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Is someone who works with children required to disclose mental illness?
May 29, 2014 4:55 PM   Subscribe

I know someone who is a teacher and he has schizophrenia. He takes medication for it and functions ok. But before he came to this country (he immigrated from Canada) he had a psychotic break where he ran down the streets with a knife, cut himself and attempted to cut others. He was taken in by police, forcibly commited and put on medication. Then he immigrated to this country. Perhaps because he didn't want to be around anyone who remembered this or maybe Canada makes it difficult to get a job as a teacher after you've had a violent break like this... I'm not sure.

But the point is that here in America, no one at his job knows about his previous break so there's no one to keep an eye on him if he becomes dangerous to the students. I thought of letting the principal of the school know, so that he can at least know what to do if this person's behavior starts to change, but then I thought- what right do I have to do this? And then I thought- if something happens to one of those kids one day will it be my fault for not letting anyone in the school know? He doesn't want people to know about his illness, but the truth is that most people know there's SOMETHING not 100% about him just by looking at him. They just figure he has turrets or something benign like that, they don't realize it's paranoid Schizophrenia. Is there a requirement for a school to know if a teacher has a severe mental illness and at least one bought of violence from it in the past?
posted by manderin to Law & Government (65 answers total) 4 users marked this as a favorite
 
he had a psychotic break where he ran down the streets with a knife, cut himself and attempted to cut others

I would personally consider it a moral obligation to tell authorities if this person worked with children, and my first preference would be for that person to tell authorities themselves, along with their current therapist or caregiver.

I would do it with misgivings and regret, but I'd do it. He attempted violence on others.
posted by A Terrible Llama at 5:00 PM on May 29 [4 favorites]


Ed code is not specific on what qualifies as "(6) Physical or mental condition unfitting him or her to instruct or associate with children" but it does say it is grounds for dismissal of a permanent employee.

That being said, you don't know that his principal doesn't know about it. Most schools ask for lists of medications/illnesses on an emergency form, so he may have disclosed it. However, I wouldn't want to risk his job by telling the principal outright. Can you ask him about it? A conversation may give you the information you need. Beyond that, I would vote for "No, don't say anything unless you see a clear indication of him being a danger to children RIGHT NOW."
posted by guster4lovers at 5:03 PM on May 29 [3 favorites]


Yes, in this case you share it through the appropriate channels. If a person who did not have a psychotic break did this, it would be a legal issue that has bearing on one's employment. Adding psychotic illness to the situation does not make it a suddenly more viable situation in terms of safety.
posted by SpacemanStix at 5:04 PM on May 29


How do you know what you know? Are you 100% sure what happened is as you describe it? Can you provide documentation?
posted by hydrophonic at 5:10 PM on May 29 [5 favorites]


I know for a fact that he did not disclose his illness or meds to anyone when becoming a school teacher in the states. Did he commit some kind of crime when he didn't disclose this information? He very adamently does not want people to know.

I'm wondering if there's a way I can call his Canadian therapist or his Canadian Health insurance provider and have them send the info to the department of education?

No He won't lose his job as a teacher. He will just have people around him who knows what signs to look for if god forbid he stops taking his meds or his meds stop working.
posted by manderin at 5:12 PM on May 29


I have mixed feelings about this, and i generally think it's NOT your place to say anything. If it's managed and he's on medication and doing good, this is exactly the kind of thing that could sink his life.

How long ago did this happen? I guess just the concept of being unmedicated and stable>psychotic break>medicated and stable with the story following you around and causing you to get 86'd from your chosen profession just strikes me as not quite right.

In addition to what hydrophonic said, which is also a good point.

The only reason i'd tell them is if he didn't seem like the type to consistently take his medication or take care of himself, and you had a reason to believe he would become a danger soon. If he's just leveled out and living his life? I don't know, it's grey area but i'd learn towards no.
posted by emptythought at 5:17 PM on May 29 [3 favorites]


I came to the States from Canada as a teacher. You need to get police clearance from your previous country to work in the next one (wrt to US/Can/UK). Personally, I'm not sure of your stake in the matter but your wanting to disclose someone else's private medical history to their employer is disturbing to me. Do you think the Canadian medical professionals will do this on your say so? I find this whole question quite disturbing, frankly. Oh, and I came here for the experience and for the job, not "to run away and hide" from Canada, so I'm not sure why you are ascribing those motives to this individual either....
posted by bquarters at 5:19 PM on May 29 [38 favorites]


No, it is not your responsibility to tell his employer. Frankly, I'm a bit skeptical about your assertion that he attempted to cut others as well as himself. Do you have documentation about that, or is this just part of a story you've heard?

