Some of you may have heard of Laura’s Law in California or Kendra’s Law (similar) in New York. These laws, and similar laws across 42 states, allow for court-ordered treatment of mental illness as a condition of community living.
In other words, they strong-arm people into treatment and this could be seen as treatment without consent. (It’s hard to argue consent when your ability to live outside a locked facility is in jeopardy.)
And this is a very good thing. It is saving lives (among other things).
What is Laura’s Law?
Laura’s Law, also known as Assisted Outpatient Treatment (AOT) is a law that targets certain people determined to be both mentally ill and dangerously violent and forces them to receive mental health treatment as a condition of community living.
To qualify until Laura’s Law you must:
- Have a serious mental illness
- Be unable to live safely in the community without supervision
- Been in a hospital or jail at least twice within 36 months or have been involved in violent behavior within the last 48 months
- Meet additional criteria (no one seems to be very specific on this)
Note that not only does the law compel the individual to seek treatment but it compels the mental health system to provide it. (This is key as some people can’t properly access services.)
Why Is Assisted Outpatient Treatment (AOT) Good?
Unbelievably, the study of similar laws in others states shows the enactment of the law:
- Keeps the public, patients, and law enforcement safer by reducing physical harm to others (47%) and property destruction (43%)
- Helps the seriously mentally ill by reducing homelessness (74%), suicide attempts (55%) and substance abuse (48%)
- Saves money by reducing arrests (83%), incarceration (87%) and hospitalization (77%)
And for those of you interested in money, Nevada County saved $1.81 for every dollar invested including $346,950 of hospitalization costs.
Why is Laura’s Law Good?
And as a piece in the Huffington Post just highlighted, Laura’s Law is showing the same gains.
- Laura’s Law reduced incarceration 78% – During the six months prior to enrollment in AOT, program participants were incarcerated for approximately 388 days. But during the six months after enrollment in AOT they were incarcerated for only 85 days, a reduction of 78%.
- Laura’s Law reduced hospitalization 86% – During the six months prior to Laura’s Law participants were hospitalized for 345 days. While enrolled in Laura’s Law only one person was hospitalized (for 49 days) for a reduction of 86%.
- Laura’s Law reduced hospitalization 77% even after discharge from Laura’s Law – Since discharge from Laura’s Law participants had 81 days of hospitalization, or a reduction of 77% in days of hospitalization.
But Laura’s Law is Treating People Against Their Will!
I know. And look how well it’s going.
Could you imagine if you took a homeless person who kept ending up in the hospital and in jail, treated them and suddenly they were in housing and didn’t get locked up anywhere?
Can you imagine what an amazing life change that would be for the person?
It’s easy to see why that kind of change can save lives.
More Statistics about Assisted Outpatient Treat (AOT)
And more stats on Assisted Outpatient Treatment you might like to know:
- Laura’s Law participants may participate in treatment planning
- Laura’s Law cannot force a person to take medication – separate court proceedings (existing) have to be undertaken for that
- Nevada County and Orange County estimate less than .003% of the population would be allowed into the program
- 75% of people in AOT programs say the program helped them take control of their lives
- 81% said that AOT helped them to get and stay well
- 90% said AOT made them more likely to keep appointments and take medication
Treating the Mentally Ill Saves Lives
It’s really, really hard to argue with those numbers. While I think it’s critical to identify the right people for the program, it seems unequivocally evident that the program works.
And this program works because of something known as anosognosia – being so ill that you believe there is nothing wrong with you. Unlike most people with a mental illness, this small subset of people “know” they are Jesus or that the FBI planted a tracker in their head. They “know” that nothing is wrong with them and that it’s everyone else that is the problem.
The Trouble with Not Treating those who Don’t Want it
The problem with never treating anyone who doesn’t want to be treated is that you miss this subset of extremely ill and extremely needy individuals. These people become “revolving door patients” who are dropped off in the hospital for frequent crises and alternately dropped off into jail for frequent legal problems. When you “know” you are Jesus, a lot of bad things can happen to you.
So when I say it’s important to treat people without consent, in some cases, these are some of the cases I’m talking about. And I think the 55% reduction in suicide attempts speaks for itself. People in this program want to live. Enough said.
My daughter is 34 years old. She has been diagnosed with blind rage at age 12, bipolar at age 15 and again in her early twenties. She is so delusional that she believes she’s fine and it’s everybody else that has a problem. She has been in and out of jail repeatedly over the past several years. I have spoken with the mental health workers at the jail and they acknowledge she has problems, however they REFUSE to recommend a 5150. They say she’s a drug addict. While this is true, she is self medicating due to her illness and they will not accept this. I was told she needs a year clean and sober before they can diagnose her. Like she’s going to get a year clean without other medications, it’s not going to happen. I am at my witts end and do not know what to do. I have told them she has no home, no clothes other than what’s on her back, no means of income, no means of treatment or anything else. She has violated her parole conditions over and over and over, again no consequences. Every time I see she’s back in jail, it just ripps a little piece of my heart out because while I know she’s safe in jail, I also know they will release her in no time. One of these days there won’t be a next time. They tell me well that’s too bad, and release her to her own devices. What do I do? Right now I am watching her kill herself, and nobody cares to help. Any suggestions would be appreciated. Thank you!
Your local NAMI or MHA may know of resources. For ex., can you get her case assigned to mental health court? Would she be eligible for guardianship or conservatorship
Here are a few links that might help you
You mention 5150, so learn about Laura’s Law. BTW, NY and perhaps other states are looking into a Laura’s Law (Assisted Outpatient Treatment, AOT) for substance abuse, but it doesn’t exist yet.
http://mentalillnesspolicy.org/states/lauraslawindex.html
How to make the system give better care
http://mentalillnesspolicy.org/coping/better-care-mentally-ill.html
Next time you need to call police, this might help
http://mentalillnesspolicy.org/coping/make911respond.html
And this might help you cope.
http://mentalillnesspolicy.org/coping/coping-tips-mentally-ill.html
(I friended you on FB, where we discuss these issues)
Best of luck
“Mental illness” IS the stigma ; illness is discovered, not just labeled, and is physical- discovered/discoverable and treated by physicians- hence the name PHYSICIAN._______________________________
– So who determines one’s “serious mental illness” and it’s treatment with or without the knowing and informed consent of the “patient or consumer”, and is that determination not, in the case of assertions by alleged experts on one’s “mental health”, a violation of their civil and human rights when and if they dissent?
– What are the definition(s) and parameters of “serious mental illness”?
– Are there agreed on references for their definition?
– Who should agree on these parameters and definitions in a “free society”, a self proclaimed group of “experts” on YOUR mind?
– How would YOU feel if you were deemed to have a “serious mental illness” you disagreed with?
