Can I be medicated against my will?

Can I be medicated against my will?  If so why?

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Another medication question.  I enjoy answering these types of questions as it amazes me the advances we’ve made  in  psychopharmacology and mental health.

The answer to the first part of your  question is a very simple yes.  You can be medicated against your will for different reasons and under certain conditions.   So that you can better understand the process,  I’m going to give you a short history on mental health to current standards and practices.

Before I go any further, I’d like you and all the readers to understand that I am in no way condoning or advocating how patients were  treated, but this was what they knew at the time.  I believe they thought  they had made quite a bit of progress from the days of  Frankensnstienesque practices and treatment of patients over hundreds of years ago. Doctors and the Psychiatric community actually thought they were helping these people. Hospitals were called asylums and the words “mental illness were rarely spoken in the the psychiatric community, and the population at large hardly knew  what the words meant.  Words such as deranged, crazy, mad, lunatic and sick in the head were the common terminology used and wasn’t considered the least bit offensive.

In the 1940’s patients were still  ware housed, (approximately 100 to 150 patients per ward)  but at least the men and women were separated . They basically lived their lives and slept in long dorm like rooms usually with the nurses station  at the end or in the middle  of the dorm so the  nursing staff could monitor  all the patients at the same time.  Some of the more “stable” women were allowed to work in the laundry, doing dishes and cleaning bathrooms.  The more “stable” men could work on the grounds make repairs etc …., of course all of this while patients were being supervised.  These men and women were never paid for their services.

As there were no real “psychiatric” drugs in the 1940’s other forms of treatment were used.  I’m quite sure many of you will find these treatments quite shocking and disturbing just as I did.  Three common treatments used were lobotomies, electro shock treatment (not the safe and quite often successful ECT of today) and insulin induced comas.  These were all believed to fix whatever was wrong with the   brain and to reduce violent outbursts.

The 1950’s took the Psychiatric community  to a entirely new level, they  literally thought they were given a miracle……… Thorazine!  The true grandfather of all psychiatric medications.  It sedated patients, made them compliant, and doctors and nurses swore the medication could cure everything from schizophrenia to depression.  Unfortunately the patients were given some extremely large doses; anywhere from 2,000 mgs /day to 5 to 6,000 mgs/day.  The upper limits today are 1,000 mgs/day.  These high doses had some extreme side effects, one of the most common is a movement disorder called Tardive Dyskinesia.  This disorder is permanent and has no cure, it can be so bad as to interfere with a persons basic daily living.  Thorazine is still used today at much,much lower doses as it is the only drug that works for a select few.  After Thorazine came Haldol, which is still a drug used very often even today.

The 1960’s started to bring about some changes in the mental health field.  A significant  amount of FDA approved medications for treatment of psychosis, schizophrenia, depression and manic depression were now available.   Lithium was  hailed as the wonder drug to treat manic depression which we now call bipolar DO.   Lithium is still one of the most often prescribed medications to treat bipolar DO.  However  the most important thing we saw in the 1960’s

was the changes in patient care for the mentally ill.  New laws, patients rights, and the standard of care for mentally ill patients began to change in a very drastic and positive way.

The 1970’s and 80’s continued to see massive improvements in patient care and psychiatric care facilities had to meet a standard of care from both state and federal levels to remain in operation.

The organization  that is considered to have some of the highest caliber of standards is JCAHO; Joint Commission on Accreditation of Health  Care  Organizations.  They give a facility one time to fail, when they come back and the facility does not meet their standards, depending on the degree and severity of the citation they can close a facility.

In 1978 Rennie V Klein established law that a patient (voluntary/ involuntary)  has the right to refuse psychotropic medication unless there is a court order. (Patients could be medicated  against their will in a psychiatric emergency).

In 1979 Rogers V Okin,  The U.S. Court of Appeals for the 1st Circuit established that a competent patient committed to a psychiatric hospital has the right to refuse medication in a non emergency situation.

The 1990’s to present continues to make progress in the area of patients rights.   We have seen numerous FDA approved drugs that are safer,  have less side effects and work very well when prescribed with other medications to treat a great many mental illnesses.  We now have SSRI’s, SNRI’s  and a multitude of atypical anti psychotics.  The old archaic thinking that more than two drugs in the same classification is polypharmocology went out with rotary phones.

A person who arrives at a hospital on a 72 involuntary hold can be mediated  against their will.  For a person who comes in  on a voluntary basis there are a couple of things that can happen.  You can be medicated against your   will in a psychiatric emergency and you can be placed on a 72 involuntary hold if you meet criteria.  After the 72 hours has passed and the psychiatrist thinks you need more care, he can certify you as a 5250.  The exact reason why he thinks you need to stay must be stated on the 5250 form. Two other doctors must sign it.  At the same time he can also file a medication  competency certification stating that you are not competent to make a decision about your treatment and/ or your medications.  Again two doctors must sign it.  A med comp hearing usually happens that day or the very next day.  You will have an attorney to represent you and there will be an attorney representing the hospital.  The judge will also have your chart to look over and the doctors statements. The judge may choose to ask questions of both attorney’s and yourself.  If the judge decides you need more treatment including medication you no longer have choice to refuse medications.