If, as you say, people know there's something "off" by looking at him, then I suspect they already have an eye on him. Let the guy put his life together and move forward.
posted by Sal and Richard at 5:19 PM on May 29 [2 favorites]


Why do you have such a hard on to wreck someone's life? You know a lot about him obviously, apparently you know who his therapist is and who his insurance provider is in Canada. So what's your axe to grind here? I know you're couching as if it was all about "think of the children!" but that doesn't ring true when you are so obviously deeply involved in this person's life.

He's medicated, he's not harming anyone. Reporting this to someone is unlikely to help anyone and is fairly likely to ruin the guy's life. Is that your goal? If so then I suggest that you practice looking in the mirror and telling yourself what a horrible person you are.

Adding psychotic illness to the situation does not make it a suddenly more viable situation in terms of safety.

Sure it does, because medication can help people, like it's apparently helping the subject of the OP.
posted by Sternmeyer at 5:20 PM on May 29 [9 favorites]


In Ontario, a diagnosis of schizophrenia does not exclude someone from teaching; their job is protected against discrimination by the OHRC and the Unions are very strong in defending this right. If the violence occurred while he was having a psychotic break then he was not criminally responsible and should not have a criminal record. If he is currently medicated (and there have been great strides in medication the past few years including higher compliance due to the injectable drugs) then he is unlikely to have another break. His health is between him and his doctor and you should not become involved, and potentially ruin his life, with the partial information you have.
posted by saucysault at 5:22 PM on May 29 [25 favorites]


@empty No he is currently on his meds and doing fine. That's the only reason why I bothered asking this question. If he wasn't doing well I would have already called his principal. I'm even more worried now that someone on this thread has mentioned this person is required to list medications on an emergency form and he didn't. I guess it's just that shooting in California that's gotten to me. It's the second time in a short period that someone with a history of mental illness and some violence has caused death in schools and everyone is blaming the people who knew there was something wrong with the guy and didn't do anything about it. Well, I know about this person's history where he was thrown into an institution and medicated against his will for this incident with the knife. He doesn't have a criminal record. The incident is ONLY on his medical record. I don't know why. In any case, I'm one of the few people who knows about it because I lived with him and family for years, and after this recent school shooting I wonder if something were to happen people will blame me and his parents for not telling the school about his illness.

Edited to add: I guess Saucy above has answered why it's only on his medical record.
posted by manderin at 5:25 PM on May 29 [2 favorites]


I'm not surprised that he's adamant that others not know about his past. Just look at what you're considering doing with the incomplete knowledge you have. Let his doctor, a professional with a much better grasp of the situation, manage his medications and health. It's not heroic or even appropriate to potentially destroy someone's life because of some imagined chance that this person would become murderous.
posted by quince at 5:33 PM on May 29 [19 favorites]


after this recent school shooting I wonder if something were to happen people will blame me and his parents for not telling

You are catastrophising.
posted by Kerasia at 5:35 PM on May 29 [16 favorites]


No, you can NOT call his Canadian therapist or his health insurance, no you may NOT ask them to send someone else's medical records to another party.

You say you 'know' all about his medical history because you lived with his family..... do you have PROOF, actual documented proof that you legally obtained? HOW do you 'know' he hasn't disclosed his medications on the school emergency contact forms: have you SEEN those forms, and if so HOW did you see them? Did he himself show them to you, or did *someone* violate the privacy of the school's personnel files?

To be totally honest, you sound very vindictive, as if your claim of being worried about The Children's Safety is just an excuse to try and drag this man through the mud.
posted by easily confused at 5:40 PM on May 29 [2 favorites]


If He is on medication he is being monitored by a professional regularly and that professional has the duty to warn if he believes the person is a threat. Let his doctor who is a professional handle it.

Obviously if he goes off his medication and tanks call the police and they will hospitalize him again.

Relax. It is not your responsibility.
posted by AlexiaSky at 5:45 PM on May 29 [6 favorites]


Yes I do have proof. I didn't mention why I know or how I know because that's really not relevant to the discussion. I think some of you are getting emotionally charged over something that doesn't need to be. It's either right to let his principal know that he did not speak the truth on his emergency form, or it's wrong to do so.

Since this very appropriate and simple question is getting to some people on here, I've decided it would be best to just speak to his therapist about it and I'll let her decide whether or not to tell them. He hasn't told her where he works. I'll let her know and she can decide to tell them or not to tell them. That's probably the right thing.