– How would you feel if you were coerced or forced to accept psychiatric “treatment” you didn’t want?- jim keiser(pg admin) -________
https://www.facebook.com/jpkeis?fref=photo
Quotes for further consideration:
“This is not a group for me… psychiatry has been almost completely bought out by the drug companies…We condone and promote the widespread use and misuse of toxic chemicals that we know have serious long term effects…tardive dyskinesia, tardive dementia and serious withdrawal syndromes. This level of intellectual/scientific dishonesty is just too egregious for me … I want no part of a psychiatry of oppression and social control.”- Dr Loren Mosher’s powerful and moving 1998 letter of resignation from the American Psychiatric Association (His words are even truer today than they were in 1998)
“The impact of IOC (involuntary outpatient commitment) on all people is that it puts people at risk of being court-controlled and subjected to torture for exercising their right to free and informed consent in health care – a right which is theoretically recognized by the U.S. Govt and State Govts even for people using mental health services, if you are not already locked up or court-ordered. In other words, although it is only enforced against a small minority, it instills fear into people and chills the exercise of their constitutional and common law right (not to mention their human right) to control their own bodies and health. This has reinforced the so-called culture of compliance in the mental health system, which creates an underclass of people to be controlled, who are told that they must only aspire to obedience and not to freedom.”-FB friend, activist , attorney
“There’s an understandable tendency to blame medication madness on the individual rather than on the drug. After all, many of these people have mental problems or they wouldn’t be taking psychiatric drugs. The truth is these drugs often drive people crazy who previously seemed normal or healthy.” – Peter R. Breggin, MD(psychiatrist), Medication Madness, p. 21
“…laws of the following kinds appear necessary.
A legal right to drug-free care:
The necessity of this legal right was shown above as we answered the question: Who shall control our brains? and concluded that it is intolerable coercion when people in distress are given help only on the condition that they accept mind-altering and brain-damaging drugs and other somatic brain intrusions.
We are talking here of a right that is a natural and self-evident consequence of the value system of our society. Some examples have been given, and countless tragic cases could be cited, that illustrate the need for legal protection of this right. …”~Lars Martensson, M.D. (from Dangerous Prescription Drugs)
“…The Special Rapporteur on Torture (United Nations) recently called for an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs such as neuroleptics, the use of restraint and solitary confinement, for both long- and short- term application.
Furthermore the U.S. National Council on Disability recommended, ‘Laws that allow the use of involuntary treatments such as forced drugging and inpatient and outpatient commitment should be viewed as inherently suspect, because they are incompatible with the principle of self-determination. Public policy needs to move in the direction of a totally voluntary community-based mental health system that safeguards human dignity and respects individual autonomy.’ “-Tina Minkowitz, Esq.
There are workable non-drug alternatives to the mainstream of psychiatric ‘treatment’, less profitable to the so called ‘experts’ and drug companies, or not at all- I believe a prime motivation for their censorship by mainstream media, and every level of government. The medical profession should be promoting ‘differential’ diagnosis of psychiatric oriented symptoms, and disciplining psychiatrists/other physicians who neglect it, to the point of revoking their licenses. The only reason I’m still here, and many others beginning to speak out, is “noncompliance”. -jim keiser
It is so wrong to force someone to get treatment that they don’t want. If a person with any other type of illness met those same qualifications they wouldn’t be forced into any sort of treatment. Have you ever heard of a diabetic who has been to the hospital or jail twice being forced to take insulin? Not everyone wants “treatment” for their illness. Just because you or I might agree that something improved our lives doesn’t mean that it is the right thing for the next person.
This law was not put in place to help those with mental illness, it was put in place for those who are scared of us and want to control us. Have you noticed that the law is not named after the person who really needed the help in this case? This law was really created because people think that we’re a danger to them but people with mental illness are not the real danger in this country. Individuals who suffer from a severe mental illness are 2 1/2 times more likely to be the victims of violence than the rest of the population and the majority of violent acts in this country are committed by people who do not have a mental illness.
More effort should be put into educating people about mental illness instead of trying to force treatment on those who may not want it.
My mother’s God Daughter has Bipolar I with psychotic features. She was first symptomatic at 15, and is now 40. With every serious episode, here symptoms appear to become more severe. She cannot keep housing- even community housing- because she damages property and gets into altercations with other residents. She has been raped and assaulted repeatedly when on a high, because she “parties” with strangers, accepts lifts to places she doesn’t know etc etc. She gets hospitalised when it gets really bad, and put on meds. She calms down, and is more or less normal- NOT drugged out and sedated btw, just pretty normal- until she gets out again, where here boyfriend who is anti psychiatry , and pro-health food/vitamins( though he drinks heavily!) pressures her to go off the meds, because they are “poison”. And round and round it goes. Or has gone….
Recently, it got so bad- threats of harm to herself, others, living fulltime on the street- that she was finally forced to stay in hospital for 6 months straight, and is now under ongoing close monitoring( we are in Australia). Now it comes down to this for me- was it an abuse of her “right” to choose? Maybe. Would I have the guts to tell her 14 year old daughter (who lives with her Dad) that we left her mother to die in an alley, because she has the right to choose that? Uh- don’t f-ing think so.
And lastly- if we universally agree that a person can be so compromised by mental illness that they cannot be held responsible for a crime (ie they cannot have “chosen” to commit it), then why so much argument against a person being in no state to make decisions about treatment??
We all understand that it’s a potentially slippery slope when the state makes those kinds of calls- but to avoid making them is often a final and *sheer drop* for real people, with real loved ones, in the here and now. It’s just not a simple black and white issue, and making it one avoids the responsibility we all have grapple with the problem of taking care of those that sometimes REALLY cannot do it for themselves.
Hi Alex,
Such a great comment. Thank-you so much for that real-world situation.
And you make a good point. If we agree about legal lack of guilt due to mental illness then it seems obvious that these people can’t make decisions about treatment either. When you put it that way, it does seem terribly logical.
– Natasha Tracy
Most of the other people like me I’ve known, when we’ve been in very bad straights, our most difficult challenge has been accessing services, accessing care, getting appointments, getting our meds.
States are really bad about obeying laws that say they’re forced to do something. But laws that say someone else is forced to do something and they’re forced to make it possible for someone else to comply–states generally do that. With this law, it looks like somebody who understood bureaucracy looked at the state and designed a law that would actually succeed at forcing the state to “cough it up” and actually provide the required services to these patients.
It looks like a law crafted by a bureaucratic genius–one devious sob–to in *theory* force the patient, but in *reality* force the state. Clever. You have to stay on top of it to keep bits of it from being amended and then abused–the antipsychiatry people are right about that. But otherwise, it’s a very clever way of ensuring the most needy mental patients get priority access to scarce social services.
I think the important part of AOT is the question of who is forced to do what. The patient is forced to show up to meetings and participate in developing a treatment plan–but it sounds like that’s all.
The local government is forced not to ignore the patient and to actually provide the patient the services it’s supposed to provide. Honestly, that’s where I see the merits of this “forced treatment.” Most of the fellow patients I have known have admitted that, whether they agreed with their diagnosis or not or wanted to take pills or not, they were having difficulties and they did need social services from the government so they could get back on their feet.
