Friday, July 11, 2014

Forced Treatment of the Mentally Ill

Longtime readers of this blog know that I have consistently supported the involuntary commitment of people who suffer from severe mental illness.

Faced with a choice between confiscating 300,000,000 guns and committing potentially homicidal schizophrenics against their will, I opt for the latter. More so since today’s medications can help these patients to get better and to function in society.  

It’s a win/win, for the patient and for the community.

Now, I am pleasantly surprised to report that San Francisco—of all places-- has just passed a law allowing the forced commitment of the mentally ill.

Reuters has the story:

The San Francisco Board of Supervisors, which passes legislation for the California city and county, adopted by a vote of 9-2 a measure known as Laura's Law.

If given final approval it would allow court-ordered outpatient treatment for people with chronic and severe mental illness deemed a risk to themselves or others or who have been jailed or hospitalized more than once in the prior three years, among other conditions.

San Francisco legislator Mark Farrell, who proposed the legislation to the board, said the program would help vulnerable sick people "and provide the families the support they deserve".

Such people are clearly ill. They are most often suffering from a brain disease. They are incapable of making a free choice. A community that cares will help them, even if they refuse all assistance. It will not just leave them to fend for themselves.

Interestingly, the San Francisco law is modeled on a similar law in New York:

Modeled after a similar involuntary treatment law passed in New York in 1999, California lawmakers passed Laura's Law in 2002 after 19-year-old Laura Wilcox was shot and killed by a mentally ill patient at a Nevada County behavioral health clinic where she was an intern.

The state law allows family members, police officers or mental health professionals to file petitions requesting the court-mandated treatment of a mentally ill person.

Individual counties can opt out. Laura's Law has only been fully adopted by three California counties: Nevada, Orange, and Yolo. It is expected to receive final approval from supervisors next week and then be signed into law by San Francisco Mayor Edwin Lee, who has expressed support for the program.

Naturally, civil libertarians will do everything in their power to stop implementation:

The law's implementation has been slow and sparse due to the concerns about civil rights, resources and costs.

"This is the wrong direction for any community but especially a progressive community like San Francisco," said Mental Health Association of San Francisco Executive Director Eduardo Vega.

"There's no real doubt that this is a process that fosters stigma around mental illness," Vega told Reuters after the vote.

The law requires city health officials to offer a mental health patient voluntary treatment before being forced into an involuntary outpatient program.

It also appoints a three-person panel to each case, which includes a forensic psychiatrist who would review the case to determine if a court-mandate is necessary.

In other words, precautions exist within the law to prevent abuse.

Amazingly, director Vega believes that progressive communities should not be treating those whose illness makes them incapable of making a rational decision about treatment.

Progressive values demand that these suffering individuals—rest assured, they are suffering—be left to their own devices, regardless of the cost, to themselves or the community.

As for the notion that this stigmatizes mental illness, let’s be clear. Strictly speaking these people are suffering from a brain disease. There is no stigma attached to brain disease. An individual suffering from such a condition lacks free will and cannot be held responsible for his actions.

Anyone who believes that these patients are suffering from a mental illness and possess free will must hold them responsible for their aberrant actions. At that point they will effectively be stigmatized.

Treating them with the best available medication does not stigmatize them. It helps them; it relieves them of their pain; it allows them to function in society.

If you refuse to commit a psychotic killer involuntarily and he shoots up a school then you are saying that you are willing to sacrifice human lives in favor of a misguided idea. The shame should be yours, entirely.


Anonymous said...

An issue like this is where Progressive-Libertarian unity demonstrates the increasing nuttiness of our "Do whatever you want" culture. There are practical consequences to all this. This kind of issue illustrates the wacky ends activists will go to be logically consistent in creating their quasi-anarchic society. In doing so, we are forced abandon health or safety on civil liberties grounds. In its place, we have this cruelty masked by a sophisticated, cool, chic indifference. Real human suffering isn't even a consideration. Like most Progressive-Libertarian ideas, the radicals get to enjoy their armchair theories, and the rest of us have to live with the dystopian aftermath. That's the new "progress," that's the new "liberty." No thanks.

The whole "anything goes" attitude in our culture is tied to free love and drug use -- either as an active lifestyle or a romantic memory of "the way we were." This may seem like a stretch, but often it seems that people oppose forced institutionalization of the mentally ill because they deem every human condition normal or natural. You have to live in a fantasy world to believe that, which is where I find most ideological Progressives and Libertarians (and libertines) live. Life itself is a hypothesis or notion, with moral/ethical choice held to the standard of whether it's a "victimless crime" or not. Nothing has practical consequence. Everything is a theoretical abstraction, with cautions that we're only one step away from a police state run by squares. "Sure, there are 300 million guns, but there shouldn't be... that's the gun culture's fault. Schizophrenics just want to roam the streets looking for their next fix and be left alone. What's wrong with that?"

What's wrong with that? Plenty.

This kind of position is influenced by a charming narrative that every psychotic is Randle Murphy -- quite normal in disguise -- and those who believe in forced treatment are empowering the Nurse Ratcheds of the world.

Psychotics are a danger to themselves and to other people. Their lack of professional care is collateral damage in the war for sexual and narcotic freedom. This bourgeois bohemian sophistication (to use David Brooks' description) evinces no true compassion and human engagement. It's another example of tolerance as a substitute for love. It's being nice because others will deal with the mess.

