Wednesday, June 20, 2007

Mental illness and the price of 'free will'

From the Los Angeles Times: (read the full article by clicking the link)
Mental illness and the price of 'free will'

Are laws protecting the right to refuse psychiatric treatment doing
more harm than good?

By Susan Partovi,

SUSAN PARTOVI is a staff physician at the Venice Family Clinic and an assistant professor at UCLA's David Geffen School of Medicine. She is also the medical director for Homeless Health Care Los Angeles.
.............Since the deinstitutionalization of the 1980s, when state laws protecting the right to refuse psychiatric treatment were strengthened, it has been extremely difficult to involuntarily hospitalize the mentally ill or mentally impaired. Though psychiatrists are the only ones who make legal determinations, other physicians, the police and the paramedics all know the criteria: "If the patient is at risk of harming him/herself or others … ".....

......There's a homeless man in Santa Monica who sits on the same stoop all day, every day. He has matted hair down to his hips, long nails and a honeydew melon-sized hernia easily visible under his filthy clothes. He's quite benign, but he refuses anything from me or the outreach workers I go out with. Isn't he harming himself? Isn't it harmful to live in the streets, not bathe, not seek a doctor's attention for a chronic condition?

In the wake of the massacre at Virginia Tech, we've been repeatedly told that we all need to be able to spot the warning signs of mental illness. But it's not rocket science. Seung-hui Cho was severely mentally ill — and there were several attempts to "help" him by his teachers at Virginia Tech, whose efforts were thwarted.

The law allows people their free will to refuse treatment. As someone on the front lines of treating the mentally ill, I would like to see the law take better care of people like William, the homeless man with the hernia and Cho — and, by extension, the 32 people he killed.

Perhaps the issue confronting us is not about free will at all. Perhaps it's about our own disinclination as citizens and taxpayers to fund more treatment facilities, counselors and hospitals for the mentally ill. And perhaps "free will" is the propaganda we've decided to believe instead.

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