I looked into outpatient commitment – or “assisted outpatient treatment” (how’s that for a euphemism?). Forty-four states have outpatient commitment laws. Most of these laws require a person with a psychiatric diagnosis to be court ordered to accept outpatient treatment, including medication, for their illness. These laws vary from state to state, but usually require that the individual has a history of noncompliance with medication and multiple hospitalizations or poses a risk for violence against self or others. If these individuals don’t comply they are forced into inpatient treatment, which usually includes medication. The websites I found overwhelmingly supported such laws. It’s supposed to be controversial, but I found only three sites opposed to it. I found two blogs by patients and a website by the New York branch of the ACLU. All the psychiatry websites I looked at supported outpatient commitment. That’s not surprising. Most of them seem to sincerely believe it helps & is in the patient’s best interests. Leading the pack of these psychiatrists is E. Fuller Torrey, MD who founded the Treatment Advocacy Center. I’m sure Dr.Torrey means well, but he doesn’t consider the patients’ point of view. He advocates for the families of the mentally ill. No one seems to be listening to the patients.
Everyone responds to medications differently & the medications often have intolerable side effects. There seems to be a consensus that the medications – particularly antipsychotics – will magically work. Some people don’t respond to medications. What works for one patient may not work for another. And antipsychotics often make the negative symptoms of schizophrenia, such as flat affect and lack of motivation, worse.
Most of the mentally ill people I’ve met know they’re sick. Only a small minority don’t have insight into their condition. It’s tragic, but the Treatment Advocacy Center focuses on the very few mentally ill people who don’t know they’re sick. Dr. Torrey and other psychiatrists who advocate for outpatient commitment increase stigma against the mentally ill. It encourages people to fear the mentally ill. These psychiatrists focus on the very few patients who are violent and not the majority who are no more dangerous than the general population.
I read John McManamy’s blog about forced outpatient treatment & it was very informative. His argument is that if the medications worked better and had fewer side effects, then the patients would take them. But most drug companies have no incentive to develop better medications because they’re making a ton of money from the drugs available now. Some researchers are looking into nicotine as a treatment. Many people with schizophrenia smoke because it helps them think better. Hopefully someday medications will be developed that will help people with psychotic disorders think better as well as take away their delusions and hallucinations.
There are already inpatient commitment laws. People who don’t meet those criteria shouldn’t be forced into treatment. I’m not against inpatient commitment for persons who pose a threat to themselves or others, but if they don’t meet those criteria then they should be allowed to make their own choices regarding treatment. They have a right to be crazy.