Compulsory Treatment Is Not a Solution to the Mental Health Crisis

The mistaken belief that mental illness leads to violent crime persists despite ample evidence to the contrary. Horrific cases are often assumed to be the fault of a person who is mentally ill, and in situations where that belief is vindicated by an announcement that the suspect was indeed mentally ill, the next suggestion is that compulsory treatment would have prevented the crime. That mentally ill people should be forced to undergo treatment, specifically forced to take medications, for the benefit of society as a whole.

Two states, California and New York, have laws providing for mandatory treatment, the need for which, of course, is determined by law enforcement, families, and mental health providers, not the patient. Both laws are based on horrific crimes that involved people with mental illness, and the belief that ‘if only’ the patient had been in treatment at the time, those cases wouldn’t have happened. And clearly, people with mental illness cannot be trusted to seek treatment on their own and adhere to treatment, thus, they should be forced to undergo treatment and provide documentation to prove it.

Writing at Bitch Magazine, Anna Pearce noted that:

What studies do show about the link between violent crimes—here defined as “threatening, hitting, fighting, or otherwise hurting another person”—and people with mental health conditions has far less to do with having a mental health diagnosis, and far more to do with our access to care, our support in our communities, and whether or not we’re abusing alcohol or other types of drugs.

The key thing here is access to care. Advocates of compulsory treatment act like people with mental illness are freely allowed to rampage through society, not taking advantage of the numerous resources available to us. That we are just difficult, or stubborn, and refuse treatment for no good reason. In fact, there are a number of good reasons why many of us do not receive regular mental health care.

The first is stigma. Many people express reluctance about seeking treatment because of social attitudes about mental illness. They fear the potential consequences if they enter treatment, for their families, for their jobs, for their relationships. Mentally ill mothers, for example, have an incentive to stay away from formal treatment because the practice of removing children from homes with a mentally ill parent, particularly a mother, still happens. If seeking treatment means that your children might be taken away, that’s a compelling reason not to go.

The second can be a simple economic one. Mental health treatment is expensive. Visiting a psychiatrist or counselor is expensive, as is paying for medications, if they are deemed beneficial for a patient. Many people with mental illness are uninsured and have low incomes. Those who do have insurance may have poor coverage, despite mental health parity laws. Faced with the choice between eating and making a counseling appointment, patients make the choice that suits them best at the time, which is staying alive.

The third can be a straight-up lack of resources. Many communities have very, very poor access to mental health care. People actively seeking treatment may not be able to access it. Patients who desperately want to be in therapy, or who would like to discuss the use of medications, have doors closed in their faces all the time, or encounter a series of barriers that make it extremely difficult to pursue treatment and follow through. For patients on the verge of psychiatric crisis, or those in crisis, each barrier decreases the chances of making it into treatment. People with untreated mental illness can experience difficulties with tasks of daily living, let alone jumping extremely complex bureacratic hoops just to get care.

Claims that people with mental illness can’t be trusted to seek treatment are based in social attitudes about mental illness, and what it means, not reality. And the idea that compulsory medication is somehow a fix to issues like crime is ridiculous. It’s also highly inefficient. If people are truly concerned about mental health services, and really do want to improve access to care so that mentally ill people can get treatment, they shouldn’t be starting with emergency care, compulsory treatment for people in deep psychiatric crisis.

They should be starting with making services readily available to all people, so that people can seek intervention before entering crisis. This has clear social benefits; it’s less expensive than mandating and monitoring compulsory treatment, for one thing, and it also means that people will be more likely to adhere to treatment, since that seems to be what is most important to society. Calls for compulsory medication aren’t about providing help to people with mental illness, but about controlling us. And we are far more likely to be able to stick with treatment when we start early and voluntarily, working with people we want to work with, controlling our own treatment and self-advocating throughout the process.

It’s far cheaper to make, for example, drop-in counseling services available than to force someone in crisis to undergo treatment. Once the crisis ends and support is withdrawn, the patient is likely to start spiraling downward, starting the process all over again. When support for people with mental illness doesn’t include things like improving access to housing for mentally ill homeless people, or strict anti-discrimination laws specifically focusing on mental illness in the workplace, and other indicators of true social support and inclusion, patients have no incentive to start, let alone continue, treatment.

Those who demand compulsory medication in the name of public safety are rarely involved in community initiatives to improve access to mental health care. Many routinely vote down and argue against propositions to extend access in their communities, to ensure that anyone who wants mental health care can access it without judgement or hassle. Their concerns about mental health issues, thus, ring false, because their focus is not on the needs of human beings, but on manufactured panic about mental illness and society.