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by Chance Martin
After decades of neglect, our state legislature is being
aggressively lobbied to restore California's mental
health system. All of the treatment enhancements and
services that are being proposed are desperately
needed and would be welcome, with one exception:
an attack on the civil rights of mentally disabled
people called involuntary outpatient commitment.
Involuntary outpatient commitment is the cornerstone
of AB 1800, an assembly bill sponsored by
Assemblymember Helen Thompson.
Involuntary outpatient commitment is court-mandated
medication compliance. In some cases, it can mean a
person is court-ordered to keep regular clinic
appointments to receive long-lasting injections of
powerful psychiatric drugs. The consequences of
non-compliance are hospital commitment and forced
drugging. These proposed legal provisions are termed
"assisted treatment." In practice, its primary victims
are poor and homeless people, particularly
African-American men. In some urban areas,
homelessness itself is interpreted as proof of "grave
disability," creating the justification to drug homeless
people against their will. In states where this policy is
law, forced medication coupled with a lack of medical
supervision has led to deaths due to toxic levels of
psychiatric medication.
At New York's Bellevue hospital, a pilot study
testing the viability of involuntary outpatient
commitment failed to support its advocates' claims. A
three year study of its relative effectiveness found no
statistically significant differences between the
experimental group, a control group, and those who
discontinued treatment in the areas of
re-hospitalization, arrests, violence, symptomatology,
or quality of life. It concluded: "there is no indication
that, overall, the court order for outpatient
commitment produces better outcomes for clients or
the community than enhanced services alone."
Alarmingly, it also noted that the court procedures
themselves became perfunctory, and accountability
was so lacking that renewal orders frequently
occurred without a formal hearing, despite the fact
that "the court order itself had no discernible added
value in producing better outcomes."
The betrayal of the de-institutionalization movement in
California only became apparent when the state-funded
community-based mental health services we were promised
to replace the snake pits were themselves facing extinction.
Now we are faced with a proposal to criminalize an entire
community of people based on disability. Disability isn't a
choice, it's something each of us learns to accommodate as
best we can. We need to ask ourselves: how many violent
acts committed by untreated mentally ill people, however
sensationalized, might have been prevented if a
comprehensive range of voluntary, culturally appropriate
community mental health services were available?
A look at twentieth century history gives the best
illustration of how far stigmatization, scapegoating and
hate can go when misrepresented as scientific authority.
Eugenics originated as a sub-discipline of psychiatry right
here in the United States. The first compulsory sterilization
laws in Germany were modeled on American sterilization
laws enacted a decade before. In the three years from
1941-1943, over 42,000 Americans were sterilized under
the Model Eugenical Sterilization Law. California led the
nation with over 10,000 forced sterilizations (mostly
persons of color). The "mental diseases" targeted by this
law were "insane," "feeble-minded," "epileptics," and
"idiots."
The Holocaust's first victims were "mentally ill" people.
The first extermination facilities were designed and
operated by psychiatrists, who later trained the SS how to
use them. In a culture where ruling authority was
maintained in the name of a higher "biological" principle,
psychiatrists weren't ordered to murder people, they were
simply empowered to do so by their government, and so
they did. In 1941, 90,000 German psychiatric inmates
were murdered, 71,000 in gas chambers at psychiatric
institutions.
If our generation remembers no other lesson, we must
remember that no supposed biological marker - no stigma -
is reason enough to deny anyone's liberty. We must
support fully funded, community-based, VOLUNTARY
mental health treatment before we consider discarding
someone else's self determination.
If it isn't voluntary, it isn't treatment! |