Thanks to everyone that answered.
posted by manderin at 5:46 PM on May 29 [4 favorites]


Don't butt in with his therapist. Let it be and let them do what they need to do. Unless he has explicitly given you permission you have no right.
posted by AlexiaSky at 5:52 PM on May 29 [8 favorites]


And the emergency form thing is probably a district policy and you have no idea of its even required.
posted by AlexiaSky at 5:53 PM on May 29 [2 favorites]


I think some of you are getting emotionally charged over something that doesn't need to be.

Uhh, pot, meet kettle. I realize you're probably essentially done here, but your entire second post was essentially an appeal to emotion.

I also won't appologize for being upset by this, as someone with a MI that has specifically been crapped on by this whole shooting situation.

Most of your questions, including why it's only on his medical record have been answered in this thread.

Just don't try and paint this as anything but an emotional response, because you have gotten just as emotional about this as anyone replying. Your feelings are not somehow more valid than ours.
posted by emptythought at 5:54 PM on May 29 [21 favorites]


He has a therapist. He is on medication. He is more likely to be a victim of a crime than commit one. He has a right to move on with his life. Schizophrenia isn't a precursor to bring a murderer. I think you are letting your reaction to the recent shooting propel you down a route that will destroy a person's life. Your actions are the reason why there is a large stigma about revealing mental illness.
posted by kanata at 5:56 PM on May 29 [36 favorites]


I've decided it would be best to just speak to his therapist about it and I'll let her decide whether or not to tell them.

I would consider that, by doing this, you would be contributing to the much larger and more dangerous problem of discouraging folks with mental health issues from getting the professional and medical help that they need.
posted by lalex at 5:56 PM on May 29 [40 favorites]


Just to be clear, it would be wrong to contact his Principal or his therapist.
posted by quince at 5:57 PM on May 29 [15 favorites]


It is wrong to contact his therapist or principal. His medical history is not your business. Having schizophrenia does not make him more likely to commit murder or to commit violent acts (it makes it more likely he will be a victim of them).

By catastrophizing in this way and overriding his desire to keep his medical history private, you are helping to stigmatize mental illness. That stigma is what keeps many people from getting help, which does appreciable harm. You are also being disrespectful and inappropriate, and putting a man's livelihood (and therefore his own safety and health) at risk.

You are talking about doing actual harm. Please don't.
posted by rue72 at 6:02 PM on May 29 [24 favorites]


Before contacting the therapist (which in my opinion is a morally wrong) you should at least do the due diligence that there is anything like a requirement to disclose medications and illness to his employer. I've frankly never heard of such a thing except in cases where the illness impacts the required duties (soooo, maybe a visually impaired trucker would mention not being able to see oncoming traffic before getting in their rig?). I can think of no reason that a treated and monitored mental illness would need to be disclosed.
posted by saucysault at 6:02 PM on May 29


Be aware your interference in this man's life could be construed as defamation and make you liable for damages.

Do yourself a favor and mind your own business.
posted by Pudhoho at 6:04 PM on May 29 [3 favorites]


It's either right to let his principal know that he did not speak the truth on his emergency form, or it's wrong to do so.

Then let's be very clear on this:

It's NOT RIGHT to let his principal know the things that you know. That is HIS medical information and ONLY HIS medical information, and you have absolutely NO RIGHT to disclose it to anyone. And that's exactly what his therapist will tell you when you bring your busy-body self to her office.

The reason that he very adamantly does not want people to know is because people like you are out there and completely willing to destroy his career even though he's medication-compliant, doing well, and no more a risk to anyone than you are.

You need to step off.

Also, totally in agreement with what pudhoho and kanata said.
posted by magstheaxe at 6:04 PM on May 29 [26 favorites]


I'm not sure you have dealy with someone with active pervasive delusions who is not medicated. I have. It's a part of my job. And ALL of them wouldn't have been able to pass going to work. Everybody would notice. From the eye movements from following hallucinations to talking to himself to being unable to distinguish reality from delusion. Like he would walk into the school and people would think he was at the very least high and he would be reported. And Holy hell do students talk about this stuff.

Usually socially people deteriorate as well. And teaching is a very social job.

Some people do learn to manage a schizophrenia without medication. They learn their delusions and become able to basically ignore them.

It isn't up to you. Keeping secrets isn't a crime. It is normal. You panicking is not normal.
posted by AlexiaSky at 6:06 PM on May 29 [9 favorites]


If you know for a fact that this happened, and you know that he may be a potential harm to others in a way that did not get the proper oversight, yes it is okay to share this information with others. The question is whether or not you actually do know. If that question is resolved for you in good conscience, then it is simply not correct to say that it is wrong to share this information, if a concern is warranted.
posted by SpacemanStix at 6:13 PM on May 29 [6 favorites]


With all due respect, I think panicking is completely normal. It's been a fraught week. And I get why the fact that he is keeping information from his employer and therapist worries you. So I do empathize. But as others have said, interfering without solid information that he is not complying with his treatment plan is wrong.

