needed at all points in the journey and not just when it is easy. Many have not forgotten times when people could be locked up against their will for prolonged periods. They could be forced to accept treatments they did not want. This could be done based solely on the orders of a doctor or a male head of household. As a result, many are very cautious about the use of these types of intervention. The current standards must always include that the person is a danger to themselves or others. However, how that is interpreted can vary.

There are person and family-centered crisis planning practices that help people maintain the maximum amount of choice and control possible during a mental health crisis. These include things like advanced psychiatric directives or the crisis planning section of a WRAP©. These proactive and person-centered planning processes complete over time and when the person is well. They ensure crisis is less likely to happen. It also gives professionals, family members and other supporters clarity about what the person prefers in a crisis situation.

There are many strategies for helping people make better decisions, even when in the throes of an acute episode. Unfortunately too few professionals are skilled in shared decision-making models, especially with people in actives states of symptoms. Nor are families and others encouraged to learn and engage these approaches. These strategies take time. They are built on the foundation of a strong relationship and trust. However, when used properly, they can lead to better outcomes and help avoid escalation of challenges.

In addition, very few psychiatric crises are followed up with crisis management planning. This type of planning is a way of thinking about prevention strategies and response should serious symptoms reoccur. Too many people cycle in and out of the hospital and crisis services. When there, they may feel that people do not listen to them. They may experience situations they do not like. Eventually, they may lose trust in supporters and begin to avoid services. Crisis management planning can help to stop this cycle.

Sadly, because we have not built our mental health system to be robust and proactive, too many people go without services. This is true even people with who have very serious conditions. Sometimes this is because services are organized in ways they don’t prefer. Examples can include shelters which may feel overwhelming or services that require sobriety. It may be that the person wants services but there are none. For example, they may want to work with a therapist or seek medications and other treatments but they have no mental health coverage.

Sometimes in desperation, a family member or professional will actively work to get people committed. They may even try to get the person arrested. They feel if they can get the person into the system, they will at least have food and shelter. Some people express appreciation for the resources that come with commitment or arrest and diversion. However this is not a good way to obtain necessary services. There, can be unexpected consequences. There is no guarantee the person will be diverted from jail or prison if arrested. They may have to live with a criminal record that makes working or housing harder in the future. These processes often strain family relationships. It would be better for communities and individuals to find other ways to get the resources they need to recover. Professionals who see these issue can engage in system advocacy for access, prevention, and early intervention.