Involuntary Mental Health Treatment Laws Debated

The efforts of families with mentally ill relatives and lawmakers nationwide to ease laws prohibiting those with mental illness who refuse to take medication from being forced into treatment are being met with strong opposition from those who believe that such policies would constitute a violation of civil rights, USA Today reports. The debate surrounding involuntary commitment has its origins in the 1960s, when, following the exposure of abuses in the nation's state-run institutions, all 50 states passed patient rights' laws for the mentally ill giving them the right "to make their own bad decisions" -- in other words, granting them the "right to be mentally ill." Under these laws, "the mentally ill cannot be forced into treatment involuntarily in any state unless they are dangerous or so gravely disabled that they cannot care for themselves." But with the deinstitutionalization of mental health care and a general shortage in mental health services funding, many believe that the system has gone too far, often leaving the mentally ill and the general public in physical danger.

Advocates for reform state that the civil rights argument against involuntary commitment fails to recognize the state of mental health care today. It is estimated that more than one-third of the nation's homeless population is mentally ill, and a 1999 Department of Justice study found that 16% of U.S. prison inmates have a mental illness. And USA Today reports that there are now "more mentally ill people in U.S. prisons and jails than there are in mental hospitals." California Assembly member Helen Thomson (D), who last year led a failed state effort to "establish a forced-treatment outpatient program," said, "Nobody is advocating that we reopen the state hospitals, the way it was in the 1930s, '40s and '50s. [But] we have gone from hospital-based care to prison-based care. The opponents who say, 'Don't take my rights away' refuse to look at what really has happened. The people in the state prison system don't have any rights. They are locked up." Many homeless mentally ill individuals resort to drugs and alcohol in the absence of medication, only to be arrested and go through the revolving door of the nation's "chronically underfunded mental health system," USA Today reports. And some mentally ill people suffer from a "lack of insight" in which their brain does not recognize that they are sick, precluding them from seeking treatment, while others "simply refuse treatment." USA Today reports that state laws prohibiting involuntary treatment have left families with the burden of caring for mentally ill family members, "leav[ing] them exhausted and at odds with doctors, judges and the police."

Despite these arguments and several highly publicized incidents involving crimes committed by the mentally ill, many civil libertarians and former patients stand opposed to loosening involuntary commitment laws, while many mental health advocates believe that this issue has obscured the larger problem of a lack of funding for mental health services. Ira Burnim, legal director of the Bazalon Center for Mental Health Law, said, "If you're legally competent and not dangerous, you get the right to make your own bad decisions. It happens all the time. Do people lack insight when they continue smoking? When they have end-stage heart disease and they don't follow their doctor's advice?" Sally Zinman, the head of the California Network of Mental Health Clients, which lobbied against Thomson's proposed bill, said, "Have you ever been in a place where the doors are locked and you don't have the keys? Restraint and seclusion are overused. They have killed people." Moreover, forced treatment opponents ask how much of a benefit is gained from requiring treatment in a system that cannot adequately handle the current number of mentally ill patients undergoing treatment. With 12 state legislatures now weighing changes in forced treatment laws, the debate is not likely to subside anytime soon (Parker, USA Today, 2/12).

So far, New York is the only state that has enacted a forced treatment law, and it did so only after the "horrific death" of Kendra Webdale, who was pushed in front of an oncoming subway train by a schizophrenic man who had not been taking his medication. Fourteen months after "Kendra's Law" went into effect, USA Today reports that both the arguments citing the need for public safety in support of the measure and the counter-arguments that it would lead to a widespread "round[ing] up of the mentally ill" were "overblown." So far, only 512 mental patients "with a history of refusing previously prescribed treatment" have been forced into court-ordered treatment. Of the 3,169 individuals that have been evaluated, 837 "have been provided with more services, but not court-ordered treatment," while 1,308 were deemed to have needed neither services nor treatment. Roger Klingman, a New York Office of Mental Health spokesperson, said, "What's interesting is that we have a large number of people who are receiving enhanced services as a result of this law. It has prompted a closer look at those people most at risk" (Parker, USA Today, 2/12).