Tuesday, Nov 29 2016 • 11 a.m. (ET)
The Debate Over Involuntary Psychiatric Treatment
The Debate Over Involuntary Psychiatric Treatment
Many mental health experts say forcing someone into psychiatric care against their will can be necessary to protect people dangerous to themselves and others. But in some certain cases it is illegal, and some see involuntary commitment as a violation of someone’s civil rights. A look at how patients can be both helped and traumatized by involuntary psychiatric care, and what the data indicates about its role in preventing violence, suicide and mass murder.
Pete Earley author of more than a dozen books, including the best-seller: "Crazy: A Father's Search Through America's Mental Health Madness," which was a finalist for a Pulitzer Prize in 2007. He is a former Washington Post reporter. His the father of an adult son diagnosed with bipolar disorder.
Dinah Miller, MD instructor in psychiatry, Johns Hopkins School of Medicine; co-author: "Committed: The Battle over Involuntary Psychiatric Care"
Annette Hanson, MD assistant professor of psychiatry, University of Maryland School of Medicine and Johns Hopkins University School of Medicine; director, University of Maryland forensic psychiatry program; co-author of "Committed: The Battle over Involuntary Psychiatric Care"
"Jamie" (pseudonym) social worker who has been diagnosed with a psychotic disorder. "Jamie" is a pseudonym.
"Lily" (pseudonym) an administrative assistant who has been diagnosed with bipolar disorder
I wish I could listen. I am really interested in the data about suicide and violence prevention.
I think it’s strange that in regular hospitals, errors kill thousands of people each year and no one wants to shut them down completely. Predictable, everyday hospital error is the third leading cause of death in many adult populations.
Because no matter how many mistakes or bad experiences there are in medical treatment centers, ill people often need medical treatment they cannot choose for themselves. If someone is unconscious on the ground from a heart attack, their right to lie quietly on the ground is not protected over their need for medical treatment. The legal right to remain psychotic should be treated like the legal right to voluntarily forego medical treatment that would improve or save a person’s life: for any other serious medical condition, only a competent person with full decision making capacity is legally allowed to make the choice not to receive treatment.
Not that the medical system is perfect, not that things don’t go wrong due to regular hospital error for medical patients all the time, but the lie that the medical system is trying not to violate civil rights is the worst. This lie is most glaringly revealed by the statistic that hundreds of thousands of people with severe mental illness are incarcerated. They have lost all of their civil rights. In the United States each day, ten times more people with SMI are incarcerated than are being cared for in hospitals. Even without committing a crime, a person displaying signs of serious psychosis is often taken to jail instead of to an emergency room. We know with certainty that not treating people with severe mental illness does not preserve their rights.
I am sorry some people (there are never any statistical percentages offered or measures or definitions of the harm of being involuntarily committed) had a hard time in mental hospitals and were not treated well. I really think anything that caused that should be reformed. In a system with adequate funding, facilities, and resources for treatment of mental illness, most of the bad experiences of involuntary hospitalization could be prevented too.
[quote=“Hereandhere, post:2, topic:2891”]
If someone is unconscious on the ground from a heart attack, their right to lie quietly on the ground is not protected over their need for medical treatment.
[/quote] Brilliantly put.
I am a bit on the fence about involuntary treatment. It certainly has been a big factor in my son’s recent ‘good phase’. I understand it can go too far, some hospitals are better than others, yada yada yada but twelve months of obligatory injections have allowed my son to make more progress in the last twelve months than in the last ten years. He hates the drugs and the side effects (though in him they are mild compared with what I have read on the other boards) but the longer he has stayed on them, the more he recognizes how skewed his thinking was before.
Anyway, now he’s back on tablets and I’m left hoping we don’t go through the whole manic cycle again, as he decides to start skipping doses when it suits him.
My feelings are that people who are severely ill need treatment.
Did you know that in San Francisco (I believe this is where, but cannot remember…) Assertive Community Treatment offers medication, but does not require it? So people with severe mental illness can receive other treatments like counseling and housing and food and vocational rehab without being forced to take medication as long as they are participating okay in the program… Many do take medicine.
Also, with voluntary treatment, many people start to take medicine after being engaged in other ways so they can meet their own goals. There is a place near L.A. that uses this model.
Anyway, I don’t think involuntary treatment has to be inpatient or has to be medication, just something to keep people safe and give the chance for stability, then recovery.
Obviously, some severe psychotic episodes require involuntary medication and secure inpatient treatment if the person is agitated or dangerous.