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Recovery Model: Mental Health Recovery Model Applied to Severely Mentally Ill; JH Rick Massimino MD

Imminent vs Immediate Danger

Why the seriously/psychotic mentally ill will continue to commit mayhem

Four questions for you to consider:

1) What is an imminent danger?
2) What is an immediate danger?
3) What is the difference between immediate and imminent?
4) Why is this difference so critical and relevant to our discussions about mass murders and mental illness (Newtown, Aurora, Virginia Tech, Tucson, etc?)


If you ask 100 lawyers or psychiatrists or police officers to define and explain the difference between immediate and imminent danger you will get an interchangeable use of both words with an individualized interpretation. In other words for the huge majority of individuals and web articles, imminent and immediate danger are the same thing. This fatal flaw in thinking is the genesis of the problem we now face of psychotic mentally ill individuals as perpetrators of mass murder.


Before I attempt to define immediate, we’ll review the synonyms used to define immediate:   Occurring at once; instant, of or relating to the present time and place; current, Next in line or relation:  acting or occurring without the interposition of another agency or object; direct (taking place or accomplished without delay,  contiguous in space, time, or relationship. 
In summary: An immediate danger is a present danger that is next in order and not separated by space or time.
For example: A person who has shot someone and is hiding in a school office is an immediate danger (the next event will be danger)


Before I attempt to define imminent, we’ll review the synonyms used to define imminent: near, coming, close, approaching, gathering, on the way, forthcoming, looming, menacing, brewing, impending, upcoming, on the horizon, in the pipeline, near at hand.
In summary: An imminent danger is an anticipated danger that is likely to happen, is impending, and is separated by space or time. This impending danger could be one hour, one day, or an unknown time away but is still imminent.
For example: a gigantic meteor that is certain to hit the Earth in a month’s time, is not an immediate danger because it is not the next event to happen, but it is certainly an imminent danger of life threatening consequences which will occur in the near future (30 days, 27 days, 35 days, time uncertain).
Is a young person sitting on a park bench mumbling to himself due to persistent auditory hallucinations and unable to adequately explain his life situation, an immediate or imminent danger? In today’s reality this person is not deemed either. He sits quietly and appears to not be a threat to either himself or others. Only after he attacks a child playing in the park will he be deemed an immediate danger. Was he an imminent danger while he was sitting on a park bench mumbling to himself due to persistent auditory hallucinations and unable to adequately explain his life situation?  The answer is YES. He was in an imminent danger of grave disability (unable to provide food, clothing or shelter for himself). He was an imminent danger to himself either by self harm due to disorganized thinking (wandering into the street or provoking another person due to his bizarre behavior) or self harm due to suicidal behavior. He was also an imminent danger to others because the untreated psychotic state is extremely dangerous and unpredictable.

Why will no action to control and treat this young man be taken until he hurts himself or another person? Some of the answers are the following:

-The police officer knows that the mental health system is clogged and if the young man is placed on a 5150 (involuntary hold) he will be released almost immediately without receiving treatment.
-By acting compassionately and honestly in assessing imminent danger, the officer will be removed from his primary duty to patrol the community because he will be obligated to baby sit until a hospital accepts the patient. This can sometimes take many hours and even days.
-The officer is respecting the individual’s right to refuse help and treatment believing it to be a constitutional right. This severely disturbed mentally ill person is incapable of the rational decision to refuse treatment and by harming himself or others before intervention; we are denying others the right to a free and safe community.   Yet a similarly emergent medical condition such as a traumatic injury or a heart attack would never prompt the question “Do you want to accept medical care?”
-The officer is being expected to properly evaluate and make a disposition during a medical emergency without the proper training or knowledge needed for making such a decision. 
Consider the following vignette: Police are called to a private family home because a previously diagnosed mentally ill person is expressing bizarre thoughts, behaving erratically, and scaring family members. After a brief assessment by the police, the family is told by the officers, “We can’t do anything. He is not yet sick enough. He needs to hurt someone or break the law for us to act.” In other words, the officer has determined that there is no imminent danger. This scenario or similar scenarios are played out in incalculable numbers all across the country every day. 

The consequences of the flawed interpretation of imminent vs immediate danger and lack of appropriate medical care for psychotic individuals (which should be rendered) results in the periodic mayhem involving the seriously mentally ill we too often see occurring in our country.