Laws mandating court-ordered involuntary outpatient treatment and forced medication have been on the books for 20 years in some states. States soften the language, calling it Assisted Outpatient Treatment (AOT), intending the treatment for those diagnosed with sever bipolar disorder or schizophrenia. I can see how appropriate use could save money and lives. But the extension of coercive mental health care proposed by Rep. Tim Murphy (R., Pa.) goes too far – there is great danger in forced medication and psychiatric hospitalization. Murphy’s reactionary bill has the potential to trap the bodies and blunt the brains of hundreds of thousands of patients fairly or unfairly diagnosed with mental illness.
First let’s look at a quick cost-benefit. Larry Drain of Hopeworks Community has done the research. He says, in contrast to psychiatric hospitalization, that, “Peer support centers in Tennessee serve 3500 people a day for $4.5 million dollars and reduce hospitalization for 90% of the people who attend. A hospital bed costs $335K a year and doesn’t even reduce psychiatric hospitalization.” Do the math: hospitalizing people for psychiatric concerns is costly and one hospitalization does nothing to lower the risk of future hospitalizations (as opposed to peer support models that do reduce future hospitalizations).
The broader definition of effectiveness is another issue. Why do lawmakers assume that psychiatric hospitalization is helpful? Anecdotally, I know very few people in the health care industry who think inpatient care is particularly effective. And, any time the UNHRC issues bulletins in which mental health care is compared to torture, and class action suits about terrifying care in hospitals are brought and won, it seems as if legislators would get the point: restrictive care is expensive and doesn’t work!
From the patient perspective, almost no one wants hospitalization. It’s terrifying and often as injurious as it is helpful. It used to be a familiar threat for us kids when we misbehaved: “We’ll send you to Broughton!” From the patient perspective, “effective” means you get better. And “better” means you can function outside of the hospital. Psychiatric hospitalization doesn’t make patients better.
The problem is assumptions and expectations. We are whipped in a frenzy to correlate mental illness with horrific violent behavior. For some, this unfair assumption justifies drugging people diagnosed with mental illness into stupor (or perhaps unintended violence as side effects of medication!). The expectation is that “those people” are violent, and that “those people” who are medicated are unable to function. Physical incarceration or mental incapacitation is preferable to the violence we expect. Who cares about human rights?
Representative Murphy probably can’t conceive of the value of healthy, strong, sustaining relationships that are honest and effective as healing in situations of mental illness. If he could, he might see, as I do, that reducing the crises in mental health care is dependent on helping people increase their self-capacities (not making them dependent on medications or psychiatric incarceration). Only by working with instead of against people diagnosed with mental illness to boost skills and coping mechanisms can we contain health care costs and create true effectiveness. By collaborating with instead of incarcerating this population of vibrant, worthwhile, challenged individuals we can see real change.
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