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Involuntary medication acts to divide



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By Anne Donahue - Published: January 3, 2008

Amidst the central topics of economic stability, its prongs of health and education spending, and our environmental challenges, many smaller but philosophically critical discussions will wind through the Legislature this year.

Within health care, some of our biases are likely to be played out in a potentially intense new debate over whether to expedite court orders to force persons with mental illnesses to be injected with controversial mind-altering drugs in the name of saving money on the state hospital "Futures" plan.

The debate will focus on the only Vermonters who can be locked up against their will for weeks, without any court hearing, based upon a hypothetical risk of harm to others (not a crime already committed) or to themselves.

If we did not have them on the public tab behind locked doors we would ask different questions than the ones that will surface for involuntary mental health care. Ironically, more than two-thirds of the health care in Vermont is already on the public tab – actually, virtually all of it, since it comes out of either taxes or wages pooled together – but we look elsewhere than forced treatment compliance for cost and quality initiatives in other types of care.

How are some of the questions different?

  • We have grown in the momentum for looking for alternatives to the most invasive health care treatments.

  • We are moving to smarter care management through patient involvement, recognizing that more collaboration and illness self-management is what brings greater consistency in treatment and thus better (and less expensive) outcomes.

  • We have begun to learn that "overuse" – accessing unnecessary levels of intervention – is one of our cost drivers. Just "doing something" isn't always best. Sometimes time heals.

  • We have begun to recognize how much the pharmaceutical industry is driving medical decision-making, both through conscious marketing to us, and more subliminal impacts upon physicians. Those same companies provide substantial funding to national public advocacy groups as well as to political lobbyists.

  • We are realizing that in the resulting demand for quick relief, we have exponentially expanded use of new and expensive drugs, many of them prescribed "off label," and then have wrung our hands when our children look for "off label" drug relief or when "self-medication" leads to addiction.

    How are we upending all of that in new proposals for treatment for those with serious mental illnesses? Instead of spending the time to work towards mutual agreement on a treatment plan, many more Vermonters would be forcibly injected with risky drugs to get them out of a hospital faster. Some of those same drugs are now known for such side effects as diabetes, a chronic, debilitating and expensive illness – one of those facts that pharmaceutical companies knew and hid and for which they are now paying out billions in damages.

    Instead of support for alternative healing strategies craved by many of these Vermonters, we would stress the temporary pharmaceutical quick fix – a response that accepts the sales pitch that drugs are the only and best course of treatment.

    We are not focusing on the question, is this person capable of making medical decisions despite an illness? Or, how do we address any other situation of invasive medical treatment for a person who cannot make a decision fully on their own? What are the criteria for any of us in being allowed, or not being allowed, a medical decision that a physician disagrees with? Are we prepared for the implications of the answers, or can we again just shunt this off as being somehow different if it involves psychiatric illness instead of other decision-making impairments such as unconsciousness, senility, stroke … or it involves visible public cost?

    While we build new hospital wings for everything else – all on public dollars – we don't want to have to spend capital money on modern alternative solutions to the decertified asylum in Waterbury.

    After all, we do legitimately also have roads and schools and offices in urgent need of care. Perhaps those are just easier to understand how to address.

    So we want to believe that if our community hospitals can just add a few more bolts to the doors and to forcibly inject medications into patients who don't comply with a doctor's treatment plan within a week, they will be able to "handle" such patients quickly and efficiently.

    We are willing to build a new, cheaper non-hospital institution for those who don't respond to medications, but we do not want to recognize that this component is primarily for our own self-interest, to allay our fears about the tiny number of those whose symptoms do include violence.

    We don't seem to be interested in understanding the need for providing both the kind of top-flight inpatient care that is needed for all highest-severity illness, and for the collaborative alternatives that we are trying to encourage among "willing" patients of every other kind.

    Vermont is hailed as the most progressive state on many fronts, including in "parity" – the recognition that mental health is part of, not different from, the rest of our health.

    Sadly for our country, even Vermont's version of parity for insurance coverage still allows separate funnels of money to carve out mental health treatment from integrated care.

    Sadly for our state, this year we will be looking to other, less progressive states to use as examples to address the issues of treatment for those who have been diagnosed with a serious mental illness and believe they need a difference response than drugs to succeed in life.

