APA, NAMI defend AOT in WSJ

The Wall Street Journal [subscription required] today ran three strong letters to the editor in support of assisted outpatient treatment and TAC.

As one family member said so eloquently: “I can safely say to the civil libertarians that this isn't the life [my brother] would have chosen for himself; it was chosen for him by his untreated illness.

Steven S. Sharfstein, M.D., President of the American Psychiatric Association:

One of the great tragedies of modern psychiatry is the large number of incarcerated individuals who are mentally ill or drug addicted ("A Doctor's Fight: More Forced Care for the Mentally Ill," page one, Feb. 1). This is the inevitable consequence of our reluctance to use caring, coercive approaches, such as assisted outpatient treatment. A person suffering from paranoid schizophrenia with a history of multiple hospitalizations for being dangerous and a reluctance to abide by outpatient treatment is a perfect example of someone who would benefit from these approaches. We must balance individual rights and freedom with policies aimed at caring coercion. Our responsibility to each other and our respect for personal rights lie at the center of our social and moral choices as Americans.

The Treatment Advocacy Center is to be commended for its sustained advocacy on behalf of the most vulnerable mentally ill patients who lack the insight to seek and continue effective care and benefit from assisted outpatient treatment.

Shari L. Steinberg, New York:

My 41-year-old brother has suffered from serious mental illness since he was 15. At times, his behavior has become sufficiently threatening or dangerous to require involuntary hospitalization. Like many others with this disease, he doesn't believe that he is ill (a neurological deficit known as anosognosia) and therefore refuses to voluntarily comply with treatment or to take medication, even though it has proven remarkably effective. As a result, my smart, funny and talented brother has spent much of the past 25 years homeless, jobless and delusional. I can safely say to the civil libertarians that this isn't the life he would have chosen for himself; it was chosen for him by his untreated illness.

Before Kendra's Law, there was nothing my family could do to force him to obtain treatment. Although the law isn't a panacea and the mental health system is a disgrace, being forced to stay in treatment is the only chance he has of resurrecting his life.

Michael Fitzpatrick, Executive Director, National Alliance on Mental Illness:

Using the term "force" to describe state laws authorizing court-ordered treatment overlooks the point about what these laws are intended to accomplish. Most people with serious mental illnesses are able to make informed decisions about treatment. In a minority of cases, mental illness negatively affects insight and ability to recognize the need for treatment. The greatest risk is to the individuals themselves.

A New York State Office of Mental Health report shows that the impact of Kendra's Law has been positive in reducing hospitalizations, arrests, homelessness and other consequences from lack of treatment. And most people treated under Kendra's Law say it has helped them.

When narrowly crafted and sufficiently protective of civil liberties, laws authorizing court-ordered outpatient treatment can be both humane and beneficial.