Proposals to Force More Involuntary Treatment Stir Debate

By Tom Jackman
Washington Post Staff Writer
Thursday, February 7, 2008; B04

In the debate over Virginia's mental health system, they're called "consumers." Some of them call themselves survivors.

They are mentally ill people who have been through the system and didn't like it. They criticize the humiliation of being handcuffed, the forced administration of antipsychotic drugs or the debilitating side effects of the drugs. And they don't think the government is best suited to choose their treatment.

Rather than forcing more people into involuntary treatment by lowering the legal criteria or enforcing outpatient treatment -- approaches that Virginia's General Assembly is considering -- consumers and their supporters say they think the money for those approaches would be better spent on counseling, housing and jobs for the majority of the mentally ill, who aren't dangerous or helpless.

Since the Virginia Tech shootings in April, which were committed by a mentally ill student who did not receive mandated treatment, many mental health advocates have called for a lower standard for involuntary treatment and easier access to patient records for determining a person's treatment. Under Virginia laws, some of the most stringent in the country, a mentally ill person can be committed only if he poses an "imminent danger to self or others" or demonstrates an "inability to care for" himself.

But a group of consumers is fighting back. They say they think that changing the imminent-danger standard is a bad idea and that opening patient records will discourage people from seeking treatment.

As the debate heats up in Richmond over how to fix Virginia's mental health system, consumers are lobbying legislators and testifying at hearings. A consumers' rally outside the state Capitol last week attracted more than 650 supporters and a number of legislators, said organizer David Mangano of Chesterfield County.

"The problem has much more to do with the system's failures, not with the language of the law," said Mangano, a consumer and family advocate for Chesterfield Mental Health Support Services. "The actual number of people who are great safety risks and great risk to the community are very small compared to the number who need services. If you start changing practices, changing the code, to try to catch those people [who are risks], what really have you done with all the people who don't belong there and have really good reasons not to comply with treatment?"

Consumers say that providing counseling, peer support, housing and jobs should take precedence over forced treatment. Michael Allen, a lawyer formerly with the Bazelon Center for Mental Health Law in Washington, said: "The problem in Virginia is not [revising] what standard is used to treat people against their will. The question is, do we make mental health services available in a timely fashion? Do we make it comprehensive and holistic or wait until they fall to the bottom?"

Some consumers have had positive experiences with treatment and are also fighting to revise Virginia's system. Jonathan Stanley said that in his 20s, he spent three years in a cycle of increasingly psychotic episodes, ending with an incident in which he stood naked in a New York City deli and was forcibly hospitalized for seven weeks.

He said doctors determined the proper medication for him. He finished college and law school, and now works for the Treatment Advocacy Center in Arlington County. He is lobbying for change in Richmond, including modifying the existing imminent-danger criteria, which he called "the most restrictive in the country."

Stanley is seeking support for more mandatory outpatient treatment, modeled after New York's Kendra's Law. He said that 80 percent of people emerging from such programs "say their coerced treatment has helped them get and stay well. Those are the consumer voices that I listen to the most."

Most mentally ill people are functional and want to make their own choices but need help, many consumers say.

Yaakob Hakohane of Arlington had been through decades of legal and mental health experiences. In the early 1990s, he helped create a group to advocate on behalf of the mentally ill. But even he said he was amazed by how easily he was involuntarily committed to a mental hospital last summer.

Hakohane, who suffered a brain injury as a teenager, said he fell and hit his head on a sidewalk one afternoon in July in Crystal City. He became disoriented and said police and paramedics who responded "were kicking and poking me," so he decided not to talk to them.

Hakohane was also suspicious of the people who treated him in the emergency room. He remained silent and was temporarily detained. When he went to a civil commitment hearing two days later, despite the testimony of two people who said he was perfectly rational, he was ordered into treatment for up to six months.

"It seems obvious from this experience [that] it's not hard to commit people," said his friend Diane Engster, who attended the hearing.

"It's easy," Hakohane said. "Anybody can commit anybody else." He said he cooperated with his doctors and was released in a week.

Consumers such as Engster, who founded the Northern Virginia Mental Health Consumers Association with Hakohane, are also troubled by attempts to open up patients' records. Special justices who decide whether to commit a person typically do not have access to psychiatric histories, and legislation is pending to allow that.

Alison Hymes, a Charlottesville consumer advocate who served on a state Supreme Court task force on mental health law reform, writes a blog about such issues. She wrote that if the state requires mental health providers to turn over patient records, "mental health practice in this state will never be the same. Patients/clients/consumers will not be able to trust their secret thoughts and feelings with their clinicians. Clinicians will not be able to abide by the ethical standards of their professions. People will not seek help and those who are already receiving therapy, such as myself, will quit."

Virginia is going through an unprecedented examination of its mental health system after the slayings at Virginia Tech. This is one in an occasional series of reports about problems in the system.