Rights of the Mentally Ill
Rights of the Mentally IllMental illness, especially the three serious diseases of bipolar disorder, schizophrenia, and major depression are a huge social problem that affects more than just those it afflicts. More than 2.3 million Americans suffer from bipolar disorder and 20 percent of them commit suicide, according to the National Institute of Mental Health. Schizophrenia and major depression affects another 2 million and one in 10 eventually dies by suicide (LaFond 30). Add to that 19 million adults who suffer from major depression and it is a large amount of the population who suffer from a mental illness. Out of these 23.3 million people who suffer from these diseases, as few as 20 percent receive treatment for their conditions. (LaFond, 30) Many of the mentally ill simply shun away attempts to help them. Whether or not mental health patients should be allowed to do this is a question that is asked by many. It is argued that they, like every other human being, have the civil right to make their own decisions regarding their body. Many of these people do not even know the difference between reality and fiction, so how can they be expected to make conscious decisions concerning treatment for their illness? These people are given the opportunity to refuse needed treatment, and it is not their fault. The problem lies within a legal system that ignores the topic of mental health and refuses to come up with a working alternative to get mental patients the care they need and deserve.
It is impossible to understand mental disability laws if you do not have a basic understanding about mental illness. There are numerous different strains of mental illness, some more severe than others. They range anywhere from obsessive disorders to manic depression. As stated previously there are three mental disorders that are considered most serious; bipolar disorder, Schizophrenia, and major depression. Schizophrenia is a group of psychotic disorders characterized by six -month or longer disturbances in thought, perception, behavior, and communication. Both manic depression and bipolar disorder are pathological mood swings from mania to depression with a tendency to reoccur and remit spontaneously (www.mental health.com). Those who have been diagnosed with any of these three should be under the care of a doctor and or a psychiatrist. A problem that faces many people who have these illnesses is that they are unaware that is in fact what they have. Mental disorders can go undiagnosed for years. There are however numerous warning signs of mental illness. Marked personality change over an extended period of time, confused thinking and/or strange ideas, prolonged severe depression, withdrawal from society, and delusions or hallucinations are some of the warning signs that a person may be suffering from a mental disorder. (Attlen 306) Mental illness is hard to diagnose. A blood test or a simple visit to a doctor cannot determine a person’s mental state. Diagnosing a mental illness is a long process that requires numerous tests and evaluations by doctors and/or psychiatrists. When evaluating a patient for mental illness the doctor takes a lot of information regarding the persons’ family history, daily life, and childhood that can be helpful in diagnosing them.
Although doctors are now able to diagnose mental illness easier than in the past, they are still do not have a definite answer as to what causes mental illness. It is believed that those who suffer from mental illness are born with an inborn vulnerability to a particular condition. Signs of the disorder may not be visible until something triggers it, such as environmental stress. Scientists have found that a person who has a strong physiological vulnerability to mental illness requires relatively little environmental stress to provoke an episode. (Lewine 254) For people with severe mental disorders it also takes less and less stress to provoke every successive episode. The brain, therefore, becomes accustomed to responding to this tension and does so with increasing ease, unless therapy and/or medication intervene. The onset and course of the diseases can be dependent on all of these interrelated fields. Once a diagnosis is made the patient can be easily treated in most cases.
“Patients who suffer from severe mental illnesses are most times not aware or not accepting of the fact that they have a mental disorder”, says Kathy Pemberton, a social worker for the Beth Israel Deaconess Medical Centers psychiatric unit. Most feel that their delusions and their mania are normal. This is probably the main reason why so many people who are mentally incompetent do not seek treatment. Although these people are clearly victims of mental illness, their legal rights allow them to get away with refusing treatment. The sad reality is that this is too often the case in regards to mental illness. Most severely mentally ill patients obviously belong in a mental health facility for some certain period of time; the problem is getting them there.
This is where things begin to get complicated. People cannot be forced to receive treatment that they do not want. As Americans we are allowed to decide what happens to our own bodies; it is our civil right. Unfortunately, there is not a separate set of legal rights for mental health patients. To make matters worse, over the past few decades they have been receiving more and more legal rights concerning what they do as far as refusing treatment(Hiller 155-156). This is mainly because in the early and mid 1900’s it was very simple to get someone committed (Hiller 155). Often times families of people with mental disorders or even people without a real disorder, would get them committed against their will. In most cases the families were rich and had something to gain by getting rid of the person they “locked up”. One call to the authorities telling them that a family member was mentally ill, a man in a white coat would come out to their house retrieve the so called mentally ill person, and take them to a hospital. No examination, no evaluation like they have now, they just threw them in the asylum without any real diagnosis (Hiller 156). Granted, this is by far not the best way of getting mentally ill patient in a hospital, but letting them roam the streets isn’t any better.
In many cases, a person requiring mental help may have friends or family who want to assist the person in getting treatment although they may not want it. This causes a great deal of stress for all parties involved. Families are torn apart in many cases of involuntary committal. This could be avoided if the legal system could implement an easier way of getting mental health patients the care that they need.
No area of mental disability arouses more controversy than civil commitment. Involuntary institutionalization creates a conflict between the individuals right to liberty and governments power to shield vulnerable citizens from harm and to protect society from danger. Although its purpose is therapeutic, the Supreme Court has termed involuntary commitment a “massive curtainment of liberty.” Individuals are held under lock and key, separated from their families, deprived of personal privacy, and subjected to the possibility of forced treatment with drugs that may have serious side effects (Levy 248). Commitment infringes the right to liberty, to freedom of association, to travel, and bodily autonomy. Although it may not sound good on paper, it must be realized that a lot of people with serious mental disabilities are a potential danger to themselves and to society. Allowing them to remain untreated in society, is a disservice to themselves and to the people around them.
