Would a 72-hour mental health hold on Trump be effective?

A psychiatrist at the University of California, Davis rejected a Yale psychiatrist’s proposal to request a mental health hold of President Donald Trump.

This article first appeared in Salon.

Bandy X. Lee, a psychiatrist at the Yale University School of Medicine, told Salon last month that Speaker of the House Nancy Pelosi, D-Calif., should submit Trump to an “involuntary evaluation.”

“As a co-worker, she has the right to have him submit to an involuntary evaluation, but she has not,” Lee said of Pelosi. “I am beginning to believe that a mental health hold, which we have tried to avoid, will become inevitable.”

Lee told Salon in a subsequent interview that citizens could also draw up a petition.

“Citizens, as the president’s employers, are acceptable auspices, especially if Congress or other governmental bodies are not acting,” she said.

Amy Barnhorst, a psychiatry professor and the vice-chair for clinical services at UC Davis, told Salon this week that imposing a mental health hold on the president would be a bad idea.

Barnhorst, who works with patients in psychiatric hospital crisis units and in jail, nearly all of whom are on involuntary emergency psychiatric holds, spoke to Salon about Lee’s proposal, the dangers posed by the president and whether political candidates should have their mental health scrutinized.

Salon: Dr. Bandy Lee recently proposed a petition to request an involuntary mental health hold of the president. How do you feel about her proposal?

Barnhorst: I think it's a really bad way to go. It's not just inappropriate and would be really ineffective, but I think it's very damaging to our profession and the patients we take care of to suggest something like that.

A mental health hold is a very delicate tool that we use for people who very badly need treatment but aren't able to accept that treatment. It's not something that should be thrown around as a punishment for your enemies. It's something that we use to get people into care, and as physicians, we all have the power to do things to people that are risky or potentially dangerous to those people in the name of healing them. And that's what an emergency mental health hold is for — it’s the power that physicians have to weigh in the balance. What's the chance that this person would be a harm to themselves or to society, and how do I weigh that against how much I think it would help them if I put this hold on them and tried to get them better?

It's the same way if you're a surgeon, and you look at somebody who has a really infected foot. And if it's bad enough it could spread to the rest of their body and not be treatable. And you may have to consider amputating that foot. And that's a really big power to have over patients — the ability to take off their limb — but it's something that we may do in order to ensure their overall health and wellbeing.

A mental health hold is similar. It's something we would do to ensure a person's overall health and wellbeing. Surgeons don't go around lopping off the feet of their enemy in order to debilitate them. We shouldn't go around applying mental health holds to people we don't like in order to debilitate them.

I think Dr. Lee would argue that the president poses a danger to others. We discussed the escalating tensions with Iran, for example.

Well, I think it's hard to disagree with the fact that our president poses a danger. Personal politics aside, every president poses a danger to some people every time they order any kind of military action, any kind of rescue operation. You're putting people's lives at risk, and as president that's something that again is an analysis you make a lot. Whether it's troops, or emergency personnel or your Secret Service, you're putting people's lives at risk and in danger.

Now whether or not you think Trump is making those decisions in the thoughtful calculated way with the council of expert advisors is a whole different problem. But yeah, I would agree that he, like those who have happened before him, is putting lives at risk. Maybe more recklessly and with less knowledge and foresight than other presidents have. However, a mental health hold is only appropriate for somebody, and it's only legally applicable to somebody who's putting people's lives at risk because of an untreated mental illness.

Secondarily, the purpose of that mental health hold. It’s not to sweep the streets and cleanse society of anybody who poses any kind of risk of danger. That's way beyond what the psychiatric system can handle. It's to treat those people who are suffering from an untreated mental illness that's causing them to be dangerous. It's to treat them and get them better. People who are just out there committing acts of violence — armed robbery, domestic abuse, murder — for the most part, they're not driven by mental illness.

Very little of that violence is driven by an untreated mental illness. About 4 percent of community violence is driven by an untreated mental illness. So the other 96 percent are just people out there doing bad things, and it's not appropriate to put all those people on an involuntary mental health hold and lock them up in a hospital for 72 hours, do nothing to them and then release them.

And that gets to the second aspect of this, which is that there's no real point of holding somebody who's dangerous. Yes, I agree that Trump is putting many people's lives at risk. But putting them on an involuntary psychiatric hold when there's no treatment for what ails them and then releasing them later? Maybe we get three days without him tweeting, but that's all that's going to get us.

One of Lee's other proposals was to evaluate the mental health of candidates before they take office. Is that something you would endorse?

I think the same way that candidates have their physical health scrutinized, they could have their mental health scrutinized. But we have to ask ourselves: What would we do with that information? Say you found out a candidate had a history of depression in their thirties, and it was treated and they got better and they're fine now. That may be something that we'd want to know about a president — like that he had had a stroke or heart attack — but I don't know that it would necessarily rule out for having that office.

There may be some things that would be ruled out for having that office in a mental health history, but I have to think that those things would probably have caused other problems along the way. If a president were so mentally all that he had been found incompetent to stand trial, that would be pretty concerning because a legal office had found him unable to participate in court proceedings. But a president who was involved in legal proceedings where he had to go to court to be found competent? I don't think that that bit of information would be the only concerning thing.

Is there anything you would like to add that we haven't touched on?

Just that I think it's really important that we distinguish between people who have mental illness, who are generally not contributing largely to the violence in the world, and who are struggling and who need care in a system that is very overwhelmed and has a hard time managing the patients out there.

That's really different than the group of people who we find dislikable, immoral, detestable. We don't like the decisions they make. We disagree with their politics. And so to call that group of people "crazy" or "mentally ill" is really insulting to people who struggle with mental illness.

For a physician to want to wield part of their power that they have earned through patient trust, to wield that in a way over somebody that they consider a foe or an opponent in order to stop them, I think that's a very dangerous ethical road for physicians to go down regardless of specialty. And that for the 96 percent of violence going on out there in the world, that's not attributable to mental illness. There are other approaches for it: impeachment proceedings, legal intervention. But if we have a president who's making these decisions — and there are people in his party, people in his constituency, people in his Cabinet who agree with his decision making — it's really hard to argue that it's based on him being delusional and mentally ill.

This interview was lightly edited for length and clarity.