Should Involuntary Treatment for the Mentally Ill Be the Law?

Before I make my exit for the month of November to take part in NaNoWriMo, let me leave you with something meaty to chew on while I’m offline.

In 2002, California passed legislation allowing judges to order involuntary treatment for people with severe mental illnesses if they have a history of being jailed, hospitalized or show violent behavior towards themselves or others. The law was dubbed “Laura’s Law” after Laura Wilcox, a college student who was shot to death in 2001 by a man with an untreated mental illness. It was modeled after “Kendra’s Law,” similar legislation passed in New York state. Short-term involuntary hospitalization was already legal in California in cases where patients had already shown they were a danger to themselves or others. But Laura’s Law was touted as a preventative measure allowing family members, mental health workers or parole officers to request treatment for the ill before they do anything harmful, especially in cases where a patient’s condition inhibits them from making rational decisions about treatment. The law, however, left it up to counties to decide if they want to implement it, and they’ve been reluctant to do so not only because it’s controversial in terms of civil rights but because of funding problems. Almost a decade later, only one of California’s 58 counties has adopted it, Wilcox’s Nevada County. A second is running a pilot program.

Read more: http://www.time.com/time/nation/article/0,8599,2098044,00.html#ixzz1cLtES3O4

Obviously, there are two sides in this debate.

On the one hand, if someone is a threat to themselves or others, isn’t it a duty of society to see that laws are put in place to protect the person as well as the masses?

On the other hand, there are laws in place to protect this thing called Civil Rights.

Which side are you on in this debate?

Do you oppose it because it is not only an incursion on Civil Rights, but has the ability to needlessly propagate the stigma that the mentally ill population as a whole is incapable of making decisions?  Does the notion of involuntary treatment really have the ability to, “…stem violence against those with psychiatric disabilities or the homeless…?”    Is it a throwback to earlier times when individuals could be institutionalized against their will?

Or, are you in favor of the adoption of a Laura’s Law / Kendra’s Law since a study (in NY State) showed a significant reduction in the number of days mental patients spent in jail, in the hospital and on the streets? Do you believe involuntary treatment could save money by reducing the need for intervention by law enforcement, medical emergency personnel, the courts, and lessens the trauma and anguish of family and friends?

Discuss.

This is a very interesting one that I hope sparks a lot of debate. I have a tough time making a decision because I see both sides. Yes, I want people to get the help they need and not be a danger to themselves and others. But, I can see the blurry line in the sand. How far does this extend out? We have a law here in Allegheny County that is very similar, but I’m not sure of the specifics. I do know that friends, family, police and / or medical professionals all have the power to hospitalize you. Here, it’s called a 302 – it’s the police code.

Here in Allegheny County, we only have one psychiatric hospital. Every other hospital has a limited psychiatric ward. A person who is being 302’ed goes through a lengthy evaluation. This is just to make the final decision on whether a person is to be admitted or not. I think that’s a good safeguard right there.

But, here are some problems with that safeguard. Many people who do need emergency psychiatric care are turned away because they are “low-risk” and there aren’t enough beds to go around for everyone. This is a result of state institutions being shut down – both a good and a bad thing that happened here. So, therefore, they don’t get the treatment that they need, when they need it.

Here’s another loophole. How are we supposed to profile these people? When do we, as friends and family, decide that things are out of control or threatening enough to hospitalize another person? And worse, what if that person isn’t going to go willingly? I know I wouldn’t. If my husband attempted to 302 me, he better have an damn good reason for it, like I’ve completely lost my mind and I’m a threat to my son.

What about the folks who really need it and no one seems to recognize that? A local man, George Soldini, kept a blog called, “Crazy George”. He broadcasted all over the internet his intention of going on a shooting spree and taking his own life while he was at it. And he did. He killed three women in that tragedy (his target demographic), and took his own life. People around me called him a monster and a murderer. I read his blog, and I was sad for him. Sure, he did something horrific. But if one person had taken note of his blog. If only one person reached out, would this tragedy still have happened? And that’s the problem. Not taking notice of the people who really need the help.

Thoughts?

