How do you define risk of self to harm or others? Words matter.

Whew. What a whirlwind few days, and what a difference location makes. 

Our loved one was hospitalized in the local psychiatric hospital five days ago. Two days ago, we had a hearing to see if they would be kept longer than the original 5 day hold.  

The directions we received to prepare for the hearing were spectacular. We were told to identify all instances where our loved one was a danger to self, danger to others or unable to care for themself for the past 30 days. This may not sound like a big deal, but it's huge!  The national standard is that someone's civil liberties can be curtailed if they are at risk of harm to self, others or unable to care for themselves. The problem comes in defining what precisely that means. It may seem like splitting hairs, but it really is a huge deal. 

In Oregon, risk of harm to self or others, or inability to care for oneself has been defined by the courts as needing to be imminent, meaning that the person is about to be a risk of harm to self or others, or about to be unable to take care of themself.  How, precisely, are we to prove that our loved one is in the future, about to be a risk of harm to self or others? 

The fact that the test in Oregon and many other states points to a yet-to-occur action is absurd.  Innocent until proven guilty is looking at action that's taken place in the past. But for people with significant mental illness in these states, past action has no bearing on this test. The fact that our loved one was hospitalized numerous times, threatened our life, ran naked through town in winter weather, stole a hammer to kill their spouse - none of this was relevant to hearings. What we had to do was to prove that they were at imminent risk of harm to self or others.  It's absurd that the standard to get protective medical care is based on my crystal ball. it's even more absurd that I was asked to predict the behavior of someone with significant mental illness.  

Compare that with Pennsylvania, where the standard is based on the past 30 days of behavior and activity.  I can absolutely demonstrate that my love one was a risk of harm to self, others or unable to care for themself based on the previous 30 days of behavior.  

In Oregon, a bill was proposed last year to clarify precisely this issue, to specify that the standard that judges should consider is the past 30 days of activity, not the potential of imminent future harm. The bill was killed by being sent to a committee from which it never came out.  

At the hearing yesterday, the psychiatrist recommended that our loved one remain committed for 20 days with inpatient and/or outpatient care. Our loved one agreed, in large part because they trusted their doctor. 

Over the next 20 days, we'll work with the care team to provide the least restrictive, most supportive and most appropriate services for our loved one. I expect them to be released within a week-ish, and we'll begin to take advantage of another great difference in the systems.  Pennsylvania has a more robust mandatory outpatient treatment system, which provides our loved one with more structure and accountability for their recovery after release from the hospital. It also provides my husband and me more support in the job of caregiving.

In the past 30 days, our loved one has been in a facility 75% of the time, between jail and two different hospitals. They are a risk of harm to self or others, and most definitely unable to care for their own basic needs.  Thanks to the standard that allows me to demonstrate that, rather than predict it.