They wanted the combination of social services, at least in terms of housing help and practical counseling, and help filling out applications for other assistance, if nothing else. So the practical counseling part of therapy was very much on their own agenda for themselves in terms of “treatment program” whether they agreed about anything else diagnostically or not.
It seems to me that the core of the AOT and Laura’s Law is that it forces the government more than it forces the patient, and that by forcing the government to work WITH the patient when it makes the patient show up, it really is making an effort to limit its compulsions on the patient to the minimum amount of restriction it takes to get the patient in place to receive safety net social services that the patient PROBABLY wants anyway.
Hi Julie,
I think yours is a very important point and one that has been missed by many. AOT isn’t just about the mentally ill person it’s also about the system and holding them accountable for actually helping the person with the mental illness and doing what they say they’re going to do.
“Most of the fellow patients I have known have admitted that, whether they agreed with their diagnosis or not or wanted to take pills or not, they were having difficulties and they did need social services from the government so they could get back on their feet.”
Yes, and I hear that all the time from people too. Access to services is a big problem for seriously ill people. Heck, it can be a huge challenge for people that are more functional.
Thanks for your comments.
– Natasha Tracy
Saved lives ? A nueroleptic life is not a life for many people. The normal way of describing the effect of these drugs is ” I feel like a zombie ” or anhedonia.
Anhedonia: Loss of the capacity to experience pleasure. The inability to gain pleasure from normally pleasurable experiences. Anhedonia is a common reaction to these drugs.
An anhedonic mother finds no joy from playing with her baby. An anhedonic football fan is not excited when his team wins. An anhedonic teenager feels no pleasure from passing the driving test.
Of couse It takes forced treatment ..
Treatment means giving up all the feelings that make life worth living.
Informed_consent,
That is poppycock.
Most people get treatment for a serious mental illness because their life wasn’t worth living in the first place. Treatment doesn’t make it so, illness does.
And you know what causes anhedonia – depression.
– Natasha Tracy
Only the nueroleptics need forcing, The drugs that block dopamine, the chemical that makes things feel good in life.
and Its not ! poppycock . There is a reason it takes force. This law is not a “good” thing that “helps” people, mabey its the lesser or two evils in some cases.
Someone who has never expirienced the neuroleptics effects on there own brain and body should not be part of this debate.
Informed,
A. Many people have a place in this debate regardless as to their personal experience and to write off someone (like, say, a doctor’s) opinion simply because they don’t take a medication is ridiculous.
B. Not that it’s any of your business but I have been on many antipsychotics and have lots of first-hand experience.
– Natasha Tracy
Lively discussion. Those who want information about the research on anosognosia can find a summary of the 15 most relevant studies here: http://mentalillnesspolicy.org/medical/anosognosia-studies.html
Those who want to know the results from AOT around the country can find it here: http://mentalillnesspolicy.org/aot/outpatient-commitment-research.html
The six more recent and larger studies on AOT in NY can be found here http://mentalillnesspolicy.org/kendras-law/research/kendras-law-studies.html
The best short article on the civil liberties implications can be found here: http://mentalillnesspolicy.org/media/bestmedia/uncivilliberties.html
A legal analysis showing that AOT is a constitutional exercise of the states police powers and parens patraie powers can be found here: http://mentalillnesspolicy.org/kendras-law/kendras-law-constitutional.html
3 articles on Consumer support for AOT can be found here: http://mentalillnesspolicy.org/aot/consumers-like-aot.html
Finally, many quoted problems in post-Czarist Russia regarding inpatient commitment of political enemies. It should be pointed out that AOT lowers the rate on inpatient commitment .
Great resources. Thanks for posting – I tweeted.
– Natasha
Your links are all to one source, Mental Illness Policy Org, which is a campaigning organisation for the introduction of outpatient commitment orders. It might have been better to link to a greater diversity of sources.
In particular, your links to research on anosognosia link to fairly old research and do not take account of the fact that there is no established evidence that “lack of insight” reflects a neurological deficit of any type.
Further, there is no *good* evidence that AOT reduces in-patient commitment. It may do, but that is not established. Swartz’s studies are not methodologically rigorous enough to establish this fact …
In the former Soviet Union if you were a dissident you risked psychiatric hospitalization and forced treatment if you spoke out against the State. The reasoning was that if you did not believe in the Communist system you must have a mental illness.
Given the loss of personal freedoms we as a society has experienced since the events of 911 voluntarily supporting the suspension of civil rights is a risky proposition.
Most of the benefits of this so called “Laura’s Law” do not address the opinions of the actual patients but site statistics based on economic gains by the State.
I am mentally well and have sustained my wellness but it has been my choice.
Natasha, thank you for this concise summary of what an Assisted Outpatient Treatment Law can mean to a person, their families, and to the communities in which they live. As you have pointed out in your comments several times, AOT laws cannot compel a person to take medication, or to be hospitalized, but to be involved in a treatment plan, and for the mental health “system” to stay involved with the person.
Just that act alone can provide the necessary support structure a person needs to begin their journey of recovery. Ensuring that the mental health system sticks with the person is a crucial component.
I too believe that assisted outpatient treatment can and does save lives. If you want a bit of a wake up call as to what really happens to people on the streets who are continuously going through what I call the ‘revolving door’ – check out our work at http://www.outpostforhope.org.
Our efforts are to spotlight and raise awareness for ‘the missing, missing’ – and ‘the kids off the grid’. This is a silent but growing population of folks who are unaccounted for and mostly lost among the homeless.
I know from personal and professional experience in doing this work for over 12 years.
I encourage you to visit and learn more and to watch the story about the search for my sister Ashley, who has been lost and missing with untreated bipolar disorder on the upcoming Lifetime movie “Bringing Ashley Home” airing January 15, 2012.
I happen to be in a community treatment program in Canada. Taking meds and attending psychiatric appts. was a condition of my release from the hospital. I have never been in jail nor was I violent. I believe everyone who has been hospitalized here has to participate in these programs. For me it has worked great. My psychosis is gone-it wasn’t when I was released from the hospital. If i had been left on my own I doubt i would have kept up with meds because I didn’t believe I was delusional. I’m shocked that so many people are against the ill getting help to be well. My life is completely different because I have been in this program.
Hi Ana,
It’s great to hear from someone who was actually in one of these programs and had a positive experience. It sounds to me like the program worked exactly as it should have and it allowed you to take control of your life.
” I’m shocked that so many people are against the ill getting help to be well. My life is completely different because I have been in this program.”
I’m probably less shocked than you, but yes, it is surprising.
How long does this program last? (If you feel like sharing.) Do you feel you were coerced into this program?
– Natasha Tracy
Hi All,
I know I haven’t had a chance to respond to everyone as I normally do due to the holiday season. I will be posting a follow-up on this shortly.
Thank-you.
– Natasha Tracy
Herb,
I still stand by my analysis of your comments. You are attempting to argue about something I never mentioned. Further, you are arguing against you own public position. If you want to have a conversation with me, keep it on the topics I mentioned. As yet, you have not touched on any of my post, instead you have commented on some poorly structured strawman of what you envisage my post to be.
