[NYAPRS Enews] AP: Vt Mental Health Reform May Founder On Forced Drugging

[Harvey Rosenthal]

Mental Health Reform May Founder On Forced Drugging

By Dave Gram Associated Press   November 16, 2007 

 

MONTPELIER, Vt. --A move to have regional hospitals care for more
acutely mentally ill patients could be derailed over the question of how
much power the facilities should have to medicate patients against their
will.

 

The debate over "involuntary medication" or "forced drugging" -- the
terms of art used by proponents and opponents, respectively -- has
flared up several times in the Vermont Legislature and courts in recent
decades.

 

Now it has reared its head again as lawmakers begin to consider the
findings of a report issued earlier this week on how to replace
Vermont's troubled, century-old state hospital in Waterbury.

 

The report by a team of three consultants hired by the Legislature
called for replacing the Waterbury facility with one designed to care
for the long-term mentally ill, while gearing up community hospitals
around the state to handle acute cases -- those in mental health crises.

 

One big issue, though, is how those community hospitals should handle a
patient deemed by doctors to be in need of one or more of the powerful
psychiatric drugs on the market, when the patient doesn't want to be
medicated.

 

Many patients are helped by the drugs, according to some of those
testifying at a legislative hearing on Friday. Others maintain the
trauma already brought on by their psychosis was worsened by being
forced to take the medications.

 

And there are civil liberties concerns. "It's a very serious intrusion
on someone's liberty and autonomy" to be forced to ingest mind-altering
chemicals, said Jack McCullough, an attorney and director of the Mental
Health Law Project at Vermont Legal Aid.

 

Xenia Williams, 59, of Barre Town, a self-described "psychiatric
survivor" who has done three stints at the Waterbury state hospital,
said she was "held down and shot up" with Thorozine, a powerful
anti-psychotic drug, while being treated at a mental health facility in
Massachusetts.

 

"It made me sleep for 20 hours and I felt like I had cement in my
brain," she said. "It was horrible. It was like being raped both in your
body and in your mind."

 

The state Department of Mental Health currently has a policy that drugs
can be administered against a patient's will only in Waterbury, and not
in the psychiatric wards operated by some of Vermont's community
hospitals.

 

Forced medication occurs only after at least two court hearings -- one
in which the person is committed to in-patient psychiatric care, and a
second in which a judge signs off on the state's request that the
patient be drugged against his or her will.

 

If more people in psychiatric crisis are sent to the community
hospitals, those facilities are widely expected to assume the role of
administering the medications. But the hospitals have expressed strong
reservations about waiting for the two-step judicial process, which can
take more than three months, before they administer the drugs.

 

Vermont began its current debate over the future of the state hospital
more than three years ago. Early in that process, the Vermont
Association of Hospitals and Health Systems outlined its position on
forced medication in a statement shared with lawmakers.

 

"If a patient is treated involuntarily, it should not require two
separate judicial actions to initiate treatment and medication," the
association said. "There should be one judicial action to determine
treatment and if necessary, medication administration. Courts must make
commitment determinations within 48 hours with adjudications at the
facility."

 

Association Vice President Jill Olson said Friday the group had since
backed away from that position and had not settled on a new one. But she
called the forced medication issue "the area where we're least likely to
come to consensus" with other participants in the debate.

 

She added that the hospitals have even more fundamental issues with the
push for regionalization of mental health, among them what she said
would be the need for renovating spaces and adding staff to deal with
more seriously mentally ill patients.

 

Ken Libertoff, executive director of the Vermont Association for Mental
Health, agreed that resolving the involuntary medication issue is the
biggest stumbling block to bringing the envisioned reforms to fruition.

 

"We as a state would be foolish to let a whole potential plan fail for
an inability to solve a hard issue," Libertoff said. "And this is a hard
issue."

 

http://www.boston.com/news/local/vermont/articles/2007/11/16/mental_heal
th_reform_may_founder_on_forced_drugging/ 

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