Force has always been an option in medicine, and though rarely employed, is respected. Its integrity is maintained very simply: Doctors must demonstrate in an open court that a particular treatment is necessary. And the individuals choosing to deny the treatment must demonstrate in open court that the doctors are in error. The court proceeding is public, a very real protection against abuses of power. Each side has legal representation, and each attorney adheres to the ethics of the American Bar Association, to fully, vigorously, represent their clients.
Such an approach has not existed in the field of psychiatry, where hearings are held in secret, records are seldom kept, and no case law can be built to protect the rights of the individuals subjected to the secret hearings. Perhaps outpatient commitment laws will provide opportunity to build case law. Perhaps outpatient commitment will encourage more vigorous legal representation. Only time will tell.
I know of no state that has presently provided monies for court costs (if anyone reading this does, please inform me), California has left it to counties to do so. Florida’s counties are saying they do not have the funds. And so the circle closes: Was the man who murdered Kendra deprived of services because no monies were available to provide it? Will those monies now be made available? Do legislators have a commitment to better mental health programs? Certainly they cannot be forced to provide for that system. Or are we witnessing a knee-jerk reaction to the need for better mental health services, an emotional response that will not reach into pockets to provide dollars? Prevention may be, in the long run, cheaper than addressing crises, but crises seem to drive the political arena.
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Harold Maio is Consulting Editor for the Psychiatric Rehabilitation Journal, Boston University; a board member of Partners in Crisis, an organization of the judiciary, law enforcement and advocates working to solve the problems of mental health in jails; and a board member of Florida Self Directed Care, an organization that believes in the ability of people to direct their own mental health services. He provides editing services to universities and goverments on sensitive language and lectures widely. His main interest is the relationship between ethics and langage.