Dear Natasha
I dont know where you get your statistics from but a recent study has actually concluded that there is no benefit whatever from Community Treatment Orders and similar legislation except that the people so treated were less likely to be victims of crime (I wonder if that’s just a coincidence) The study is here: Cochrane study on Compulsory Outpatient Treatment orders finds little evidence of efficacy http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004408.pub3/pdf
Now perhaps someone will actually ask the people on the recieving end what they think about it. Oh no, I forget, they’re too ill to have an opinion…
There are only 2 RCTs currently on any form of outpatient treatment programme (there was one planned for the UK – not sure if it went ahead or has been published yet). There have been a number of naturalistic studies, however, not least a series of reviews mandated by the legislation governing the New York AOT.
In the 2009 evaluation of the New York assisted outpatient treatment law they did interview 3 groups of patients (those not on AOT, those on AOT currently and those who had recently finished an AOT). It’s not a perfect study but you can find the results here:
http://www.omh.state.ny.us/omhweb/resources/publications/aot_program_evaluation/#cFour
I wish they hadn’t restricted themselves to structured interviews or had at least constructed their questionnaire following some pilot open ended interviews so that patients could have had a greater role in defining the “effectiveness” or not of treatment. Also, it seems extraordinary that they didn’t ask them whether they supported the law or not …
Natasha, I can’t comment under the relevant posts, so I’ll have to do so here …
Re Icarus Poll. People on Icarus FB didn’t really respond to the poll/post at all. I’ve no doubt most of them would be against any form of coercion but I was trying to elicit their arguments.
Re “lack of insight”/”anosognosia” . Treatment refusal is considered one of the principal domains of “lack of insight” or “anosognosia”. Again, as the term “anosognosia” is borrowed from neurology its use within psychiatry is invariably used to argue that the inability to self assess (or to self-assess in manner considered appropriate by particular clinical personnel and in a particular context) is itself the result of neurological deficit. The term “lack of insight” is agnostic as to causes.
Consider the following extract detailing a presentation on this question given at a Treatment Advocacy Centre workshop:
“Dr. Amador lucidly described, that a prevalent effect of mental illness is that a person can lose, or have impaired, the ability for self-assessment. This is a physiological symptom of mental illness known as anosognosia. It is akin to the results of physical trauma to certain parts of the brain. Dr. Amador convincingly showed that what are commonly termed “treatment denials” instead result from illness making a person unable to assess
his or her own condition.”
http://www.treatmentadvocacycenter.org/storage/documents/2000july-augustcatalyst.pdf
Over here in the survivor movement we all know that “lack of insight” or anosognosia is shrink-speak for “doesnt agree with me”. There must be something seriously wrong with a person who doesnt agree with their psychiatrist because psychiatrists know everything and are always right.
Will no one mention the fact that CTOs, or their American versions, are illegal in regard to the UN Convention of the Rights of Persons with Disabilities? MindFreedom International, based in the States, will enlighten you Natasha. Your views are really very ill and uninformed and I suggest that you get your facts rights before you air your views in a public arena. Antipsychiatry is about getting things right, not about forced treatment in any way, shape or form. It is probably far more accountable in its thinking and the work that it has been doing than most of medical psychiatry. Read Basaglia, read Fanon, (both psychiatrists of what you would call antipsychiaty, although I am not even sure you know what antipsychiatry really is) read the thinkers from different perspectives including the survivor movement, and you may be able to start formulating some real, not naive and dangerous, thoughts.
Hi Anne-Laure,
You’re certainly welcome to feel that way but I don’t believe it to be the case. Moreover, this law does not provide for the forced use of medication so I’m not sure how requiring people have a treatment plan would go against the UN anything.
But I could be wrong.
– Natasha
I was born into totalitarian country. Thanks to lucky stars we are no longer totalitarian, but I think I will go for rest of my life with maybe paranoid distrust to authorities.
The communist regime treated the dissidents as danger to society. Some of them were locked up in psych institutions and doped up. I often joke (as much as it is pretty tragic and unjokable) that I would take uranium mines over this “treatment”.
This can become a slippery slope and yeah, it could be abused and misused. And we are already seen medicilization of personal traits. There is a label for every anarchist out there. Or at least for unruly kids. And if god-forbid something was to happen and things were to go wrong, there will be tools to use against the oposition.
Saving lifes? Is there a data on lifes saved versus lifes screwed up?
You seem pretty dismissive of traumas that forced treatment can cause and of too many failings of psychiatry.
Hi VenusHalley,
My intent is not to dismiss bad outcomes, because bad outcomes are real and deserve real attention. What I do endeavour to say though, is that they are the exception – by far – and not the rule.
I appreciate the concerns anyone would have after coming from a totalitarian reign but as stated, only .003% of people would ever be eligible for this program and only a minority of those would likely get put into the program.
And again, while I said it in the piece, I’ll note again that this law cannot force medication.
– Natasha Tracy
“… Lyme, PANDAS, Mitochondrial Disease, Dysautonomia, Lupus, MS, Fibromyalgia, Chronic Fatigue Syndrome and so many other disorders/diseases are misdiagnosed every day. Sick victims are getting tossed in psyche wards against their will at an alarming rate. Somatoform illness is especially popular these days. This in turn leads to a diagnosis that leaves you the victim with very limited rights and doctors with unchecked power. You’ve just become a guinea pig for medical research and a huge profit for pharmaceutical companies… We need to expose all those responsible and hold them
accountable….If you do happen to have a ‘mental illness’, you carry a label that people will judge you by for the rest of your life. You cannot get good care in hospitals because as soon as they see benzos or anti-depressants, everything changes. We need to not only change the way mental illness is perceived but how we are treated…”-(Misdiagnosed…It’s All in Your Head; Facebook group)
__________________________________________________
A revolving door- “There’s an understandable tendency to blame medication madness on the individual rather than on the drug. After all, many of these people have mental problems or they wouldn’t be taking psychiatric drugs. The truth is these drugs often drive people crazy who previously seemed normal or healthy.” – Peter R. Breggin, Medication Madness, p. 21
…laws of the following kinds appear necessary.
“…A legal right to drug-free care:
The necessity of this legal right was shown above as we answered the question: Who shall control our brains? and concluded that it is intolerable coercion when people in distress are given help only on the condition that they accept mind-altering and brain-damaging drugs and other somatic brain intrusions.
We are talking here of a right that is a natural and self-evident consequence of the value system of our society. Some examples have been given, and countless tragic cases could be cited, that illustrate the need for legal protection of this right. …”~Lars Martensson, M.D. (from Dangerous Prescription Drugs)
AOT orders are a short step away from court ordered /psychiatric forced, nonconsensual drugging.
“…The Special Rapporteur on Torture (United Nations) recently called for an absolute ban on all forced and non-consensual medical interventions against persons with disabilities, including the non-consensual administration of psychosurgery, electroshock and mind-altering drugs such as neuroleptics, the use of restraint and solitary confinement, for both long- and short- term application.
