Involuntary treatment
Encyclopedia
Involuntary treatment 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.
that involuntary hospitalization and/or treatment violates an individual's civil rights
. The individual must be exhibiting behavior that is a danger to themselves or others and a court order must be received for more than 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. The statutes vary somewhat from state to state.
In 1979, the 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. Rogers v. Okin
established the patient's right to make treatment decisions.
Additional U.S. Supreme Court decisions have added more restraints to involuntary commitment and treatment. Foucha v. Louisiana
established the unconstitutionality of the continued commitment of an insanity acquittee 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
imposed stringent limits on the right of a lower court to order the forcible administration of antipsychotic medication to a criminal defendant who had been determined to be incompetent to stand trial for the sole purpose of making them competent and able to be tried. In Washington v. Harper
the Supreme Court upheld the involuntary medication of correctional facility inmates only under certain conditions as determined by established policy and procedures.
, 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
.
Civil and human rights activists, Anti-psychiatry
groups, and members of the psychiatric survivors movement
, vigorously oppose involuntary treatment on human rights
grounds. Also, critics oppose involuntary treatment because of the significant potential for side effects
, ranging from mild to severe structural brain damage
, 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.
The Church of Scientology
is also aggressively opposed to involuntary treatment. In the United States
case law rulings 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, to name a few.
s, mood stabilizer
s, sedative
s and antipsychotic
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
without consent.
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
Consent
Consent refers to the provision of approval or agreement, particularly and especially after thoughtful consideration.- Types of consent :*Implied consent is a controversial form of consent which is not expressly granted by a person, but rather inferred from a person's actions and the facts and...
. 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.
Limitations on forcible treatment
In 1975, the U.S. Supreme Court ruled in O'Connor v. DonaldsonO'Connor v. Donaldson
O'Connor v. Donaldson, 422 U.S. 563 , was a landmark decision in mental health law. The United States Supreme Court ruled that a state cannot constitutionally confine, without more, a non-dangerous individual who is capable of surviving safely in freedom by themselves or with the help of willing...
that involuntary hospitalization and/or treatment violates an individual's civil rights
Civil rights
Civil and political rights are a class of rights that protect individuals' freedom from unwarranted infringement by governments and private organizations, and ensure one's ability to participate in the civil and political life of the state without discrimination or repression.Civil rights include...
. The individual must be exhibiting behavior that is a danger to themselves or others and a court order must be received for more than 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. The statutes vary somewhat from state to state.
In 1979, the United States Court of Appeals for the First Circuit
United States Court of Appeals for the First Circuit
The United States Court of Appeals for the First Circuit is a federal court with appellate jurisdiction over the district courts in the following districts:* District of Maine* District of Massachusetts...
established in Rogers v. Okin
Rogers v. Okin
Rogers v. Okin was a landmark case in which the United States Court of Appeals for the First Circuit considered whether a mental patient, committed to a state psychiatric facility and assumed to be competent, has the right to make treatment decisions in non-emergency...
that a competent patient committed to a psychiatric hospital
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
has the right to refuse treatment in non-emergency situations. The case of Rennie v. Klein
Rennie v. Klein
Rennie v. Klein was a case heard in the Federal District Court of New Jersey in 1978 to decide whether an involuntarily committed mental patient has a constitutional right to refuse psychiatric medication...
established that an involuntarily committed individual has a constitutional right to refuse psychotropic medication without a court order. Rogers v. Okin
Rogers v. Okin
Rogers v. Okin was a landmark case in which the United States Court of Appeals for the First Circuit considered whether a mental patient, committed to a state psychiatric facility and assumed to be competent, has the right to make treatment decisions in non-emergency...
established the patient's right to make treatment decisions.
