1 Boring Old Man

Our Georgia Law allows any officer of the law, any physician, any mental health worker, or any two citizens to apply for a court-ordered evaluation for mental illness provided that the person is mentally ill and dangerous to self or others. Arizona has one of the more permissive versions – any person can apply and the criteria are mentally ill and dangerous or acutely, persistently, or gravely disabled.

Mental Health Commitment Law in the U.S. has evolved over the years, and the combination of mentally ill and dangerous has become standard – though neither criteria is clearly defined. Every State has provisions for early judicial review. When I first started Psychiatric training, I really didn’t enjoy anything about the process. After a time, I became more comfortable with it. I didn’t like it, but I understood that people who were around mental illness all the time were the best choice for making at least the initial decisions. The law places the evaluator in a clear double bind. First, keep our streets safe! Then, don’t you dare abridge any person’s civil rights! The reason for the second part is obvious. Commitment deprives a person of due process at least for a short time. We don’t do that in America. That’s the reason for rapid judicial review.

Jared Loughner was well qualified for such an order. The ball was dropped most obviously by Pima Community College where he definitely made himself known. But as an evaluator, how does one assess the issue of dangerousness? Sometimes it’s easy. The person has either threatened or initiated violent behavior. In people actively hallucinating, the presence of hallucinations directing lethality are obvious indicators. But often the determination has to be subjective. One of the things that often makes the decision is the evaluator’s personal feeling in interviewing the patient. That’s not so arbitrary as it sounds. In this case, the Professor and a classmate both were frightened and worried about him showing up with a gun. That’s a solid piece of data – an empathic connection that’s frightening. Think of your reaction to his mug shot, as an example.