Should Mental Health Professionals Ever Lie?

To say I was in a foul mood was an understatement. I'd been escorted by the police to the Midtown Community Mental Health Center's Crisis Invtervention Unit (CIU). I'd been waiting for a few hours to talk to a therapist, which is annoying even when psychiatric symptoms haven't flared up. But I was in for a surprise.

The crisis counselor asked if I knew why I was there. I said no. She dropped a bombshell--my therapist said that I'd pulled out a knife and started cutting on myself. That was news to me! I showed her my arms, proving that I had not done so. She asked who my therapist was. When I answered, the crisis counselor shook her head and said that my therapist had a reputation of exaggerating a psychiatric patient's symptoms.

In other words, my therapist was willing to lie to get me treatment she thought I needed.

Why those who say yes are right--in part

Dr. E. Fuller Torrey stated “It would probably be difficult to find any American Psychiatrist working with the mentally ill who has not, at a minimum, exaggerated the dangerousness of a mentally ill person’s behavior to obtain a judicial order for commitment. … Thus, ignoring the law, exaggerating symptoms, and outright lying by families to get care for those who need it are important reasons the mental illness system is not even worse than it is.”

Go to any meeting sponsored by the National Alliance on Mental Illness (NAMI) and you'll hear why lying is so tempting. A friend of my mother's has a son with bipolar disorder. A few years ago, his behavior became odd and reckless. For example, he had a manic episode in Las Vegas and drained his bank account. He also took off to help with Hurricane Katrina relief--by himself, without his medication. Because he was not suicidal or homicidal, there was nothing she could do except watch him self-destruct. His therapist even said "There's nothing we can do but wait until he's in the hospital or jail."

Why those who say no are right--in part

My therapist's lie negatively affected our relationship. I no longer trusted her, and without trust, therapy is impossible. I eventually asked for a different therapist and found one who promised not to lie to me or about me. I was still able to get the treatment I needed. Were there times the police were involved in my treatment? Yes. But I trusted this therapist, and I trusted her judgment when she wanted me to go to the hospital. This seemed to make hospitalization easier, because I knew I needed to be there.

In some states, lying in order to get someone admitted to a mental institution is a crime. This was the case when I lived in Texas. It didn't seem to negatively affect the mental health system.

I understand why some mental health professionals lie. It's not easy to watch someone you care about make harmful decisions. However, we don't force people to receive medical treatment for a more traditional physical illness unless lives are at stake. Why should mental illness be any different?

Where I stand

I believe that a mental health professional should not lie because trust is so important in the therapeutic relationship. That said, the system needs reformed. The criteria for involuntary treatment should not be whether or not a person is suicidal or homicidal. The person's judgment and actions should be taken into account. It should be on a case by case basis.

I like Michigan's law, which allows commitment of a person “whose judgment is so impaired that he or she is unable to understand his or her need for treatment and whose continued behavior as the result of this mental illness can reasonably be expected, on the basis of competent clinical opinion, to result in significant physical harm to himself or herself or others”“. Oregon's law is also good; the law states any person who “[h]as been committed and hospitalized twice in the last three years, is showing symptoms or behavior similar to those that preceded and led to a prior hospitalization and, unless treated, will continue, to a reasonable medical probability, to deteriorate to become a danger to self or others or unable to provide for basic needs” may be committed.

Is the mental health system difficult to navigate when a person doesn't want treatment? Absolutely. Does that justify lying? The jury may still be out on that one. There is no simple answer.