Yeah. There are degrees of force, aren't there? My son has been 'voluntarily' sent to the hospital on several occasions where ... hmmm ... he pretty much had his arm twisted or he was roped into agreeing. And once you go 'voluntarily,' you can't just voluntarily check yourself out.

Elyn Saks has an interesting take on this subject. She advocates forcibly medicating the psychotic person during the first episode. Then once they're thinking clearly they can say whether they'd like to be forcibly medicated the next time - unless they're a danger to self or others, of course. Their wishes can be recorded in some kind of advance directive.

Some people are grateful that someone else got them to a hospital and medicated them. My son has never been grateful. He's been through this several times now, and he's pretty clear that he doesn't want to be involuntarily hospitalized and forcibly medicated. He never sees any up side to it.

I see this with my son too. Even in retrospect, he often doesn't understand how out of control he was and how others were perceiving him. From his point of view he was fine, and everyone should have left him alone. From everyone else's view, he was not able to care for himself.

It must be difficult for the professionals. They have to choose one of the options available to them, and the options are sometimes all "bad." As a family member, I think I have a little more choice. I can provide my son a home, make sure he eats, etc., while he's still in psychosis and not medicated. But for a professional trying to keep an unemployed, homeless person who is living in an alternate reality safe, it must be challenging. For example, the mental health transitional housing alternatives in this area require that the person be taking medication. No medication means the homeless shelter.

The last time my son was staying in transitional housing, he was very delusional. He was leaving the house barefoot and coatless in extremely cold weather. He fished an empty pizza box out of the trash at 2 am one time and tried to bake it in the oven - set the fire alarm off and woke the whole house. He clearly needed supervision. But the mhc required he be medicated, and he strongly objected.

I don't know what the answer is. I can imagine a world where people in a psychotic episode who can't care for themselves would have a safe place to stay. But the world I imagine and reality are two different things.