Involuntary treatment

Involuntary treatment (also referred to by proponents as assisted treatment and by critics as forced drugging) refers to medical treatment undertaken without a person's consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections. These are typically individuals who have been diagnosed with a mental illness and are deemed by a court to be a danger to themselves or others.

United States

Limitations on forcible treatment

In 1975, the United States Supreme Court ruled in "O'Connor v. Donaldson" that involuntary hospitalization and/or treatment violates an individual's civil rights. The individual must be exhibiting behavior that is a danger to himself or others and a court order must be received for more that a 72 hour hold. The treatment must take place in the least restrictive setting possible. This ruling has severely limited involuntary treatment and hospitalization in the United States. [cite web
year=
month=
url=http://www.treatmentadvocacycenter.org/LegalResources/CaseLaws/Case1.htm
title=O'Connor v. Donaldson, 422 U.S. 563 (1975)
publisher=
accessdate=2007-10-02 ] The statutes vary somewhat from state to state. [cite web
year=
month=
url=http://www.psychlaws.org/LegalResources/index.htm#statutes
title=Legal standard/requirements for assisted treatment, by state
publisher=
accessdate=2007-10-02 ]

In 1979, United States Court of Appeals for the First Circuit established in "Rogers v. Okin" that a competent patient committed to a psychiatric hospital has the right to refuse treatment in non-emergency situations. The case of "Rennie v. Klein" established that an involuntarily committed individual has a constitutional right to refuse psychotropic medication without a court order. [cite web
url=http://www.treatmentadvocacycenter.org/LegalResources/CaseLaws/Case6.htm
title=Rennie v. Klein, 462 F. Supp. 1131 (D.N.J. 1978)
publisher=treatmentadvocacycenter.org
accessdate=2007-10-09] "Rogers v. Okin" established the patient's right to make treatment decisions.

Additional U.S. Supreme Court decision have added more restraints to involuntary commitment and treatment. "Foucha v. Louisiana" established the unconstitutionality of the continued commitment of an insanity aquittee who was not suffering from a mental illness. In"Jackson v. Indiana" the court ruled that a person adjudicated incompetent could not be indefinitely committed. In "Perry v. Louisiana" the court struck down the forcible medication of a prisoner for the purposes of rendering him competent to be executed. In "Riggins v. Nevada" the court ruled that a defendant had the right to refuse psychiatric medication while he was on trial, given to mitigate his psychiatric symptoms. "Sell v. United States" severely limited the ability of a psychiatric hospital to forcibly medicate a patient. In "Washington v. Harper" the Supreme Court upheld the involuntary medication of prisoners in a correctional facility inmates only under certain conditions as determined by established policy and procedures. [cite web
url=http://www.druglibrary.org/schaffer/legal/l1990/Harper.htm
title=Washington' et al, Petitioners v. Walter Harper
publisher=
accessdate=2007-10-10]

Justifications and criticisms

Justification for involuntary treatment is often attempted by emphasizing the potential for severe consequences that may result from lack of treatment, such as homelessness, victimization, suicide, violence. However, critics argue that psychiatric treatment can also have severe consequences such as misdiagnosis [http://www.psychologytoday.com/htdocs/prod/PTOArticle/PTO-20030624-000001.asp] , psychiatric assault and disabling drug side effects.

Involuntary treatment is generally undertaken at the behest of family members. Supporters of involuntary treatment include mainstream organizations such as the National Alliance on Mental Illness (NAMI) and the American Psychiatric Association. Involuntary treatment's biggest supporter in the United States is the Treatment Advocacy Center.

