Is Forced Treatment for Mental Illness Okay?

psychward

There is a word for not knowing when you are sick and it is called “anosognosia.” Like everything in the world of mental illness there is controversy about it. Some people don’t believe it exists at all, while others have developed extensive research projects defending it as a term.

But let’s cut to the chase. Is there ever a time when someone with a mental illness may not know he or she is sick? The answer to that question is “yes.” I don’t know if people can deny that is true, but many people who are experiencing psychotic episodes do not know they are sick. Some people who experience full-blown manic episodes have lost insight and don’t know they are sick. When this happens family members are left to try and find a way to get their loved one treatment in the hopes of bringing them back to reality.

Forty years ago the Supreme Court ruled that in order to be committed involuntarily one must be found “a danger to himself or others.” Some states have added language to include “an immediate danger.” Sometimes this is interpreted to mean even if a person may become a possible danger to himself or others, unless it is happening in the moment the person cannot be forced into treatment.

The problem with this law is that it really discounts situations when people are unable to competently judge for themselves when help might be necessary. Although many who have mental illness may never become a danger to themselves or others they may still benefit from treatment intervention. The bottom-line is you cannot legally make someone take medications.

I have been on both sides of this issue. I have filled out papers in the court house to have a family member committed during a manic episode, only to watch the system fail and for her not to get treatment. It took about three months before I was able to get her much needed help. In the meantime, I lost a number of sleepless nights and had to deal with the danger of someone not in her right frame of mind.  Just standing by waiting for the “shoe to drop.” Something bad would have happened if I had not have finally gotten her treatment because she had some major physical health issues and needed hospitalization. Without a mental state she may not have been able to communicate those life threatening physical symptoms.

In my own situation I have been involuntarily committed. Each time this happened I did not know I was ill. No matter how much anyone reasoned with me I felt like I was “fine.” I could not understand why people wanted me to get “locked up” for treatment.

Did the fact I was taken against my will into treatment cause me trauma? You bet it did. But if I were to sign a psychiatric Advanced Directive I would give family members who I trust the ability to make decisions for me, if I am unable to make them myself. And as a person who has benefited from treatment I want that intervention to take place.  All this can be spelled out in an Advanced Directive.

I understand the arguments on both sides of the fence. One where people have been fighting for mental disability rights for years to remove the archaic treatment and/or abuse that took place in mental institutions. They have brought freedom of choice for the mentally ill population. The freedom to accept or refuse treatment based on patients rights.

What if you want treatment when you are well, but refuse it when you don’t know you are sick? What should happen to you? What if the treatment team recommends more high-risk treatment like electro convulsive therapy (ECT)? Do you have a right to deny specific treatment options or are you at the mercy of the providers who evaluate you?

So many questions and not one clear cut example that makes this issue any less charged. I think the best solution is to write an Advanced Directive while you are well and put that in a place where everyone can find it. This way at least some of your wishes have a chance at being carried out.

For those who can’t get a loved one treatment, my heart goes out to you. It’s just a tough position to be in all the way around. This definitely makes the case for more education, information and awareness for mental illness, so people can be in a better position to make informed choices. It’s not perfect but who wants to go back in time to the 1960’s where anyone could have someone committed into an institution. That’s not a just solution either.

For a heart-wrenching story from the Washington Post about the inability of a family to help a man in need of treatment read Behind the yellow door, a man’s mental illness worsens. It will make you think about whether or not forced treatment is humane.

To read more about Advance Directives click here Advanced Directives Information.

 

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23 thoughts on “Is Forced Treatment for Mental Illness Okay?

  1. “The bottom-line is you cannot legally make someone take medications.” What is your source on this? I don’t doubt you, but when I look up the matter, I get rather confused. And I ask because medication has been forced on me before in psychiatric hospitals…many times. I wrote about one time here, if you want to read: http://journeyofkylie.com/2014/05/26/psychiatry-exposed-part-1-medication/

    Interesting topic for sure. I too have been traumatized by psychiatric hospitals, and each time I have been (3 times), it was involuntary. I feel like there has to be a better way to fuel good mental health. I say that because most people suffering from mental illness are detached from reality. And what better way to bring them back to reality than place them in a completely unrealistic place? (She says sarcastically). I don’t have the solution, but I feel like psychiatric hospitals are not the answer. I’ll be writing about this on my blog more in the future. Thanks for a thought-provoking post!

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    1. I have my degree in nursing, and as far as patient’s rights go, a patient has the right to refuse medications. The only time they cannot refuse it is if they are on certain types of commitments and under certain judges orders. Even under 72 hour holds they should have the right to refuse medications, however they might just be put under a longer hold if they are not progressing. Under a commitment to a state hospital though, they are usually required to take the medications.

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      1. Hmmm…I have never been in a state hospital. But it is possible that I was under judges orders. I’ll have to look into it/ask my parents. I’m interested in knowing. Thanks for the info!