You mentioned that you lived with his family. Are you still close to them? Perhaps sharing your concerns with them would be enough to assuage your fears?

Again, I get where you're coming from. But I honestly don't think there's enough here to warrant violating his privacy.
posted by snickerdoodle at 6:18 PM on May 29 [2 favorites]


You say that 'most people know there's SOMETHING not 100% about him just by looking at him'. (And I'm assuming that by 'turrets', you mean 'Tourette's'?). What does that even mean? And if it's so obvious, why do you think his employer hasn't noticed?

Something doesn't add up here.
posted by Salamander at 6:19 PM on May 29 [10 favorites]


Right now, he's doing okay. Or at least it sounds like he's doing okay even if "everyone can tell." I suspect everyone can't tell if he's not already being watched out for.

Honestly, it sounds like you want to destroy this guy's career to me. Because it would destroy it to blab this. I would ONLY blab it if he was actually becoming a danger to himself or others again. Right now he's not, right? Yes, you're catastrophizing.
posted by jenfullmoon at 6:22 PM on May 29 [1 favorite]


You're fretting about feeling responsible for his potential violent episodes, yes? How about this scenario:

He's currently medicated, seeing a therapist, and doing fine. You butt in and put his employment in jeopardy*. He can no longer afford insurance, or other means of paying for his meds and therapy. Several months later, he goes off the deep end and slashes children at a playground. How will you feel then? You won't just be passively responsible anymore.

*You say he won't lose his job over this, but you don't know that for a fact. When it comes down to brass tacks, the school board may look for any other possible reason to get rid of him rather than have the 'liability' of a reported danger on payroll.
posted by CKmtl at 6:24 PM on May 29 [7 favorites]


No, teachers are not required to disclose mental illness or other disabilities. They are supposed to disclose if they have been convicted of felonies, though. But if the felony happened outside of the state, that is not readily accessible for me to find out on my own.

Is there a requirement for a school to know if a teacher has a severe mental illness and at least one bought of violence from it in the past?

I hire teachers. In my state of Massachusetts, teachers have to have a clean CORI. A CORI has "a record of all criminal cases where you appeared before a judge in a court in Massachusetts. Your CORI includes pending charges, prior convictions, and cases that ended without a conviction (for example, a finding of not guilty, or cases that were dismissed)."

Anything that happens outside MA would not be in this record and if I were looking to hire someone, I wouldn't know about illegal activity outside of the state.

Now, as far as being an administrator who would receive this call, I would thank you for calling and move on.

And then I would drop the matter. For various legal reasons, I wouldn't ask the teacher if he had a mental illness because legally, I can't ask that.

So the short answer as a school administrator is sure, you could call, and I would do nothing with the information.
posted by kinetic at 6:27 PM on May 29 [5 favorites]


I think here (I am not a teacher) they can all you about criminal convictions and that's about it. If he hasn't be charged with a crime he can teach. Having a mental illness is not a crime.
Having a job is a very good thing. He managed to educate himself pass licensure and do regular work things like interact with a large number of children each day, keep a routine, call if he can't show up etc. All these things indicate he is very grounded in reality.
posted by AlexiaSky at 6:34 PM on May 29 [1 favorite]


Is this the same guy you were planning to take to small claims court over a security deposit dispute, who you described as mentally ill and heavily medicated?
posted by strangely stunted trees at 6:38 PM on May 29 [5 favorites]


Jeez, people, dial back the judgement about the OP's motivations. For those of us in California, recent events have us all examining our perspective and collective responsibility in these horrifying situations.

That said, OP, please do not hold yourself responsible for some potential future event that most likely: a) would not end up happening, and b) would not be your "fault" even if it did. The most you should do is quietly check in periodically to assess for yourself if he seems a danger and then, and only then, should you think about notifying anyone.
posted by hapax_legomenon at 6:41 PM on May 29 [11 favorites]


I think the reason people are responding to this in an emotionally charged way is that it's horrifying to imagine that someone with such intimate access to obviously very personal information about us is extrapolating all the ways in which we might someday, somehow commit heinous acts, based on terrifyingly faulty reasoning and paranoia. I would be deeply upset to learn that someone who plainly respected me so little had such high access to information about my life. I suggest your best avenue of approach is to remove yourself from all interactions with him and his family, and trust that he has people in his life--friends, partners, co-workers--who can provide the kind of support he needs, when/if he needs it, with respect and with reasonable boundaries.
posted by tapir-whorf at 7:17 PM on May 29 [11 favorites]


You're caught in a bind.