Anti-psychiatry groups, loosely allied with members of the psychiatric survivors movement, vigorously oppose involuntary treatment on civil rights grounds. Also, critics oppose involuntary treatment because of the significant potential for side effects, ranging from mild to severe structural brain damage [ [http://psychrights.org/Research/Digest/NLPs/MonkeysonNeuroleptics.pdf Effect of Chronic Exposure to Antipsychotic Medication on Cell Numbers in the Parietal Cortex of Macaque Monkeys] , by Glenn T Konopaske, Karl-Anton Dorph-Petersen, Joseph N Pierri, Qiang Wu, Allan R Sampson and David A Lewis, Neuropsychopharmacology, 2006, 1-8.] [ [http://psychrights.org/Research/Digest/NLPs/ICP2005BonelliNLapoptosis.pdf The influence of psychotropic drugs on cerebral cell female neurovulnerability to antipsychotics] , by Raphael M. Bonelli, Peter Hofmann, Andreas Aschoff, Gerald Niederwieser, Clemens Heuberger, Gustaf Jirikowski and Hans-Peter Kapfhammer, International Clinical Psychopharmacology 2005, 20:145-149] , and because of its emphasis upon enforcing compliance via chemical restraints over practices aimed at achieving mental health. Critics, such as the New York Civil Liberties Union, have denounced the strong racial and socioeconomic biases in forced treatment orders. [New York Lawyers for the Public Interest, Inc., "Implementatation of Kendra's Law is Severely Biased" (April 7, 2005) [http://nylpi.org/pub/Kendras_Law_04-07-05.pdf http://nylpi.org/pub/Kendras_Law_04-07-05.pdf] (PDF)] [NYCLU Testimony On Extending Kendra's Law [http://www.nyclu.org/aot_program_tstmny_040805.html http://www.nyclu.org/aot_program_tstmny_040805.html] ]

The Church of Scientology is also aggressively opposed to involuntary treatment. In the United States case law ruling have almost eliminated the legal right to involuntarily treat a patient or incarcerated inmate in non-emergency situations, starting in 1975 with "O'Connor v. Donaldson", "Rennie v. Klein" in 1978 and "Rogers v. Okin" in 1979, and continuing with "Washington v. Harper" (1990), to name a few.

Methods

Psychiatric treatment primarily involves psychotropic medications, such as antidepressants, mood stabilizers, tranquillizers and 'anti-psychotic' or neuroleptic medication. These medications are generally considered effective by the medical community in treating severe and persistent mental illness [http://www.nimh.nih.gov/publicat/medicate.cfm#ptdep1] although they have common adverse side effects. Opponents of treatment point to other studies that suggest that long-range outcomes are much worse with treatment. [http://www.ahrp.org/infomail/05/08/29a.php] Involuntary treatment can also include commitment to a psychiatric ward and electroconvulsive therapy (also known as electroshock).

Mental health law

All but four states in the US allows for some form of involuntary treatment for short periods of time under emergency conditions, although criteria vary. [http://www.psychlaws.org/LegalResources/Index.htm#statutes] Since the late 1990s, a growing number of states have adopted "Assisted Outpatient Commitment (AOC)" laws. [http://www.psychlaws.org/GeneralResources/fact13.htm]

Under 'assisted' outpatient commitment, people committed involuntarily can live outside the psychiatric hospital, sometimes under strict conditions including reporting to mandatory psychiatric appointments, taking psychiatric drugs in the presence of a nursing team, and proving medication blood levels. Forty-two states presently allow for outpatient commitment. [http://www.psychlaws.org/LegalResources/statechart.htm]

Effects of involuntary medication

In some studies, the majority of people retrospectively agreed that involuntary medication had been in their best interest, with little or no consideration given to those who disagreed with their treatment. Anecdotal reports from opponents of involuntary medication, indicating that involuntary treatment has widespread, devastating, and lasting effects, are downplayed by studies cited by supporters, including TAC. [http://www.psychlaws.org/BriefingPapers/BP2.htm] However, other studies cast much doubt on the efficacity of involuntary treatment. [http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16034930&itool=pubmed_docsum]

ee also

* Anti-psychiatry
* E. Fuller Torrey
* Involuntary commitment – a long and detailed article dealing also with political imprisonment
* Laura's Law
* Medical ethics
* MindFreedom International
* New Freedom Commission on Mental Health
* Social control
* DSM-IV Codes
* Structured Clinical Interview for DSM-IV "(SCID)"

elected bibliography

* Appel, JM. The Forcible Treatment of Criminal Defendants. "Med & Health, RI." Nov. 2003.

References

External links

* [http://www.mhselfhelp.org/ National Mental Health Consumers' Self-Help Clearinghouse]
* [http://www.psychlaws.org/GeneralResources/article218.htm Psychlaws.org] - 'Keys to Commitment' (a guide for family members), Robert J. Kaplan, JD
* [http://www.psychlaws.org/LegalResources/CaseLaws/Case3.htm Rogers Law] , concerning involuntary treatment/commitment in Massachusetts