Involuntary treatment (also referred to by proponents as assisted treatment and by critics as forced drugging) 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.
In 1975, the U.S. Supreme Court ruled in O'Connor v. Donaldson 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 short (E.g. 72 hour) detention. 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.
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 homelessness, victimization, suicide, violence, while critics argue that involuntary treatment has the opposite effect and actually increases the risk of suicide. Critics also argue that psychiatric treatment can also have severe consequences such as misdiagnosis [dead link], psychiatric assault[clarification needed] 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[dubious ], starting in 1975 with O'Connor v. Donaldson, Rennie v. Klein in 1978 and Rogers v. Okin in 1979, to name a few.
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. Since the late 1990s, a growing number of states have adopted Assisted Outpatient Commitment (AOC) laws.
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.
Effects of involuntary medication
In a review of the literature on involuntary hospital admission, it was found that as many as 48% of respondents did not agree with their treatment., though a small 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.
- E. Fuller Torrey
- Involuntary commitment – a long and detailed article dealing also with political imprisonment
- Laura's Law
- Medical ethics
- Medical law
- MindFreedom International
- New Freedom Commission on Mental Health
- Social control
- DSM-IV Codes
- Structured Clinical Interview for DSM-IV (SCID)
- Citizens Commission on Human Rights
- Appel, JM. The Forcible Treatment of Criminal Defendants. Med & Health, RI. Nov. 2003.
- "Washington et al., Petitioners v. Walter Harper". Retrieved 2007-10-10.
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- New York Lawyers for the Public Interest, Inc., "Implementatation of Kendra's Law is Severely Biased" (April 7, 2005) http://nylpi.org/pub/Kendras_Law_04-07-05.pdf (PDF)
- NYCLU Testimony On Extending Kendra's Law
- Katsakou C, Priebe S (October 2006). "Outcomes of involuntary hospital admission—a review". Acta Psychiatr Scand 114 (4): 232–41. doi:10.1111/j.1600-0447.2006.00823.x. PMID 16968360.
- Kisely S, Campbell LA, Preston N (2005). "Compulsory community and involuntary outpatient treatment for people with severe mental disorders". Cochrane Database Syst Rev (3): CD004408. doi:10.1002/14651858.CD004408.pub2. PMID 16034930.
- 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