Here in wisconsin it appears that we have something on the books about involuntary commitment. Personally, it depends on how it is handled. If it is handled by a judge making a decision on who should be committed, then by no means would I probably favor it. Just recently it came up that I might need to be committed, and to some extent I liked that it was my own choice. But I also wasn’t thinking clearly, if my condition had worsened, then I might not had made the necessary phone calls and might have needed to be committed. I think that my girlfriend would have needed the legal power to get me locked up for a few days till I received the necessary care. And a psych ward is a far better solution than prison.

Does it increase stigma? When the law is written like it was, where it’s to protect society from the mentally ill, then I abhor the intent. It sets the mentally ill as outcasts that society should fear and have measures to protect itself against. But if it is for the good of the individual and to allow the family members some degree of control to protect their loved ones, then I see it as a beneficial law. Whether I like it or not, I am a burden to my family members, and that burden should have some reciprocity in their control over my life. I also like the idea that there might be some sort of safety catch for when I really lose it and my girlfriend can do something about it. I also like the idea that my psychiatrist might be able to pull me out and let me heal, which is a priority in my case. But that’s because I have a good pdoc and I trust him. However, it would be traumatizing to be pulled out of my life because someone thought I was too unstable.

So I guess I’m mixed about it as well, it’d be traumatizing, but in some cases, limited cases, I think that it is important to have laws like this to allow the family some degree of control and protection for mentally ill individuals.

For a follow up, I think that I’ll talk to a professor about it and see what they think about the issue.

I’m not offering up an opinion, but I am going to re-post this on the Canvas Facebook page. I think people need to be made aware of it, and perhaps we can generate both that awareness and constructive discussion.

Here in Washington State involuntary commitment can happen when patients have been referred by the court for a civil or criminal commitment under RCW 71.05 or RCW 10.77, but obviously they’ve had to have already committed some kind of offense to reach that point. I have two friends who have been subject to this law and were involuntarily committed after having run-ins with the law while experiencing extreme manic episodes.

To be honest, it might’ve helped protect both my friends and the people directly around them at the time, but just from what I’ve seen it hasn’t made much of a difference long-term over the management of their illnesses. Both have returned to “normal” life, but nothing seems to have changed from where everything started, so I get worried when people look at involuntary commitment as a “solution”.

There have been times in my own life when, looking back, I wish someone had made the executive decision to hospitalize me. At one point I even entered a hospital, but then checked myself out less than 12 hours later when my mood suddenly switched from depressed to manic. In my own mind I felt (better than) fine, but upon leaving the hospital I went directly to the University I was attending and completely wreaked havoc on the life I had at the time.

If it was someone I loved and trusted (like my partner), I would allow them to make the final call in having me hospitalized. In the event that happened I have faith he wouldn’t do a thing unless I was doing much more harm than good. If it is a question of someone making the call for me, I can handle that.

However, like I said, the system here wont do anything unless you’ve already committed a crime (and been caught) which has always felt backwards to me.

How about we actually have the funds and resources available for people to get mental health care in the first place? Then they wouldn’t have to wait until they committed crimes or were a threat to others to get treatment. The mental health facilities in Washington state are far too few to be able to treat even a fraction of the whole here, it is a system setting people up for failure. I’ve had doctors and nurses tell me that to be seen promptly for mental health care that sometimes I should “do something drastic” in order to receive medical attention. Certainly one of the most horrifying things I have ever heard in my life.

Telling people that unless they attempt suicide, commit a crime, or become a threat to other people they wont get treated? Yes.

And then laws get made about ways to try to deal with this behavior. Ridiculous. Fix the real problem, not the symptoms.

See, here in Pittsburgh it’s difficult, if not impossible, to voluntarily walk into a hospital and become hospitalized. 302 is a catch all here. Police, family, friends, doctors, whomever can make the attempt to 302. A 302 isn’t even guarenteed to put a person in inpatient. Usually, they refer to this pitiful attempt at a day program. I guess they think that if you can walk yourself into the hospital, or have someone take without a fight, then you aren’t sick enough.

