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Involuntary Treatment Meeting Summary
Meeting Objective Two:
Identify Effective Practices for Reducing Coercion
and Involuntary Interventions and Methods
for Disseminating Effective Practices
There's still time to change the road you're on.
- Jimmy Page & Robert Plant, quoted by J. Rock Johnson
Discussion about how to reduce coercion and involuntary interventions addressed another of the meeting's objectives. Deep rifts were evident among meeting participants on this subject, beginning with their beliefs about whether involuntary interventions should be abolished altogether or are necessary at times. Those with the former point of view feet that involuntary intervention is never humane, represents an abrogation of the principles of medical care, causes harm to consumers/survivors/ex-patients and to society as a whole, and should be abolished. Others believe that involuntary interventions should continue to be an option because they can save lives, reduce the suffering of people with mental illness, and protect others from harm. However, they believe that involuntary interventions should always be used with care and as a "last resort" within a continuum of crisis prevention & intervention services; the degree of coercion should always be minimized.
While there was substantial disagreement on whether involuntary treatment should ever be provided, the group-agreed that problems and abuses occur in the current system and that change is desirable. Interest was expressed in reducing the frequency of coercive practices surrounding hospitalization and involuntary commitment was characterized as an emergency procedure that represents the failure of other, less coercive crisis prevention and crisis management measures. Participants generally held that a fully-developed array of accessible crisis services could dramatically reduce the need for involuntary commitment.
Given the diversity of opinions, it is not surprising that the proposed methods for reducing coercion and involuntary interventions (objective two) varied as well. The following are some of the proposals designed to reduce involuntary interventions that were advanced at the meeting.
- Document best practices in crisis prevention and alternatives to hospitalization, such as:
- personal care assistance,
- respite care,
- mobile crisis teams,
- peer supports,
- in home supportive services,
- foster homes, and
- outreach.
- Evaluate models for consumer-directed alternatives to hospitalization.
- Evaluate methods for employing advance directives and durable power of attorney for health care to reduce coercion. Explore the issues of revocability and the efficacy of provisions specifying that certain types of treatment must be obtained in a crisis.
- Evaluate methods for employing mediation to reduce the incidence of involuntary interventions and coercion.
- Reform informed consent practices to ensure procedural fairness and choice among real alternatives.
- Reform civil commitment procedures so that:
- people who conduct evaluations for civil commitment have been adequately trained and have no financial interest in admission;
- people who conduct evaluations for civil commitment are licensed to evaluate and arrange for other
- treatment and support options; and
- people who monitor the frequency of coercion have no vested interest in the outcome
- Require accreditation agencies such as the Health Care Finance Administration (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and Commission on Accreditation of Rehabilitation Facilities (CARF) to adopt uniform standards and measures related to involuntary intervention.
- Educate the press and general public about the frequency of coercive practices and their effect on individuals with mental illness, their friends and family members, and practitioners.
- Encourage states to adopt the guidelines from the State of Massachusetts for seclusion and restraints and patients= rights in private or public institutions (including the right to privacy in the bathroom, access to lawyers, right to write mail, unlimited access to telephone, and access to visitors).
- While the above list of proposals is intended to reduce the need for involuntary interventions, another set of proposals was promulgated with the aim of ending involuntary interventions altogether. These are listed below.
- Prohibit billing of the individual of his/her third party payer for unwanted treatment (including evaluation, transportation by ambulance, and hospital days during an involuntary stay). Hold the people who initiate involuntary interventions financially liable for the cost of treatment.
- Gather uniform and accurate data on the present use of coercion and involuntary interventions nationwide.
- Inquire about and examine the reasons why people refuse treatment.
- Remove the Anot guilty by reason of insanity@ plea in the criminal code so that individuals are responsible for their own actions, develop a criminal record for criminal acts, and are not 100% exonerated due to mental illness
- Separate the use of force from voluntary mental health care. Establish a distinct profession or trade that involves administering unwanted interventions.
- Seek a constitutional amendment banning the use of physical force in the name of treatment.
- Employ mediation procedures only if they are characterized by equality of bargaining power.
- Repeal outpatient commitment laws.
- Repeal parity laws that require insurance payment for unwanted treatment.
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