I’ve missed your comments - although I guess you’ve got more important things on your mind right now - like creating a new little person! Hope you are well.

But what if a person is so sick that they are incapable of rational consenting behaviour? First, how do you determine this? Second, how do you respond? This seems to me to be the crux of the problem with mental illness treatment.

Many will voluntarily admit themselves - in these cases the only issue is one of capacity of available facilities.

However, it’s those who refuse treatment, who may well be hell-bent on self-destruction that pose a real problem: how can we assess their rationality? Does a person have a right to self-destruct? Do we have a right to stop them and in what circumstances?

These are the fundamental questions that are contemplated regularly by policy makers in the field, and it’s exactly what makes the area so difficult to deal with.

It reminds me of the conundrum that was posed by a famous death penalty case in the USA. An inmate on death row had decided that he was sick of the lengthy, agonising appeals process, and decided that he would rather die than suffer through the tortuous doubt any further. So he told his legal advisors to cease all appeals and accept the death penalty. At that point, the corrections department determined that he could not possibly be acting rationally: he must be suicidal. So he was removed from death row and treated for depression so that he might resume the appeals process and return to death row for a further number of years. Apparently he could only be put to death as long as he didn’t want to die - as soon as he did want to die, the State had no mandate to kill him!

The idea of a “right to suicide” might be controversial, but it may be worth thinking of it as a person’s ultimate right, in the context of suffering all types of pain. As long as we’ve done our best, and cared our best - another question for government and society - there may be little we can do.

I agree. I would say carers for the mentally ill, the disabled, the ill and the elderly are all undervalued, over-worked and underpaid. Our society just doesn’t value professions which care for others - it’s all about the bottom line.

In my post, I was not suggesting that case workers do not care. Rather I suggest that there are simply not enough resources for everyone to be cared for adequately.

Unless there is a profit to be made or a performance pay regime to implement it seems as a community we look the other way.

Case workers in mental illness are grossly overworked and underpaid. Many people with mental illness require the consistency and certainty that a regular caseworker brings but too often the workers burn out, leave and the continuity of care is lost.