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I Support the Right to Fail

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In New York State, as in many other states in the US, unless you are mandated to or in a forced treatment programme, you can fail out of society and be admitted to a psychiatric hospital for rehabilitation. Commonly, this is called assisted outpatient treatment (AOT). People labeled V-SPMI (violently and persistently mentally ill) cycle around back into the system. The pattern should go from being a patient in the hospital to independent living. But sometimes, life takes its turns.

Some states operate differently and offer even fewer freedoms. Some states provide more privileges but less supportive services. The endorsement of the right to fail must be a national human right for public mental health care recipients.  Next to the modern mission by the New York Office of Mental Health and other states, mental health regulatory bodies profess dignity, hope, and recovery. Reformers and activists must write to our politicians. Politicians must sign this into law and inscribe it with the right to fail.

People need to pay attention to the history of our mental health system. It should reflect this all-important pendulum. Some might even call it a continuum. It’s called ‘dignity in risk, or risk of harm’. By basic definition, ‘dignity of risk’ is the right to take chances when engaging in life exploration experiences and the right to fail in these activities. Meanwhile, ‘risk of harm’ is an impending threat of a person or persons causing substantial physical injuries to oneself or others. Naturally, these expressions have been around for many years. And the debate still rages on in 2022. Since de-institutionalization, people aren’t sure about the future of people living with diagnosed mental health conditions living out in the community.

  • Is this person or that person discharged from a hospital and allowed to live independently in a community? 
  • Where does a person fall on this continuum of being more of a risk or stable? 
  • What is stable living? 
  • What is failure? 
  • How do clinicians determine who is stable? 

Clinicians can do their best to assess and predict outcomes. Do professionals ever really know what other people are capable of doing? Clinicians assess for safety concerns and look at the complete clinical picture of a person before being released into the community. Depending on the precipitating event of the identified person, the length of stay in the hospital will be different. Under consideration is past violent ideation, homicidal or suicidal ideation, lethality, strengths, weaknesses, history, all of these considered? And, is this enough? Each individual makes their own decisions moving forward. I work with these folks as a therapist. I also have a mental health diagnosis, and I still wonder about the answer to this debate on Dignity and risk.

During my tenure of having mental health issues, I have done many unfathomable things. I still cannot express regret for many of the items. I have done in my past or live down. Since my diagnosis, I have also done wonderful, beautiful things in my lifetime and would never want to forget these memories. The light outshines the darkness every time my freedom is involved. People with mental health issues cannot ever give up this privilege.

There is risk in dignity. There is also dignity in having choices and dignity in failure. I support the right to fail.

Max E. Guttman, LCSW  is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.


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