Yes, if he stabs someone, anonymous people on the internet will blame you. It's unlikely, but still.

Most people with mental illness, are not, and will not be violent.
Buuuut. He already has been.
We're not talking about the average person with mental illness, we're talking about someone with with mental illness AND a history of violence.


Tell the Therapist. They can't disclose anything to you, but you can disclose things to them. If your Someone has problems with medication, or is increasingly erratic, their work situation is relevent, and their Therapist needs all the information to make the best judgement call in that situation.


Then bow out, becaues there's not much else you can do.
posted by Elysum at 7:20 PM on May 29 [7 favorites]


They do perform back ground checks on prospective teachers. I had one performed on me before I could student-teach. I can't imagine that the school does not know about an event like this.
posted by munchingzombie at 7:29 PM on May 29


munchingzombie: "They do perform back ground checks on prospective teachers. I had one performed on me before I could student-teach. I can't imagine that the school does not know about an event like this."

Unfortunately, the state-to-state (and one imagines country-to-country) methods of transmission of the data used for teacher background checks do not contain all relevant information. My district stepped up to using a considerably more expensive, thorough system of background checking for teachers after a nearby district hired a high school teacher who was convicted of raping an underage girl in Tennessee and this was not transmitted to the Illinois police authorities doing the background check. We probably had one teacher a year in my district (with 1100 teachers) who had to be released when we (or the state) found out information that the background check should have turned up (mostly it's minor drug convictions, public nudity convictions, or a problem with teaching credentials; only rarely is it something actually concerning rather than kind-of piddling regulatory stuff); now it's probably one every two years since we use the expensive system that's far above the state minimum requirement. But plenty of people who shouldn't be passed by the system do slip through the cracks when they move jurisdictions.

(PS, a lot of these teachers actually correctly put their minor drug conviction on their licensure application and the state background checkers manage not to notice it's already on the form OR turn it up in their background check.)
posted by Eyebrows McGee at 7:40 PM on May 29 [3 favorites]


Most of the people here responding don't have personal experience with schizophrenics. I do. I've known THREE of them... two of which were family members. All of them tried to kill me and members of my family at one point. One of them shoved a knife right through a relative's shoulder. So I guess I'm biased when I say- absolutely call his/her therapist. I would absolutely call him and tell him where his patient works. Then if he has a problem with it he can do something about it.

We're living in a very PC culture right now that tries to turn a blind eye to the fact that schizophrenics are the most violent of those who suffer from mental illness when their meds do not work- and the meds don't always keep working. Sometimes they stop working. My uncle's meds worked great for almost 15 years and then they stopped working and long story short he's been locked up for almost a decade now. I used to sound like a lot of these people on here- Really defensive and called people in my family who sounded judgmental towards the illness "bigots" for having those thoughts. Then I was almost slashed in the face and I changed my PC tune right then and there. It wasn't their fault, they are sick, but it's not my fault either and I shouldn't be getting my face slashed for the sake of someone's supposed mental health privacy rights.

I can understand why he doesn't want his employers to know about his illness, but fuck that. He's working with kids. He should've thought about that before he decided to work with kids. As far as I'm concerned once you start working with kids your right to privacy in severe mental health issues takes a back seat. But that's just me. I don't care if people disagree with me. If I were you I would feel an obligation to disclose it. Go ahead and tell his therapist. Either the therapist will say it's fine and you can stop worrying or the therapist will decide to let the employer know he/she doesn't feel comfortable with where your friend is working. Either way no harm done. The therapist is the expert on his care. Anyone who says that the person assigned as the expert in this person's mental health shouldn't be given the opportunity to make a decision in this matter are not thinking clearly. They are saying- Don't get the expert involved, just do as I say...Don't take the expert's word for it- take MY word for it instead. Garbage. Please ignore them and call the therapist.
posted by olivetree at 7:46 PM on May 29 [8 favorites]


trust that he has people in his life--friends, partners, co-workers--who can provide the kind of support he needs, when/if he needs it, with respect and with reasonable boundaries.

Yes, that would be nice. Mental health system isn't that good though. This may be coming from one of those support people.

Just as a bit of a derail:
The worst bit of dealing with someone with a severe mental illness, is trying to decide when they are no longer capable of autonomy.
Anyone who has ever been involuntarily sectioned, like this person will have been for trying to stab themselves and others, has been sectioned because people around them looked at them, and had to decide that they weren't ok. Not ok enough for autonomy.
Not just, had information disclosed to their therapist, but they weren't actually ok enough to not be committed to a psychiatric ward.
And it's the people around them who had to make that FIRST call, for that to happen (In this case, it was probably strangers in the street, because those friends and family didn't pick up on it first).
YES that's freaking horrifying.
What if you make a mistake? What if you call when they're not a danger to themselves and others? What if you don't call when they are?


