Forced Psychiatric Treatment - U.S.

[Ren]

Subject: Section 224 of HR4302

"The 123-page Protecting Access to Medicare Act of 2014, H.R. 4302, includes a four-year, $60 million grant program (Sec. 224) to expand involuntary outpatient commitment (IOC) – also called Assisted Outpatient Treatment (AOT) – in states that have laws authorizing IOC.

The laws allow courts to mandate someone with a serious mental illness to follow a specific treatment plan, usually requiring medication."

Above from: http://www.madinamerica.com/2014/03...ious-forced-treatment-addition-medicare-bill/

See also - from a google search: http://www.examiner.com/article/mental-health-advocates-strongly-disapprove-of-forced-treatment-bill


To my understanding, this has now passed (House and Senate).

 

[SilverbladeTE]

while some few do need hospitalized against their will, it should always sbe remembered that the Soviet Union accused its dissidents of mental disorders, had them locked up in mental asylums and tortured with drugs and psychological abuse.
Also, such people make excellent guinea pigs for drug companies because there is no need for "informed consent",

Beware when you fight monsters, ...

 

[barbc56]

Anyone have source to the actual wording of this part of the bill?

I can't access PDFs.

Thanks.

Barb

 

[N.A.Wright]

@barb

Text version at https://www.govtrack.us/congress/bills/113/hr4302/text


224.
Assisted outpatient treatment grant program for individuals with serious mental illness
(a)
In general
The Secretary shall establish a 4-year pilot program to award not more than 50 grants each year to eligible entities for assisted outpatient treatment programs for individuals with serious mental illness.
(b)
Consultation
The Secretary shall carry out this section in consultation with the Director of the National Institute of Mental Health, the Attorney General of the United States, the Administrator of the Administration for Community Living, and the Administrator of the Substance Abuse and Mental Health Services Administration.
(c)
Selecting among applicants
The Secretary—
(1)
may only award grants under this section to applicants that have not previously implemented an assisted outpatient treatment program; and
(2)
shall evaluate applicants based on their potential to reduce hospitalization, homelessness, incarceration, and interaction with the criminal justice system while improving the health and social outcomes of the patient.
(d)
Use of grant
An assisted outpatient treatment program funded with a grant awarded under this section shall include—
(1)
evaluating the medical and social needs of the patients who are participating in the program;
(2)
preparing and executing treatment plans for such patients that—
(A)
include criteria for completion of court-ordered treatment; and
(B)
provide for monitoring of the patient’s compliance with the treatment plan, including compliance with medication and other treatment regimens;
(3)
providing for such patients case management services that support the treatment plan;
(4)
ensuring appropriate referrals to medical and social service providers;
(5)
evaluating the process for implementing the program to ensure consistency with the patient’s needs and State law; and
(6)
measuring treatment outcomes, including health and social outcomes such as rates of incarceration, health care utilization, and homelessness.
(e)
Report
Not later than the end of each of fiscal years 2016, 2017, and 2018, the Secretary shall submit a report to the appropriate congressional committees on the grant program under this section. Each such report shall include an evaluation of the following:
(1)
Cost savings and public health outcomes such as mortality, suicide, substance abuse, hospitalization, and use of services.
(2)
Rates of incarceration by patients.
(3)
Rates of homelessness among patients.
(4)
Patient and family satisfaction with program participation.
(f)
Definitions
In this section:
(1)
The term assisted outpatient treatment means medically prescribed mental health treatment that a patient receives while living in a community under the terms of a law authorizing a State or local court to order such treatment.
(2)
The term eligible entity means a county, city, mental health system, mental health court, or any other entity with authority under the law of the State in which the grantee is located to implement, monitor, and oversee assisted outpatient treatment programs.
(3)
The term Secretary means the Secretary of Health and Human Services.
(g)
Funding
(1)
Amount of grants
A grant under this section shall be in an amount that is not more than $1,000,000 for each of fiscal years 2015 through 2018. Subject to the preceding sentence, the Secretary shall determine the amount of each grant based on the population of the area, including estimated patients, to be served under the grant.
(2)
Authorization of appropriations
There is authorized to be appropriated to carry out this section $15,000,000 for each of fiscal years 2015 through 2018.