Now both parts of the question have been answered.   So now let us look at why medications  are so important and why they receive so much attention.

Doctors didn’t just start handing out pills to the mentally ill  and say here, these are special happy pills,  (pt) ‘How do   they work’  (Dr) “Well we’re not so sure yet, but we promise they will make you happy!’.  Hmm…thinks pt, I really have been feeling crappy and I’d like to feel happy.  (pt) ‘Dr. I’d like to take the happy pills’.  (Dr.)””Oh good we do so want you to feel happy!”   A bit ridiculous, don’t you think?.

Mental illness has been studied since the beginning of civilization.  We could ponder and discuss just this subject for quite some time, but let’s get back to medications.  The advances of psychiatry and the study of the brain in the last 100 years has been remarkable.  Years of research and study of the human brain  has revealed some very interesting facts.   The brain has  many functions and utilizes several different chemicals called neurotransmitters to carry out these functions.Jonathan Dunn MD Former President of the Ohio Psychiatric Association    “Medication…….is a step toward reducing the intense suffering that occurs when people are actively ill and their illness interferes with their ability to obtain the treatment they need”If there is an imbalance or malfunction of one or some of these neurotransmitters it will affect how the brain functions in those areas.  The three most common neurotransmitters that are associated with mental health are Dopamine, Seratonin and Norepinephrine. They affect mood, emotion, feelings and very importantly thought processes. When these neurotransmitters become imbalanced, either too high or too low, they can seriously alter a persons perception of mood, emotions and rational thought processes.

Most Psychiatrists, Psychologists, General Practitioners and other Health Care Providers all believe this is the main cause of mental illness;  simple chemistry.

This is why medications work.  They bring balance back to the imbalanced chemicals in the brain.

I realize there is some controversy with regards to mental illness and medication.  I find this rather odd as there seems to be no controversy about diabetes and medication, heart disease and medication or hypertension and medication.  I could continue on but I think you get the picture.

There is an extensive list of persons, groups and organizations who support the use of medication whether it be involuntarily administered under court order, or voluntarily taken by the patient themselves, here are just a few;

1)  The patient themselves;  Patients will express appreciation for making them take their medication when they were too decompensated to make the choice for themselves.

2)  The patient’s family for helping their loved  get treatment they need.

3)  NAMI    National Alliance on Mental Illness

4)  APA    American Psychiatric Association

Former Justice Andrew Douglas of The Ohio State Supreme Court;  ” The warehousing of those such patients…….such a result is inhumane and,, therefore unacceptable”   “Mental illness robs a person of the capacity to make informed decisions”   “Mental illness and incompetence are not and the same”

Jonathan Dunn MD Former President of the Ohio Psychiatric Association    “Medication…….is a step toward reducing the intense suffering that occurs when people are actively ill and their illness interferes with their ability to obtain the treatment they need”

Kathleen Sebelius   Secretary of Health and Human Services is spearheading  a  campaign to help all states improve thier Mental Health Programs but she’s starting with the few states who have no Mental Health Programs at all.

Secretary Sebelius is adamant about removing the stigma of mental illness.  Among the many plans she has in accomplishing this goal is ti first do away with the term “mental illness”  and replacing it  with the more appropriate term “neurobiological illness”.

Secretary Sebelius states   “The long establised split between “mental” and “physical” health is  NOT  justified in research and should  NOT  be perpetuated in healthcare”

Statements made by both Mr. Dunn and Mr. Douglas are both insightful and so very true.  They both envisioned the direction  in which the Mental Health field needed to be headed.

The statement made by Secretary of Health and Human Services Kathleen Sebelius show us the path the Mental Health field needs strive for and  stay on.

I have seen 1st hand how the right diagnosis, treatment AND medication can change a person’s life.   I’m bipolar and I know most of you reading this will understand what I mean when I say it is mentally as well as physically TORMENTING to have a mental illness that is untreated.  I know some will not agree but medicating  someone who is actively depressed, psychotic, paranoid, manic….etc,  on an involuntary basis is very humane.  These people are suffering and they are completely unable to help themselves at that moment. The language just makes it sound like we’re doing something awful to people.

I have had so many patients come up to me after a 14 or30 day hold and tell me how much better they feel being on medication.

I think this statement speaks for itself.

I hope this answered your question, I understand how important it is to understand the “why” for an answer you’re given.


One thought on “Can I be medicated against my will?

  1. My father worked at one of Britain’s last Victorian Asylum’s for many years, right up until it closed in 1998 – by then known as an Acute Services Centre. The hospital was opened, though, under the name “Pauper Asylum for Lunatics.” Isn’t it strange how language changes, from the overt to the vague, in this case.

    I visited the hospital before it closed, one Christmas as a child I handed out bags of sweets to the patients. The architecture of the place is still incredibly imposing, with plants and wildlife now fighting through the 19th century windows.

    There is a calm in the idea that all is peaceful there now.

    In the UK we have moved away from the habit of central institutions for the mentally ill towards local community resource centres. This change in attitude not only reflects the change in how we treat mental illness, but also how we view it. It may have been logical 200 years ago to lump everyone together under the same roof and same diagnosis. Now we know that psychiatric illness comprises a myriad of individual diagnostic criteria, with treatment being very much as bespoke as any system will allow.

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