I've definitely been in the situation where we held off for a day or two in an involuntary committal, and it didn't help the situation (yes, including by the account of the person who was being committed).
They just went deeper, and took longer to come out of it.
Anyway, point being. Yes. This is the situation friends, partners, and co-workers of people with severe mental health issues, deal with.
It's all a game of harm minimisation.
Committal, it's not cool, and it robs dignity and autonomy from someone who is having trouble with both of those things.
But fellow mefites, let me know when they've come up with something better.
posted by Elysum at 7:47 PM on May 29 [4 favorites]


Actually, I do have a wealth of personal experience with people with schizophrenia, and people with other mental illnesses that have led to psychotic breaks. Others in this thread likely do as well. I have also taught in a public school system. I stand by my advice above.
posted by rue72 at 7:49 PM on May 29 [6 favorites]


Tell the Therapist. They can't disclose anything to you, but you can disclose things to them. If your Someone has problems with medication, or is increasingly erratic, their work situation is relevent, and their Therapist needs all the information to make the best judgement call in that situation.

A therapist would be in violation of HIPPA regulations to even acknowledge to the OP that they are treating this individual without the permission of the individual or a judge's order.

As a therapist, if an individual called me to discuss another person, I wouldn't even acknowledge I'm treating them, much less discuss them, no matter which way the information was flowing, without a signed release or court order. I certainly wouldn't exchange or accept any information from you.

This is not your business, you have no standing in this. The system may be flawed, but the system does exist.
posted by HuronBob at 8:11 PM on May 29 [8 favorites]


It's either right to let his principal know that he did not speak the truth on his emergency form, or it's wrong to do so.

From the information provided, it doesn't seem that you have any idea what he listed on an emergency form and what he didn't, but I'll say this: these are not employment checks, and they are not a comprehensive medical form. They are forms that you fill out every year with your name and doctor's name and emergency contacts and (only in some districts I've worked in) any life-threatening allergies/medical conditions. They are not a legal document and they are not a "give us private medical info" form. They give the school permission to have you transported to a hospital if you're unconscious or something. That's it. Definitely not a form on which you would disclose sensitive information like a mental health diagnosis, and I have never seen one ask you to list medications you take (because that would be a huge legal nightmare for the school). There's nothing to "lie" about.
posted by lysimache at 8:13 PM on May 29 [2 favorites]


Most of the people here responding don't have personal experience with schizophrenics.

I recognise most of the usernames in this thread; we have written in this community over several years about our personal experiences with people with mental illness, including schizophrenia. Please do not assume we are being "PC" (a pretty offensive term, to myself at least).
posted by saucysault at 8:23 PM on May 29 [11 favorites]


I think it's fuuuuucked up he's hiding his profession from his therapist, so yes, go ahead and let his caregiver know.

Then you have to consider this:

"Is this the same guy you were planning to take to small claims court over a security deposit dispute, who you described as mentally ill and heavily medicated?"

You need to disengage from this man and his family. They're toxic and you are sinking to their level.

It's too bad you'll be notifying his caregiver out of spite, but yes, someone professionally trained to evaluate this person should be in a position to contact his employer if the need came up.

I'm also kinda wondering how you know what he has or has not told his therapist....

But whatever. The worst that happens is the therapist already knows he works with kids and you're dismissed as an axe grinding crackpot.



(I wonder how many people arguing for you to mind your own business have children because being a parent certainly influenced my answer.)
posted by jbenben at 8:26 PM on May 29 [4 favorites]


You might be interested to read this NIH report on violence and mental illness.

The most sophisticated research suggests that for people with major mental illnesses, including schizophrenia, they perpetrate violence at the same rate as non-schizophrenic controls - but going off medication is a risk factor, as is substance abuse. (Substance abuse is a risk factor for violence in the non-schizophrenic population too, of course, as is being young, male or poor.)

Among those who have experienced violence at the hands of a person with a mental illness, 87% were family members, and violence typically occurred in the home.

