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Commentary | VOICES / A FORUM FOR COMMUNITY ISSUES

A Legal Threat to Mentally Ill

September 21, 2002

A bill awaiting Gov. Gray Davis' signature would involuntarily commit mentally ill people to outpatient treatment programs based on the decision of a court-ordered hearing. Not sticking with a treatment course and committing a serious act of violence against oneself or others are some of the criteria to be considered in making this determination. KAREN KARLITZ spoke with an opponent of the measure, AB 1421.

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SALLY ZINMAN

Executive director, California Network of Mental Health Clients

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This bill speaks of an array of services for those with psychiatric disabilities, but we believe it is really about forced medication, which is detrimental to people's recovery as well as to their civil rights.

Recovery is about self-determination and choice, about people being partners in their treatment and life plans. This is not a new concept. Physically disabled people have been talking about it for many years.

Recovery from psychiatric disabilities is possible. I was diagnosed with paranoid schizophrenia a long time ago, and I have recovered.

A few exemplary mental health service models were initiated in the last several years. The Village in Long Beach, for example, offers voluntary rehabilitative services including housing, income support, jobs and job training, and socialization. Its success has been phenomenal.

But AB 1421 would undermine this exceptional program.

When you use force, you drive people away. Psychiatrically disabled people are no different from anyone else. They don't want to be forced to do things, and when they are, they have a tendency to run in the other direction.

A 1989 California Department of Health study, the Well Being Project, found that about 55% of those who had experienced forced treatment later refused all mental health treatment.

Also, if you mix voluntary patients with involuntary ones, it changes the nature of the program.

There's no argument that people out there are suffering, that many of the homeless have mental disabilities (although a lower percentage than people think) and that some end up in jails instead of receiving mental health services. Proponents of this bill say this is because of problems with the current laws. We think it's a failure of the system, which rarely provided the voluntary community services promised when most of the state mental hospitals were closed.

The bill has moved forward, I believe, because of the stereotypes and stigma surrounding people with psychiatric disabilities. One stereotype has it that they're violent. But in the words of the U.S. surgeon general in a 1999 report: "The overall contribution of mental disorders to the total level of violence in society is exceptionally small."

A second stereotype is that the psychiatrically disabled are childlike and therefore need others to make decisions for their own protection. This too has been disproved.

But all the research and reports don't seem to matter. Exploiting centuries-old stereotypes is how this bill reached the governor's desk.

Another problem with this proposed legislation is that it views medication as a magic bullet without side effects. The truth is, medication doesn't always work. Many patients try various drugs before finding one that is effective, and in time it too may stop working. When people reject services, we should look at why instead of automatically assuming it's because they're incapable of making good decisions.

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