Then I read your brief post about how you are shocked that a mental health professional would help, and I don't understand. Could you please gently explain and help me understand what is shocking about this?
Thank you!
First- I'm a psychiatric social worker by training, and worked in community mental health for about 10 years. (currently I teach).
Mentally ill people have the same rights to privacy and confidentiality as anyone else. They have the right to refuse treatment. These rights are overriden only when the person is dangerous to himself or others. In that case, the library should call 911 and the cops can notify the mental health center crisis worker to meet them at the library, if they need help (for example, if the person is on a ledge). But we had a stout rule that the cops were to secure the situation before we went in- that was after I responded on a call and the mentally ill person had over a dozen loaded guns. Our rule was that the cops were to transport the person to either the hospital or the jail, and we would respond and assess there.
I would seriously doubt that a mental status exam could be done in a library without violating HIPAA. If a person isn't dangerous to themselves or others, they have a legal right to be as mentally ill, and as loud and inappropriate, as they care to be in a public place, until they commit some other crime, when they can be taken into custody and a judge can rule on whether they are legally competent or whether they should be committed for assessment and/or treatment.
Now, it sounds like most of the patrons are going to conclude that there is something wrong with these people- but as a therapist, my presence sort of confirms the diagnosis. By even responding, I'm confirming that I have reason to believe this person is mentally ill- I wouldn't have left my office and come to the library if I didn't.
It's easy to say that a hallucinating psychotic person needs someone to step in and take control...but there's a slippery slope here. Suppose someone is having a bad day, and they yell at the library staff. Should they have to submit to a mental status exam because they might be mentally ill? Think about all the Special Snowflakes we talk about here...some of them seem a little questionable to me, but where do we stop? How about with state hospitals, where people were admitted with 'life sentences' because their families were embarrassed by their conduct? Or in the 19th century, when men could have their wives admitted for being poor housekeepers...since obviously any woman who didn't love to cook and clean had to be mentally ill? And how many dictatorships have admitted political dissidents to mental hospitals to silence them?
We had this exact situation (well, it was a fast food restaurant) happen when I was in practice. The CEO was furious that the psychologist on call hadn't responded, and threatened to fire her. He sent out a memo stating that we would go anywhere and assess anyone. He was stunned when the clinical director and assistant clinical director went to his office and told him that if he were serious, they were going back to their offices to prepare their letters of resignation.
I am not sure of the profession of the person who agreed to this...but my reading of the Code of Ethics for social workers is such that you could be brought up on legal charges and lose your license for going up to people who are not endangering anyone, and starting to do a mental status exam in full view of others.
I hope this makes it clearer.