Furthermore the U.S. National Council on Disability recommended, ‘Laws that allow the use of involuntary treatments such as forced drugging and inpatient and outpatient commitment should be viewed as inherently suspect, because they are incompatible with the principle of self-determination. Public policy needs to move in the direction of a totally voluntary community-based mental health system that safeguards human dignity and respects individual autonomy.’ “-Tina Minkowitz, Esq.
The “benefits” of your desired AOT are more of the following:
Psychiatrists conspire to “medicate”(drug), often following the coercion of parents by mental health ‘experts’, the legal force of CPS(Child Protective Services), the courts, “support groups” and psychiatrists, if not the schools; to drug their children after a spurious, fraudulent psychiatric labeling ‘diagnosis’ based on shallow and prejudiced “screening” and information. “Differential” diagnosis is ignored(of possible actual underlying medical conditions). The risks of the drugs are inadequately disclosed, the existence of alternatives is suppressed, and the child winds up labeled, stigmatized and very possibly damaged, both mentally and physically, very possibly in unrepairable ways- at great profit to this corrupt, special interest plagued system bloated with conflicts of interest- at the expense of the child’s and parents’, and society’s best interests, health and liberties. Parents (& others) are too often indoctrinated into a corrupt ‘mental health’ system, coerced, and given no choice but to drug their children in this manner and with destructive consequences. -jim keiser
-“The problem with psychiatric diagnoses is not that they are meaningless, but that they may be, and often are, swung as semantic blackjacks: cracking the subject’s dignity and respectability destroys him just as effectively as cracking his skull. The difference is that the man who wields a blackjack is recognized by everyone as a thug, but one who wields a psychiatric diagnosis is not.” – Thomas Szasz
“In the war on mental illness, the psychiatrists are the soldiers of fortune, the patients the prisoners of misfortune.”~Thomas Szasz, Coercion as Cure, p. 112.
By the way, does anyone know the evidence base for “anosognosia” as a neurological deficit in patients who haven’t been treated with antipsychotics? Whatever about “lack of insight” (which can of course be problematic and is often used to refer to more than simply lack of belief that one is ill), anosognosia carries different implications.
Hi Fiachra,
What do you mean evidence base? Anosognosia is common in people with psychosis but I’m not sure of numbers on it, per se.
– Natasha Tracy
The use of the term anosognosia implies that lack of insight or awareness of illness – howsoever defined – is the result of a neurological deficit.
The use of the term, therefore, requires substantial evidence not simply that a subset of psychotic patients lack insight but that this correlates to a some neurological deficit and that this correlation is replicated in other studies.
It is also appears from animal and human studies that taking antipsychotics results in dose specific losses of brain volume over time (“subtle but measurable”) http://archpsyc.ama-assn.org/cgi/content/short/68/2/128.
Therefore the question is whether there is an established and replicated correlation between “lack of insight” (and particularly the domain of treatment refusal) in psychotic patients who have *not* been treated with antipsychotic medication (probably first episode psychosis)?
(I’ll look this up myself and see …)
Also, even if there is such an association, there are also many rational reasons why patients would refuse treatment if, for example, they had little tolerance for a given medication. Such patients may be deemed to lack insight or suffer from “anosognosia”. Indeed, it is possible that in any instance where patients and doctors differ to a significant degree over the definition of mental illness, the appropriateness of a diagnosis in a given instance or the benefit of a given treatment course that the physician could assign patient dissent to some neurological deficit. In a field such as psychiatry where the definition of mental illness is enormously elastic this appears to be problematic.
Further, where would it place the small but not inconsiderable number of users/survivors whose response to psychiatry as generally derived from their own experiences with coercive psychiatry is essentially politicised and who largely reject medical and psychiatric definitions of their person? Would it be proper to designate all such persons as suffering from “anosognosia”?
I dunno, but I think it is a term that would have to be used to with great care …
Also bear in mind that while these AOTs are used on only a small proportion of people with psychiatric diagnoses psychiatrists like Torrey estimate that up to half of patients with a diagnosis of schizophrenia and 40 per cent of those diagnosed with bipolar suffer from “anosognosia” – assuming that this refers in the main to treatment resistance that leaves open an incredible degree of expansion for AOTs (although admittedly the only study I’ve seen on the topic has discounted mission creep in its implementation).
It’s hardly definitive but here’s a recent study for first episode psychosis of the neurological correlates for anosognosia
The relationship between insight and neurological dysfunction in first-episode psychosis, European Psychiatry (2011) doi:10.1016/j.eurpsy.2011.01.002
Abstract
Purpose
Impaired insight is commonly seen in psychosis and some studies have proposed that is a biologically based deficit. Support for this view comes from the excess of neurological soft signs (NSS) observed in patients with psychoses and their neural correlates which demonstrate a degree of overlap with the regions of interest implicated in neuroimaging studies of insight. The aim was to examine the relationship between NSS and insight in a sample of 241 first-episode psychosis patients.
Method
Total scores and subscale scores from three insight measures and two NSS scales were correlated in addition to factors representing overall insight and NSS which we created using principal component analysis.
Results
There were only four significant associations when we controlled for symptoms. “Softer” Condensed Neurological Evaluation (CNE) signs were associated with our overall insight factor (r = 0.19, P = 0.02), with total Birchwood (r = −0.24, P < 0.01), and the Birchwood subscales; recognition of mental illness (r = −0.24, P < 0.01) and need for treatment (r = −0.18, P = 0.02). Total Neurological Evaluation Scale (NES) and recognition of the achieved effects of medication were also weakly correlated (r = 0.14, P = 0.04).
Conclusion
This study does not support a direct link between neurological dysfunction and insight in psychosis. Our understanding of insight as a concept remains in its infancy.
I'll quote a little extract from the study as it defines "insight" and reviews the literature …
Insight in psychosis is a multidimensional concept that includes awareness of symptoms, recognition that one suffers from a mental illness, and acceptance of the need for treatment. Impaired insight is clinically important, as it is associated with higher levels of psychotic symptoms, lower rates of treatment adherence and in increased likelihood of involuntary admission.
Lack of insight is a characteristic feature of many psychiatric disorders. According to the DSM-IV, ‘‘A majority of individuals with schizophrenia lack insight regarding the fact they have a psychotic illness. Evidence suggests that poor insight is a manifestation of the illness itself rather than a copingstrategy. It may be comparable to the lack of awareness of neurological deficits seen in stroke, termed anosognosia’’.
The idea of lack of insight in psychosis being a biological deficit developed from research that noted similarities between patients with schizophrenia and those with anosognosia. Anosognosia is a condition in which a person who suffers a disability due to a brain injury seems unaware of the existence of theirhandicap, and has been attributed to both diffuse
damage and focal brain lesions. This has prompted several studies to examine the neuropsychological and neuroanatomical correlates of insight in psychosis. Some have supported a neuropsychological model, while others have rejected it. Others have partially supported the model, reporting that insight correlated only with particular measures of
neurocognitive dysfunction but not all, the most commonly cited associations being with impaired set-shifting and error monitoring.
