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People do not end up in psychiatric hospitals because of some vague or mysterious government agenda. This isn't the former Soviet Union where psychiatric "treatment" was a means of bringing you back into line with the party's desires.
They end up there because they represent a clear and present danger to themselves or someone else. A good proportion of these folks understand that they are in need of assistance, come for an evaluation and sign themselves in.
There are, however, some folks who don't get that.
And still need help.
And, as a consequence of being severely mentally ill, represent a clear and present danger to themselves or someone else. The specific criteria for dangerousness vary from state to state, but contain usually four essential elements ... attempt of homicide or physical harm to another, attempt of suicide, attempt of self multilative behavior, or being so debilitated by the mental illness that the person is unable to meet their needs for food safety of shelter to such an extent that grevious bodily harm will occur if such behavior goes untreated.
You can't put someone in the hospital because they are wacky, or merely because they talk to people you can't see. You also can't (state laws vary) put someone away just because they are drugging or drinking or retarded or senile.
Any attempt to hospitalize someone against their will is a multi-step process. There are some general similarities.
First, someone having directly observed the potential patient's behavior goes to the commitment authority ... sometimes a common pleas court judge, sometimes a specialist designated by the mental health administration of the state or county. They file paperwork which is then reviewed against the legal standard specified for both mental illness and dangerous behavior. If it meets the criteria specified in the law, a warrant is issued and then the individual is picked up and brought before a psychiatrist for evaluation. That doctor decides whether the patient, on the basis of the interview is indeed dangerous to themselves or others, and is hospitalized for a brief period of treatment and observation.
Not every one who is evaluated is admitted.
If the treating physician during the admission feels the person needs further treatment, before the expiration of the original commitment (depending on the state, usually between 72 and 120 hours later) there is a hearing before the mental health court to determine the need for further inpatient treatment. Additional court reviews occur from that point at specified intervals.
At each step it becomes HARDER for the hospital to prove justification for continuing inpatient treatment. The legal standard requires that care be provided at the "least restrictive setting."
The majority of funding for inpatient (and outpatient) psychiatric treatment comes from insurance payments. Many of these are private insurers. There is also insurance coverage provided to people who are on state or federal benefits. Medicaid and Medicare both have provisions for psychiatric funding. Some folks don't qualify for such programs, still need help, and receive it through funds earmarked by the counties for inpatient psychiatric stays. Self-pay for inpatient treatment is rare, but happens on occasion. A lot of treatment goes unpaid and unfunded. Hospitals eat the cost.
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The problem with both Laing and Szasz, is that they were psychiatrists who did not believe in psychiatric illness ... kind of like a botanist who doesn't believe in dutch elm disease. It's clear to EVERYONE ELSE that the tree has dutch elm disease. Saying it doesn't have it won't change the matter.
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