Eleanor Finch
The concept of what constitutes a danger to self or others is a complex and controversial topic, with varying interpretations and applications across different regions. This principle, often referred to as the dangerousness standard or obligatory dangerousness criterion, plays a significant role in mental health law and practice. It is defined as an individual's ability to cause imminent and long-term harm to themselves or others, either physically or mentally. This concept is a critical factor in determining involuntary hospitalization or treatment for mental illness. While some argue that it is necessary for protecting individuals and those around them, others criticize it as unethical and a potential violation of civil rights. The criteria for assessing dangerousness vary, encompassing factors such as substance abuse, mental illness, violent behaviour, and suicidal ideation.
| Characteristics | Values |
|---|---|
| Mental condition | Mental illness, disease, or disorder |
| Inflicting harm | Self-harm, suicide attempts, threatening to inflict harm |
| Substance abuse | Excessive use of alcohol, misuse of prescription medications or illegal drugs |
| Behaviour | Violence, threatening behaviour, disruptive behaviour, high frequency of unsafe behaviour |
| History | Established pattern of past dangerous behaviour |
| Inaction | Lack of capacity to care for oneself |
| Long-term harm | Physical or severe emotional harm |
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What You'll Learn
Self-harm or suicide attempts
Self-harm and suicide attempts are related but distinct concepts. Self-harm refers to intentionally injuring oneself without the desire to cause death, while suicide attempts involve a clear intention to end one's life. However, the line between the two can sometimes blur, and self-harm can escalate into suicidal behaviours over time. Understanding the nuances of self-harm and suicide attempts is crucial for providing appropriate support and interventions.
Self-harm, or nonsuicidal self-injury, encompasses behaviours such as cutting, burning, or hitting oneself, resulting in physical harm without the intent to die. It is often a maladaptive coping mechanism employed to manage acute or chronic stress, emotional distress, or painful feelings. While self-harm is not driven by suicidal thoughts, it can indicate underlying mental health issues and psychosocial difficulties. Those who self-harm may do so to feel relief, express anger towards themselves, or communicate their distress to others. Importantly, self-harm is not a sustainable coping mechanism, and individuals may find themselves in a cycle where they need to escalate their self-harm to achieve the same effect.
Suicide attempts, on the other hand, involve a clear intent to end one's life. While the specific motivations may vary, suicide attempts often arise from a desire to escape an intolerable situation or state of mind. Suicide attempts are typically more lethal in nature than standard self-harm methods, reflecting a more intense psychological distress. It is important to recognize that suicidal thoughts and behaviours are complex and influenced by various factors, including social circumstances, family dynamics, and mental health issues.
The relationship between self-harm and suicide attempts is complex and interconnected. While most individuals who self-harm do not have suicidal thoughts initially, self-harm can increase the risk of transitioning to suicidal behaviours. The very act of self-harm reduces inhibition against suicidal acts, making it easier for an individual to act on suicidal impulses if they develop. Additionally, certain risk factors, such as a history of alcohol or substance abuse, family conflict, and feelings of isolation, are common to both self-harm and suicide attempts, further complicating the distinction between the two.
To support individuals engaging in self-harm or exhibiting suicidal ideation, it is crucial to provide access to mental healthcare professionals. Treatments such as Cognitive Behaviour Therapy (CBT), Dialectical Behaviour Therapy (DBT), and Problem-Solving Therapy (PST) can help address underlying issues, improve coping mechanisms, and reduce the risk of self-harm and suicide attempts. Early intervention and comprehensive risk assessments are vital to ensuring individuals receive the support they need to lead fulfilling and healthy lives.
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Threats of harm to self or others
In the context of mental health, the "dangerousness" standard is often used to determine if an individual is a danger to themselves or others. This standard mandates evidence of dangerousness to oneself or others before involuntary treatment for mental illness can be administered. This criterion is controversial, with critics arguing that it is unethical and harmful, while supporters contend that it is necessary to protect those who are mentally ill and those impacted by their involuntary treatment.
In the United States, the dangerousness criterion was created in the 1900s and officially established in 1964 by the Ervin Act in Washington, D.C. Most states continue to rely on this standard for involuntary hospitalization, which is contingent upon, not a necessary feature of, mental illness. To establish dangerousness to oneself, an individual must demonstrate self-harm or suicidal tendencies, with a reasonable probability of repetition or death if left untreated.
