AHunter has been on several threads with comments about the use of psychiatric medications on individuals against their will.
While I believe that other threads have addressed this in times past it has been a long time past, and I do not recall one in GD. (I certainly can be wrong, I’d do a search, but I’m more interested in opening a new discussion anyway.)
Under what circumstances is the imposition of medication, specifically psychiatric medication but should be the same for any intervention, justified without consent?
How does that ideal differ from actual practice? From what the current law states?
I believe it is justified when the patient is incapable of making such decisions for himself. For example minors, those incompetent to make decisions for themselves due to mental defect, or someone greviously injured to the point where communication is not possible.
Well, what defines the inability to make such decisions? Although minors aren’t legally considered capable of such responsibility, I know plenty of minors who are more capable than most adults.
What “mental defects” should be considered sufficient? Most people believe depressed people are unable to make rational decisions (although the evidence suggests the majority of them are perfectly capable).
Just my opinion, but I think that they shouldn’t be able to force you to take anything unless you’re in a position to hurt others because of your illness. The side-effects from psych drugs are frequently worse than the disease. If you want to be crazy, you should be allowed to, unless you’re violent (in which case, you can either take your meds or be locked up so you can’t hurt anyone).
Perfectly normal and “sane” people possess the ability to injure others – obviously. Yet we don’t consider them threats most of the time. People considered to be mentally ill actually are less likely than normals to injure or attack others, statistically, but they’re still considered dangerous by the general populace. The problem isn’t that the mentally ill aremore prone to violence, it’s that people don’t feel that they can predict when a mentally ill person will become violent; thus, they perceive them as a greater threat than the more-dangerous but “predictable” people.
Unfortunately, people with mental disorders are generally at greater risk for violent behavior than those without. However, this varies by the specific condition one wishes to consider. People with schizophrenia show higher rates of violent behavior and are over-represented among forensic populations (Walsh E., Buchanan A., Fahy T. (2002). Violence and schizophrenia: examining the evidence. British Journal of Psychiatry, 180, 490-495.) Patients with schizophrenia as compared with those without schizophrenia show violent behavior that is less dependent on life events and history of stressors (Klassen D., O’Connor WA. (1988). Predicting violence in schizophrenic and non-schizophrenic patients: A prospective study. Journal of Community Psychology, 16, 217-227.) People with depression and bipolar disorder are at far greater risk for suicide than those without. People with Conduct Disorder are far more likely to aggress, commit violence, carry weapons and commit crimes as adults. Interestingly, anxiety appears to indicate a lower risk of violence, aggression or criminality, in general. Interestingly, lower levels of salivary cortisol have been found among those with ODD, CD and specifically aggressive behavior, and IIRC, was found to be higher among those with anxiety disorders (see work by Keith McBurnett and summaries in Burke, Loeber & Birmaher, 2002).
Mangetout said, “I doubt if it is ever as cut-and-dried as that.”
It isn’t. Mental illness is complex. It’s treatment is even moreso. I still don’t like the thought of being told what to ingest.
TVAA said, “Perfectly normal and “sane” people possess the ability to injure others – obviously. Yet we don’t consider them threats most of the time. People considered to be mentally ill actually are less likely than normals to injure or attack others, statistically, but they’re still considered dangerous by the general populace. The problem isn’t that the mentally ill aremore prone to violence, it’s that people don’t feel that they can predict when a mentally ill person will become violent; thus, they perceive them as a greater threat than the more-dangerous but “predictable” people.”
I agree. I don’t think they’re a greater threat than the general populace, but I do think the ones that are violent (that’s those that are proven…not perceived) should be on meds if they’re to be out in the public. If they choose not to do the drugs, I don’t see any other way than to lock them up so they can’t hurt people (or themselves).
People who have been successfully treated for the symptoms of various mental illnesses are no more likely to be violent than the average person. People without treatment are more than ten times as likely to be violent, but only when the effects of street drugs and alcohol are included; when excluded, they’re only about 3.5 times more likely.
However, the studies I accessed didn’t distinguish between violence-towards-others and violence-toward-self (self-injury, suicide, etc.). Unfortunately I was unable to find a study that examined these issues separately.
Interestingly, people with very mild symptoms are at a much greater risk for violence than normal, but those with more severe symptoms are much less of a risk.
I don’t doubt that as a group all mentally ill are less likely to injure or engage in physical violence. I would, however, have to see a cite before I believe that individuals afflicted with specific psychiatric disorders are no more violent than the population at large. For instance I would doubt that a sufferer of depression is any more likely to be violent than the general population. An unmedicated schizophrenic certainly is. http://www.psychlaws.org/BriefingPapers/BP8.htm
My brother is a schizophrenic. He has delusions which can lead him to bizarre and sometimes violent behavior. Forcible medication is possible only with the imminent threat of harm to himself or others. His family knows from experience when that time is approaching. The law requires the overt act before any intervention can be made.
It irks me to hear claims that people with severe mental illness just see the world differently. Not that they don’t, however their view of the world may involve a vast conspiracy with innocent victims being the unknowing protagonists.
The only way schizophrenics with a history of violence can be treated effectively is with medication. Within that sub-group forcible medication may well be necessary to protect the larger population.
So the consensus seems to be that the individual must represent a clear and present threat of imminent and significant danger to his/her self or others. (Say with better evidence than we had against Saddam. ;)) Does “compentence” to make healthcare decisions come into play? Or is it the threat of sufficent risk sufficient whether competent or not? And an “incompentent” individual is still free to make choices so long as they do not abutt against that danger critera?
fruitbat says that practice is consistent with that consensus danger view in his experience. Is that other’s experiences?
