Proposals to Force More Involuntary Treatment Stir Debate
By Tom Jackman
Washington Post Staff Writer
Thursday, February 7, 2008; B04
http://www.washingtonpost.com/wp-dyn/content/article/2008/02/06/
AR2008020604102_pf.html
In the debate over Virginia’s mental health system, they’re called
“consumers.” Some of them call themselves survivors.
They are mentally ill people who have been through the system and
didn’t like it. They criticize the humiliation of being handcuffed,
the forced administration of antipsychotic drugs or the debilitating
side effects of the drugs. And they don’t think the government is
best suited to choose their treatment.
Rather than forcing more people into involuntary treatment by
lowering the legal criteria or enforcing outpatient treatment —
approaches that Virginia’s General Assembly is considering —
consumers and their supporters say they think the money for those
approaches would be better spent on counseling, housing and jobs for
the majority of the mentally ill, who aren’t dangerous or helpless.
Since the Virginia Tech shootings in April, which were committed by a
mentally ill student who did not receive mandated treatment, many
mental health advocates have called for a lower standard for
involuntary treatment and easier access to patient records for
determining a person’s treatment. Under Virginia laws, some of the
most stringent in the country, a mentally ill person can be committed
only if he poses an “imminent danger to self or others” or
demonstrates an “inability to care for” himself.
But a group of consumers is fighting back. They say they think that
changing the imminent-danger standard is a bad idea and that opening
patient records will discourage people from seeking treatment.
As the debate heats up in Richmond over how to fix Virginia’s mental
health system, consumers are lobbying legislators and testifying at
hearings. A consumers’ rally outside the state Capitol last week
attracted more than 650 supporters and a number of legislators, said
organizer David Mangano of Chesterfield County.
“The problem has much more to do with the system’s failures, not with
the language of the law,” said Mangano, a consumer and family
advocate for Chesterfield Mental Health Support Services. “The actual
number of people who are great safety risks and great risk to the
community are very small compared to the number who need services. If
you start changing practices, changing the code, to try to catch
those people [who are risks], what really have you done with all the
people who don’t belong there and have really good reasons not to
comply with treatment?”
Consumers say that providing counseling, peer support, housing and
jobs should take precedence over forced treatment. Michael Allen, a
lawyer formerly with the Bazelon Center for Mental Health Law in
Washington, said: “The problem in Virginia is not [revising] what
standard is used to treat people against their will. The question is,
do we make mental health services available in a timely fashion? Do
we make it comprehensive and holistic or wait until they fall to the
bottom?”
Some consumers have had positive experiences with treatment and are
also fighting to revise Virginia’s system. Jonathan Stanley said that
in his 20s, he spent three years in a cycle of increasingly psychotic
episodes, ending with an incident in which he stood naked in a New
York City deli and was forcibly hospitalized for seven weeks.
He said doctors determined the proper medication for him. He finished
college and law school, and now works for the Treatment Advocacy
Center in Arlington County. He is lobbying for change in Richmond,
including modifying the existing imminent-danger criteria, which he
called “the most restrictive in the country.”
Stanley is seeking support for more mandatory outpatient treatment,
modeled after New York’s Kendra’s Law. He said that 80 percent of
people emerging from such programs “say their coerced treatment has
helped them get and stay well. Those are the consumer voices that I
listen to the most.”
Most mentally ill people are functional and want to make their own
choices but need help, many consumers say.
Yaakob Hakohane of Arlington had been through decades of legal and
mental health experiences. In the early 1990s, he helped create a
group to advocate on behalf of the mentally ill. But even he said he
was amazed by how easily he was involuntarily committed to a mental
hospital last summer.
Hakohane, who suffered a brain injury as a teenager, said he fell and
hit his head on a sidewalk one afternoon in July in Crystal City. He
became disoriented and said police and paramedics who responded “were
kicking and poking me,” so he decided not to talk to them.
Hakohane was also suspicious of the people who treated him in the
emergency room. He remained silent and was temporarily detained. When
he went to a civil commitment hearing two days later, despite the
testimony of two people who said he was perfectly rational, he was
ordered into treatment for up to six months.
“It seems obvious from this experience [that] it’s not hard to commit
people,” said his friend Diane Engster, who attended the hearing.
“It’s easy,” Hakohane said. “Anybody can commit anybody else.” He
said he cooperated with his doctors and was released in a week.
Consumers such as Engster, who founded the Northern Virginia Mental
Health Consumers Association with Hakohane, are also troubled by
attempts to open up patients’ records. Special justices who decide
whether to commit a person typically do not have access to
psychiatric histories, and legislation is pending to allow that.
Alison Hymes, a Charlottesville consumer advocate who served on a
state Supreme Court task force on mental health law reform, writes a
blog about such issues. She wrote that if the state requires mental
health providers to turn over patient records, “mental health
practice in this state will never be the same. Patients/clients/
consumers will not be able to trust their secret thoughts and
feelings with their clinicians. Clinicians will not be able to abide
by the ethical standards of their professions. People will not seek
help and those who are already receiving therapy, such as myself,
will quit.”