The average wait for outpatient is 4 to 8 weeks here. I was lucky and waited 4 and that’s only because the right person dropped “possible bipolar disorder untreated for over 10 years” in the right place. It was enough to make a doctor panic and make room for an intake. (Thank you, Dr. D.)

You’re right. The services need to be out there. But, instead of the law demonizing disorders, they should be encouraging education. The law makes it sound like evberyone who acts a little funny is a threat to society and should be wrangled up and thrown in the dungeon. Education. What are these disorders? What are the sympotoms and red flags? What do you do if you think you or someone else might be affected. Etc.

I’ve heard too many horror stories about people who really needed help that are cut loose from jail or custody because the state or their families couldn’t legally commit them. I think it’s irresponsible of us as a society to not provide a safety net for folks who are so sick they are hurting themselves, destroying property, etc. Personally, if I’m that ill I cannot be the one to decide my fate–I don’t have the capacity.

The states who have adopted some sort of commitment procedure seem to have a lot of checks and balances in place to prevent the kind of Civil Rights violations we all fear. I think it’s more a matter of funding than law.

I live in Washington State and in fact have been writing a blog since September 4, 2010 because of failure of Washington State DBHR outlined in RCW 71.05.520 – Protection of rights to, ““The department of social and health services shall have the responsibility to determine whether all rights of individuals recognized and guaranteed by the provisions of this chapter and the Constitutions of the state of Washington and the United States are in fact protected and effectively secured.

To this end, the department shall assign appropriate staff who shall from time to time as may be necessary have authority to examine records, inspect facilities, attend proceedings, and do whatever is necessary to monitor, evaluate, and assure adherence to such rights. Such persons shall also recommend such additional safeguards or procedures as may be appropriate to secure individual rights set forth in this chapter and as guaranteed by the state and federal Constitutions.”

[1973 1st ex.s. c 142 § 57.] My son was involuntarily committed when he sought to be hospitalized because two mental health professionals the DMHP and a psychiatrist committed forgery and perjury—The State would not conduct an investigation, in fact denied for months they had any authority, or even a duty to do so. The fact is, several employees of the State lied to me–including David Reed who is in charge of the PACT program; who claimed that there had never to his knowledge been any allegations of civil rights violations in Involuntary Commitment proceedings. I knew The fact that a Court Order was obtained using a forged document both of these professionals alleging that my son had done things that he in fact did not do, AND that I was asked for my son to be committed. The State authorities and his attorney claimed his Constitutional Rights were preserved and defended. There is no way that this can be since the information used to obtain the order was outright lies. It took one minute and twenty six seconds for the hearing.

The Seattle Times is irresponsible in the manner it reports mental health stories and Nicole Brodeur–well she apparently has no knowledge of what the ethics of journalism are.

your post asks is should involuntary treatment be the law, and my answer is HELL NO—the failure to conform to ethical scientific standards in developing diagnostic and treatment criteria; these are developed by a consensus of subjective opinions which are then voted into existence by the American Academy of Psychiatry. A blog you may be interested in is 1 Boring Old Man written by a retired psychiatrist.
http://1boringoldman.com/

I was at one time told I would need to take psych drugs the rest of my life for bipolar; and I have not needed to take them for over six years now…It is possible to recover and some people can even taper of the drugs before they do permanent damage. My heart was damaged, but I wasn’t even told it was possible by the three psychiatrists who prescribed the drug that caused the damage.

Hi, Becky:

Sorry for taking a while to get back. I lived in WA state for 15 years and found their laws and treatment of the mentally ill…interesting. I am also no fan of Nicole Brodeur. I could go on and on about her inability to ethically report on the wood used to make a chair but I will spare you the diatribe. 🙂

Thank you for the link to 1 Boring Old Man. I am headed over there right now. A blog you may enjoy is by Crazy Mermaid. She lives in WA also and we were both in the same hospital for bipolar, but not at the same time. Check it out if you have time: http://crazymer1.wordpress.com

I hope things go better for you and your son. Although I wasn’t involuntarily committed, I’ve heard several stories about what an incredible circus it is in WA. Crazy Mermaid addresses this in her blog. My best goes out to both of you. Be well. Thanks for stopping by.

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