Competence isn’t relevant to me. It might affect the way in which I responded to the risk of violence, just as I wouldn’t treat a competent person who threatened me the same as I would a delirious person who did the same, but it shouldn’t affect the nature of the restrictions I’d put on the person.
I wouldn’t even restrict all people who threatened me with violence. It would depend greatly on the nature of the threat and the circumstances in which it occurred.
I’ve personally participated in the forced medication of people in psych treatment many times.
Literally, I’ve been the person who has held the patient down while a shot was administered by the nurse.
I’ve also participated in the (what I’d call) coerced medication of others. For instance, not allowing a person out of a seclusion room until they’ve voluntarily taken medication.
It’s pretty clear (usually) when you give someone a shot of haldol in the ass that they’re not gonna calm down otherwise (usually they’re already being held down by others, and have been for at least about 10" or so). This area is not that gray.
But we’ve been mostly talking about psychotic disorders; it’s pretty clear when someone who is psychotic isn’t able to make informed decisions about his well being.
I’m thinking it gets more fuzzy when we talk about the likes of an adolescent with bipolar disorder (manic depressive disorder). Now, laws vary regarding what decisions a minor is able to make for himself, but generally the parent is ultimately responsible, right?
Now, it’s pretty forseeable that a 15 year old in a manic state is likely to get into all kinds of trouble. I personally think the parents should ultimately force the kid to take meds if the kid doesn’t willingly do so.
Fruitbat said, “My brother is a schizophrenic. He has delusions which can lead him to bizarre and sometimes violent behavior. Forcible medication is possible only with the imminent threat of harm to himself or others. His family knows from experience when that time is approaching. The law requires the overt act before any intervention can be made.”
Sorry to hear your family has been affected by this horrible disease. How long does he stay on his medication? What are the criteria for taking him off it? Just curious…I have a cousin who is schizophrenic. To the best of my knowledge, he is always on his medication (I don’t think he’s ever had a violent episode).
Minor child - any healthcare decisions (including mental health) are parents to make within a wide latitude short of abuse or neglect.
Adult whose illness leaves mental judgement intact - includes most depression and others - free to make decisions unless a clear and present danger to self or others is shown.
But what about incompetent adults, and how to decide that?
Examples:
A very delayed adult with an mental age equivilent of 10. Should this person make their own healthcare decisions?
Someone in the midst of a manic episode, by definition prone to rash and imulsive decisions. Competent to make major healthcare decisions? Not only about psych meds but say about surgery or chemo.
Where does the line get drawn? I really don’t have a firm idea about this yet and would love to hear some thoughts. I wish AHunter would stop by, he has some strong thoughts based on personal experiences that I’d like to see fleshed out before I decide what I think about where the line should set.
My experience with forced psychiatric care. When it is known that you have a potentially dangerous psychiatric condition, in my case manic depression, it is easy for someone, say an employer to have you detained for evaluation. My condition is considered dangerous, if you ever watch Law and Order you’ll see. They frequently look for bipolar people.
The first thing I came to know was that from the moment the judge signs the order, you have no rights until a psychiatrist says that you are capable of exercising those rights.
You cannot pick your own doctor. The deputy that detained me picked me up during a session with my psychiatrist. He said, “I have an order to detain you for evaluation.” I pointed to my doctor and said, “There’s a psychiatrist, I have been in his care for several years, ask him for an evaluation.” He said, “you have to come with me.”
You cannot pick your own hospital. I was taken to the nearest indigent care facility to see a phsychiatrist. I was held for ten hours waiting to see a doctor. They wanted to isolate me, naked in a rubber room. I asked the cop and he said that since I had been good so far, he would let me sit outside with him.
When you spend ten hours waiting for a psychiatric evaluation in handcuffs. When the doctor gets there, you are crazy.
The doctor assigned to you does not have to follow the treatment plan you are already under. I was unable to resume my treatment prescribed by my doctor until I was released into my wife’s custody three weeks later.
As a result of this experience, I only reluctantly reveal that I have a psychiatric condition. After all, once an employer thought it would be easier/cheaper to have me put away than fire me.
I would also like to know. Who would determine that people are crazy? Who would pay for the medication? This is really a big deal as I pay a lot of money for my maintenance meds and my biannual blood profile. What’s your opinion?
I am curious about the frequency of forced use of medication that occurs in the absence of any prior criminal act. First, are there agencies or institutions outside of courts of law that can compel someone to take medications against their will? What are the procedures that would engage a court of law other than criminal behavior or a petition for commitment procedures? In the case of the former, how frequent is it for non-violent criminal acts to result in some compulsory treatment? In the case of the latter, what circumstances outside of a danger to self or others result in a granted petition for involuntary commitment?
I ask because my sense of how the process already works is that people aren’t compelled to do anything unless they first commit a violent or serious criminal act, or present a risk of violence to themselves or someone else, or are a child compelled by their parents to engage in treatment. However, I don’t know the literature, if there is any, on the topic.
I don’t mean to put you on the spot hlanelee, but had you committed some crime or presented some threat to others that resulted in the police seeking you out?
Just for the record, two days before I was committed, I had consulted with an attorney and was pressing suit for an illegal disiplinary action by my employer.
If someone is known to have a psychiatric condition and several witnesses on someone’s payroll “agree” to testify, it’s relatively easy to have someone detained for evaluation. One of the witnesses told me all about it. He was sorry, he had a family to feed