A number of neuroimaging studies have found associations between insight and anatomical abnormalities:frontal cortical atrophy, smaller dorsolateral prefrontal cortex, and lower
grey matter volumes in the temporal and parietal regions. The areas implicated vary from study to study and do not necessarily reflect the neuropsychological associations.
The conflicting findings are presumably due to the employment of different measures of insight compounded by small sample sizes and cross-sectional samples of patients with varying phases of illness.
There is an excess of minor neurological abnormalities or neurological soft signs (NSS) in patients with psychoses. These have been shown to be associated with regional grey matter
volume changes in both patients with psychosis and healthy individuals, some of which overlap with the regions of interest implicated in studies of insight. Therefore, if impaired insight in psychosis was indeed related to neurological dysfunction, one would expect it to be related to NSS.
[…]
5. Concluding remark
This study does not provide support for a direct link between neurological dysfunction, as measured by NSS, and insight in psychosis. Associations between NSS measures and insight when present were weakand, after controlling for symptoms, the majority of associations were lost.The apparent association between impaired insight and neurological dysfunction may be in part explained by the presence of psychotic symptoms and may not stem directly from a neurological deficit.
http://www.sciencedirect.com/science/article/pii/S0924933811000058
Fiachra,
Well, I buy that. Psychosis symptoms themselves cause a lack of insight which makes perfect sense to me. Almost seems like the definition of many delusions.
– Natasha Tracy
Hi Fiachra,
And I would never suggest that treatment _refusal_ in and of itself represented anosognosia. Lack of insight is a very specific symptom. (And by the way, I do not believe the definition involved neurological deficit it is simply a symptom like delusions of hallucinations.)
– Natasha Tracy
Hi Natasha,
I contacted you through twitter in regard to this blog post. On twitter I share an account with a number of people called TallaTrialogue (we have a range of views on psychiatry).
In those messages I suggested that the data that you present above should be qualified in some instances to reflect the quality and limitations of these studies and you suggested I post a response here, so here goes.
1. Lack of randomised control trial data supporting Compulsory Outpatient Treatment orders (including AOTs).
RCTs are the gold standard for evidence based medicine and it is unthinkable that any form of medication, for instance, would be introduced in the absence of a positive RCT. Given that AOTs entail the compromise of a person’s natural right to liberty it can be argued that would require an equally robust evidence base. (There are of course lots of potential problems with RCTs, not least their expense, and naturalised studies have their advantages, but they would be necessary to properly evaluate AOTs/COTs, I think).
As the most recent review of the literature demonstrates, to date there have only been two RCTs on the outcomes of Compulsory Outpatient Treatment orders.
See S.R. Kisely, L.A. Campbell and N.J. Preston, ‘Compulsory Community and Involuntary Outpatient Treatment for People with Severe Mental Disorders’ Cochrane, (2011) http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004408.pub3/pdf
This review stated:
“We found little evidence that compulsory community treatment was effective in any of the main outcome indices: health service use (2 RCTs, n = 416, RR for readmission to hospital by 11-13 months 0.98 CI 0.79 to 1.2); social functioning (2 RCTs, n = 416, RR for arrested at least once by 11-12 months 0.97 CI 0.62 to 1.52); mental state; quality of life (2 RCTs, n = 416, RR for homelessness 0.67 CI 0.39 to 1.15) or satisfaction with care (2 RCTs, n = 416, RR for perceived coercion 1.36 CI 0.97 to 1.89). However, risk of victimisation may decrease with OPC (1 RCT, n = 264, RR 0.5 CI 0.31 to 0.8). In terms of numbers needed to treat (NNT), it would take 85 OPC orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. The NNT for the reduction of victimisation was lower at six (CI 6 to 6.5). A new search for trials in 2008 did not find any new trials that were relevant to this review.”
And:
“Compulsory community treatment results in no significant difference in service use, social functioning or quality of life compared with standard care. People receiving compulsory community treatment were, however, less likely to be victims of violent or non-violent crime. It is unclear whether this benefit is due to the intensity of the treatment or its compulsory nature. Evaluation of a wide range of outcomes should be considered when this type of legislation is introduced.”
Similarly, see: http://www.rand.org/pubs/research_briefs/RB4537/index1.html
In the absence of proper RCTs controlling for selection bias and despite the positive and admittedly pretty credible evaluation of outcomes for the implementation of Kendra’s Law in New York (http://www.omh.state.ny.us/omhweb/resources/publications/aot_program_evaluation/) the evidence base for the AOTs or COTs as effective must be considered as thin.
2. Figures for Laura’s Law.
You cite several outcome statistics on the implementation of Laura’s Law taken from a Huffington Post article (http://www.huffingtonpost.com/dj-jaffe/lauras-law-works-for-ment_b_1152563.html) to the effect that it has reduced incarceration by 78% and hospitalisation by 86% during the time of the order and by 77% for the period following the lapse of the order. These statistics appear to have been taken from an Assisted Outpatient Treatment outcomes report issued in February 2011 by the Los Angeles County Department of Mental Health, available here http://lauras-law.org/states/california/lalauraslawstudy.pdf The report detailed the outcomes for all persons served with an AOT from April 2010 until December 2010. This total number of people so served with AOTs was ten.
The outcomes as of December 2010 for this group of ten individuals were detailed as follows:
2 had been discharged to lower levels of care
2 were AWOL
2 were hospitalised
1 was arrested
3 were still in the programme.
Aside from problems of selection bias, generalizing on the success of Laura’s Law from the outcomes of such a small number of individuals is deeply problematic and, I think, without validity.
3. Names of the laws.
There are a series of compulsory outpatient treatment laws which are named after victims of rather notorious violent attacks by people with a mental illness diagnosis (Brian’s Law, Laura’s Law, Kendra’s Law, etc). While studies of Kendra’s Law indicate that those diagnosed as mentally ill feel no more stigmatised whether they were under an Assisted Outpatient Treatment order or not, one can’t help feel that the naming of these laws after victims of such egregious violent crimes must add to the general societal sense of those deemed mentally ill as violent and dangerous and hence influence more general levels of stigmatisation.(This point was made by Kisely but I can’t find the link at the moment).
Fiachra
Hi Fiachra,
Thanks for all the additional information.
The trouble is though – selection bias _is_ the point. Only very select people should ever be involved in a program like this so random controlling isn’t very reasonable. I can’t comment on the 2 RTCs below, but I would note the _fact_ that they are random is a problem. It’s not the same thing as random drug trials.
Not that it would be impossible to design a proper RTC, but it would be unethical.
Nevertheless, the number you’ve presented don’t support the major benefits but also don’t suggest harm (worth noting for many) and note that there is a reduction in victimization, which is still a win, in my opinion.
2. And you’re right, the numbers come from AOL programs in New York and California (mostly New York as it has been running there longer.)
3. Names of the laws.
You’re right, the names of the laws are a problem. I called it Laura’s Law in several places but also AOT for that reason. Unfortunately, people know the law by “Laura” and so I need to refer to it as that in order for people to know what I’m talking about.
