Three Myths About Involuntary Treatment for Mental Illness

There are many myths about involuntary treatment for mental illness (The Realities of Involuntary Treatment). Involuntary treatment is extremely controversial, and that's an understatement along the lines of saying, "The Arctic is kind of chilly." Part of the reason it's so controversial is because we rarely do it for other illnesses. We prefer to let people "die with their rights." While I'm hesitant to recommend involuntary treatment become standard operating procedure, I can discuss three myths about involuntary treatment.

Myth One: Involuntary Treatment Strains the Hospital

While it is true that many hospital patients are there against their will, that is the exception, not the rule (Involuntary Treatment - Commitment to a Psychiatric Hospital). Involuntary treatment is actually designed to keep the individual out of the hospital. Let's use Kendra's Law from New York as an example. Under Kendra's Law, which allows Assisted Outpatient Treatment, also known as Involuntary Outpatient Commitment, hospitalizations have gone down. According to MentalIllnessPolicy.org, people subject to Kendra's Law have generally done well. The stats:

• 74 percent fewer patients became homeless.
• 77 percent fewer patients were hospitalized.
• 83 percent fewer patients were arrested.
• 87 percent fewer patients were incarcerated.

A 1998 study of an involuntary outpatient commitment program at New York City's Bellevue Hospital found that it cut hospital stays in half, from 101 days in the 11 months following discharge for those without court orders to 43 days of hospitalization for those with court orders.

Letting people go untreated until a crisis is what strains the hospital. Involuntary outpatient commitment not only keeps people out of the hospital, but it cuts hospital stays when they are hospitalized.

Myth Two: All Mental Health Consumers Oppose Involuntary Treatment

I used to be opposed to involuntary treatment except in the case of danger to others. While I'm still concerned about civil liberties, the fact is most patients who've received involuntary treatment, myself among them, have agreed with the decision in retrospect. According to MentalIllnessPolicy.org:

• 75 percent of patients reported that involuntary outpatient commitment helped them gain control over their lives.
• 81 percent of patients said that involuntary outpatient commitment helped them to get and stay well.
• 90 percent of patients said involuntary outpatient commitment made them more likely to stay on medication and in therapy.
• 87 percent of patients said they believed in their case manager’s ability to help.
• 88 percent of patients said that they and their case manager agreed on their treatment plan.

While about half of the mental health consumers interviewed said that the process of involuntary outpatient commitment made them feel angry and ashamed, the majority were pleased with the results. I'm one of them. I resented the process of being committed--still do as it's very degrading--but in hindsight, it was the right thing to do (Psychiatric Hospitalization: What I Wish I’d Known). It even became unnecessary as I realized how much better I felt on my medications, in treatment, and sober, and decided to comply with treatment.

Not all mental health consumers oppose involuntary treatment, and based on my experience, those that do are typically antipsychiatry or lack insight into their condition. Which leads to the next myth, the myth that involuntary treatment violates civil liberties.

Myth Three: Involuntary Treatment Violates Civil Liberties

Civil liberties are near sacred. I personally am torn on this issue, because while I have experienced involuntary treatment and found it helped, I want my rights. But we've taken our concern about civil liberties too far. As I often say, "In Indianapolis, you can be as mentally ill as you want as long as you're not dangerous." That means you can live in rodent-infested housing, wander the streets at three o'clock in the morning talking to yourself, have little to no food in your living space, and no one will intervene because you have rights. But how is it not an infringement of civil liberties to live like that? Humans have a right to get well.

Involuntary treatment should be carefully regulated--it should only be done when the individual can't take care of him or herself or is dangerous to self or others and meets these criteria repeatedly. If this can be done on an outpatient basis, great, do it on an outpatient basis. If we can keep individuals with mental illness on medication and in treatment long enough, most will decide to stay on medication and in treatment. So involuntary treatment is usually temporary.

At the end of the day, it's about what works--and involuntary treatment usually works.

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