Finding help for schizophrenia in a ‘broken’ system

One reason so many families find themselves in this bind is America’s legal standard for involuntary hospitalization, said Dominic Sisti, a medical ethicist at the University of Pennsylvania.

“We have such a high bar for providing [compulsory] treatment to individuals, that a lot of individuals who don’t meet that high bar, that threshold, are left out in the cold,” Sisti said. He added that, like Tom, a lot of people with schizophrenia don’t realize how sick they are.

Most states rely on the “dangerousness” standard — meaning that someone must present a clear and present danger to themselves or others to be involuntarily committed.

It wasn’t always that way. Sisti said commitment standards used to be a lot looser, based more on whether individuals needed psychiatric help, and whether they were likely to continue declining.

In fact, Sisti said, it used to be frighteningly easy for families to commit their loved ones.

“It was abused,” he said. “There were lots of people who were involuntarily committed under the sort of guise that they were really sick and potentially getting sick, when they really weren’t. Maybe they were just, like, a hassle to the family, or they just didn’t have anywhere else to go.”