Your point is well-taken however
Thank-you for such a well thought-out comment and the additional information.
– Natasha
I’m rushing so this answer will have to be quick.
There’s no reason beyond expense (and perhaps legal considerations in some jurisdictions) why you couldn’t do a RCT. Select all patients eligible/suitable for trial. Assign half to AOT and intensive community services. Assign the other half just to intensive community services. Measure outcomes. It’s only unethical if it’s already been established that AOT’s are of incontrovertible and sufficient benefit to justify AOT and I don’t think that that is yet the case.
Having said that there is a definite and age-old issue here re coercion and therapy in psychiatry and the need to prevent a lot of people with mental health issues from ending up in prison etc … I mean the issues are not trivial or black and white and should be approached in a pragmatic way. I’ll post a bit more on this when I get the chance and try and get my head around it …
The question has prompted me to post a poll on the subject at the Icarus Project Group on facebook. I’ll be interested in seeing the response:
http://www.facebook.com/questions/10150437086758931/?qa_ref=pp
I’ve also posted my comments on the figures used above to DJ Jaffe’s original article available here: http://www.huffingtonpost.com/dj-jaffe/lauras-law-works-for-ment_b_1152563.html#postComment
My comment there is awaiting moderation
Well, the Icarus Project is a very specific bunch of people so I can tell you what the poll will say without even looking at it.
– Natasha
Right after I read your article I ran across this quote by C.S. Lewis:
Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.
It makes one start to look at the presuppositions inherent in both views.
Hi R.K.,
Well, my perspective is thinking about those who _could_ be helped but aren’t because they don’t have the insight to understand that they need it. And about those who are constantly in jail because of mental illness-related crime. And those who are constantly in the ER because of their illness.
My perspective is thinking about what to do for them.
– Natasha Tracy
Certainly Natasha, I also see that you have a certain bit of optimism that is likely inherently necessary for your writing. I mentioned the presuppositions though because it makes me look at other things going on in the Psychiatric community. Allow me to use the following example: It was only 38 years ago that homosexuality was still listed in the DSM (III?) as a mental illness. Now suppose Texas, who had until a very few years ago had some very strict sodomy laws, had actively enforced them. So now we have a group of people who if they actively pursue their lifestyle choice (and lets not get into if sexuality is determined by genetics, somatic expression or anything else it is inconsequential for this example) would have been repeat offenders of the sodomy laws. Now this group fits with parts 1-3 of the definition (by the use of the above situation) and could be subject to forced hospitalization. I will not go further with the example as it is quite honestly pretty offensive, but you could substitute any group into the same situation, say believers in the flying spagetti monster or any other supernatural being, so on and so forth.
Now I am playing a huge devil’s advocate here, I just think it is something that merits discussion. I believe that the vast majority of treatable people once stable would choose to remain on medication or in a protected environment as opposed to being in jail/ on the street, but there will always be some who do not.
I remember one bipolar person who just loved being manic too much to stay compliant on meds, even though they did things like sell everything they own to a pawn shop for a bus ticket and a crappy violin believing that they could learn to play violin for a major city symphony and get a job performing even though they had never even learned to read music.
People such as the above example need to be protected as well, sometimes from the system.
I believe there is a solution that would prevent anyone from ever getting to the point that the Laura’s Laws would ever need to be enacted, I just have no way of convincing enough people to do what it would take to make the changes, we are too used to governments being societies safety nets for everyone instead of having the family/community/charitable/religious organizations handle it as they did in the past.
In any case end of my ‘diatribe.’
Dear Mr. Brumbelow,
“I believe there is a solution that would prevent anyone from ever getting to the point that the Laura’s Laws would ever need to be enacted, I just have no way of convincing enough people to do what it would take to make the changes, we are too used to governments being societies safety nets for everyone instead of having the family/community/charitable/religious organizations handle it as they did in the past.” — R.K. Brumbelow
Without my taking any position on this particular subject other than my pointing out to you in your idealism and youthfulness that if one were to carefully look back to the past (i.e. just 50 years ago) this patient population was in reality treated horrifically and in a manner far less than the ideal you conceive of it to be. Actually, it was quite shameful and by the today’s standards would be an outrage. As for family, community and religious organizations filling the bill today you still miss the realities of what actually is taking place.
Warmly,
Herb
vnsdepression@gmail.com
http://www.vnstherapy-herb.blogspot.com/
Herb,
Thank you for expressing your ignorance. I can assure you that your ad hominem comments, specious argumentation, and attempted equivocation will be granted every ounce it is due.
Good day.
R.K. Brumbelow
Dear Mr. Brumbelow,
I apologize for my error in citing what I believed to be your idealism and youthfulness not as a negative means to present a position.
Let be more be more to the point. “Family/community/charitable/religious organizations” have been in existence for centuries. Most of this challenged population had a mother and father and come from family and were part of community/charitable and religious organizations.
So why these many patients ended up under institutional or state and/or government care and the fact that Natasha rightfully addresses these issues?
So instead of you thinking my thoughts as specious and an attempted equivocation read up on the history and the treatment of these individuals who were, once again, at one time part of a family and community. Least I forget, one of the historical worse culprits was the religious organizations you referred to.
And while you’re at it you might also start with your apparent home state, Georgia. It’s not a pretty picture in my opinion. Here’s one suggestion to start you off.
http://www.silcga.org/articles/SILCREPORT.pdf
Warmly,
Herb
vnsdepression@gmail.com
http://www.vnstherapy-herb.blogspot.com/
Hi guys, I’m happy to see the lively conversation but we need to keep it above personal attacks please.
– Natasha
The trouble with forced medicalisation is that it is open to abuse. Someone who has been abused has lost part of their life and has very little chance of redress. What do you say to someone (e.g. Adam Ant , the UK pop singer) who said that it is too easy to be sectioned and who spent 7 years on treatment and who now feels that this period of life was wasted by the drugs ? He couldn’t write music, he couldn’t make love during those 7 years. There are many thousands like him.
Hi Andrew,
Well, in the case of this law, patients cannot be forcibly medicated and they are not sectioned – they live in the community, that is the whole point.
– Natasha Tracy
According to an international study, that the UK Department used in it’s assesment of the UK equivalent (community treatment orders) these laws, which are quite popular in many countries now, have not reduced the number of revolving door patients, increased the number of medication compliant patients or anything else that they were designed to do.
it is a reputable study conducted internationally. So obviously your figures are different from the ones the UK government found.
In Western Lapland they do not compulsory treat people and use very few drugs but they have one of the best outcomes in the developed world for severe mental distress. Often they resolve first episode psychosis in under 6 months. People like the treatment on offer so they go back and ask for more if there is a crisis. They use something called Open Dialogue, which is a type of family therapy conducted in the home and in which other people significant to the distressed person’s life are asked along (teacher, employer, probation or police officer if the criminal justice system is involved). They have a meeting every day for up to two weeks in a crisis and then tail it off. Anyone can call the service and ask for a meeting to be convened. The distressed person may not them sleves attend if they do not want to. Sometimes they listen in by sitting in the next room, but if the people in their social network understand and support them better often the symptoms will quite quickly subside – although helping them get back to work etc. takes longer. The system is cheaper than many other mental health systems in the rest of the developed world.
