The law states that no one can be forced into treatment against their will unless they are at risk of harming themselves or others (this varies by state, but the laws are very similar in all of the United States).
Unfortunately, this means people with addiction or mental illness will only get treatment when they are in crisis unless they seek treatment on their own accord. Unfortunately, many people are in denial of their illnesses. The illness tells them they’re not sick.
Treating patients only in times of crisis isn’t real treatment. It’s going from one emergency to another. But it’s what we’ve got to work with in America, where substance abuse treatment and mental health treatment is underfunded. I believe our money is where our heart is. Right now, we are voting with our wallets and saying we don’t care that much about addiction or mental health.
Civil rights protects individual rights, but also harms patients and their families who live with the poor decision making from their loved ones on a daily basis. Families suffer with the patient (who doesn’t know they’re sick) until the situation reaches a crisis. I feel for these families.
Patients could go to jail for not making their appointments if they are court ordered for treatment. However, we cannot force them to engage in psychotherapy or take medications. Medications can only be forced in a hospital if a patient becomes a danger to themselves or others. That is the law. I hope the law may change one day.
I would like to see patients have a health care power of attorney assigned to them when they are in a stable mental state. If they become unable to make good decisions because of mental illness or addiction, the power of attorney could be implemented. This would mean the client is incapacitated, which could be determined by a treating physician.
If the courts do not force treatment, there are times when I can make a case where someone is a threat to themselves or others and commit them to a mental hospital or a substance abuse inpatient treatment center. Sometimes patients walk out into traffic or drive drunk with their children in the car. Sometimes they lose track of reality and don’t bathe or eat for days. These are just a few examples of when emergency commitment is indicated.
If someone is a threat to themselves or others, many times there is not a hospital bed because the psychiatric hospitals are underfunded. Sometimes, the emergency room physician will void the papers and send the patient home if the patient improves and there is no psychiatric or addiction center with a bed available. I am not saying this is right or wrong. I don’t think our patients should spend thousands of dollars sitting in an expensive emergency bed without getting the treatment they need. I do think as a society we could do a better job of caring for our friends, neighbors, and families with addiction or mental illness.
Waiting for the person to become “a danger to themselves or others” may mean that we have to wait for them to say they are having thoughts of hurting themselves or others, or actually display violent behaviors. As a society, is that what we prefer? That is something that we need to decide as citizens of the world.
Of course, the other side of the story is that when people hit their rock bottom, they will be ready to change and seek treatment themselves. Sometimes continuing to use drugs or alcohol can lead to a ‘bottom’ that can lead to recovery. We don’t judge anyone’s process in 12-step meetings. Something unfortunate can teach us a valuable lesson.
Something that is labeled “good” can turn out to be the worst thing to ever happen. Just look at some lottery winners that end up having a lot of adversity after winning the lotto. The money is looked upon as “good.” Then before you know it, they are hounded by every collection agency, charity, or long-lost relative. Someone experiencing a negative event because of addiction may be the “bottom” that changes their life for the better.
This article was written by an anonymous psychiatrist and author of Hope For Addiction: Help and Hope for Families of Those Struggling with Addiction.