LA backs Cal. laws to mandate mental health treatment, violating Mental Health Rights?

[HereSince1628]

http://latimesblogs.latimes.com/lanow/2013/03/la-county-supes-back-court-ordered-mental-health-treatment-bills-.html

The Los Angeles County Board of Supervisors this week threw its weight behind Laura’s Law –- which allows counties to create court-ordered outpatient mental health treatment for the severely ill who have cycled through hospitals or jails and refused voluntary care -- saying in a resolution that such programs have been shown to “significantly reduce” homelessness, hospitalization and arrest.

The resolution, authored by Supervisor Michael D. Antonovich, directs the county’s chief executive and legislative advocates to get behind five new state bills that would make it easier for counties to create such programs and secure “mental health treatment for those who refuse to get help on their own.”

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Is this good social policy or a violation of The Mental Health Declaration of Human Rights? Which include that " No person shall be forced to undergo any psychiatric or psychological treatment against his or her will." see-- http://www.cchrint.org/about-us/declaration-of-human-rights/

Some say this is good and effective policy, the mother of a man who commited a murder/suicide favors the current CA intiative that would provide, among other things, the funding necessary for all CA counties to implement 'Laura's Law"

Mother of Gunman Fights for "Laura's Law"

http://www.nbcsandiego.com/news/local/Michelle-Kwik-Evan-Kwik-Encinitas-Standofff-Lauras-Law-198348471.html

After losing her mentally ill son in a 10-hour standoff in Encinitas last month, one mother is now fighting for change over the appropriate treatment of those suffering from mental illness in San Diego.

Elementary school nurse Michelle Kwik buried her 22-year-old son, Evan Kwik, last month after she says she was unable to get him proper treatment for severe mental illness.

On Feb. 20, Evan barricaded himself inside his mother’s home on Del Rio Avenue, leading to a long, overnight standoff with law enforcement officers.

During the standoff, Evan shot and wounded two deputies before ultimately turning a gun on himself while hiding in a crawl space in his mother’s attic.

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[Betsy Ross]

1. Damn. This could work out great

For those having difficulty getting or paying for mental healthcare.
Kind of like going to jail for medial care.

[HereSince1628]

2. I think the equivalence is more like being forced into treatment for TB or

an STD. Historically both have been done in various places around the US in the interest of public health and safety.

Getting jailed generally requires a willful violation of the law. I don't thing anyone working in a mental health field would see acquiring a mental illness as a willful act. I'm not sure if committing a crime to access prison healthcare is actually a common practice.

An ethical issue is whether every person has a right to refuse psychological treatment.

Pubic fear of the mentally ill is quite elevated after the Tucson, Aurora CO, and Newtown killings and sentiment is running high for government to provide protection from persons with mental illness.

It's generally accepted that a person with a mental ill has the right to refuse "shock" treatments, be it electro-shock, insulin-shock etc, as well refusal of hallucinogens or and other psychoactive drugs.

Should a state be able to mandate any of those extreme treatments as well?

[Betsy Ross]

6. I have a psychiatrist and insurance

But both can be elusive or difficult to get a hold of when you are in the pit of depression. It is access to treatment that I was referring to. It ain't easy to get help, especially when you are sick.

[get the red out]

3. This is actually good

So long as the court requires the demonstration of need, I think it would be helpful. When a person is in a delusional state (which I have seen first hand with family members) they cannot differentiate what is good for them or not any more than a comatose person can. It is neglecting a person's needs to not have something like this in place, it is neglecting their family's needs and society's as well.

[HereSince1628]

4. Supposing a person as incompetent makes it seem an easier question

It also raised the the question of whether or not such incompetence is mostly where such a law would be used.

It certainly doesn't identify a range of treatments proffered by the mandate, which is in turn influenced as much by the underlying objective of society mandating treatment as it is the condition of the person to be treated.

The objective of mandated treatment could be exclusively or primarily public safety or the objective could be primarily or exclusively for the good of the patient. The willingness of society to limit the range of treatments could be quite different depending upon what is trying to be achieved.

If the goal is public safety, particularly safety from violent behavior, then the persons being placed under compulsory treatment should be the ones that are likely to be dangerous. At this time isn't any evidence that the psychological industry has the capacity to accurate predict who those people are. A person whose mental state may include considerable delusions or hallucinations may be no more or even less dangerous than an apparently high functioning person with no delusions. There is simply no good and reliable way to identify potentially dangerous persons among the mentally ill.

If the goal is treating the mental illness then returning the person to his or her highest state of function is desirable. And effectiveness of treatment is an overarching concern.

With respect to the patient's best outcomes, a psychologist writing in a NY times letter to the editor writes that patients may resent and resist mandated treatment and have poor outcomes.

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http://www.nytimes.com/2013/02/03/opinion/sunday/sunday-dialogue-treating-the-mentally-ill.html?pagewanted=all&_r=0

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... for most patients experiencing psychotic states, mandated treatment may create more problems than it solves.

For many medical conditions, better outcomes occur when patients share in treatment design and disease management. Imposed treatments tend to engender resistance and resentment. This is also true for psychiatric conditions.

Patients with psychotic symptoms often feel that their own experience is dismissed as meaningless, like the ravings of an intoxicated or delirious person. Decisions to decline antipsychotic medications are often regarded mainly as a manifestation of illness — an illness the person is too sick to recognize — even though many people might reject antipsychotics because of metabolic and other toxicities.
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Which brings us back to the problem of the rights of the patient ordered into compulsory treatment...

Once subject to compulsory treatment does the mental patient, retain any right to reject types of treatment, particularly the right to refuse sterilization, electroshock treatment, insulin shock, lobotomy (or any other psychosurgical brain operation), aversion therapy, narcotherapy, deep sleep therapy, and/or any drugs producing unwanted side effects?

Does a patient have the right to refuse vocational therapy that requires working without payment or at wages lower than standard for similar work in the community at large?

[get the red out]

5. There are a lot of ways to die

There are a lot of ways to die when someone is loose and delusional on the street. I'm not a Psychiatrist, but some of the treatments you listed are rather ancient and hardly in the mainstream. Yes, medications can produce unwanted side effects; but once the person can come back to a more reasonable state, they SHOULD be listened to and they, hopefully, could discuss any side effects with their doctors.

Nothing is perfect, but I'd rather try to save human beings who are sick from dying out on the street wandering around without the ability to make rational decisions for themselves. I do not want to imprison anyone, but there are times when it is a life or death situation and people haven't the ability to request help.

We should probably agree to disagree. I support this idea, and I will keep supporting it. I've seen loved ones in great danger and that experience has formed my opinion.

[HereSince1628]

7. The treatments I mentioned are all listed in the Mental Health Declaration of Human Rights

I too am interested in saving lives and quality of lives.

I didn't post this because it wasn't controversial, but because it IS controversial, with rational positions on both sides.

Exploration of both sides is an educational product of such discussions and awareness of both sides is a generally good thing.

[Neoma]

8. I can't say that this is good...

...

Lets just say someone in my life was threatened to be put in psychward because s/he's atheist and they were going to use their knowledge of her/his depression as a way to do it.

I'm afraid of abuse of these kinds of laws, because yes, the mentally ill do become victims of cruel people when that knowledge comes out...

On the other hand, I know someone that needs help but won't get it because our state doesn't accept common law marriage and he became violent, through cocaine abuse though.

It's a toss up. Case by case basis. One person with bipolar can be completely different than another person with bipolar. You can't stick laws to these things sometimes. And because of this, either way you put it, someone will get hurt.