If competent, effective help that people liked was on offer then the sort of laws you wirte about would become irrelevent. As it is the international study into them (with quite different outcomes from the ones you state – where did you get those outcomes? they look far to hight to be real) suggests they are having no impact on outcomes either.
Hi John,
The numbers aren’t perfect in the States because they are not Randomized controlled studies, so that I know for sure, and I can’t comment on the UK numbers as I’m not familiar with their programs or how they are applied.
I know that there are some places that are able to handle first-episode psychosis in a unique way involving the family but that’s not what this program is about. Certainly, if that program works, it would be great to see in North America.
The outcomes are from the links I provided in the piece. And there have been several studies in the programs in various states.
– Natasha Tracy
Hi Natasha, the numbers form the study that the UK Department of Health used were not from a UK study, they were from a metastudy of several countries where similar laws were enacted. Which is why I was suspicious of your figures.
I tend to use studies and quotes of people I respect, and they look at various studies that have been done and interpret them. That is called a metastudy. I don’t have the expertise to interogate the resulsts of studies (how big was the sample size, how was the experiment conducted, how was the results interpreted), I leave that up to people who do have the expertise. However, it seems you also lack that expertise, so all we are left with is one set of, “experts,” say CTO’s (as they are called in the UK) are useless and annoy people, and another set say of people say they are wonderful.
I see however that a new post on your blog does have this expertise and agrees with what I have read and says they are pretty useless. As you agree with me there are some good ways of helping people that do not use coercion and which are effective a lot of the time and which people like. I’d really like to hear about them more rather than forced treatment.
Hi John,
I’m not sure what post you’re referring to but I will say that if I had to pick between treating someone via their choice or not because of their choice I would always pick to treat them by choice, it’s just not always possible.
– Natasha Tracy
When it is YOU that is being forcibly ‘treated’ you will change your mind. It always starts with one group thought to be a threat then moves onto other groups. Look at the Holocaust. Also the boundaries keep moving – look at the amount of kids being diagnosed ADHD when they are just boisterous normal kids.
Unfortunately when the ‘treatment’ is dangerous to mind and body (which it is) then forced ‘treatment’ is against human rights. Lobotomy was considered a good ‘treatment’ once. I was forcibly treated against my will and they were wrong and I sued. They settled out of court but the trauma of those 8 days remains with me still.
Hi Cheryl,
I’m sorry you had that experience. They may have been absolutely wrong in your case. The trouble is that they are not always wrong.
Have you read this: https://natashatracy.com/mental-illness-issues/doctors/doctors-should-treat-mentally-ill-without-consent/
What do you suggest we, as a society, do when a person cannot legally consent to treatment?
– Natasha Tracy
Unfortunately they are often wrong. Until you have been detained against your will, abused and forcibly held down and drugged you cannot appreciate the sheer fear of knowing they can do what they like to you (including ECT) and you can do nothing about it. The ‘safeguards’ are non existent – just a rubber stamp.
If you decide to continue with their drugs you will eventually find yourself in this position as the drugs will make you madder than you ever were to start with. Be warned.
In principal only do I agree with this law.. American laws over time have a way of being manipulated and construed to better serve the police and/or district attorneys around the united states. They also seem to be misconstrued and abused by overly concerned and ignorant jhonny-do-righters that are biased toward the mentally ill. Even if impeccable stranded operating procedures were in place, a system of stringent double and triple check verifications would have to be used. People don’t want to take their time and educate themselves on mental illness. Because of that , the rights of some perfectly capable and productive mentally ill people will be violated because of ignorance and fear… People gather there info on mental illness from the media, not from a credible source. There’s only two types of “Crazie’s” in the normie world.. The first type is the adult with severe developemental issues. Ex. (Something About Mary and Of mice and Men) Then you have the second type, a homicidal manic killer they see in horrer flix. Just saying, a over zeaalous nigherhood watch member will use this to get people off the streets that are known to be ill, but are no threat just because of their unfounded fears. Just saying a this will turn out bad, just watch.
Andrew,
I definitely can’t comment on how things will go over time, just what the information is I have now. And it is important to note there is judicial and other oversight on this program. And, if the above number is correct, only a teeny-tiny fraction of people would ever qualify for this program. Additionally, short-sighted people (which most people seem to be) may see this as a cost, rather than a savings (which it appears to be) which makes them less motivated to put people in the program.
“Because of that , the rights of some perfectly capable and productive mentally ill people will be violated because of ignorance and fear”
You say that, but I wonder how “capable” a person is if they are repeatedly violent and in contact with the police. I don’t think that defines capable.
Maybe it will turn out badly, maybe you’re right, but in other places, like New York, this hasn’t been seen yet.
– Natasha Tracy
Many people are traumatized (or retraumatized) for the rest of their life because of forced treatment and human rights violations http://www.ncbi.nlm.nih.gov/pubmed/21054728. So let people who want forced treatment have that, but let others have voluntary help.
Hi Sigrun,
I have no doubt that some kinds of treatment can be traumatizing. This law only allows for very specific treatment though and you can’t do things like medicate against someone’s will.
But to be fair, we, as a people, need to do something for people who reject treatment because they don’t have the insight to know that they need it. And yes, that may mean forced treatment. If I had a better idea, I would suggest it, but I just don’t have one.
And it’s worth noting that people undergoing AOT have the same feelings, both positive and negative, as those undergoing voluntary treatment.
– Natasha Tracy
Wow! You just wrote the best description of AOT that I have ever read!
Well thank-you Carla, I try. :)
– Natasha
The anti-psychiatry folks are going to jump all over this one, so fasten your seat belt. Hope it’s not too brutal but you’ve handled more difficult issues beautifully.
I’d like to add another reason the stats have been so good and that is because these laws require the treatment team to be accountable! Folks in AOT stop “falling through the cracks” as do most folks who are receiving public mental health services. In addition to that, the AOT folks are put on the fast track for housing, substance abuse treatment and medication monitoring. All these additional factors add up to successful outcomes..
As always, thank you for the wonderful work you do!
Hi Judy,
Yup, I figure the antipsychiatry folks are on their way, but it’s OK, I don’t mind. I consider the subject important regardless.
Accountability – yes! I love this. It’s so great to see people _getting_real_effective_ help. Anything that helps close the cracks, even a little, is a good thing, I think.
Thank-you for your kind words.
– Natasha Tracy
Dear Natasha
Keep up the good fight against the evil forces of antipsychiatry and your sterling efforts to misinform the public. Congratulations on your campaigh to make sure us schizophrenics are kept under control. Seriously though, what are you going to do if your friend the shrink changes your diagnosis and puts you on Supervised Community Treatment or whatever they call it in America?
Merry Christmas
Jean