The Willamette Week, a local newspaper in the Portland, Oregon area ran an article regarding state Attorney General, Hardy Myers' taskforce proposal to expand forced or coerced treatment. This is my response which appeared in condensed form in the April 14, 1999 edition. The original article follows:
Dear Editor Zusman,
I am writing regarding the March 24, 1999 article in Willamette Week titled Unlocking Doors.
Ms. O'Hagan wrote, "And the proposal Myers is considering has an impressive pedigree. It was hammered out over an 18-month period by the best thinkers and strongest advocates in the field, people Myers himself appointed as part of a blue-ribbon task force."
Unfortunately, this "blue-ribbon task force" was fundamentally flawed. When he was able to be present, the one, single voice representing those who could be impacted by the work of the task force, must have found it daunting to face the rest of the group. Appointing a single mental health consumer to this task force was akin to appointing an affirmative action task force of all white males.
Imagine if you will, a task force charged with developing potential changes to Oregon laws regarding access issues for people in wheelchairs. It would be absurd to envision such a task force comprised of a sole person in a wheelchair while the remainder of the task force was comprised of able bodied people.
The task force attempted to address the issue of what happens when people with psychiatric disabilities choose to not take personal responsibility for their lives. However, to address this issue, the only way the task force could imagine dealing with this situation is the use of legislated force or coercion to try and make people take psychiatric medication. After all, the only way the current public mental health system knows how to "treat" people is with powerful drugs. Many mental health clients reject these drugs not because of the rather euphemistically named "side effects" but because of real effects which can be painful and sometimes permanently disfiguring or even result in death.
The task force met without the benefit of significant input from those who have recovered from "mental illness". While some people tragically die because they choose to not take personal responsibility for their lives, there are better ways to reach people than with often mind-numbing drugs. I know from experience that each person is an individual and must be taught ways of coping which will work for them. For some this choice may include taking psychiatric medication. For others, the choice may include meditation and stress reducing techniques or vitamin therapy or other forms of wholistic health practices.
It is wrong to attempt to legislate one set of rules which could be applied across the board to everyone in a class. It is also wrong to attempt to legislate a set of rules which supports force and coercion as a way to make people take personal responsibility for their lives. Attempted legislative efforts of this type are reminescent of the laws which were passed by Nazi Germany prior to WWII. The many atrocities of the holocaust were predicated by passing laws which allowed the use of force in protecting the interests of the state. The first group to be eliminated were those who were different because of a psychiatric label.
The task force should, instead, have sought considerable input from those who have recovered from "mental illness." The task force should not have assumed that the problem is lack of compliance with taking medication nor should they have assumed that forcing or coercing someone to take their medication will solve a person's problems. Force and coercion do not work.
As Dr. Daniel Fisher, M.D., psychiatrist and researcher recently pointed out in an interview on CNN: "forced treatment blocks recovery; forced treatment destroys trust and trust is the cornerstone of recovery; forced treatment creates fear and dependency not recovery; forced treatment violates human and civil rights; forced treatment is costly, diverting money from recovery oriented services; forced treatment is a form of abuse and retraumatization; forced treatment is based on the false belief that people labeled with mental illness are more violent than the rest of society despite a MacArthur study proving that people with mental illness are not more violent; forced treatment could happen to anyone because anyone could be labeled mentally ill."
There are effective and proven ways to help people and they are cost effective and affordable. Peer support practices have proven successful in helping people learn to take personal responsibility for their lives and to live and thrive successfully in the community. Compassionate and understanding assistance from those who have "been there" could have helped prevent the tragedy of Mary Boos without resorting to the extreme of condoning the use of force or coercion. Perhaps if Mary Boos had a peer who believed in her instead of a system and parents who believed in forcing or coercing another adult to take psychiatric drugs, she'd still be alive.
Instead of seeking the counsel of judges, parents, and mental health professionals who are filled with stories of what doesn't work, the Attorney General, Hardy Myers, would have been better off seeking the counsel of those who have been labeled mentally ill and then recovered. They would have been able to suggest ways which do work. They would also have NOT suggested increased use of force and coercion.
1530 10th St.
West Linn, OR
WILLAMETTE WEEK NEWS STORY
Trying to figure out how to help severely mentally ill people who don't want treatment is enough to drive you crazy. Just ask the Oregon attorney general.
BY MAUREEN O'HAGAN
<SIDEBAR> Although a judge can commit a person with a serious mental illness for six months, most people stay for less than two weeks.
<SIDEBAR> Living on the streets and foraging for food isn't enough to get a person with a mental illness committed to a hospital.
<SIDEBAR> At least 70 percent of people with serious and chronic mental illnesses also suffer from drug or alcohol abuse.
This week, Attorney General Hardy Myers is considering whether to ask the Legislature to overhaul the way Oregonians with severe mental illnesses are treated.
There is no doubt that the current system--with its paltry funding and routine tragedies--is in desperate need of change. And the proposal Myers is considering has an impressive pedigree. It was hammered out over an 18-month period by the best thinkers and strongest advocates in the field, people Myers himself appointed as part of a blue-ribbon task force.
Yet the proposal is doomed to failure. Most task-force members don't even support it.
The episode may offer proof that even the best intentions go awry under the tutelage of a broad-based task force. But it is also testament to the sheer magnitude of the problem of treating people with serious mental illnesses.
