Treatment Of Involuntary Psychiatric Patients Essay, Research Paper

The past thirty years have seen great changes in the treatments available for people with

mental illness. Advances in neuroleptic medications, better understanding of the neurobiological

aspects of mental illness and more effective styles of psychosocial intervention have all improved

the services available for the mentally ill. However, the last three decades have also been a period

in which several obstacles to the access of care have made the treatment of persons with mental

illness more difficult. Although designed to protect those who suffer from mental illness, changes

in policy and law have created difficulties in delivering services to involuntary clients and assisting

them to control their illnesses.

People with severe mental illness require a variety of interventions in order to successfully

manage their conditions. Basic needs such as housing, vocational training, and financial assistance

are all areas which, although perhaps taken for granted by many, can be of great difficulty for

someone with a mental illness. People may require varying degrees of assistance in these areas as

well as with managing interpersonal relations and other spheres of social and emotional

functioning (Hershberg & Posner, 1992). Most people with mental illness can benefit greatly

from the use of antipsychotic medications. In the past, many of the drugs offered to mentally ill

people to control their psychoses, such as haldol and stelazine, would sometimes produce side

effects almost as debilitating as the illness itself. However, in recent years, advances in the field of

neuroleptic medications have produced new drugs which are far more effective than their

predecessors and which cause far fewer negative side effects. It can be argued that without a

medical control of severe mental illness through medication, assisting clients to function

adequately for extended periods of time can be an almost impossible task (Isaac & Armat, 1992;

Torrey, 1995).

Although established to protect the people s rights and put a stop to past abuses, current laws

and policy can prove to be difficult hurdles to overcome when working with persons with mental

illness. Since the 1960s, deinstitutionalisation and changes in rights protection have greatly

altered the face of psychiatric care. Before these changes, many people were unnecessarily

hospitalised for lengthy periods and subject to poor treatment, over medication and in some cases

to questionable medical procedures (Torrey, 1995). In response to the situation, survivors of the

previous institutional system, their families and civil rights groups fought for the protection of

patients and succeeded in having laws and medical practices changed. These protections are

crucial in order to avoid a return to past abusive practices. They do, however, necessitate that

professionals working with people with metal illness be creative in working within the constraints

of the existing laws.

Under normal circumstances, people are not required to accept any form of treatment for their

illness. It is common for psychiatric patients to refuse medical and psychosocial intervention.

The very nature of many mental illnesses may lead the person to believe that they are not actually

ill but in fact well and living in a sick world. In many cases, after a short hospitalisations, patients

are discharged into the community and have the choice as to whether or not to continue

treatment. Sometimes, when people are under the effects of medication and feeling relatively

well, they believe that they are no longer are sick and cease following their medication programs

and other aspects of their follow up. Sometimes the effects are devastating. The fact that a

surprisingly large portion of the homeless population are in fact people who have dropped out

of treatment programs for mental illness and their being homeless is a consequence, direct or

otherwise, of their dropping out is a frightening and concrete example of the possible outcome of

treatment refusal. (Torrey, 1997; Torrey, 1988).

With such clients, it is often necessary to be creative in order to convince them to follow their

treatments. Abramson (1989) uses the term paternalistic beneficence to describe actions taken to

serve the best interests on the client while depriving the person to some degree of their right of

choice. While this may take the form of outright decision making for the client, other more subtle

forms of paternalistic beneficence are possible. Some clients may seek certain services while

refusing others. In some cases, withholding desired services and only providing them if the client

complies to certain conditions may be justifiable. In the case of people who are mentally ill and

homeless, material assistance such as budgeting or assistance in finding housing might be given on

the condition that the client agrees to be followed by a physician. Although it may sound

unethical to suggest refusing services, it may be justifiable if the end result is that the client gets

the treatment they need. Also, in the case of the mentally ill, certain services may be useless if not

accompanied by medical follow up. For example, assisting a person to find an apartment when

they accept no other support and are incapable of maintaining the living arrangement for any

length of time due to their untreated illness might not be productive and turn out to be only a

temporary arrangement and a frustrating, confusing failure for the client.

A number of other strategies can also be used. If necessary, legal procedure is available to

oblige clients to follow treatment plans and for forced hospitalisation. However, although a court

order may bring about the care a person needs, it is a last resort and is often only enough to have

a person evaluated by a psychiatrist or hospitalised for a short period but can not force people to

take their medication. In some cases, people with metal illness are required to do so but usually

only when the criminal justice system is involved and following a treatment plan is part of the

person s probation or parole terms. Torrey (1995) suggests the implication of family members

whenever possible. By using the family s influence, as well as having them present throughout the

helping process to reassure their loved one of the positive outcomes of treatment, convincing the

client to accept the help needed may be facilitated. When the family is involved, time must be

taken to educate them on aspects of the illness and possible outcomes.

However, Isaac and Armat (1992) suggest that without some sort of mandatory adherence to

taking medication for clients, treatment plans can not be truly successful. They describe a number

of successful programs which use public legal authority in a system similar to a public curatorship

of a person s treatment plan. The authors note that without such measures to keep clients on

their medication, community services can not be entirely successful. Torrey (1997) suggests that

similar programs might be needed to reach the hard to treat clients who are presently not

receiving any sort of treatment. This refers to those who have been hospitalised several times,

usually by way of court order, then released only to again stop taking their medication and retreat

from view until the next court order. Simply hospitalising and re-hospitalising these people is not

necessarily beneficial and is extremely costly. Although mandatory adherence to treatment is not

the answer for all clients, it may be an effective response for some who have a tendency to drop

out of treatment. While some regions of the USA have such programs, Quebec only forces

adherence to treatment through its legal system as a condition of probation or parole when the

person s untreated illness has lead to criminal acts.

It is sometimes suggested that the current laws do too much to protect clients rights and

impede assisting them (Torrey, 1997). Although treatment is sometimes made difficult, the

protection is essential. Without it, clients would be disempowered and possibly rendered unable

to play an active part in their treatment plan. Whenever possible, clients should be able to have at

least some choice in what services they do or do not receive. Having the choice bestows a sense

of responsibility upon the client and improves chances of long term adherence to a plan of service

(Torrey, 1995). By providing incentives and assistance to make those choices, clients may have

their needs met while at the same time playing an active part in determining the outcome of their

illness. For those clients who can not be reached in this way, a more flexible and creative legal

tool is needed as suggested by Isaac and Armat (1992). However, there is no one response to

dealing with clients who might not adhere to treatment plans and the legal system is not the

answer for all. What is needed and can assist in almost all cases is a general flexibility as well as

creativity and tolerance, all of which are at times lacking in our system. Not only must health and

social services be less rigid but also the legal system. If all players can adopt a mentality suited to

this population, treatment might be better provided to more people without threatening the

protections of human rights as they presently exist.