Forced Treatment Of SMI Individuials

Question 1

What is anosognosia?

Answer 1

The neurological inability of an individual experiencing psychosis to appreciate they are sick and need treatment.

Affects 47%-57% of schizophrenia patients

Question 2

What are the arguments for forced treatment of patients with SMI?

Answer 2

1) The right to refuse has bad consequences for the patients themselves, fellow patients, doctors, and institutions
2) Medications are effective and benefits outweigh the negative side-effects, and are always used to treat psychosis (whether alone or with therapy)
3) Medications make therapy more effective
4) Treatment refusal by patients increases costs: institutional from violent untreated patients, financial costs of warehousing patients before they can be treated, legal costs from resolving treatment refusal disputes
5) Anosognosia prevents patients from knowing they need treatment (implied consent? They would want treatment if they knew they needed it)
6) Treatment reduces recidivism (hospital and prison), reduced victimization, quality of life improvements

Question 3

What are some arguments supporting the point that medications are effective?

Answer 3

1) There has been a decrease in the need for hospital beds (from 50% to less than 10%) since the 1950s and the advent
of chlorpromazine
2) When good care is available and patients take their medication the majority of them can return to work/school and be productive members of society
3) Those with schizophrenia not receiving drugs die at a rate ten time higher than patients on medication
4) Medications return people to normal functioning, and the side effects of first-generation antipsychotics were still better than the risk of death from untreated psychosis, lethal Catalonia, suicide, accidents, infection and other harms

Question 4

What is Brakell and Davis’s recommendation regarding who decides on the treatment of SMI patients refusing treatment?

Answer 4

• Only the treating physician, not judges
• Physician should be allowed to initiate treatment over the patient’s objection with minimal legal interference once all courses of treatment and plausible alternatives have been rejected

Question 5

What are the arguments against forced treatment of SMI patients?

Answer 5

1) Based on the laws of several states regarding the constitutional limits on forced drugging, people are constitutionally entitled to noncoercive, nondrugging, recovery-oriented alternative before involuntary commitment and forced drugging can occur (and even then it must be in the person’s best interest)
2) Honouring people’s rights can play a crucial role in transforming the mental health system to one of a recovery culture
3) The current system of involuntary commitment and forced drugging makes it too easy to override individual rights, despite the Constitution
4) People are found incompetent when they are not, when the system doesn’t know what else to do with them

Question 6

How does the current system of involuntary commitment and forced drugging makes it too easy to override individual rights, despite the Constitution?

Answer 6

1) Psychiatric testimony regarding a person’s dangerousness is highly unreliable with a high likelihood of overestimation (and also psychiatrists lie and the courts don’t care)
2) The person must be found incompetent to refuse medication in order to be forcefully treated; but there is no scientific proof that forced drugging is in the individual’s best interest
- overreliance on medication his increased the rate of disability
- the medications can cause harm (newer drugs have doubled the risk of death in schizophrenia over the older drugs)

Question 7

What are ways to change the system to benefit patients with SMI?

Answer 7

1) Establishing the right to effective assistance of counsel (cases should take half a day to represent zealously, forcing the system to look for alternatives)
2) There should be challenges to state proceedings, such as expert witnesses
3) Changing public attitudes and understanding about drugs will help to change the court systems
4) An effective public relations campaign showing both sides of the issue
5) Make alternative treatments available so there will be options other than forced medication (then these treatments would also be available to patients not under a court order as well)