 

[barbc56]

@N.A.Wright

Thank you so much. I am not a lawyer but speaking from my extensive experience of watching almost every episode of Law and Order, where the hell does this say we are all in mortal danger of being thrown in a psychiatric ward. If it does, I missed it but it wouldn't be the first time.

evaluating the process for implementing the program to ensure consistency with the patient’s needs and State law

So it sounds like this bill is purely fiscal and follows state guidelines that are already in place to determine the risk/benifits of a psychiatric placement?

Barb

 

[vamah]

I think this is probably in reaction to a recent inceident where a Congressman from my state was attacked and injured by his son who then killed himeself (the son). There were a lot of stories after that said that the son had been comitted a few days before, but let go because there weren't any available beds. Other stories have said that there were actually beds available although the judge or whoever thought there were not.

This is a terrible tragedy, but hard cases make bad law and they are pouring more money into pscychiatrtic drugs and treatment. Who knows if they will even help the small number of severely mentally I'll people who need it, or just classify more people as psych cases. And, probably, stigmatize people with psych diagnoses as being dangerous and violent, when only a very small number actually are.

 

[taniaaust1]

@N.A.Wright

Thank you so much. I am not a lawyer but speaking from my extensive experience of watching almost every episode of Law and Order, where the hell does this say we are all in mortal danger of being thrown in a psychiatric ward. If it does, I missed it but it wouldn't be the first time.


So it sounds like this bill is purely fiscal and follows state guidelines that are already in place to determine the risk/benifits of a psychiatric placement?

Barb

shall evaluate applicants based on their potential to reduce hospitalization, homelessness, incarceration, and interaction with the criminal justice system while improving the health and social outcomes of the patient.

The risk is that many who have ME/CFS do face homelessness due to not being able to work, family abandonment and how hard it can be to get onto state benefits for those with this illness.

Leonard Jason quotes in a recent article "Diseases can stimatize" page 28 of "Talking Point" Issue 1, 2014 (the offical journal of ME/CFS Australia (SA) states that "85% of clinicians view "CFS as a wholly or partially psychiatric disorder"

So with that many drs at there seeing our illness in this manner, it wouldnt be a far cry at all to think that this could put some who have ME/CFS at risk of being forcably incarcerated ..esp when many who have ME/CFS refuse to do the medically recommended treatment eg CBT and GET!! Our refusal to do these treatments can just be seen as a further evidence of us having mental health issue.

 

[barbc56]

@taniaaust1

I don't believe I have disputed what you are saying and am a bit puzzled why you would think otherwise.

That being said, I am in the states where things are a bit different, so in that respect, I get what you are saying.

At first glance, I see this bill as a positive. As with me/cfs, I am a strong advocate for mental health programs being funded as much as possible, especially preventative services in the latter. I don't see anything that gives the state more power over mental health decisions. It looks like the bill is simply increasing funding.

Look how shabbily returning vets have been treated because mental health services have been abysmally absent.

Think what happened at Fort Hood a couple of days ago. The second time, in the same place, people killed by someone with a mental illness possibly caused by the stress of being in a war where money was spent that could have seen better uses and in the end, very little was accomplished.

Rant over!

Barb

 

[WillowJ]

this is where it's bad policy to elect mostly lawyers and businessmen to Congress, and then allow them to decide medical policy. They should stay hands off. There is a contingent of medical people in Congress, although I guess most of their training is not up to date.

It's nonsense to force people to comply with psychiatric care when nothing in psychiatry is science-based. Some of the medicines will help some of the people, but there are no guidelines that can ensure what appropriate treatment is. Even if there were a reasonable standard as in medicine, there are always exceptions to the standard.

I agree with @vamah : an incident, although tragic, cannot decide policy. It will unfairly increase stigmatization of psychiatric-classified disease, and put at risk of miscare both those with diseases generally classified as psychiatric and people with unusual, hard to diagnose, and disputed diseases.

 

[taniaaust1]

@taniaaust1
I am in the states where things are a bit different, so in that respect, I get what you are saying.

Yeah the treatment of the GWS people is shocking.

Isnt Leonard Jason who had the article in my countries/states journal.. I think he's American, in the US (I know he isnt an Australian here), so those figures over how many doctors believe this illness is a psych thing "
"85% of clinicians view "CFS as a wholly or partially psychiatric disorder", would actually be from your country, the US.

In the US, GET and CBT are the recommended treatments for ME/CFS too.

(here in Australia, Ive only ever had one doctor tell me about GET and I dont think Ive had any recommend me CBT for ME/CFS as there isnt any CFS clinic which do CBT in my state).