The process to get a patient involuntarily committed is a long one. The first step a family must take to get their loved one committed is to file a Chapter 12, which is a court order that forces a patient to seek treatment. A Chapter 12 can only be granted when and if the patient becomes physically or verbally threatening, and it forces a patient into hospitalization. Once in a facility the patient still has the right to refuse treatment (Hiller 134). After the patient is in a facility for at least three days they can attempt to sign themselves out of the hospital. When a patient does this they are not just simply let out into the streets again. A group of psychiatrists and mental health professionals evaluate the patient and decide if they should be hospitalized or not. If the doctors feel that the patient is not in a state in which they can be released, a review for involuntary admission and treatment is scheduled and the pateint must remain in the facility until a judge release them.
There are two kinds of commitment hearings: a preliminary or probably cause hearing and a full hearing. A preliminary hearing is held to determine whether there is sufficient evidence to justify commitment proceedings and continuing the individuals’ confinement. A preliminary hearing is shorter and less formal than a full hearing and generally requires less proof. (Levy 44) Typically, the facility needs only show that there is reasonable cause to believe that the individual meets the commitment standard. A hearing of this kind can be held shortly after admission and can often safeguard against improper confinement. Preliminary hearings are the most common type of commitment hearing. Both preliminary hearings and full hearings are stressful and upsetting for the patient and their family alike. A hearing of this kind can often times destroy the relationship between a family and the patient. Things can be said in the courtroom, which may not have been otherwise, which cause a lasting effect on the relationship.
Although commitment hearings seem to work well, it is not the case in many situations. Frustration with a revolving door commitment process that can temporarily stabilize a patient often fails to fully restore quality of life as in the case of Mrs. Kathryn Thompson and her son. Mrs. Thompson is an elderly woman from Boston who, for the past 20 something years has lived with her son who suffers from manic depression and bipolar disorder. He was diagnosed in 1982 and was committed to a mental health facility in Boston. After aproximentily three months of commitment, he was released upon the conditions that he would take Tegritol, an antipsychotic medication. When on the medication, he went through daily life without any problems. He lived this way for 13 years. This past December, for reasons unknown to Mrs. Thompson, he stopped taking the medication. The effects were not noticeable at first, but after aproximentily four weeks she began to notice some of the same signs she had seen 13 years before when he was first diagnosed. “He was constantly paranoid that someone was out to kill him, he became detached from society, and verbally abusive to myself and the rest of my family,” Mrs. Thompson says.
After a few weeks of living in constant fear that her son would hurt himself or someone else, she decided to take action. One day while he was at work, Mrs. Thompson and her family gathered at her house, made the necessary calls, filed a Chapter 12 with the Boston Police, and waited. “When he got home and saw everyone in the house, he knew something was up. We tried to talk to him but he just screamed and yelled. It got violent and eventually he ran out of the house,” says Mrs. Thompson. He was gone that night and the next few days following. Since a Chapter 12 expires after twenty -four hours, there was nothing much that the family could do. Eventually he did get into a hospital, after his practicing psychiatrist called him at work and demanded he go to an emergency room.
“He stayed at the Beth Israel Deaconess Medical Center psychiatric unit for about two weeks before he filed for release,” says Mrs. Thompson. His doctors agreed with the family and when the hearing took place it was decided that he would be forced to stay in the hospital. Although this was a step in the right direction to his recovery it was not enough. Even though a person is admitted to a hospital, that does not mean that they are going to get well. No medications were administered, and there were just two hours a day of group therapy. Mental illness is a medical problem, just like cancer or AIDS or any other illnesses, and mental illness needs proper treatment and that includes medication. After two months in the mental health facility, Mrs. Thompson’s son was released. Family ties have been severed and he is still not taking his medication.
Mrs. Thompson’s story is just one of the thousands of tales of confusion, frustration, and horror from a mental health system hobbled by lack of money and split by a philosophical argument over whether the government should force treatment on people even when they don’t want it. Stories like hers are all too common in the mental health system. Although hers did not have a happy ending, a lot of cases end much worse in homicide and suicide. Mental health is a problem that most people do not look to as a major problem in society today.
Exasperation, anger and society’s fear of the mentally ill have caused legislators and courts over the last decade to consider new ways to force those with serious mental illnesses into treatment. (Levy 377) Critics say that such measures may do little more than ease political consciences, especially when they are emotionally motivated. (Hiller 148) Advocates of stricter legal controls on the mentally ill feel that it is shameful that at time when there are so many advances that can improve a patients conditions, the system designed for their protection can in tern, shield them from effective care.
For those who have not had to deal with it, the mental health system may seem to work rather well. Those who have dealt with and who have been exposed to the horrors of how poorly the mental health system works can attest to the fact that the system needs a great deal of work. Clearly mental illness is a problem that is growing in America. Many times people do not see just how serious the problem of proper care is. The American government has to take a look at the laws regarding mental illness and make some changes. Laws that work for most of the country and that are meant to serve as effective ways for patients to have control over their body, often times prove to do more damage than good to mental health patients. Anyone can see that people with a severe mental illness are in no state to make decisions concerning their treatment or lack there of. The debate between whether or not treatment should be forced upon those with severe mental illness will continue to fester. The truth of the matter is either way individuals, families, and society suffers.
Works Cited
Attlen, Mary. Caring for a Loved One with Mental Illness. New York, Random House: 1996.
Hiller, Marc. Medical Ethics and the Law. Cambridge, Massachusetts. Ballinger
Publishing.
LaFond, John. Back to the Asylum. New York, Oxford Press. 1992
Levy, Robert. The Rights of People with Mental Illness. Illinois, Southern Illinois
University Press. 1996
Lewine, Richard. Caring For those With Mental Illness. New York, Random House.
1984