Forced Treatment Doesn't
Work
The promise of community mental health service was
neither funded nor fulfilled.
By Vicki Fox Wieselthier and Michael Allen
In the wake of a handful of highly publicized
violent incidents involving people with mental illness, advocates of forced
treatment have suggested that court-ordered "outpatient commitment"
will make our communities safer. One example is the piece by E. Fuller Torrey and Mary T. Zdanowicz
["Deinstitutionalization Hasn't Worked," op-ed, July 9]. The problem
is that outpatient commitment doesn't work. Worse yet, the threat of forced
treatment drives people away from the supports they need while stealing the
resources necessary to support voluntary services with proven effects.
Outpatient commitment is being touted as a
quick fix that will make law-abiding citizens safe on the streets. Its
proponents would oppress an entire class of citizens on the basis of misguided
fear. While doing very little to improve public safety, outpatient commitment
would force people with certain psychiatric diagnoses to take powerful
medications and comply with treatment orders as a condition of living in the
community. Noncompliance would be punished by readmission to an inpatient
psychiatric facility.
Forced treatment advocates make a series of
false claims. The first exaggerates both the dangerousness of people with
mental illnesses and the effectiveness of outpatient commitment. Study after
study has found that most people with serious mental illnesses are no more
dangerous than the general population. In May 1998 Dr. Bruce Link commented in
the Archives of General Psychiatry: "To date, nearly every modern study
indicates that public fears are way out of proportion to the empirical reality.
The magnitude of the violence risk associated with mental illness is comparable
to that associated with age, educational attainment, and gender."
Research also shows that coercive measures
provide no benefit to people with mental illness. The only controlled study
released to date concludes that individuals provided
voluntary, enhanced community services did just as well as those under
commitment orders who had access to the same services.
It's a very different situation from, for
example, that which occurs when a person is court-ordered to receive treatment
for tuberculosis. In the case of TB, there is no doubt about the validity of
the diagnosis, the effectiveness of the treatment and the public health risk of
active TB.
Pro-force advocates also claim that nearly
half of those individuals with schizophrenia or manic depression lack the
insight necessary to recognize their need for treatment. The truth behind the
headlines is that many of those recently involved in acts of violence had been
begging for mental health services only to be told that the services they were
requesting could not be provided. The dollars to pay for them were not there.
Court orders will do little to increase the
availability of services where they do not exist. What court-ordered treatment
will do is reallocate what few dollars are in the system so that one will have
to be caught in the outpatient commitment net to get any treatment at all. When
the system is required to make services available to people for whom a court
has ordered treatment, it simultaneously must deprive others of effective,
voluntary services. Every dollar that is spent on force is a dollar that is not
available to pay for services that really work -- peer support, outreach,
adequate housing, jobs programs and rehabilitation.
Finally, mental health professionals
themselves admit that there is no reliable assessment tool to determine who
might belong to that small group of individuals who might actually be violent.
According to the American Psychiatric Association, "Psychiatrists have no
special knowledge or ability with which to predict dangerous behavior. Studies
have shown that even with patients in which there is a history of violent acts,
predictions of future violence will be wrong for two out of every three
patients." Far from being a safety net, outpatient commitment will operate
as a dragnet, pulling in and confining people who pose no risk to themselves or
others.
The promise of deinstitutionalization -- that
money would be reinvested in community mental health care -- was never
fulfilled. Civil rights and mental health consumer advocates are at the
forefront of the campaign for adequate funding. If pro-force advocates
redirected their multimillion-dollar budgets and joined this campaign, we
finally could make good on the promise and improve the quality -- and safety --
of all of our lives.
[END]