 

[barbc56]

I can only say that, IMHO, it's quite a leap to interpret this bill as anything but a fiscal decision.

I have never been offered cbt nor get, but that could just be a reflection of my experiences.

While a lot of things in this thread may be factual, I fail to see the relevance of those issues to this bill.
Barb

 

[WillowJ]

In the US, GET and CBT are the recommended treatments for ME/CFS too.

(here in Australia, Ive only ever had one doctor tell me about GET and I dont think Ive had any recommend me CBT for ME/CFS as there isnt any CFS clinic which do CBT in my state).

We don't actually have any facilities to do CBT/GET for CFS patients, either, but what the recommendation does do is convince many docs our condition is not important and caused by deconditioning and worrying.

 

[Ren]

I believe the nightmare begins something like this...

Barb: "Hello, Doctor..."

Doctor: "Barb, I'm gonna level with you. CFS is a wastebasket diagnosis that doesn't help patients in any way. The history and symptoms you describe are actually what we call Somatic Symptom Disorder or SSD for short. This is good though - this means we have an answer. We know what the problem is, and we know how to fix it...

Now here's your treatment plan..., and I'm gonna let Jane from child services speak to you about how important it is for you and your children for you to maintain this treatment plan... What's SSD? Nothing to worry about. Have you heard of Justina Pelletier? She's a famous person with SSD. She was sick for a long time, but now the right doctors are helping her, and we're gonna help you too..."

 

[N.A.Wright]

@N.A.Wright

Thank you so much. I am not a lawyer but speaking from my extensive experience of watching almost every episode of Law and Order, where the hell does this say we are all in mortal danger of being thrown in a psychiatric ward. If it does, I missed it but it wouldn't be the first time.

So it sounds like this bill is purely fiscal and follows state guidelines that are already in place to determine the risk/benifits of a psychiatric placement?

Barb

I'm a distant observer, but this seems like an entirely logical extension of the Federal Government acknowledging a fiscal responsibility to support citizen's health (or however Obamacare is described). The alternative to spending this money is (as far as I can see) that mentally ill people would be locked up unncessarily either in inadequate institutions or even worse in prisons. Or of course desperately ill people are left to their own devices and end up harming themselves and others, the consequences in a country with liberal gun laws being pretty obvious to everyone. No-one should be comfortable with the State being able to mandate treament, but if the only alternative is 'euthanasia by cop' then it seems by far the lesser of two evils.

With estimates of over a million people in US prisons having mental health impacts, it really looks as though the US is using prison as a substitute for proper mental health provision - expanded mandated treatment might be a somewhat more humane approach, though $60m is hardly going to scratch the surface. Psychiatry might be an inadequate specialism - but I think I'd rather deal with community based treatment than deal with US prison system if I was in some sort psycholgical crisis.

 

[Ren]

Wow. I'm truly horrified that people support this bill. My intent was to inform, so that others would be better aware of the dangers and take steps to protect themselves and loved ones. Despite what others say, I do hope people will research psychiatric abuse, the potential ease of abuse with this bill, professional and legal opinions regarding the bill, etc. P.S. I'm thankful for and fully support the US' "liberal gun laws"...

 

[N.A.Wright]

Wow. I'm truly horrified that people support this bill. My intent was to inform, so that others would be better aware of the dangers and take steps to protect themselves and loved ones. Despite what others say, I do hope people will research psychiatric abuse, the potential ease of abuse with this bill, professional and legal opinions regarding the bill, etc. P.S. I'm thankful for and fully support the US' "liberal gun laws"...

As I said I'm a distant observer so 'support' isn't what I'm offering one way or the other. It does seem like a contradiction to me though, that if you have wide availability of firearms - legal and not legal, that one would also not have measures in place to limit untreated mental illhealth within the population that has access to those firearms. It's why I used the phrase 'euthanasia by cop' because instead of seriously ill people being required to have treatment that at least limits their experience of distress and limits any impetus they may have to harm themselves and others, one just ends up with sick people being shot or imprisioned. All of which seems to me to be an abuse at least equivalent to One Flew Over The Cuckoo's Nest era US mental health care.