    Instead of progressing on parity of treatment approaches and integration of care, we now look to divide further, and to conquer by force.



    Rep. Anne B. Donahue (R-Northfield) is on the Human Services Committee and the Joint Mental Health Oversight Committee.







    READER COMMENTS


    The problem that is inherent in Psychiatric treatment is not the effectiveness of the course of treatment but the science behind the industry. When discussing the role of Psychiatry in mental illness we are often lead by misleading statements and unproven courses.

    When I look at news releases and statements (which usually surround some type of funding issue or new product), I always find generalities and platitudes. Statements like, "studies suggest", "experts say", "statistics point to", on and on. Yet I find no actually concrete evidence. I have never read mental illness A is proven to be caused by problem B. Even if someone was so careless as to state that, no actual evidence was given to support it. I defy anyone to find an authoritative article that states what causes a mental illness with substantiating proof. I will pay them a $1000.

    I have seen a documentary where many Psychiatrists at the 2005 and 2006 APA conventions all admitted they don't really no what causes mental illness and they don't know how to cure it. The chemical imbalance theory is just that - a theory. Yet big-pharma continues to push and market drugs for profit

    My concern is that because of the hype that a child could be given drugs when he may have a real physical problem like being allergic to foods or being on a sugar filled diet. My own son would easily have been prescribed drugs because of his hyper activity but instead we handled his nutritional needs and left him alone to outgrow some behaviors and guess what - it worked. I have also witnessed other parents putting kids on drugs where their behavior never improves or worse yet, alters into a very hostile and sometimes suicidal/homicidal pattern.

    All of the shootings in recent years that occured in schools by students have been perpertrated by kids on pshychiatric medication. Columbine, Oregon, all of them. If that is not telling I don't know what is. It scares me to think that the industry chooses to continually increase the Statistical Manual on Mental Disorder's size and scope. The "illnesses" in that manual are all voted on and are completely arbitrary. They are not required to have tests or proof that a physical science does. I could invent a mental illness called Disneyland Mania, and if voted upon by a majority, could become an offical disease. Thereby, drug companies could invent drugs or use existing ones to "treat" this disease. "Treat" and "Treatment", by the way, in the mental illness plane, have also become hackneyed terms that really don't mean anything other than we are just doing something.

    True, people have problems and sometimes big ones. However offering up a shot in the dark drug is irresponsible at best. What people don't usually look to first are the actual physical, nutrional, and allergic needs. Following that, the environmental needs includling cutting TV or video game influences.

    It is tough as a parent these days with the demands on ones time and the pressures that our busy soceity creates. However, there is no excuse to use this as a reason for drugging and potentially permanently altering or damaging their well being.
    -- Posted by Brian Godley on Sun, Jan 27, 2008, 1:54 pm EST

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    I am advocating for changes to our treatment laws in Pennsylvania for those with a severe mental illness and lack of insight into the need to seek or remain in treatment. Although many advocate for changes to treatment laws due to violent incidents that can occur with untreated mental illness and those stories are the ones that we most often see in the media, that is not what brought me to advocate for changes in my state.

    My main concern for my daughter when she stopped taking the medications that helped keep the voices under control was that when she wandered off at the suggestion of those voices, she would put herself in too dangerous a situation, and would be victimized. A friend of mine whose daughter wandered off when not taking medications ended up in jail, with a charge of robbery, because she tried to get money from a drug store, even though she had a bank account that she could have accessed. She wasn't thinkly clearly and she shouldn't be incarcerated now in order to finally receive the treatment she needed but lacked the insight to request.

    The article, "Involuntary medication acts to divide" simplifies the delay of taking medications by stating that people would be eligible for voluntary commitments simply because they don't "comply with a doctor's treatment plan within a week."

    Assisted outpatient treatment (AOT) laws such as Kendra's Law in New York, have much more stringent criteria before someone would be required to remain in treatment, including a history of hospitalizations or incarcerations.

    AOT laws are compassionate outreach programs designed to help someone regain the ability to take control of their own treatments. Without timely intervention, then the chances of homelessness, incarcerations, victiminizations, and yes, sometimes violence are increased significantly.

    Preventive, timely treatment for those with mental illness and lack of insight is just common sense and shouldn't be a divisive issue.
    -- Posted by Jeanette castello on Sat, Jan 5, 2008, 2:48 pm EST

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