Tuesday, April 03, 2007

Involuntary detention – He “willingly put others at risk”

A common retort by opponents of civil commitment is that “we don’t lock up people with diseases other than severe mental illnesses.”

But that isn’t true. Take the involuntary detention of a man with treatment-resistant tuberculosis in an Arizona jail since July. Robert Daniels refused to wear a mask and take other measures to prevent spreading his disease to the public.

Drug-resistant TB, or drug-resistant staph infections, or pandemic flu can create the need for involuntary isolation. So why is it more common for people with mental illnesses to be involuntarily detained compared to other illnesses?

"It's very uncommon that someone would both not want to take treatment and will willingly put others at risk," one expert said of Daniels.

And that is likely the rub – the word “willingly.” Unlike most other illnesses, about half of patients with schizophrenia and bipolar disorder suffer from a condition that affects their ability to recognize the risks associated with failing to treat their illnesses. Anosognosia, or lack of insight, impairs the patient’s ability to recognize that they have an illness - therefore it is more likely that they will not accept treatment that can reduce the risks associated with their untreated illness.

Committing someone to restore them to competency – so they can recognize their illness and the consequences of its nontreatment – is a measure that protects not just society, but also the patient. Most cases of people with untreated severe mental illnesses who endanger the public later turn out to be because the person thought they were saving the world from aliens, or escaping a CIA plot, or responding to commands from ethereal voices. They aren’t choosing to put people at risk – their disease leaves them with no choices.

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