Involuntary treatment is an everyday event in the emergency department and on the inpatient unit, but, for both patients and advocates, it remains the most distressing and controversial aspect of psychiatric care. We all value medical autonomy, and, even when people may be too ill to make decisions about their own care, the issue of whether to force treatment gets sticky. On the other hand, the decision not to force someone to get care when they are very sick has its own risks and distresses, and sometimes groups clash.
If you don’t believe me, check outside the convention center during the upcoming American Psychiatric Association’s annual meeting in San Diego this May. Every year, there are protesters: antipsychiatry groups who feel our treatments offer more harm than good. For those who believe the field is sullied by the pharmaceutical companies and that the treatments are harmful, forcing those treatments upon people is all the more egregious. Most years, protesters come from the Church of Scientology and MindFreedom International to make their feelings known. The pitch of the protests varies, as does the length of time they stay, but, some years, there are marchers, megaphones, and jumbotrons.
I’ve spent the last few years talking with a wide variety of patients and professionals about their views on psychiatry and on involuntary care in particular. The culmination of that project was the publication of a book I wrote with forensic psychiatrist, Annette Hanson, MD , “ Committed: The Battle Over Involuntary Psychiatric Care ” (Baltimore: Johns Hopkins University Press, 2016). With the battlefield defined, we’ve put together two symposia on involuntary care with presenters from around the country.
“The Battle Over Involuntary Psychiatric Care” will be held Wednesday, May 24, from 2 to 5 p.m. As the title suggests, the “combatants” will represent all sides. Roger Peele, MD , has been part of the APA’s governance since 1975. He will be traveling from Maryland to discuss why involuntary treatment is a good thing, an option that should be used more liberally with legislation that should be less restrictive. Former APA President Paul Appelbaum, MD , a forensic psychiatrist, will be coming from Columbia University in New York to talk about the APA’s stance on involuntary treatment over time.
On the other side of the debate, Elyn Saks, JD, PhD , will be talking about patient rights. Dr. Saks is the author of “ The Center Cannot Hold: My Journey Through Madness ” (New York: Hyperion, 2007), a memoir of her own experiences with treatment for schizophrenia. She is the founder of the Saks Institute for Mental Health Law, Policy, and Ethics at the University of Southern California in Los Angeles.
Finally, Al Galves, PhD , is on the board of directors of MindFreedom International, one of the groups that traditionally has picketed our meeting. He will be traveling from New Mexico to represent that group’s viewpoint. Dr. Galves also has a fascinating background: He holds degrees in government administration, as well as a doctorate in clinical psychology. He is the author of “ Harness Your Dark Side: Mastering Jealousy, Rage, Frustration, and Other Negative Emotions ” (Falls Hills, N.J.: New Horizon Press, 2012), and he has a long history of treatment for depression. I believe this is the first time that a member of MFI has spoken at an APA meeting.
Dr. Hanson will be the discussant who sums up what we learn from these diverse and esteemed speakers. I invite you to come for what is certain to be a lively symposium, but please leave your picket signs at the door. Our hope is not to fuel the battle but to provide an arena where diverse viewpoints can be expressed and heard. In our increasingly polarized world, we’d like to think that it is still possible to consider a variety of ideas without firing any artillery.
To add to the controversy, outpatient civil commitment continues to be held out as a panacea to get people treatment before they become dangerous. Still, each state handles outpatient care differently, if at all, so a symposium, “Outpatient Commitment: A Tour Across the States,” will be held on Tuesday, May 23, from 8 to 11 a.m. Two speakers will be coming from New York state, Ryan Bell, JD, MD , and Kimberly Butler, LCSW, MS, to talk about their experiences running an assisted outpatient treatment program in Rochester, N.Y. Erin Klekot, MD, will be talking about her experiences in Ohio. Adam Nelson, MD , will discuss the programs in California that are starting to be implemented.
Finally, Mustafa Mufti, MD , will be talking about the experience in Delaware, where they have had a great deal of experience with outpatient commitment – not without some contention – and where the state hospital and outpatient programs have been investigated by the Department of Justice. Our discussant will be Marvin Swartz, MD , from North Carolina. Dr. Swartz has coauthored the seminal studies on outpatient civil commitment results from both New York City and North Carolina.
If you’re coming to the APA, do join us. If not, both sessions are slated to be part of APA’s Meeting On Demand. Dr. Hanson will try to stream parts of the Battleground session on Periscope (wifi permitting) – follow her on Twitter if you’re interested in updates.
Finally, if you’d like to look up any session, either by topic or by presenter, the APA has provided a useful search function .
See you in San Diego!
To learn more about the latest book by Dr. Miller and Dr. Hanson, “Committed: The Battle Over Involuntary Psychiatric Care,” visit https://jhupbooks.press.jhu.edu/content/committed.