Psychotic and schizophrenic episodes are not categorized as minor disorders like ADHD. Psychotic and schizoid behavior is about losing touch with reality. Now, if you want to be really sophisticated and say there is no reality, knock yourself out. But when someone is a danger to others by living out paranoid delusions or terrifying hallucinations, they need more than a homeless shelter and/or clinic visit. Most don't recognize the need for those places. After all, their fears and visions are real, right?

Progressives believe in a life without material hardship or consequences. Libertarians want to be able to do whatever they want, as long as they're not harming others. Well, human beings at this level of mental illness are experiencing hardship, and they are harming themselves and others. Thinking that forced treatment for mentally ill persons is a harbinger for a Puritanical state is delusional on its face. That kind of thinking leads to the kind of social anarchy we see with mentally ill homeless people in our urban centers. Meanwhile, the homeless "advocates" go home at night. How much sense does that make?


Ares Olympus said...

So the only reason for "Forced Treatment of the Mentally Ill" is when we believe they may be violent?

My sister was forcefully put in a state hospital for 6 months, after she had shorter stays in a psych ward, and kept getting put back in when she'd get instable, mainly manic.

When she was there, she told me about her roommate, a women in her lower 30's who just had her 14th child, and she and her husband had wanted to set the worlds record for the most kids. I didn't hear the woman's diagnosis, but she definitely knew what she wanted, a purpose in life for fame and fortune perhaps?

Even if we try to lock up all the people who are irrational and dangerous (like decisions to have more kids than should could rationally care for), the question is how to help them.

Medication seems to do a lot, and perhaps categorically better than any amount of therapy, even if perhaps social workers or life coaches are needed to help people who are not dangerous live semi-independently.

I went to a family support group for mental illness, and the main advice I heard (from people who had partly recovered with meds mainly) is that Doctors are not mind-readers, and so patients have to offer good feedback for doctors, to help them adjust or change meds, and as well, if doctors are not willing to listen to patients, then patients can request a different doctor.

From my sister I saw from her hospitalizations both rage and anger, but also acquiescence, and a passivity, basically trying to "play nice" and "say what people want to hear" so she wouldn't feel threatened by more hospitalizations, so I guess that's both a passivity and an attempt at cleverness, to outwit those trying to control her.

I remember hearing about the Rosenhan experiment, and question how sane people behave in an insane place, and it makes me think we need to keep systems on their toes and intentionally put "FAKE ILL PEOPLE" into hospitals to see how authority is expressed, I mean whether to test systems, or even for doctors to put themselves in the patient's shoes, and see what it feels like, and perhaps learn to understand the difference between rational and irrational resistance to controls?

Oh, one thought I had was it can SEEM like anger is a bad emotion, and a sign a patient is not being cooperative, while in fact it might be the cooperative patient has given up, while the angry one is in a place for learning, like a rebellious teen fighting parental controls, the time to test responsibility is when a patient wants something, and then helpers whether social workers or coaches has something to work with.

It does seem to be troublesome work, with a million theories how to help and perhaps half of them work on various fractions of mentally ill population, so just like meds are trial and error, helping people with mental illness seems like trial and error, and you need one-on-one attention for months or years to help a person escape from their mental prisons.

So if society only cares if people are violent, I don't think the resources will be provide to really help those who can be helped.

Larry Sheldon said...

Several questions come to mind, some of which I may answer in a second reading of the article.

I got the impression from the comments that incareration was involved--I thought I saw the California law quoted as providing for "outpatient" care.

Is there a way to get the criminal law changed such that "innocent by reason of insanity" pleas are abolished and replaced with "guilty by reason of insanity" which are coupled to a different set of "punishments" that include chemical, training, counseling, and incarceration; in combinations and in appropriate places. I'd think such a plea would lead to a mandatory jury trial and would require a periodic (minimum annually) judicial review before a jury. (I'd think a review might also be triggered by petition of interested parties (family, people involved in the original complaint, attending professionals). I'd also like to seem words that carefully exclude from consideration antisocial (absent threats), unpopular and politically incorrect behaviors.

I had more questions, but I have forgotten them.

Larry Sheldon said...

Now I remember one of them.

What about the people who desperately need help, maybe even involuntary help but do not display the behavior described here?

I lived a lot of my life in California a lot of my life and when I was young the state operated "State Hospitals" to care for and protect people with "brain diseases".

Those were ordered emptied and closed (except for small remnant operations for people so ill they where near vegetative).

I believe that put a lot of people on the streets as "homeless".

In later years I worked in San Francisco and most days I walked along Third street to the train station--a path thick with "pan handlers" (who had lived in the apartments, "hotels" and flophouses in the area before the gave all that land to developers to install rich and fancy quarters and facilities).

I got to know some of them a little--many had a patter that was entertaining. One guy in particular (I started to write "old guy" but I don't think he was a lot older than me at the time) sat with a big dog that I used to tease had been sitting with man so long he was beginning to look like him.

Then one day I realized I had not seen him in a while, and started asking the others about him--all plead ignorance--the Code, I suppose.

Then one day he was back with his dog. I asked hem where he had been and he said that he had gotten a bronchitis that he could not shake (I know that one--had to stop driving a big truck for the very same reasons) and so had ["pi" word for "urinated"} on a cop's shoes to get taken in, bathed, laundered, and treated.

I regret not knowing how he had provided for the dog.

He was marginally able to care for himself--others were not. But none fit any of the peg-holes where help was provided.

Sam L. said...

Oh, but they WON'T accept responsibility for not protecting the citizens.