To establish dangerousness to others, it must be shown that the individual has inflicted, attempted, or threatened to inflict serious bodily harm, and there is a reasonable probability that this conduct will be repeated without intervention. This includes behaviour that prevents access to learning, disruptive behaviours in particular settings, and a high frequency of unsafe behaviours.
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Substance abuse
The exact cause of substance abuse is not always clear, but there are two predominant theories: genetic predisposition and learned behaviour or exposure. Addiction is a complex disease that affects brain function and behaviour, and it can develop due to various environmental factors, including overall quality of life, mental or physical abuse, early exposure to drugs, and individual personality characteristics. Additionally, social pressures and performance enhancement at work or school can also play a role in substance abuse.
Treatment for substance abuse is essential and can be effective in helping individuals stop drug use, avoid relapse, and recover their lives. It often involves a combination of medication and individual or group therapy, with an emphasis on addressing the specific situation and any co-occurring medical, psychiatric, and social problems. Detoxification is typically the first step, followed by long-term follow-up management, including group meetings, psychosocial support, and continued medical supervision. Medications can help control cravings, relieve withdrawal symptoms, and prevent relapses, while psychotherapy can aid in understanding behaviours and motivations, developing higher self-esteem, and coping with stress.
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Mental illness
Mental disorders are characterised by clinically significant disturbances in an individual's cognition, emotional regulation, or behaviour. They are associated with distress or impairment in important areas of functioning. Mental disorders are also referred to as mental health conditions, which is a broader term covering mental disorders, psychosocial disabilities, and other mental states associated with distress, impairment, or risk of self-harm.
While mental illness and criminality are often conflated, with the media portraying criminals as "crazy" individuals, data suggests that people with mental illness are more likely to be victims of violent crime than perpetrators. However, certain psychiatric conditions can increase the risk of committing a crime. Research indicates that patients with mental illness may be more prone to violence if they lack adequate treatment, experience delusions, or have long-standing paranoia. Comorbidities such as substance use disorder, unemployment, and homelessness can further compound the risk.
In the context of involuntary commitment laws in the United States, "dangerousness" is often interpreted narrowly as "imminent" dangerousness. For example, in Alabama, a respondent may be committed to inpatient treatment if a court finds clear and convincing evidence that they pose a real and present threat of substantial harm to themselves or others due to their mental illness. Similarly, Kentucky law requires that a person be a danger or threat of danger to themselves or others as a result of their mental illness to be involuntarily hospitalised.
It's important to note that mental disorders encompass a wide range of conditions, and not all of them lead to violent behaviour. For example, individuals with depression may experience a depressed mood, loss of pleasure or interest in activities, poor concentration, feelings of guilt or low self-worth, disrupted sleep, and changes in appetite or weight. While people with depression are at an increased risk of suicide, effective psychological treatments and medications are available. Similarly, bipolar disorder involves alternating depressive and manic episodes. Manic symptoms can include euphoria, increased energy, impulsive behaviour, and racing thoughts. Again, effective treatments and medications can help manage the condition and reduce the risk of suicide.
Overall, while mental illness can, in certain cases, increase the risk of harm to self or others, it is crucial to provide support, treatment, and social care to individuals with mental disorders to improve their well-being and mitigate potential risks.
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Violent behaviour
Personality traits such as emotional reactivity, impulsivity, neuroticism, and psychopathy have been significantly linked to violent behaviour. Psychopathy, characterised by antisocial and behavioural characteristics, disregard for societal norms, and high impulsivity, has been found to be one of the strongest dispositional factors associated with violence. Additionally, violent behaviour can be influenced by a combination of factors, including social and cultural environments, situational forces, genetic predisposition, neurochemical abnormalities, and personality characteristics.
Furthermore, violent or threatening behaviour can be manifested in various forms, including physical, verbal, written, or electronic communication. It is considered violent or threatening when it is unwanted and reasonably perceived to intend physical harm or cause fear of such harm. Examples include intentionally causing extreme emotional distress, engaging in harassment or stalking, and failure to comply with policies or laws, which can result in disciplinary action or legal consequences.
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Frequently asked questions
The danger to self or others is a criterion that justifies involuntary hospitalization or treatment. It is a person's ability to hurt themselves or others physically or mentally within a short period.
A danger to self is when a person inflicts serious bodily injury on themselves, attempts suicide or serious self-injury, or threatens to inflict serious bodily injury on themselves.
A danger to others is when a person inflicts, attempts to inflict, or threatens to inflict serious bodily harm on another.
Dangerous behaviours include excessive use of alcohol, misuse of prescription medications, suicidal ideation, self-mutilation, violence, or threats of violence.