But mine is a far side of the Atlantic perspective. In the UK we went through a long and painful process of dealing with these issues, I doubt anyone would suggest the current situation is perfect but the submission of the Zito Trust to Parliament in 2004 gives a good outline of the thinking that led to a change in the Law -

http://www.publications.parliament.uk/pa/jt200304/jtselect/jtment/1127/1127se76.htm

http://www.legislation.gov.uk/ukpga/2007/12/part/1/chapter/4

 

[vamah]

@N.A.Wright I think your position is a bit naive. If the money were being allocated to treat, for example, diabetes, your argument would make sense, as everyone agrees on what diabetes is and how to treat it. The same can not be said of mental illness. Very little of what psychiatry does is based on solid science. The DSM V has redefined mental illness to the extent that almost anybody - in prison or not - can be said to suffer some sort of mental disorder. Most people who do suffer from menal illness are not violent and are much more likely to harm themselves than someone else.

 

[barbc56]

Each state in the US has mandated procedures for involuntary placement in a psychiatric facility. While the laws cited below are from the state of Maine, they are fairly representative of the laws in other states.

http://www.maine.gov/dhhs/samhs/mentalhealth/rights-legal/involuntary/faq/home.html

Unfortunatly, abuse does occur but these situations are most likely the exception rather than the rule. There are checks and balances in place to guarantee a patient's rights. Unfortunately, these procedural guidelines aren't necessarily motivated by purely altruistic reasons but also from the fear of being sued as the US is a highly litigious country.

Barb

 

[N.A.Wright]

@N.A.Wright I think your position is a bit naive. If the money were being allocated to treat, for example, diabetes, your argument would make sense, as everyone agrees on what diabetes is and how to treat it. The same can not be said of mental illness. Very little of what psychiatry does is based on solid science. The DSM V has redefined mental illness to the extent that almost anybody - in prison or not - can be said to suffer some sort of mental disorder. Most people who do suffer from menal illness are not violent and are much more likely to harm themselves than someone else.

Intervening to stop someone harming themselves is surely a valid intent ? The fact that most mental illhealth doesn’t involve direct violence to self or others doesn’t make concern for the occurrence of violence invalid. The families of both the victims and aggressors of the thousand plus murders carried out each year in the US by people with a diagnosable mental illness – http://www.treatmentadvocacycenter.org/problem/consequences-of-non-treatmentwould no doubt welcome greater preventative interventions.

I think it is also wrong to say that very little of what psychiatry does is not based on solid science. Much of what psychiatry as a medical discipline does is arguably not psychiatry but manipulation of brain chemistry, which may be a blunt tool but probably has the same level of scientific validity as most other drug interventions.

If the DSM were the only reference then I guess there would be a need for serious concern, but mandated treatment in the US is a legal process involving a judge and legal representation for the patient. I’m sure there should be better safeguards in the system, but where the alternatives are complete degradation of life for those who experience psychiatric crisis, the Federal appropriation seems pretty sensible.

 

[alex3619]

The whole notion of manipulation of brain chemistry, its theories and supposed science, is currently under a spotlight. Many of these treatments are no better than placebo, but the way things are reported and pushed they sound better. The science behind such treatment is also just getting started. For example, there is no credible evidence that serotonin deficiency has anything much to do with depression, yet its widely spoken about. The serotonin hypothesis was actually disproved in the 80s.

MOST psychiatry is on quicksand, not sound science. When the diagnostic categories themselves are rubbery, what stock can we put in the "science" to treat them? Watch the proliferation of books by research scientists and psychiatrists who refute many or most of the popular claims. These books are popping up all the time.

Psych treatment mostly consists of managing patient behaviour, not cures. Drugs that help by quieting patients, including putting them into a near stupor, are part of the blend. There is some science that shows that subsets of some disorders respond really well to some of the drugs available. Sadly this is generalized way too far, in part because of the abuse of the diagnostic system, which the current DSM-V appears to foster.

Allen Frances, head of DSM-IV development, is the current front-runner opposing DSM-V because it is not fit for purpose. Too many diagnostic categories have been broadened too far, so that perhaps most of the population could be diagnosed with a psych disorder now, and the only validation check is diagnostic consistency. No other checks are made by the APA to my knowledge.

In particular the broadening of psychosomatic medicine is very worrying. Many people with regular medical disorders might now get a concurrent psychosomatic diagnosis.

There does need to be more attention to psychiatric care in the community, but also psychiatric research. What people often do not realize is that somewhere, somehow, somebody pays. Usually that is society at large. Ignoring these problems is like passing on debts for others to pay.