To the Point


To the Point: A Sutherland Institute Public Policy Perspective July 23, 1999, 99-13

Don't Violate the Rights of the Mentally Ill By Sarah Thompson, M.D.

The Executive Director of the Utah Department of Human Services (DHS) has proposed several changes to Utah's mental health laws, changes that have been enthusiastically endorsed by Governor Leavitt. These proposals claim to address the problem of "gun violence," but in actuality they would deprive Utahns of their human rights.

The DHS proposal would make it easier to commit individuals even if they pose no threat to themselves or others. The criteria suggested by DHS are so vague that it would be possible to commit virtually anyone based on misdemeanor violations, arguments with neighbors, poor hygiene, or an individual's refusal to take psychiatric medications. In effect, people would be committed based on the content of their thoughts, rather than on the basis of behavior that places themselves or others at physical risk. Once a person is committed, he would also be subjected to involuntary medication.

In addition, DHS wants to legalize outpatient commitment. This means that innocent people living peacefully in the community could be sentenced to forced medication. Those who don't cooperate would be incarcerated and injected with medications until they "agree" to cooperate. These medication sentences could be imposed for relatively trivial reasons, as previously noted. Because most psychiatric medications cause long-term changes in brain chemistry, stopping them often causes a worsening of symptoms. Thus persons who are subjected to forced medication are usually facing a lifetime of continued medication, even if the commitment is withdrawn. Outpatient commitment would be implemented through Programs for Assertive Community Treatment (P/ACT), the so-called "hospital without walls," which attempts to create hospital-type treatment for those living in the community.

While psychiatric medications can be life saving for people who need them and respond well to them, they do not work for all patients. Side effects, ranging from unpleasant to disabling to lethal, are not uncommon. In addition, many people choose not to take these medications for personal or religious reasons, or prefer to try approaches other than medication. Unfortunately, psychiatrists are often unwilling to consider any treatment other than medication, and may be openly hostile to less intrusive measures such as pastoral counseling, alternative medicine, and lifestyle changes. P/ACT makes no allowance for individual, family, or religious choice; medication is mandated. With this in mind, it is understandable that some of the strongest advocates of P/ACT are organizations funded heavily by pharmaceutical companies. Forcing a peaceful person to take medication that may permanently disable him˛even kill him˛should not be acceptable in a free society. No one should be forced to sacrifice his life for the alleged "good of society."

While P/ACT would benefit drug companies, it is unlikely to have a positive effect on violent crime. Although recent tragedies have generated a lot of hysteria, the truth is that mentally ill people living in the community are no more violent than their non-mentally ill neighbors are, as shown in a 1998 study by H.J. Steadman (Steadman, H.J., et al, _Archives of General Psychiatry_, May 1998, p. 393-401). Mental health professionals are not able to predict which people will become violent. Substance abuse, a history of violent behavior, and head injuries are all greater risk factors for violence than are schizophrenia or psychosis. Thus, there is no justification for routinely revoking the rights of the mentally ill, the vast majority of whom are non-violent.

Ultimately, P/ACT would be expanded to include the entire state, and would have its own "mental health courts" to handle commitments. In addition, law enforcement officers would be trained to identify those who might be mentally ill and to initiate commitments. These proposed special courts, that presumably would use different procedures than those used in all other legal proceedings, are unnecessary. While it would be helpful for law enforcement officers to know more about compassionately interacting with the mentally ill, there is no reason to encourage them to begin practicing medicine. While there are social costs from people with serious mental illnesses who refuse treatment, there are similar costs from people who refuse to take insulin, blood pressure medication, and so on. Yet DHS has not considered creating P/ACT teams to force people to take non-psychiatric medications, nor to incarcerate people who are "non-compliant" with smoking cessation, diet, or exercise programs. The only difference is that the mentally ill are irrationally feared and stigmatized and often unable to fight for their own rights.

Providing convenient, comprehensive, in-home care to seriously mentally ill people who choose to accept it is a humane and often cost-effective alternative to confusing and intimidating health care systems, which would make it easier for people to obtain optimal care. But such programs must remain voluntary, and not be used as an excuse to revoke civil rights. Once a precedent is created for incarcerating and drugging people for minor deviations from "normal" thoughts and behavior, how far are we from creating a system such as that used by the former Soviet Union, where people were incarcerated and drugged for politically incorrect beliefs?

The DHS plan is another expensive government mandate that would adversely affect all Utahns. It would require Utah's taxpayers to fund a program designed to invade the privacy of their fellow citizens, force them to take powerful drugs against their will, incarcerate those who do not cooperate, and erode the civil rights of everyone. Such flagrant and abusive violations of civil liberties should not be tolerated.


Sarah Thompson is a medical doctor and policy specialist who authored this piece for the Sutherland Institute, a Utah public policy research organization. Permission to reprint this article in whole or in part is granted provided credit is given to the author and to the Sutherland Institute.

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Daniel B. Newby

Director of Operations & Development


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