Virginia is going through an unprecedented examination of its mental
health system after the slayings at Virginia Tech. This is one in an
occasional series of reports about problems in the system.
moon soup 
The examination of our system unfortunately was rigged from the start and any good proposals were knocked out either before they got to our legislature or soon after. There was a proposal to actually require training of special justices, the lawyers who run hearings after watching a 10 year old video that was shot down because it cost a little money, there was a proposal to reduce the use of shackles and handcuffs in transporting folks, it was shot down, proposals to protect folks financially and medically in commitment were never sponsored at all and the proposal to reduce the ridiculous 180 day period of commitment never got a sponsor either. There was a lot of hype about creating a fairer, better system of mental health law and no follow through. It’s really sad.
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Family members often can only stand by helplessly watching their loved ones with a lack of insight to seek treatment for a mental illness endure frequent times of crisis, wait until levels of dangerousness (as determined by their state’s mental health treatment laws) are reached, then be by their side as the continuous cycle of crisis, dangerousness, and hospitalizations spin out of control.
As an advocate for changes in Pennsylvania’s outdated Mental Health Procedures Act of 1976, which requires a “clear and present danger to self or others” before someone who does not seek treatment on their own can be provided the care he or she deserves, I hope that the sensible laws that other states such as New York (under Kendra’s Law) will help our state’s legislators to understand the need to pass our proposed assisted outpatient treatment (AOT) law, SB 226 which is similar to Virginia’s proposed SB 177.
Individuals with a mental illness who also suffer from anosognosia (a.k.a. lack of insight) http://www.psychlaws.org/BriefingPapers/BP14.htm are best helped when they live in states whose laws allow for timely treatment, whether for inpatient hospitalizations or outpatient AOT follow-up care.
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I am incredibly pleased to get such thoughtful comments. Thank you so much.
Much of my work the past few years has been related to providing self-advocacy and support education for people with mental illness.I encourage and train people in the development of Wellness Recovery Action Plans (WRAP) and Psychiatric Advance Directives. I have authorized my wife as someone I trust to make decisions on my behalf if I am incapacitated. The last time I went to the hospital I was taken from my home by police and put in restraints. This was in keeping with the plan I had authorized and I later understood that it was justified. My wife was looking after my safety. As a type 1 insulin dependent diabetic, I carry the equivalent of a gun with me at all times (as far as access to suicide goes).
I am not someone who believes that people who are otherwise healthy should be left alone to kill themselves. My daughter completed suicide at the age of 13. The effects of that act haunt myself and my family 14 years later.
I do believe that
1) people should have maximum access to a variety of non-coercive treatments,
2) hospitals, while they may create a place of safety, are basically counter-recovery in most cases,
3) there need to be alternatives to hospitals where a person can be safe and still have access to fresh air, nature, other healing energies and
4) self-determination, trust, choice and community are essential elements to mental health recovery. The system as it exists keeps people sick.
As has been pointed out before on this blog, recovery from even the most severe mental illness or emotional distress is not just possible, it is probable under the right conditions. The most significant factor in non-recovery is length of time receiving traditional/ medical treatment.
Bless you for writing comments! I am so excited! I have at least 2 readers!
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I am so sorry for the loss of your daughter. Unfortunately, bills like SB177 and Kendra’s Law are not aimed at protecting folks from killing themselves, they are aimed at medicating people who others think are not thinking or acting as they wish they would. Preventing suicide is very difficult if not impossible because of how rare an act (successful suicide) is and because hospitalization often leaves folks demoralized and even more prone to kill themselves, the highest risk period for suicide being right after release from hospital for people with psychiatric diagnoses.
There is plenty of evidence that some of the psychotropic drugs may increase the risk of suicide and suicidal ideation now though. So I hardly see how Kendra type laws will prevent suicide. They will foster dependence, lead to medical side effects that are lifelong, discourage empowerment and recovery and keep people in the system for life.
The real success of Kendra’s law was not the forced treatment but the money put into services. If Virginia or Pennsylvania really wanted to help people with mental illness and their families, they would both increase funding for voluntary services including psychotherapy, respite, peer support, crisis stabilization center, employoment and housing supports and family systems therapy for those caught in unhealty power struggles with their families of orgin as adults.
Unfortunately, after all the hoopla is over, we will still have waiting lists for treatment at our public mental health centers, still lack crisis stabilization centers in most areas of the state, still lack peer support and respite in almost every part of the state, still have a huge housing problem for people with psychiatric diagnoses and still have little to no employment supports in most areas of the state. In short, we will not have the kind of system that helps people recover to the best of their ability and we will not have the medical follow up to track side effects from forced drugging so we will lose more folks to drug side effect. Death is not better than being psychotic.
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I agree- I’m sorry if I was misunderstood. Forced drugging is completely counter-recovery. There was no way anyone could have stopped my daughter- and she was on drugs (desipramine). She used her antidepressant as her means of suicide.
There is little (if any) evidence that psychiatric drugs provide much more relief from symptoms than placebo. I believe in personal choice. For those who get relief that outweighs the side effects- let that be their guide.
The system is broken but it needs much more than an overhaul- it may need to collapse under the weight of it’s own silliness before something humane can be built.
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That is so true. I think we may see that happen in my state.
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We can only hope. The system is so broken, repair seems highly improbable- the dominant culture will not easily change it’s perspective.
What is your state? (as in, one of the 50, not as in “happy)
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Virginia. Lord help me 🙂
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Lord help us all! 😉
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