Had lunch with a psychiatrist.

[CatherineM]

We were preparing for an upcoming appearance on a panel together. It's on how to keep mentally ill patients on their meds. Going to be broadcast across the province again but this time on the web too so people can email in questions rather than have to be at one of the remote sites. 

Anyway, we began discussing community treatment orders. That's where someone is court ordered to take their psychiatric meds without being locked up in hospital or jail. If they don't take them, off to the hospital. My husband and I are obviously for them since he testified before the legislature supporting passage of the act. Lots of people have issues with the idea based on personal freedom. 

What do you guys think?  Should society be allowed to force someone to take meds?  If so, what line?  Everyone with a diagnosis, or only someone who's gone off their meds and tried to hurt themselves or others?  Started the conversation because it looks like the lady who plowed into the crowd at OSU's homecoming parade was a bipolar off her meds and suicidal. How about someone who doesn't hurt anyone but lives under a bridge here in winter psychotic?

[blazeingstar]

It's a good idea, but a slippery slope.  There'd have to be alot of good for those who are immediate dangers to themselves or others, but how far do you go?  I have severe ADHD.  Sometimes this makes my productivity in the workplace near zero.  Could my employer ever stretch the law to include danger to their bottom line as a reason to force me to have meds?

The line, for me, would only include those in active crisis, and those who are deemed so mentally unstable that they are in need of legal guardianship.  Most of those people would not be driving, etc...so I don't know how far it'd go in preventing tragedies like the OSU one.

[Era Might]

My instinct is against. If it is allowed, at least it should be recognized as a form of social control and institutionalization, no different in principle from China's one child policy (which I just saw they've apparently rescinded).

[Gabriela]

Hard call. If the person is a danger to society but can be rendered non-dangerous by medication, I'd vote we give them two options: Either go on the meds and remain free, or go to prison/hospital where you can't hurt anyone.

At least that way the person has a choice.

[Sponsa-Christi]

My first instinct is "no," because this seems like a violation of personal freedom. I can see how it might be lawful and necessary to forcibly confine someone if they present a clear danger to themselves or others, but the choice to take drugs which alter one's brain chemistry seems like it pertains to more intimate sphere where a person should have an even greater right to autonomy.  

It seems like there would be a particular danger of a slippery slope here, too. I.e., how do you know where to draw the line of when to make medication compulsory? Would it only be when someone was actually violent? When there was a mere statistical risk of a person becoming violent? When someone became too depressed to function normally? Or when someone exhibits any signs of depression? Will this devolve into forcing drugs on people who were thought to be just too eccentric or quirky?

Also, I'm not a psychiatrist, but I have done some reading on this topic, and there is still a lot we don't know about exactly how psychiatric drugs actually work. Some drugs have frightening and dangerous side effects---and some drugs haven't been used long enough for us to even know what all the long-term side effects are. The history of treating mental illness is filled with well-intentioned people forcing the latest "scientific" treatments on patients, which these same treatments later being seen as barbaric in hindsight. 

I know medication has helped a lot of people, so I'm not against people taking medication that they feel helps them. But I do think the choice to take medication for mental health issues should be a free and personal one, that a person makes after weighing the risks and benefits for their particular case. 

[vee]

My first thought was Vince Li and how I hope someone is making darn sure he is taking his meds since theyve also given him more freedom than I think he deserves!

[CatherineM]

It's your 80 year old grandfather, has Alzheimer's disease, got away from nursing home and is wondering around in a daze. There will be alerts on tv and every cop will be looking for them. If it's your just turned 18 year old son, psychotic but not dangerous, wandering in a daze, you can't even get the police to take a report. Maybe he thinks he's a medieval monk working for St. Francis (real scenario). 

Does that change your opinion about forcing him on medication?  You're worried if he's eating, he's been beaten up for his shoes, but prefers walking barefoot anyway. Winter is coming fast. He is cognizant enough to say he doesn't want the medication because it turns off his communication with St. Francis. 

[dominicansoul]

I have to agree with Vee.  When it comes to dangerous patients, I don't think it's a bad order.  But if its the scenarios you mentioned above, I think it can slide a bit.  

[Sponsa-Christi]

It's your 80 year old grandfather, has Alzheimer's disease, got away from nursing home and is wondering around in a daze. There will be alerts on tv and every cop will be looking for them. If it's your just turned 18 year old son, psychotic but not dangerous, wandering in a daze, you can't even get the police to take a report. Maybe he thinks he's a medieval monk working for St. Francis (real scenario). 

Does that change your opinion about forcing him on medication?  You're worried if he's eating, he's been beaten up for his shoes, but prefers walking barefoot anyway. Winter is coming fast. He is cognizant enough to say he doesn't want the medication because it turns off his communication with St. Francis. 

I wouldn't necessarily be against a legal guardian or someone who had medical power of attorney making the decision to medicate someone who was obviously incompetent to make the choice for themselves, but I don't think the government should be allowed to force this choice. 

Also, in the situations you described, I'm not sure that medication would really be a clear, cure-all solution. It seems like the immediate problem is both cases is more like a lack of building security. And for the grandfather in particular, I don't know how much medication can really do to restore mental clarity to someone suffering from Alzheimer's or related dementia. 

Edited October 30, 2015 by Sponsa-Christi

[CatherineM]

I wasn't talking about medicating the grandfather. I just meant that we don't let the elderly wander around in a haze, but allow it if they're just mentally ill. 

[Sponsa-Christi]

I wasn't talking about medicating the grandfather. I just meant that we don't let the elderly wander around in a haze, but allow it if they're just mentally ill. 