The report also notes:
"The public most fear violence that is random, senseless, and unpredictable and they associate this with mental illness. Indeed, they are more reassured to know that someone was stabbed to death in a robbery, than stabbed to death by a psychotic man. In a series of surveys spanning several real-life events in Germany, Angermeyer and Matschinger showed that the public's desire to maintain social distance from the mentally ill increased markedly after each publicized attack, never returning to initial values. Further, these incidents corresponded with increases in public perceptions of the mentally ill as unpredictable and dangerous."
And:
"Public perceptions of the link between mental illness and violence are central to stigma and discrimination as people are more likely to condone forced legal action and coerced treatment when violence is at issue. Further, the presumption of violence may also provide a justification for bullying and otherwise victimizing the mentally ill."
I do wonder if some of this bears thinking about in the current context.
posted by Cheese Monster at 8:48 PM on May 29 [7 favorites]


No it is not the same guy as my ex-roommate. My ex-roommate had a mental illness, but it was more an OCD type thing- nothing that put people's safety at risk. I would've thought that went without saying since I can't see why anyone would voluntarily choose to live with a stranger who tried to stab people at one point, but I guess I should've mentioned it before even though it's not relevant. FYI: I surprisingly got my money back from him after I showed him some of the evidence I was going to use in court so that's no longer an issue.

As for the therapist I left a message for her a few hours ago after my last post on this thread so I'll be speaking with her tomorrow. It's been a few years since I've spoken to her about him, (his parents and I all know the therapist) but I think she'll remember me. She won't be able to tell me anything about his treatment of coarse, but I don't care about that. As long as she knows where he works and she's fine with it that's all that matters. I do want to thank all of you for your input.
posted by manderin at 9:06 PM on May 29 [3 favorites]


I understand that most schizophrenics are not violent and never will harm anybody. And I believe it when the studies show that people with major mental illness aren't more violent than other people.

But what about the mentally ill with a demonstrated history of violence? Has there been any studies looking into what's the rate of violence against others for schizophrenics who had been previously violent?

I don't know what's right in this situation. But this kind of data can be relevant to the question at hand as it give a objective sense of what are the risks involved.
posted by Pantalaimon at 9:24 PM on May 29 [3 favorites]


he did not speak the truth on his emergency form

I think there's some confusion about the emergency form. Having medications on an emergency form means your employer can tell the paramedics about any medications you're taking in case of a sudden illness or accident. It is not used to alert employers to mental illness; employers are explicitly prohibited from using this form in the way that's being suggested here.

If his employer does use this type of form, and not all employers do, there's a good chance that listing medications is optional.

Please trust that this man is being monitored by a licensed professional of his choosing. He does not need additional monitoring from you or his boss.
posted by balacat at 9:31 PM on May 29 [4 favorites]


Has there been any studies looking into what's the rate of violence against others for schizophrenics who had been previously violent?

Yes! And they have found that previously violent people with unmedicated schizophrenia were no more violent than the general population when medicated.
posted by jaguar at 9:55 PM on May 29 [5 favorites]


My dad has schizophrenia and my uncle on my mom's side has a psychotic illness as well. They've both been violent in the past, either toward others or themselves. I don't care what you do either way but it's a reasonable thing to wonder about and the OP isn't a bad person for asking.
posted by todayandtomorrow at 10:21 PM on May 29 [11 favorites]


Paranoid schizophrenia (unlike other types of schizophrenia) often carries symptoms that increase the risk for committing violence (though it still remains fairly low). Paranoid schizophrenia is also the type of schizophrenia that responds best to medication and therefore carries with it the best prognosis when treated.

So if you are using "Paranoid schizophrenia" in the clinical sense, then the fact that he is on meds and "fine now" means that his medication is working, which pretty much gets rid of most of the risk of his committing future violence (though I suspect he didn't actually commit violence against anyone else during his earlier psychotic break).

You know what also cuts the risk of someone committing violence and increases medication compliance, which again decreases the risk for violence? Having a stable job and good support network. Your attempts to rip those away from this man put him at risk.
posted by jaguar at 10:30 PM on May 29 [17 favorites]


Hmm. Add me to the list of people who have (unknowingly) lived with someone who had schizophrenia and for whom hearing "oh hey, she's a teacher now and works with small kids!" would send me into a solid panic. I hid in my room with the kitchen knives under my bed and the door locked the last week that I lived there. And she was on medications (but inconsistent with taking them, as I found out the bad way). I get what everyone is saying re. privacy, and I also get the "as long as it's managed it's fine," but it bothers me that so many people are assuming the OP must have malicious intent towards this man.

That said... If his meds are stable... I would probably not tell anyone. Unless there were other warning signs. But I do see where it could be a valid ethical dilemma.
posted by celtalitha at 11:14 PM on May 29 [1 favorite]


If you speak to his therapist without his consent then I would think it would be morally appropriate, and imperative, to let him know you are doing so. You would be injecting yourself into his personal medical life at a time even you admit he is doing fine.
.
.
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And it would be totally appropriate for him to be upset at you.
posted by edgeways at 11:16 PM on May 29 [5 favorites]


[Folks, this is obviously a difficult and sensitive issue that people feel strongly about in different ways, but I'm going to ask everyone to keep their advice concrete, useful, and helpful now, and avoid arguing with other commenters or scolding the OP. You actually know how to do this well, so let's all exercise that skill.]
posted by taz at 2:48 AM on May 30 [2 favorites]


His mental illness is protected under HIPAA laws and as he is in therapy and on medication it is being manged by a healthcare provider. That provider is highly trained in what to look for if he or she thinks there is a potential threat, and if a threat is seen he or she is required to report it to the authorities. This is their job. Please let your friend and his therapist manage his own privacy.

