For years -- over 10 to be a bit more exact-- we've had controversy here at Shrink Rap when we've talked about forced psychiatric care. It's a controversial topic not just for patients -- some who have benefited from it and some who feel injured by it, but also for psychiatrists who vary in their own views about civil liberties and medical paternalism. Ah, as I'm sure our regular readers know, it inspired us to write a book, Committed: The Battle Over Involuntary Psychiatric Care, and I do hope you'll read it.
I was pleased to read "Medicating a Prophet," in this past Sunday's New York Times. Psychiatrist Irene Hurford adds to the idea that there is not a single truth about involuntary treatment as good or bad, and that this is a complex topic where there may be more than one reality. Dr. Hurford writes:
Proponents of enforced treatment often point to horrific but rare events, like mass shootings, committed by people with mental illness. But psychosis alone is only a modest risk factor for violence. A 2009 study of more than 8,000 people with schizophrenia found that those who did not abuse drugs or alcohol were only slightly more likely than the general population to be violent.There are several studies that demonstrate that assisted outpatient treatment can reduce the risk of hospitalization, arrest, crime, victimization and violence. Few, however, are based on high-quality randomized controlled trials. A 2014 meta-analysis of three randomized-controlled studies of more than 700 people found no statistically significant benefit of enforced outpatient care in reducing hospitalizations, arrests, homelessness or improving quality of life.It can be devastating for families and doctors alike to watch psychosis seemingly claim the lives of those we love or care for. And in some situations, brief episodes of enforced inpatient or outpatient treatment may be necessary. But in my experience, weeklong inpatient stays, or yearlong outpatient treatment regimens, can do more harm than good when they engender distrust. Perhaps we must accept a new reality — to truly engage people in treatment we need to understand their own experience of psychosis and its treatment.