Can the Mentally Ill Refuse Treatment?

Can the Mentally Ill Refuse Treatment?

In an article for the USA Today, writer Laura Parker quoted E. Fuller Torrey, the head psychiatrist at the Treatment Advocacy Center in Arlington, VA, "'You can create the most beautiful treatment situation in the downtown Hilton Hotel and give out free coffee and free cigarettes but people will not accept medication if they don't think they're sick,' [...]'That's why people with severe mental illness must be treated involuntarily'" (A1). Most of the time, treatment is not performed involuntarily on the severely mentally ill (see Glossary). The mentally ill fight that they have rights and forcing treatment on them when they do not want it breaks those rights. They have gone all the way to the Supreme Court fighting for their rights. It does not seem right that those who cannot help themselves would not graciously accept help from somebody who could potentially save them.

History has a large effect on the bad reputation that involuntary treatment has earned. In some countries in Europe, up until the 1800's, the mentally ill were displayed in showcases and bound to the walls in the asylums, and the public was invited to observe their behaviors (Stavis Civil Commitment). Because of the visible mistreatment of the insane in these countries, America's founders went to the opposite extreme. The insane persons in Colonial America traveled in groups and were treated uniformly without any attempt to separate them from other outcasts or provide them with any help (Stavis Civil Commitment). However, as time moved on, there was realization that something had to be done in this country as it had been done in other countries through out the world to keep the problem of insanity under control. There were no laws to protect the rights and freedom of the insane in both private and public asylums (Weinberger and Markowitz 679). By the middle of the 1800's, a husband or father was allowed to request that his wife or children be confined, and there was no need for evidence of insanity, as there was in other cases of confinement (Weinberger and Markowitz 679). Parker revealed, "Until the 1960s there were few treatment options, so many mentally ill people were kept in big, state-run mental institutions. Some were lobotomized and sterilized and never let out. At the peak of the institution era, in 1955, there were 558,922 mental patients hospitalized in the country" (A1). In the 1960s, national laws were drafted stating that the insane could not be forced to accept treatment unless they were hazardous or gravely disabled (see Glossary) and could not provide themselves with basic needs. A state could only confine dangerous or suicidal mentally ill or a person who was unable to provide himself or herself with food and clothing (Parker A1). However, it was not until the middle of the 1970s that the Supreme Court straightforwardly addressed the requirements as well as the restraints of the due process that gives a state power to civilly commit (see Glossary) an individual for care and treatment at a psychiatric facility (Stavis Civil Commitment). The mentally ill would begin to win the fight for rights with these laws.

The new laws being drafted were based on the government's two main powers over all citizens. The first power the government has is police power; in other words, it is accountable for the protection from injury, resulting from the dangerous actions of others, for each citizen. Also, the government is considered the "father of the country," which is also known as parens patriae, and is a parent of sorts for each citizen in the country. This is altruistic because the government is responsible for all citizens, especially those who cannot care for themselves (Stavis Involuntary Hospitalization). This was the beginning of the way the mentally ill are cared for today.

Currently, there is still no real set standard for how these people should be treated. There are no national consequences for people who refuse to take the medication prescribed to help them get over or in control of their mental disability. People in each state of the country are treated differently in regards to treatment standards as well as consequences for not doing treatment that is prescribed. National standards for the involuntary treatment of the mentally ill need to be in place so that all treatment centers in the country follow the same code of conduct regarding the mentally ill.

Nationally, the country stands dividedly together on the issue of civil commitment and enforcement of medications. Ms. Saks, a professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California formulated that civil commitment today is an odd and burdensome mixture of law and medicine (Glenn). Every state in this country allows the confinement of the acutely mentally ill if they seem to be a danger to themselves or others. However, the specific criteria are different between states. If an asylum feels it has reason to detain a person unwillingly for more than 72 hours (the usual amount of time allowed in most states), an administrative hearing will be held with a lawyer standing for the patient so that the necessity can be rationalized by the hospital (Glenn). With both laws, involuntary confinement was not meant to persist for an uncertain amount of time. Courts will examine commitment directives routinely for any shift in details (Breneman 977). In an article titled "Commitment Issues: Involuntary Commitment" in Psychiatric Mental Health Nursing, the writer Mary C. Townsend, RN, MN, & CS says, "The U.S. Supreme Court in O'Connor v. Donaldson held that the existence of mental illness alone does not justify involuntary hospitalization. State standards require a specific impact or consequence to flow from the mental illness that involves danger or an inability to care for one's own needs" (87). Because of this decision, appellate jurisdictions have mandated that there be some type of confirmation when claiming dangerousness against a mentally ill individual even though one law makes it necessary and the other does not (Stavis Involuntary Hospitalization). If the most basic laws we have contradict each other on the issue of civil commitment, how can an institution or hospital be sure of its decisions?

Currently there is a major problem with the mentally ill in the United States. The numbers of untreated mentally ill people are elevating across the country. The abandonment of care is seen mostly in prisons and on the streets among the homeless. Currently, more mental patients reside in U.S. prisons than in mental institutions. In 1998 there were 283,300 mentally ill in prisons and jails while there were 61,772