On one side stand family members of mentally ill people whose main priority is to get their loved ones help--even if they don't want it. On the other are "consumer groups," often made up of people who themselves suffer from mental illnesses, who believe they should have the right to control their own destiny.
"I don't think I've ever worked on an issue that's more difficult than this," says Myers' special counsel, Mark Gardner, a former legislator and judge who chaired the task force. "It was pretty apparent right off the bat that there was not going to be consensus over this issue. I don't think it's possible."
In order to grasp the conundrum facing Myers, you first have to understand the workings of the mental-health system, whose twisted logic and dead-end streets are reminiscent of Joseph Heller's Catch-22.
For the most part, people with serious mental illnesses must seek out treatment themselves if they're interested. Many of them qualify for the Oregon Health Plan, yet because of severe funding shortages, they're sometimes met with disappointment. "If a person is mentally ill and says, 'I want some help,' the system will give some help, [but] maybe not enough or exactly what they want," says Multnomah County Judge Lewis Lawrence, who works with this population in court proceedings.
But unlike someone with, say, a broken arm, people with brain diseases like schizophrenia don't always seek treatment, either because their thinking is distorted or because they don't like the side effects of the medication. When they deteriorate to a point at which they might be dangerous, they're hauled into a hospital and treated for a few days. Ninety percent of people brought in for a hospital hold either cool off enough to be released or consent to prolonged treatment. The rest are brought before a judge for what's called a civil-commitment hearing.
This is where the legal system and the public health system collide, where the failure to help mentally ill people is most tragically clear--and where some task-force members think changes should be focused.
"I've been advocating for a few years that we make changes to the civil-commitment process," says task-force member Bill Toomey, the Multnomah County administrator in charge of the civil-commitment process. "Pretty much everybody complains about it."
Almost by definition, the daily fare in this courtroom is a parade of tragedies. Judges must wade through delusions, hallucinations and psychoses to decide if the people are a danger to themselves or others. If so, they can be committed to a hospital. If they don't fit the criteria, they must be released. Often, the process is quite unceremonious: They're simply escorted to the courthouse door.
In 1997, psychiatrist Gene Minard and another doctor approached Myers with a list of concerns, including complaints that the criteria for civil commitment had gotten dangerously narrow because of appeals-court decisions. This narrowing, Minard believes, shut out Mary Boos.
According to her mother, Carol, Mary was a lively and popular University of Oregon student before paranoid schizophrenia set in. When she agreed to treatment, her symptoms became less severe, but her medication caused dramatic side effects, including ballooning weight.
Still, Mary, living in a studio apartment with a landlady who looked out for her, fought her illness. At some point, she lost the battle. "She kind of left this world for a spiritual world," her mother says. "There were 100 days when she didn't come out of her room." Mary's parents made sure her rent was paid and she was fed, leaving grocery bags at her front door. Yet Mary refused to acknowledge her family's existence, insisting they were dead.
Carol Boos and her husband decided to seek civil commitment in 1996, arguing that their daughter could no longer take care of herself. The judge, constrained by the law that makes it almost impossible to commit people unless they're dangerous, did not agree. Mary left the courthouse in a hospital nightgown, in paper slippers, without a penny in her pocket.
"We never really had any time with Mary again," her mother says. Mary died in her apartment in October 1997, her illness untreated. The medical examiner said she died of natural causes, but her body was too decomposed to tell what happened for sure. "She lived--well, she existed--and died...behind closed doors," says Carol Boos.
Mary Boos' death, which came just one month before the task force began work, hung heavy in the members' minds and was a frequent topic of discussion. Their proposal, in theory at least, will address people like Mary. Called "intervention," it would allow judges to order certain people to accept treatment in the community. It would apply to people who don't meet the commitment criteria but are so ill that they will probably soon deteriorate to dangerous or unsafe conditions.
"The intervention process came up as a way to get the system involved earlier," explains Toomey.
If people don't follow the judge's orders, they can be hauled back into court by police and held in a locked facility for a number of days. The catch is that if people continue to refuse treatment, the judge has no real legal power to force them to accept it. Unless they deteriorate further, commitment is still not an option. The idea is that the judge's order, followed up with aggressive outreach from treatment workers, will scare, threaten or cajole people into doing what they're told.
Although the task-force members worked collaboratively on the proposal, it has turned out to have little support. "A lot of what happened with this is reality setting in: the legal parameters, the financial limitations, the differing interests," says Bob Joondeph, executive director of the Oregon Advocacy Center, a clients' rights organization. In fact, Joondeph likens discussions of treatment for people with mental illnesses to the debate over abortion, a case where opposing viewpoints will never come together.
He has a hard time believing that the proposal will do the trick for people who insist that they don't want treatment. Moreover, Joondeph says, "I don't think scaring people into treatment is the best way to go about it."
Family members of people with mental illnesses have mixed feelings about the proposal. Dr. Minard calls it "convoluted, confusing and unworkable....It appears to me the original purposes of the task force have been defeated." But Phillip Chadsey, a task-force member who is president of the local chapter of the National Alliance for the Mentally Ill, the country's leading family organization, supports the proposal. "It gives a right to treatment, which means the state has to pay for it," he says.
Gardner says he's not sure what Myers will do about the proposal, but he says that the process had made one thing abundantly clear to him: A key ailment of the public mental-health system is poor funding. "If I was back in the Legislature, I would do everything in my power to get more money into this system," Gardner says. "It is tremendously underfunded."
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Willamette Week | originally published March 24, 1999