HIPAA info on Mental Illness disclosure

NAMI info on same
posted by danapiper at 7:34 AM on May 30 [3 favorites]


I would've thought that went without saying since I can't see why anyone would voluntarily choose to live with a stranger who tried to stab people at one point, but I guess I should've mentioned it before even though it's not relevant

I'm one of the few people who knows about it because I lived with him and family for

So, have you lived with him or not?
If you lived with him, how was he?
posted by KogeLiz at 7:49 AM on May 30 [6 favorites]


My experience is outdated but my paranoid schizophrenic family member was terrible at staying on her meds. So the idea that him taking his meds now = everything is all good and there's no reason to worry, doesn't make a darned bit of sense to me. Giving his therapist the heads up on where he's working, and then leaving the rest to her seems a good course.

It seems like the OP's concern is that there's a major disconnect between the people who are aware of the man's history (and so able to provide some level of support and monitoring) and those who he is living and working around now. That seems totally valid to me. It definitely seems better to let the first group know (which will hopefully improve their ability to support him) rather than the second (which feels like it would probably just damage his new life without adding support).
posted by pennypiper at 9:08 AM on May 30 [4 favorites]


I also think it's worth noting, OP, since it's coming up in here a lot that "I knew someone who was bad at taking their medication and therefor..." is about as specious as "I knew someone who used to be an alcoholic and fell off the wagon and got wasted all the time therefor...".

I knew a person like this who did a shitty thing = all people like this should be side-eyed is crappy logic, keep that in mind.
posted by emptythought at 10:58 AM on May 30 [4 favorites]


It is also worth noting that people taking the new class of medication (atypical antipsychotics) for schizophrenia have been shown to have a much higher med compliance rate than people taking the older antipsychotics, mainly because the side effects are a little less severe.
posted by jaguar at 11:35 AM on May 30 [3 favorites]


One thing occurred to me: if he is currently getting a prescription for his anti-psychotics, he must be under the care of a medical profession here in the States. If that's the case, it's hard to imagine that medical professional is unaware of his current job. . . . .
posted by Pantalaimon at 1:44 PM on May 30


It seems like the OP's concern is that there's a major disconnect between the people who are aware of the man's history (and so able to provide some level of support and monitoring) and those who he is living and working around now. That seems totally valid to me.

This is where I come down on the issue too.

1) Do NOT contact his place of employment. The fact that you know his medical history gives you no right to disclose it.

2) I don't see anything wrong with contacting his therapist. She legally shouldn't even acknowledge he's a patient, but saying "Hi, you can't tell me anything and you can't confirm if he's even a patient of yours, but I think this guy is and here are some things you should know" keeps her legally in the clear, and you've done your ethical duty.

The problem with schizophrenia, as said above, is that the medications work until they don't. It's a degenerative illness; the best the drugs can do is control symptoms and hold back the tide somewhat. This is a person with a history of psychotic break(s?) and violence. There are significant and valid concerns about having him around children--what if he forgets his meds, or stops taking them? (Unless he's on the injectables in which case, I think, he's having to see a doctor every week or two and they'd notice if he suddenly stopped showing up.)

There could be bad news written all over this situation. There very well might not be. Disclose your concerns to the professional in charge of his care and walk away from the situation.

And FWIW I really can't blame him for wanting to distance himself from a past psychotic break; he did something bad when he was sick, he's better now, and wants (one assumes) to stay better.
posted by feckless fecal fear mongering at 8:23 AM on June 1 [1 favorite]


More and more evidence is coming to light that schizophrenia is not actually a progressive disease and that remission can and does occur.

Schizophrenia is a severe chronic mental illness, yes, but our understanding and treatment of it is moving away from looking at its diagnosis as an end ("throw 'em in a facility") and toward an understanding of the disorder's management and recovery. Relapse is not a foregone conclusion.

It is also important to remember that "he ran down the streets with a knife, cut himself and attempted to cut others" is not necessarily an objective, clinical statement and that people dump all sorts of their own biases onto interpreting an event, especially an event involving a person with mental illness. We have no actual evidence here that this particular person was ever "violent."
posted by jaguar at 9:02 AM on June 1 [4 favorites]


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