Education Lessons Medicine Policy

Involuntary Commitment (III).

“What should we do?” the outreach worker asks. “He slapped a woman at the laundromat yesterday.”

The police know him well. For at least ten years, he, along with a cadre of other homeless individuals, has spent his days in the park and nights in empty lots in the neighborhood. He limps to the right when he walks; he reportedly fractured his leg many years ago while drunk and it never healed properly.

These days, the police frequently see him before 9am because the two 40-ounce cans of beer he finished earlier in the morning have led him to call 911.

“I just wanna die,” he bawls to the dispatcher. “I’m gonna kill myself, I’m gonna jump off that bridge, I’m gonna be dead, I just wanna die.”

The police are exasperated with the hospital: “We bring him there because he has tried to kill himself when he’s drunk. Less than three hours after we drop him off, he’s right back here again and drinking! They don’t do anything, so we don’t even bother taking him there anymore. If we arrest him, he’s in jail for a few days, but he doesn’t get any help. Then he’s out and back here again.”

You’ve looked at some recent hospital records for him; he’s had numerous visits to the emergency room. His blood alcohol level is usually around 0.3%[1. A blood alcohol level of 0.08% is considered the legal limit.] and he often says that he wants to kill himself. As the alcohol leaves his system, he retracts these statements: “Nah, I’m fine. I don’t wanna die.”

He was psychiatrically hospitalized over a year ago. At that time, he said that he heard voices and drinking alcohol made them go away for a while. He started taking medication. He said he felt better. The rest of his hospitalization was uneventful. He didn’t attend the appointment scheduled for him one week after he was discharged from the hospital. He returned to the park.

“The woman in the laundromat called the police and they knew exactly who she was talking about,” the outreach worker said. “He was napping in the doorway of the laundromat and the woman asked him to move so she could get her stuff inside. He got up, followed the woman in, slapped her across the face, then left. The police couldn’t find him when they showed up.”

After speaking with you, the outreach team goes to the park to find this man to talk with him about what happened. They also intend to discuss housing, something that he continues to decline.

“I don’t wanna follow somebody else’s rules,” he has said during moments of relative sobriety. “I wanna do what I wanna do.”

The outreach team is back in less than half an hour.

“He was really pissed off,” the outreach team says. “He chucked a can of soda at us.”

“He chucked a can of soda at you?”

“We were trying to talk with him and he wasn’t having any of that. He told us to ‘f@ck off’—the usual when he’s drunk—so we said we’d come back later to talk with him. We were probably about ten feet away when an open can of Dr. Pepper flew past our heads. We got a little soda on us, but we didn’t get hit. It would’ve hurt if his aim was better.”

Does this man have a mental illness? Does he need to be sent to the hospital for psychiatric evaluation? If he doesn’t want to go to the hospital, should he be forced to go to the hospital against his will?