The article "Forced Treatment Doesn't Work" [op-ed, Aug. 5] is a string of distortions and misleading pseudo-statistics designed to undermine public confidence in scientifically proven approaches to improving the lives and treatment of persons with mental illness.
Assisted outpatient treatment laws have now been adopted by 41 states. They authorize a judge, only after a strong showing of medical necessity or dangerousness, to order a person to take his or her medicine for severe mental illness. Numerous studies show that such laws avoid or reduce involuntary hospitalization, reduce the possibility of patients falling into the criminal justice system and preserve a person's freedom to continue living in the community. Significantly, such laws improve the quality of life as well as physical and mental health.
Before 1950, the only venue to care for persons with serious mental illness was a psychiatric hospital or jail. Many of these hospitals were not pleasant places under the best of circumstances, but most were better than what preceded them -- nothing. Before the 19th century, persons with mental illness were ostracized or ignored by society, often left to wander from town to town in search of alms because no government support was available to them. In France, archers were posted at city gates to keep them out. Those who were allowed in the city were forced to labor in the sewers while chained in pairs. In England, the citizenry paid to see and ridicule the mentally ill in the government-sponsored correctional facilities. In colonial America, jailing the mentally ill was the standard practice.
The discovery in the 1950s of new psychotropic medications allowed large numbers of patients to be released from confinement in psychiatric hospitals. Called "deinstitutionalization," this has been characterized as the largest government-sponsored liberation movement in this country's history, involving an estimated 1 million persons with severe mental illness. In 1880, 98 percent of persons with severe mental illness were either in a hospital or cared for at home. Today only 2 percent of persons with severe mental illness are in hospitals, and 93 percent are in the community.
Unfortunately, the number of persons with serious mental illness in prisons and jails has increased by an astounding 2,300 percent. In 1880 it was 0.7 percent of the inmate population, but last month the Justice Department reported that in nonfederal correctional facilities, 16 percent of the inmates have been treated for a severe mental illness.
Numerous studies have found assisted treatment to be highly beneficial to patients and to society. In 1994, the New York legislature authorized a three-year "experimental" assisted outpatient treatment law at New York City's Bellevue Hospital. A generally favorable independent study and numerous tragic examples of harm caused and suffered by untreated patients led the legislature and the governor to enact "Kendra's Law," which extends the program statewide.
The authors of the op-ed article in The Post distort this study, claiming that the program made no difference. While it is true that the Bellevue Hospital "control" group (with no court order) did as well as the "experimental" group (with a court order), neither group was ever subjected to any forcible or coercive treatment. Despite hysterical claims of "oppression," all of the "experimental" patients and their lawyers freely agreed to accept the court order and generally obeyed it. The study shows that such programs more often produce cooperation than compulsion, thereby engendering a beneficial therapeutic alliance between doctor and patient.
Furthermore, the New York experience and others show that money is saved with judicial scrutiny and a reduction in hospitalization. Kendra's Law carries with it a $30 million increase in funding for services, not including the additional federal Medicaid matching funds. These laws not only commit a patient to treatment, they also commit the treatment system to the patient.
One important question that critics fail to address is what to do with a dangerous person who refuses to take medication, such as Russell Weston, the accused killer of the two Capitol guards last summer. Observers of his behavior had plenty of warning. Before he drove 17 straight hours to the Capitol, his family and others saw him talking to squirrels, shooting cats and claiming that local TV satellite dishes were a CIA spying plot.
Who could doubt the moral necessity and legal justification of compelling him to take his medication to spare two lives as well as his own freedom?
The writer, former chief counsel of the New York State Commission on Quality of Care for the Mentally Disabled, is director of the Law and Psychiatry Center at George Mason University's School of Law.