Balancing Mental Health and Civil Liberties

Any comprehensive discussion of gun violence in America must include mental health issues. A valued reader requested we explore the internal debates among mental health professionals in regards to how to best handle mental health and violence.

A major issue in the mental health debate surrounds how to balance public health and safety and individual civil liberties.  The best article I could find was from Mental Illness Policy from Herchel Hardin. This article doesn’t adress gun control or even violence, but it does shed light into an argument within the mental health community:

People asked in perplexed astonishment: ” Why don’t we provide the treatment, when the need is so obvious?” Yet every such cry of anguish is met with the rejoinder that unrequested intervention is an infringement of civil liberties. This stops everything.

Civil Liberties, after all, are a fundamental part of our democratic society. The rhetoric and lobbying results in legislative obstacles to timely and adequate treatment, and the psychiatric community is cowed by the anti-treatment climate produced. Here is the Kafkaesque irony: Far from respecting civil liberties, legal obstacles to treatment limit or destroy the liberty of the person. The best example concerns schizophrenia.

The most chronic and disabling of the major mental illnesses, schizophrenia involves a chemical imbalance in the brain, alleviated in most cases by medication. Symptoms can include confusion; inability to concentrate, to think abstractly, or to plan; thought disorder to the point of raving babble; delusions and hallucinations; and variations such as paranoia. Untreated, the disease is ravaging. Its victims cannot work or care for themselves…

Anti-treatment advocates insist that involuntary committal should be limited to cases of imminent physical danger — instances where a person is going to do bodily harm to himself or to somebody else. But the establishment of such “dangerousness” usually comes too late — a psychotic break or loss of control, leading to violence, happens suddenly. And all the while, the victim suffers the ravages of the illness itself, the degradation of life, the tragic loss of individual potential.

The anti-treatment advocates say: “If that’s how people want to live (babbling on a street corner, in rags), or if they wish to take their own lives, they should be allowed to exercise their free will. To interfere — with involuntary commital — is to deny them their civil liberties.” Whether or not anti-treatment advocates actually voice such opinions, they seem content to sacrifice a few lives here and there to uphold an abstract doctrine. Their intent, if noble, has a chilly, Stalinist justification — the odd tragedy along the way is warranted to ensure the greater good. The notion that this doctrine is misapplied escapes them. They merely deny the nature of the illness. Health (Official) Elizabeth Cull appears to have fallen into the trap of this juxtaposition. She has talked about balancing the need for treatment and civil liberties, as if they were opposites. It is with such a misconceptualization that anti-treatment lobbyists promote legislation loaded with administative and judicial obstacles to involuntary committal.

The result, …will be a certain number of illness-caused suicides every year, just as surely as if those people were lined up annually in front of a firing squad. Add to that the broader ravages of the illness, and keep in mind the manic depressives who also have a high suicide rate. A doubly ironic downstream effect: the inappropriate use of criminal prosectuion against the mentally ill, and the attendant cruelty of commital to jails and prisons rather than hospitals. Corrections officials once estimated that almost one third of adult offenders and close to half of the young offenders in the correction system have a diagnosable mental disorder.

Clinical evidence has now indicated that allowing schizophrenia to progress to a psychotic break lowers the possible level of future recovery, and subsequent psychotic breaks lower that level further – in other words, the cost of withholding treatment is permanent damage. Meanwhile, bureaucratic road-blocks, such as time consuming judicial hearings, are passed off under the cloak of “due process” – as if the illness were a crime with which one is being charged and hospitalization for treatment is punishment. Such cumbersome restraints ignore the existing adequate safeguards – the requirement for two independent assessments and a review panel to check against over-long stays. How can such degradation and death — so much inhumanity — be justified in the name of civil liberties? It cannot. The opposition to involuntary committal and treatment betrays profound misunderstanding of the principle of civil liberties. Medication can free victims from their illness — free them from the Bastille of their psychosis — and restore their dignity, their free will and the meaningful exercise of their liberties.

Now, this is just one side of that particular argument. The point of this article is to shed light on what the argument is, not to advocate for one side or another.

For additional information, I will point you Mind Disorders for an excellent article concerning “involuntary hospitalization.”

In closing, I’ll leave you with a fascinating debate that occurred on Al Jazeera TV.

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2 Responses to Balancing Mental Health and Civil Liberties

  1. Suzicue says:

    Nice article! If we can improve the facilities (and there are some really good models) and ensure that people who regain health are not stigmatized forever afterward, then there exists a basis for improvement in this arena, which you have enlightened us about.
    I will have to come back and watch the entire video, but two points that they make are the following:
    Those suffering from mental health problems are more likely to be victims of crimes
    Those who abuse drugs and alcohol are 7 times more likely to commit violent crimes.
    These statistics alone contribute to my desire to see the mentally ill treated with respect, and to make sure that someone is not “set-up” under false premises for institutionalization (I’ve probably seen one too many movies… 🙂 ) and to advocate that the mentally ill will be protected against unsavory treatment in facilities. I guess my bottom line is that a lot of money needs to go into it, and it would have to be well-spent.
    Thanks; keep digging! 🙂

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