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Public Education & Policy :: Position Papers Position on Involuntary Outpatient Commitment/Expanding Forced Treatment March, 2001 The California Network of Mental Health Clients (CNMHC) is the formal voice for and of people diagnosed with mental illness in California. The CNMHC membership through surveys and three statewide Conferences, has identified stopping the expansion of forced treatment, including involuntary outpatient commitment, as a public policy imperative. Voluntary enhanced services are the answer to the mental suffering that surrounds us, not the expansion of forced treatment. Before resorting to the extreme measure of denying the rights of a whole group of persons, try voluntary services. Deinstitutionalization did not fail; it was never completed. People with mental disabilities were never offered the full array of voluntary community mental health services they were promised, including medications, housing, job and benefits assistance, outreach teams and other alternative support for people in crisis, client-run and self-help services, such as peer counseling. A recent study of outpatient commitment in New York City found that, when comparing a control group to persons court ordered to outpatient commitment, there was no difference in any qualitative or quantitative outcomes. The positive element with both the court ordered and non court ordered groups was the enhanced community services offered to both. The increase of people with mental disabilities in our jails and among our homeless on the streets is a failure of a system to provide assess to voluntary community services of the kind clients want and need. It is not a failure - a defect - of the people. The Mental Health: A Report of the Surgeon General states, "One point is clear: the need for coercion should be reduced significantly when adequate services are readily accessible to individuals with severe mental disorders who pose a threat of danger to themselves or others." California has moved in the direction of making adequate services readily available to people with mental disabilities with AB 34 and AB 2034; it should build on this initiative. The Surgeon General's Report further states, "Almost all agree that coercion should not be a substitute for effective care that is sought voluntarily". Coercive treatment is ultimately ineffective. The expansion of forced treatment will not stop "treatment noncompliance," which is viewed as a problem that more forced treatment will solve. In fact, researchers have found that forced treatment causes noncompliance. The Well Being Project, a research project supported by the California Department of Mental Health, found that 55% of clients interviewed who had experienced forced treatment reported that fear of forced treatment caused them to avoid all treatment for psychological and emotional problems. Moreover, coercion seriously undermines the therapeutic relationship between a client and his/her therapist. The rationale supporting AB 1800 and the expansion of forced treatment is flawed because it is based on false myths. 1. The false myth that people with mental disabilities are violent. Studies indicate that people diagnosed with major mental illnesses account for a very small percentage of the violence in American society. For example, the MacArthur Violence Risk Assessment Study found that "the prevalence of violence among people who have been discharged from a hospital and who do not have symptoms of substance abuse is about the same as the prevalence of violence among other people living in their communities who do not have symptoms of substance abuse." The Surgeon General's Report substantiates this. "Yet, to put this all in perspective, the overall contribution of mental disorders to the total level of violence in society is exceptionally small". Yet proponents of the expansion of forced treatment have purposely conducted a campaign to link mental illness with violence, so as to encourage public stereotypes that people with psychiatric disabilities are dangerous, exploiting public fears of crime, and promoting forced treatment as a public safety measure. 2. The false myth that people with mental disabilities lack capacity to make decisions and have no insight into their condition. Most people with mental disabilities are competent to make decisions about their treatment. According to the MacArthur Treatment Competence Study, "Most patients hospitalized with serious mental illness have abilities similar to persons without mental illness for making treatment decisions. Taken by itself, mental illness does not invariably impair decision making capacities." In the Surgeon General's words, "Typically, people retain their personality and, in most cases, their ability to take responsibility for themselves." Nevertheless, to advance their agenda, proponents of the expansion of forced treatment liken mental disabilities to Alzheimer or a stroke and assert that persons with mental disabilities are incapable of making decisions and have no insight into their condition. Avoiding treatment because of the experience of a system that is coercive, harmful or/and simply ineffective is not lack of insight. 3. The false myth that there are new wonder drugs that always work and provide safe treatment for people diagnosed with mental illness. Studies indicate that , "at best, drug treatment provides significant help in only about 50% of schizophrenic patients" ..."at least, 30 - 40% of manic-depressives are not helped sufficiently by lithium or by any of the mood stabilizer..." (Elliot Valenstein, Ph.D., Blaming the Brain ) Psychiatric medications are powerful and can have serious, sometimes life threatening side effects. The adverse affects, such as extreme weight gain, zombie-like feeling, unending restlessness, tremors and tardive dyskinesia, irreversible neurological damage whose symptoms include twitches of the face, arms and tongue, of the older, still more commonly prescribed psychotropic drugs, are well known and a major reason why consumers choose to avoid them. Moreover new brain imaging research indicates there are harmful affects to the brain itself from the newer "miracle" and older drugs. Choice is Essential for Recovery Choice is so important a concept to human kind and human dignity, that medical interventions, with only the exception of psychiatric, are soundly based on choice, including extensive consent policies and procedures. Informed choice about treatment and control over one's own individualized path to health, is necessary for recovery. Treatment and civil rights are not antithetical to each other; in fact, good treatment can only occur in an atmosphere of choice and freedom. While providing necessary safeguards of individual liberties, the current commitment criteria of the LPS Act is adequate. Under the current law, in 1998 in Los Angles County alone 43,000 people were involuntarily committed to 72 hour holds; 20,000 were held involuntarily for an additional 14 days. This represents an overall increase in forced treatment over previous years. Civil commitment is not only being done throughout the state, but is steadily increasing. The mental health community, in forums held throughout the state, did identify inconsistent and uneven application of the current law across counties as a major problem. In a state that avowals client empowerment, a client driven system, and client inclusion in decision making, the fact that clients of the state overwhelming oppose increasing forced treatment is in itself a powerful reason to oppose it. The people for whom this approach intends to help, oppose it. References
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