Chicago Boyz

What Are Chicago Boyz Readers Reading?

  •   Enter your email to be notified of new posts:
  •   Problem? Question?
  •   Contact Authors:

  • CB Twitter Feed
  • Blog Posts (RSS 2.0)
  • Blog Posts (Atom 0.3)
  • Incoming Links
  • Recent Comments

    • Loading...
  • Authors

  • Notable Discussions

  • Recent Posts

  • Blogroll

  • Categories

  • Archives

  • Reiteration

    Posted by Assistant Village Idiot on November 22nd, 2018 (All posts by )

    Whenever a tragedy with a mental health angle occurs, there are predictable responses. These vary in awareness of the realities. As I have made my living working with psychiatric emergencies for forty years, I know enough to be at least moderately helpful, and from time to time I reiterate some points that get consistently missed.

    After the fact, and working from scraps of information, many people conclude that it was patently obvious that the bomber or shooter or pact suicide was dangerous and ill. Therefore, they believe that the emergency room, or clinic, or hospital messed up by not picking up on the obvious and moving to treat that person. Well, we could always do better, as in everything else, and sometimes it’s true, but that conclusion is often spectacularly wrong. No, that’s just making excuses. The guy told them he was thinking about killing people and was also suicidal. We admit over 2,000 people a year to our 150-bed involuntary facility, and every single one of them reaches some threshold of dangerousness, enough that it has to hold up at minimum, at a probable cause hearing. The suicide and homicide rates of our discharges is not that much higher than the general population. (The self-harming rate is much higher.)

    Yet they have said and done dangerous things, which is how they got to our hospital. When I read the news stories of what the killer said when he was brought in for evaluation two months or two years before, I am seldom impressed with how alarmingly dangerous the statements are. I have known thousands of people who have said or done similar things. Sometimes the quotes or actions do sound more alarming to me, but not reliably. Most usually, the person is acting more rationally after a little treatment and is no longer actively suicidal or homicidal. We have to decide what is the safe amount of time after to hold them to reduce the risk.

    There will also be accusations that “they said he wasn’t dangerous.” Read more closely. No one says that. What happens is that people need to do or say things that we can bring before a judge and make a case that they are dangerous enough to lock up and/or force into treatment. Because this is America, and you can’t just think someone’s dangerous, lock the door for as long as you like, and not have to answer to anyone. You can have that world if you want it, I suppose, but you are going to need to raise the number of expensive hospitals about tenfold, filled with people who could be working and caring for families.

    Outpatient treatment has variations on this. The ER and clinic people can say “You need treatment” all they want, but it’s usually entirely voluntary. Even if there is court-ordered treatment, it’s usually limited and rounding up people who don’t show for appointments can be tricky.

    You learn early in this business that if the mental health system has ever touched someone, there is lots of the general public which believes we are still responsible for making sure they don’t do anything bad ever again. I’ve had many family members complain to me in anger over an admission “You let him out too soon three years ago, and I told you he would be back.” To us, three years is a long time of a person somehow surviving in the community. That’s a successful discharge. Hell, sometimes we will call a week a successful discharge, of a person having a volatile six months. They might be in six times. We used to keep them for those six months instead. They got worse. Being out and dealing with everyday problems is good for you.

    Xavier Amador is particularly good at explaining mental illness. There are longer talks for affected families or treating professionals in the sidebar, also good, if you choose to watch over at Youtube.


    2 Responses to “Reiteration”

    1. Mike K Says:

      I am surprised that the guy who shot up Mercy Hospital ED and killed three people had a permit and even a CCW permit for guns, though.

      He had a history of spousal abuse and was kicked out of the Chicago Fire Academy and threatened to shoot it up.

      Of course, in states like Illinois and California, the gun permits process is corrupt. Illinois has a governor in prison for selling commercial drivers’ licenses. I wonder if they will ever find and report how that guy got his permit? Probably not.

      I took an all day course and had a month long background check to get a CCW permit in Arizona.

    2. Grurray Says:

      I was just reading on Second City Cop that the gunman worked for an alderman last year. This would be after he was fired from the fire department and after his previous wife took out a restraining order on him.

      The mere fact that he worked in some capacity for the fire department tells me he was connected to someone. You just don’t work there without being juiced in.

    Leave a Reply

    Comments Policy:  By commenting here you acknowledge that you have read the Chicago Boyz blog Comments Policy, which is posted under the comment entry box below, and agree to its terms.

    A real-time preview of your comment will appear under the comment entry box below.

    Comments Policy

    Chicago Boyz values reader contributions and invites you to comment as long as you accept a few stipulations:

    1) Chicago Boyz authors tend to share a broad outlook on issues but there is no party or company line. Each of us decides what to write and how to respond to comments on his own posts. Occasionally one or another of us will delete a comment as off-topic, excessively rude or otherwise unproductive. You may think that we deleted your comment unjustly, and you may be right, but it is usually best if you can accept it and move on.

    2) If you post a comment and it doesn't show up it was probably blocked by our spam filter. We batch-delete spam comments, typically in the morning. If you email us promptly at we may be able to retrieve and publish your comment.

    3) You may use common HTML tags (italic, bold, etc.). Please use the "href" tag to post long URLs. The spam filter tends to block comments that contain multiple URLs. If you want to post multiple URLs you should either spread them across multiple comments or email us so that we can make sure that your comment gets posted.

    4) This blog is private property. The First Amendment does not apply. We have no obligation to publish your comments, follow your instructions or indulge your arguments. If you are unwilling to operate within these loose constraints you should probably start your own blog and leave us alone.

    5) Comments made on the Chicago Boyz blog are solely the responsibility of the commenter. No comment on any post on Chicago Boyz is to be taken as a statement from or by any contributor to Chicago Boyz, the Chicago Boyz blog, its administrators or owners. Chicago Boyz and its contributors, administrators and owners, by permitting comments, do not thereby endorse any claim or opinion or statement made by any commenter, nor do they represent that any claim or statement made in any comment is true. Further, Chicago Boyz and its contributors, administrators and owners expressly reject and disclaim any association with any comment which suggests any threat of bodily harm to any person, including without limitation any elected official.

    6) Commenters may not post content that infringes intellectual property rights. Comments that violate this rule are subject to deletion or editing to remove the infringing content. Commenters who repeatedly violate this rule may be banned from further commenting on Chicago Boyz. See our DMCA policy for more information.