But, there is a difference between restricting someone's movements and forcibly doing something to their body (such as compelling them to take drugs which change their brain chemistry). While in general competent adults do have the right to come and go as they chose, I think the right to determine what is done to one's own body is even more primary and fundamentally important---and I'm even tempted to say "sacrosanct." 

[CatherineM]

Okay, imagine you are this kid's parents.  How do you handle it?  Just wash your hands of him and move on to focus on your other kids?  The actual parents involved struggled to get their son help and off the street for 10 years.  The Dad had a heart attack and had to retire early from the Mounties.  They eventually got help for him by filing a report with the police that he had threatened to kill them.  He's been stable for 15 years now in a group home.  When you're off meds, it does a bit of damage to the brain, a bit like a constant seizure.  The longer it takes to get on meds, the longer they are off meds, the lower their cognitive functioning will be long term.  Those ten years on the street did enough brain damage that he's not capable of independent living, but he can hold a job washing dishes, and has a good relationship with his mom.  His Dad died five years ago.  He has no relationship with his brother.  His niece and nephews didn't know they had an uncle until they saw a picture of him at their grandmother's house.  He has to wait on holidays until they are gone before visiting.

Imagine being the pastor of this family coming to you for advice, or a spiritual director, or family counselor, or just a compassionate friend.  How would you have helped them through this nightmare?

[Sponsa-Christi]

Okay, imagine you are this kid's parents.  How do you handle it?  Just wash your hands of him and move on to focus on your other kids?  The actual parents involved struggled to get their son help and off the street for 10 years.  The Dad had a heart attack and had to retire early from the Mounties.  They eventually got help for him by filing a report with the police that he had threatened to kill them.  He's been stable for 15 years now in a group home.  When you're off meds, it does a bit of damage to the brain, a bit like a constant seizure.  The longer it takes to get on meds, the longer they are off meds, the lower their cognitive functioning will be long term.  Those ten years on the street did enough brain damage that he's not capable of independent living, but he can hold a job washing dishes, and has a good relationship with his mom.  His Dad died five years ago.  He has no relationship with his brother.  His niece and nephews didn't know they had an uncle until they saw a picture of him at their grandmother's house.  He has to wait on holidays until they are gone before visiting.

Imagine being the pastor of this family coming to you for advice, or a spiritual director, or family counselor, or just a compassionate friend.  How would you have helped them through this nightmare?

I'm not denying that this is a difficult situation, or that medication may have been the right thing for this young man in particular. 

But the original post wasn't framed as: "What is objectively the best way for the family of this young man to handle this specific situation?" It was framed as, essentially: "Should the government categorically have the right to compel mentally ill people in general to take psychiatric drugs?"

These are two very different questions, with vastly different implications.  

[Era Might]

Okay, imagine you are this kid's parents.  How do you handle it?  Just wash your hands of him and move on to focus on your other kids?  The actual parents involved struggled to get their son help and off the street for 10 years.  The Dad had a heart attack and had to retire early from the Mounties.  They eventually got help for him by filing a report with the police that he had threatened to kill them.  He's been stable for 15 years now in a group home.  When you're off meds, it does a bit of damage to the brain, a bit like a constant seizure.  The longer it takes to get on meds, the longer they are off meds, the lower their cognitive functioning will be long term.  Those ten years on the street did enough brain damage that he's not capable of independent living, but he can hold a job washing dishes, and has a good relationship with his mom.  His Dad died five years ago.  He has no relationship with his brother.  His niece and nephews didn't know they had an uncle until they saw a picture of him at their grandmother's house.  He has to wait on holidays until they are gone before visiting.

Imagine being the pastor of this family coming to you for advice, or a spiritual director, or family counselor, or just a compassionate friend.  How would you have helped them through this nightmare?

What does he want from his life? And if he can't answer that, who does? Any attempt to "help" him is going to be an imposition of what someone else thinks should happen with his life. There is no fabric to his life...is the goal to give him a stable community? Save his brain? Help him find the freedom of decision? Prevent him from self-destruction? Whichever is chosen requires someone to make a decision about his life. In another age the priority would be saving his soul. That's unacceptable today, but it's acceptable to save his body. Same idea, different social objective.

 

[blazeingstar]

Okay, imagine you are this kid's parents.  How do you handle it?  Just wash your hands of him and move on to focus on your other kids?  The actual parents involved struggled to get their son help and off the street for 10 years.  The Dad had a heart attack and had to retire early from the Mounties.  They eventually got help for him by filing a report with the police that he had threatened to kill them.  He's been stable for 15 years now in a group home.  When you're off meds, it does a bit of damage to the brain, a bit like a constant seizure.  The longer it takes to get on meds, the longer they are off meds, the lower their cognitive functioning will be long term.  Those ten years on the street did enough brain damage that he's not capable of independent living, but he can hold a job washing dishes, and has a good relationship with his mom.  His Dad died five years ago.  He has no relationship with his brother.  His niece and nephews didn't know they had an uncle until they saw a picture of him at their grandmother's house.  He has to wait on holidays until they are gone before visiting.

Imagine being the pastor of this family coming to you for advice, or a spiritual director, or family counselor, or just a compassionate friend.  How would you have helped them through this nightmare?

Again, this is where a guardian would come into play.  If he's not capable of independent living then he needs a legal guardian, preferably one from a state agency who can be unbiased where family may not.  In this case, as others have stated  where he's incapable of caring for himself, he has a choice, hospital/long term care unit or meds.