Additional U.S. Supreme Court decisions have added more restraints to involuntary commitment and treatment. Foucha v. Louisiana
Foucha v. Louisiana
Foucha v. Louisiana, 504 U.S. 71 , was a U.S. Supreme Court case in which the court addressed the criteria for the continued commitment of an individual who had been found not guilty by reason of insanity...
established the unconstitutionality of the continued commitment of an insanity acquittee who was not suffering from a mental illness. In Jackson v. Indiana
Jackson v. Indiana
Jackson v. Indiana was a landmark decision of the U.S. Supreme Court that determined a state violated due process by involuntarily committing a criminal defendant for an indefinite period of time solely on the basis of his permanent incompetency to stand trial on the charges filed against...
the court ruled that a person adjudicated incompetent
Adjudicative competence
Adjudicative competence, also referred to as competence to stand trial, is a legal construct describing the criminal defendant's ability to understand and participate in legal proceedings. This includes the defendant's current ability to participate in various pleas and waivers of rights. It is...
could not be indefinitely committed. In Perry v. Louisiana
Perry v. Louisiana
Perry v. Louisiana is a case brought before the U.S. Supreme Court over the legality of the forcibly medicating a death row inmate with a mental disorder in order to render him competent to be executed.-Circumstances:...
the court struck down the forcible medication of a prisoner for the purposes of rendering him competent to be executed. In Riggins v. Nevada
Riggins v. Nevada
Riggins v. Nevada, is a U.S. Supreme Court case in which the court decided whether a mentally ill person can be forced to take antipsychotic medication while they are on trial to allow the state to make sure they remain competent during the trial....
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
Sell v. United States
Sell v. United States, is a landmark decision in which the United States Supreme Court imposed stringent limits on the right of a lower court to order the forcible administration of antipsychotic medication to a criminal defendant who had been determined to be incompetent to stand trial for the...
imposed stringent limits on the right of a lower court to order the forcible administration of antipsychotic medication to a criminal defendant who had been determined to be incompetent to stand trial for the sole purpose of making them competent and able to be tried. In Washington v. Harper
Washington v. Harper
Washington v. Harper 494 U.S. 210 is a case in which an incarcerated inmate sued the state of Washington over the issue of involuntary medication, specifically antipsychotic medication.-Circumstances:...
the Supreme Court upheld the involuntary medication of correctional facility inmates only under certain conditions as determined by established policy and procedures.
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 homelessnessHomelessness
Homelessness describes the condition of people without a regular dwelling. People who are homeless are unable or unwilling to acquire and maintain regular, safe, and adequate housing, or lack "fixed, regular, and adequate night-time residence." The legal definition of "homeless" varies from country...
, victimization, suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
, violence
Violence
Violence is the use of physical force to apply a state to others contrary to their wishes. violence, while often a stand-alone issue, is often the culmination of other kinds of conflict, e.g...
. 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
National Alliance on Mental Illness
The National Alliance on Mental Illness was founded in 1979 as the National Alliance for the Mentally Ill. NAMI is a nation-wide American advocacy group, representing families and people affected by mental illness as a non-profit grass roots organization and has affiliates in every American state...
(NAMI) and the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
. Involuntary treatment's biggest supporter in the United States is the Treatment Advocacy Center
Treatment Advocacy Center
The Treatment Advocacy Center is national U.S. nonprofit organization dedicated to eliminating legal and other barriers to the timely and effective treatment of severe mental illness...
.
Civil and human rights activists, Anti-psychiatry
Anti-psychiatry
Anti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
groups, and members of the psychiatric survivors movement
Psychiatric survivors movement
The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...
, vigorously oppose involuntary treatment on human rights
Human rights
Human rights are "commonly understood as inalienable fundamental rights to which a person is inherently entitled simply because she or he is a human being." Human rights are thus conceived as universal and egalitarian . These rights may exist as natural rights or as legal rights, in both national...
grounds. Also, critics oppose involuntary treatment because of the significant potential for side effects
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
, ranging from mild to severe structural brain damage
Brain damage
"Brain damage" or "brain injury" is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors...
, and because of its emphasis upon enforcing compliance via chemical restraints over practices aimed at achieving mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
. Critics, such as the New York Civil Liberties Union
New York Civil Liberties Union
The New York Civil Liberties Union is an civil rights organization in the United States. Founded in 1951 as the New York affiliate of the American Civil Liberties Union, it is a not-for-profit, nonpartisan organization with nearly 50,000 members across New York State.NYCLU's stated mission is to...
, have denounced the strong racial and socioeconomic biases in forced treatment orders.