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    2. Kylie,
      You can’t legally make someone take medications outside of an inpatient psychiatric hospital, unless the person is court ordered to take medications. Many mental health advocacy groups fight against forced treatment, except in rare circumstances. The Bazelon Center for Mental Health (http://www.bazelon.org/Where-We-Stand/Self-Determination/Forced-Treatment.aspx) has an excellent view on Forced Treatment. I think it speaks to a bit about what you are talking about. Thanks for your insightful comment.

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  2. Thank you for addressing psychiatric advanced directives! They are very useful and so few people know about them!

    I do think that people should be able to be hospitalized against their will IF they are deemed a danger to themselves or others. I have been involuntarily committed to the hospital on multiple occasions for 72 hour holds (an when I say multiple I mean upwards of 12 times or so and other voluntary times as well) as I just refused to think that I needed help because I was ok even though I was trying to kill myself on multiple occasions. I eventually was committed to a state hospital for 6 months, and this is when I had my “ahaa” moment that something was wrong and I needed help. If I had not been court ordered, I would probably be dead. It should not happen for any situation, but I think it is ok for extreme cases of people in danger of hurting themselves and others.

    And psych advanced directives are very important. I have not made one myself, but now that I am in a new state where the hospitals are not that great compared to my previous state, I really need to make one.

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    1. Marie,
      Thanks for adding your perspective to the discussion. I agree with you that in certain circumstances involuntary commitment is a necessary tool in the mental health system. It helps people who don’t realize they are sick get the treatment they need. Sorry your journey was so tough. I hope you are doing well now. I do think Advanced Directives are very important and can be used to carry out a person’s wishes. Thanks for your comment.

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  3. Hi Amy,
    I have an Advanced Directive to ensure my wishes are carried out. The other important item I carry in my wallet is In Case Of Emergency (ICE).
    I include my name, contacts phone numbers, major health issues, name of key doctors with phone numbers.The list all of drug names, mg and how often a day. Include supplements since they can impact some treatments. At the bottom I let them know I’m an organ donor and have
    Advanced Directives. Emergency personnel in our area are trained to look in wallet behind DL. I keep it up date and have another one to take if I’m out walking without wallet. It also makes doctors appointments much easier when you have the info in one document. The post was great. I have you on my list to catch up with this week. Hope your well. 🙂

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    1. Hi Looking for the Light…thank you for the helpful suggestions about carrying a wallet card. That’s a great idea. Thanks for the compliment about the post. It’s a difficult topic to discuss.

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  4. I was recently listening to an interview with a neuroscientist whose twin brother had schizophrenia and eventually took his own life. She was asked by the interviewer if if were true that some people with mental illness lacked self pity. She answered by saying that some with mental illness lack the insight to know that they are sick and this may be what the perceived lack of self pity was pointing at.
    As for enforced treatment, that is a tricky one. I would like to think that in this day and age such things are not necessary as medication should be able to alleviate the symptoms. But the right medications are not always prescribed. I continued to have the delusional, disordred, racing and suicidal thoughts whilst under psych care. It was only when my GP prescr4ibed seroquel that things started to change for the better. The wrong meds exacerbated the symptoms and made me worse.
    But we don’t live in an ideal world. I think there should be a distinction between the risk of self harm and risk of harm to others. But the issue is complicated by not knowing when someone’s actions will go from mere thoughts to taking action. This decision seems to be very arbitrary and subjective.
    If someone is seriously at risk of harming someone else then they probably should be committed.
    Your Advance Directive would seem to be similar to a Medical Power of Attorney where someone is appointed guardian in the case of mental incapacity.
    It’s a good idea to have one so that your requirements are met. But like any legal document, they can be overturned.
    I guess it’s up to the legal profession to answer this very tricky question.

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    1. Glenn2point0 – you are so right Forcing Treatment is very tricky for so many reasons. You actually bring up another good point about whether or not the prescribed medication actually works. If you take a poll of people who have bipolar disorder you are going to find most people have been on at least 10 different medications. The point is it is difficult to find the right treatment medications and one really has to be persistent in seeking treatment. If the symptoms don’t go away, it’s worth it to keep working with your doctor or find another one if you can. I do believe the psychiatric Advance Directive is very similar to a Medical Power of Attorney and perhaps would work in the mental health area too (but I am not certain of that).

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  5. I agree with you about Advanced Directives. In my case I needed help but the South African public mental health facilities were the last place I could find it. I was committed to similar conditions to that of a jail cell, no doors on the toilets, people that were a real threat to others around me, non nourishing foods, under qualified psychiatrists and psychologists, no exposure to the outside and anything kept would be stolen. I sat staring at the walls hoping I would be left alone and safe. I came out worse than I went in

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    1. I am so sorry you had to go through such a terrible experience. I don’t know a great deal about South African public mental health, but I have heard that they do not have sufficient care for those needing it. I also heard there is a waiting list for inpatient facilities. I hope you are doing okay now. Thank you for sharing your experience.

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      1. I’m not even exaggerating when I tell you about the place my psych wanted to commit me to. The cell was below ground level, there was blood on the walls, derelict parts of the building. Rubbish dumps all over the place

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