PsychOdyssey 350: Compulsory Treatment

One of the most contentious subjects in psychiatric rehabilitation is compulsory treatment. Should the psychiatrically disabled ever be compelled to receive treatment that they do not want but that others think will help them? Especially in the wake of “Kendra’s Law” in New York, many states have recently adopted laws mandating certain levels of treatment.

The issue is fixed at the crossroads of the conflicting ideals of societal humanitarian obligations vs. individual civil rights. A significant factor relating to the issue is a condition called anosognosia, a symptom that may occur in over 70 percent of all cases of schizophrenia. Anosognosia is the state of a mind that is unaware that it is ill. And yet studies show that those with both schizophrenia and anosognosia become far more functional and self-aware when they are compliant with their medication regimens.

This mini-course looks at the issue from all sides and asks its students to think carefully about this critical issue. Especially parents with ill loved ones with anosognosia are encouraged to consider and consolidate their views on this subject. Be it hospitalization, outpatient services, or medications compliance, should a parent support or oppose a court imposing an order on their child to receive mandatory treatment?

Resource list:

Anfang, Stuart A., and Appelbaum, Paul S. (2006). Civil Commitment–The American Experience. Israel Journal of Psychiatry and Related Sciences, 43(3), 209-218

Bernkopf, D., Rubenstein, T., & Sellers, H. (Producers and Directors) (2010). Stopping the Revolving Door: A Civil Approach to Treating Severe Mental Illness [Video]. (Available from Treatment Advocacy Center, Arlington, VA). Retrieved from:http://www.vimeo.com/26171883

European Network of (ex-)Users and Survivors of Psychiatry, World Network of Users and Survivors of Psychiatry, MindFreedom International, & Benudesverband Psychiatrie-Erfahener (2007). Declaration at Dresden Against Coerced Psychiatric Treatment.

Geller, J.L. (2006). The evolution of outpatient commitment in the USA–from conundrum to quagmire. International Journal of Law and Psychiatry 29(3), 234-248. doi:10.1016/j.ijlp.2005.09.003

Lawton-Smith, S, Dawson, J. & Burns, T. (2008). Community Treatment Orders Are Not A Good Thing. The British Journal of Psychiatry 193, 96-100. doi: 10.1192/bjp.bp.107.049072

Link, B., Castille, D.M. & Stuber, J. (2008). Stigma and coercion in the context of outpatient treatment for people with mental illness. Social Science & Medicine, 67, 409-419.

MacArthur Research Network on Mental Health and the Law, The MacArthur Coercion Study (summary)

Monahan, J., Bonnie, R.J., Appelbaum, P.S., Hyde, P.S., Steadman, H.J., & Swartz, M.S. (2001). Mandated community treatment–beyond outpatient commitment. Psychiatric Services, 52(9), 1198-1205.

Munetz, M. R., & Frese, F. J. (2001). Getting Ready for Recovery–Reconciling Mandatory Treatment With the Recovery Vision. Psychiatric Rehabilitation Journal, 25(1), 35-41.

National Empowerment Center, Inc., Should Forced Medication be a Treatment Option in Patients with Schizophrenia? (Judi Chamberlin debates E. Fuller Torrey, MD on Involuntary Treatment)

New Jersey Division of Mental Health and Addiction Services, et al. (2008). Involuntary Civil Commitments Resource Binder. Retrieved from http://www.judiciary.state.nj.us/civil/ICC_ResourceBinder.pdf

Olsen, D. P. (2003), Influence and Coercion: Relational and Rights-Based Ethical Approaches Ethical Approaches to Forced Psychiatric Treatment. Journal of Pyschiatric and Mental Health Nursing, 10, 705-712.

Pyle, T.H. (2010). Outpatient Commitment: A Philosophical Dilemma for Families.


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