The Church of Scientology
Church of Scientology
The Church of Scientology is an organization devoted to the practice and the promotion of the Scientology belief system. The Church of Scientology International is the Church of Scientology's parent organization, and is responsible for the overall ecclesiastical management, dissemination and...
is also aggressively opposed to involuntary treatment. In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
case law rulings 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
O'Connor v. Donaldson
O'Connor v. Donaldson, 422 U.S. 563 , was a landmark decision in mental health law. The United States Supreme Court ruled that a state cannot constitutionally confine, without more, a non-dangerous individual who is capable of surviving safely in freedom by themselves or with the help of willing...
, Rennie v. Klein
Rennie v. Klein
Rennie v. Klein was a case heard in the Federal District Court of New Jersey in 1978 to decide whether an involuntarily committed mental patient has a constitutional right to refuse psychiatric medication...
in 1978 and Rogers v. Okin
Rogers v. Okin
Rogers v. Okin was a landmark case in which the United States Court of Appeals for the First Circuit considered whether a mental patient, committed to a state psychiatric facility and assumed to be competent, has the right to make treatment decisions in non-emergency...
in 1979, to name a few.
Methods
Psychiatric treatment primarily involves psychotropic medications, such as antidepressantAntidepressant
An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
s, mood stabilizer
Mood stabilizer
A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, typically bipolar disorder.-Uses:...
s, sedative
Sedative
A sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....
s and antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
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
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
. 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
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
without consent.
Mental health law
All but four states in the U.S. allow for some form of involuntary treatment for mental illness 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.htmUnder "assisted" outpatient commitment
Outpatient commitment
Outpatient commitment refers to mental health law that allows the compulsory, community-based treatment of individuals with mental illness.In the United States the term "assisted outpatient treatment" or "AOT" is often used and refers to a process whereby a judge orders a qualifying person with...
, people committed involuntarily can live outside the psychiatric hospital
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
, 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. However, other studies cast doubt on the efficacy of involuntary treatment.See also
- Anti-psychiatryAnti-psychiatryAnti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
- E. Fuller TorreyE. Fuller TorreyEdwin Fuller Torrey, M.D. , is an American psychiatrist and schizophrenia researcher. He is Executive Director of the Stanley Medical Research Institute and founder of the Treatment Advocacy Center , a nonprofit organization with the goals of eliminating legal and clinical obstacles to the...
- Involuntary commitmentInvoluntary commitmentInvoluntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a hospital or in the community ....
– a long and detailed article dealing also with political imprisonment - Laura's LawLaura's LawLaura's Law is a California state law that allows for court-ordered assisted outpatient treatment. To qualify for the program, the person must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior...
- Medical ethicsMedical ethicsMedical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
- Medical lawMedical lawMedical law is the branch of law which concerns the prerogatives and responsibilities of medical professionals and the rights of the patient. It should not be confused with medical jurisprudence, which is a branch of medicine, rather than a branch of law....
- MindFreedom InternationalMindFreedom InternationalMindFreedom International is an international coalition of over one hundred grassroots groups and thousands of individual members from fourteen nations. It was founded in 1990 to advocate against forced medication, medical restraints, and involuntary electroconvulsive therapy. Its stated mission is...
- New Freedom Commission on Mental HealthNew Freedom Commission on Mental HealthThe controversial New Freedom Commission on Mental Health was established by U.S. President George W. Bush in April 2002 to conduct a comprehensive study of the U.S. mental health service delivery system and make recommendations based on its findings...
- Social controlSocial controlSocial control refers generally to societal and political mechanisms or processes that regulate individual and group behavior, leading to conformity and compliance to the rules of a given society, state, or social group. Many mechanisms of social control are cross-cultural, if only in the control...
- DSM-IV CodesDSM-IV CodesDiagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR, is a manual published by the American Psychiatric Association that includes all currently recognized mental health disorders...
- Structured Clinical Interview for DSM-IVStructured Clinical Interview for DSM-IVThe Structured Clinical Interview for DSM-IV Axis I Disorders is a diagnostic exam used to determine DSM-IV Axis I disorders and Axis II disorders . There are at least 700 published studies in which the SCID was the diagnostic instrument used...
(SCID)
Selected bibliography
- Appel, JM. The Forcible Treatment of Criminal Defendants. Med & Health, RI. Nov. 2003.
External links
- National Mental Health Consumers' Self-Help Clearinghouse
- Psychlaws.org - 'Keys to Commitment' (a guide for family members), Robert J. Kaplan, JD
- Rogers Law, concerning involuntary treatment/commitment in Massachusetts