[NYAPRS Enews] W Post: Patients Wary of Easing Standards For Treatment, Access to Records

[Harvey Rosenthal]

Proposals to Force More Involuntary Treatment Stir Debate

by Tom Jackman   Washington Post     February 7, 2008

 

In the debate over Virginia's mental health system, they're called
"consumers." Some of them call themselves survivors.

 

They are mentally ill people who have been through the system and didn't
like it. They criticize the humiliation of being handcuffed, the forced
administration of antipsychotic drugs or the debilitating side effects
of the drugs. And they don't think the government is best suited to
choose their treatment.

 

Rather than forcing more people into involuntary treatment by lowering
the legal criteria or enforcing outpatient treatment -- approaches that
Virginia's General Assembly is considering -- consumers and their
supporters say they think the money for those approaches would be better
spent on counseling, housing and jobs for the majority of the mentally
ill, who aren't dangerous or helpless.

 

Since the Virginia Tech shootings in April, which were committed by a
mentally ill student who did not receive mandated treatment, many mental
health advocates have called for a lower standard for involuntary
treatment and easier access to patient records for determining a
person's treatment. Under Virginia laws, some of the most stringent in
the country, a mentally ill person can be committed only if he poses an
"imminent danger to self or others" or demonstrates an "inability to
care for" himself.

 

But a group of consumers is fighting back. They say they think that
changing the imminent-danger standard is a bad idea and that opening
patient records will discourage people from seeking treatment.

 

As the debate heats up in Richmond over how to fix Virginia's mental
health system, consumers are lobbying legislators and testifying at
hearings. A consumers' rally outside the state Capitol last week
attracted more than 650 supporters and a number of legislators, said
organizer David Mangano of Chesterfield County.

 

"The problem has much more to do with the system's failures, not with
the language of the law," said Mangano, a consumer and family advocate
for Chesterfield Mental Health Support Services. "The actual number of
people who are great safety risks and great risk to the community are
very small compared to the number who need services. If you start
changing practices, changing the code, to try to catch those people [who
are risks], what really have you done with all the people who don't
belong there and have really good reasons not to comply with treatment?"

 

Consumers say that providing counseling, peer support, housing and jobs
should take precedence over forced treatment. Michael Allen, a lawyer
formerly with the Bazelon Center for Mental Health Law in Washington,
said: "The problem in Virginia is not [revising] what standard is used
to treat people against their will. The question is, do we make mental
health services available in a timely fashion? Do we make it
comprehensive and holistic or wait until they fall to the bottom?"

 

Some consumers have had positive experiences with treatment and are also
fighting to revise Virginia's system. Jonathan Stanley said that in his
20s, he spent three years in a cycle of increasingly psychotic episodes,
ending with an incident in which he stood naked in a New York City deli
and was forcibly hospitalized for seven weeks.

 

He said doctors determined the proper medication for him. He finished
college and law school, and now works for the Treatment Advocacy Center
in Arlington County. He is lobbying for change in Richmond, including
modifying the existing imminent-danger criteria, which he called "the
most restrictive in the country."

 

Stanley is seeking support for more mandatory outpatient treatment,
modeled after New York's Kendra's Law. He said that 80 percent of people
emerging from such programs "say their coerced treatment has helped them
get and stay well. Those are the consumer voices that I listen to the
most."

 

Most mentally ill people are functional and want to make their own
choices but need help, many consumers say.

 

Yaakob Hakohane of Arlington had been through decades of legal and
mental health experiences. In the early 1990s, he helped create a group
to advocate on behalf of the mentally ill. But even he said he was
amazed by how easily he was involuntarily committed to a mental hospital
last summer.

 

Hakohane, who suffered a brain injury as a teenager, said he fell and
hit his head on a sidewalk one afternoon in July in Crystal City. He
became disoriented and said police and paramedics who responded "were
kicking and poking me," so he decided not to talk to them.

 

Hakohane was also suspicious of the people who treated him in the
emergency room. He remained silent and was temporarily detained. When he
went to a civil commitment hearing two days later, despite the testimony
of two people who said he was perfectly rational, he was ordered into
treatment for up to six months.

 

"It seems obvious from this experience [that] it's not hard to commit
people," said his friend Diane Engster, who attended the hearing.

 

"It's easy," Hakohane said. "Anybody can commit anybody else." He said
he cooperated with his doctors and was released in a week.

 

Consumers such as Engster, who founded the Northern Virginia Mental
Health Consumers Association with Hakohane, are also troubled by
attempts to open up patients' records. Special justices who decide
whether to commit a person typically do not have access to psychiatric
histories, and legislation is pending to allow that.

 

Alison Hymes, a Charlottesville consumer advocate who served on a state
Supreme Court task force on mental health law reform, writes a blog
about such issues. She wrote that if the state requires mental health
providers to turn over patient records, "mental health practice in this
state will never be the same. Patients/clients/consumers will not be
able to trust their secret thoughts and feelings with their clinicians.
Clinicians will not be able to abide by the ethical standards of their
professions. People will not seek help and those who are already
receiving therapy, such as myself, will quit."

 

Virginia is going through an unprecedented examination of its mental
health system after the slayings at Virginia Tech. This is one in an
occasional series of reports about problems in the system.

 

http://www.washingtonpost.com/wp-dyn/content/article/2008/02/06/AR200802
0604102_pf.html 

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