tag:blogger.com,1999:blog-26666124.post1539380444859075104..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: The Kelly Case and Forced Psychiatric MedicationsUnknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-26666124.post-846982579008197432018-03-31T12:24:50.643-04:002018-03-31T12:24:50.643-04:00An assumption being made in all of this discussion...An assumption being made in all of this discussion is that the medication will work. Sometimes medications don't work, and not only that, but sometimes medications create side effects and paradoxical reactions and make the patient suffer greatly. In some cases forced medication could be seen as cruel and unusual punishment.Anonymoushttps://www.blogger.com/profile/04904948180533337535noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-68122163174369472882010-10-28T13:08:08.186-04:002010-10-28T13:08:08.186-04:00I'm a psych nurse on a forensic unit in a stat...I'm a psych nurse on a forensic unit in a state hospital. This is a huge concern and actually tends to lengthen the loss of liberty of patients. What is also a concern is patients found not guilty by reason of insanity. They can be held in the hospital for years and some for life. If they refuse medications they could be unmedicated for years which has shown to cause significant degeneration to brain function even if they become medicated at a later date. Emergency medications given during an episode of imminent risk are usally limited to sedatives which will have no bearing on long term mental health symptoms.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-88903622159862505782008-01-10T21:32:00.000-05:002008-01-10T21:32:00.000-05:00Kerap. I posted under the wrong account. So much ...Kerap. I posted under the wrong account. So much for protecting my anonymity! I need to get the accounts straightened out in my brain! heh<BR/><BR/>Here's my comment again:<BR/>I definitely think this is a problem. For one, it's a problem for the safety of the other patients and staff working at a maximum security facility because you're right: who is to say when and where a person's illness might make them very dangerous? Also, if the person is so dangerous as to need this secure facility but can only be forced to take medication once they are on the outside, then how will the physicians, nurses, and other staff ever know if this person is controlled on medication enough to be released? (Not necessarily this particular person, as I don't know what his terms of commitment are, but I'm referring to the average person who has the chance to be released but cannot be forced to take medication while "safe" in the facility.) Basically you can never treat this person on a stable medication regimen and enforce that they take the medication until they are doing better, so the only point in having them in the facility is simply to keep them out of society, but not to rehabilitate them. So what is the point?<BR/><BR/>I know I'm not saying anything differently than what you wrote, but still - this is just mind-boggling! I agree that people should have a choice, but when they are unable to make that choice, this seems a very bizarre and non-sensical solution from the courts.<BR/><BR/>One correction... You wrote: "This means that a person who is mentally ill and dangerous can only be forced to take medication if they are not dangerous WHILE they are in the hospital even if they would be dangerous if they were not in the hospital."<BR/><BR/>I may not be reading this correctly as it is a wordy sentence, but do you mean that a person who is mentally ill and dangerous can NOT be forced to take medication if they are not dangerous WHILE they are in the hospital even if they would be dangerous if they were not in the hospital? Or perhaps that they can ONLY be forced to take medication if they are dangerous while they are in the hospital AND dangerous while outside the hospital. Either way - something about that seems to be off...<BR/><BR/>Good topic, and I would definitely like to hear Clink and Roy chime in on it as well. I imagine that Clink can comment on the forensic psychiatry component and that Roy can comment on severely ill inpatients. Both of those perspectives would be a great addition to the topic!<BR/><BR/>Take care,<BR/>Carrie :)NeoNurseChichttps://www.blogger.com/profile/16120931307124798416noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-80743336409817237602008-01-10T20:09:00.000-05:002008-01-10T20:09:00.000-05:00Keep breathing-- thanks, I'll fix it, I just get t...Keep breathing-- thanks, I'll fix it, I just get too excited to keep my thoughts straight.<BR/><BR/>eek, abf: Maryland has different laws than Mass, and emergencies in the field are completely different then in an inpatient facility, and I've never worked at a forensic psychiatric hospital so I'll have to leave this to ClinkShrink.<BR/>Thanks for reading and commenting.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-91399615116758584922008-01-10T09:44:00.000-05:002008-01-10T09:44:00.000-05:00EEK, This is a rough one Hanid. Personally some of...EEK, This is a rough one Hanid. Personally some of the rational seems flawed to me. This is a person who was deemed incompetant to stand trial. If this is true then under what I always knew as "implied consent" the patient can be given meds because he has already been deemed "incompetant."<BR/>If he has the legal right to refuse treatment, shouldn't he then have the ability to stand trial? <BR/>Again I am not a lawyer or a shrink, but I was a paramedic, and under a number of circumstances patients can not refuse treatment. Of course this is sometimes a very grey area. For example the person having an acute MI often tries to refuse treatment, mostly out of denial. We would work very hard to convince this person to agree to treatment. If they continued to refuse, we could say that they are not rational because they are hypoxic. (this only can be said when the patient is symptomatic) and under "implied consent" we would treat them. Hypoxia being one criteria for a patient who is not legally able to refuse treatment. <BR/>Of course most medical emergencies differ, (although I have fought with many hypoglycemic patients), from psychiatric emergencies because there is a grey area here. <BR/>My point though is that this just seems like something out of "One Flew Over the Cuckoo's Nest" Where the lead character was placed in a mental institution (forgive me my lack of political correctness on the term) because he wanted to get out of going to jail. Maybe this is a stark example but it seems to fit somewhat the Kelly case. <BR/>I can see why the shrinks are pissed.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-9963987829889664752008-01-09T22:55:00.001-05:002008-01-09T22:55:00.001-05:00Oh yeah, I found you a pic of Perkins.Oh yeah, I found you a pic of Perkins.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-7658033086446656272008-01-09T22:55:00.000-05:002008-01-09T22:55:00.000-05:00We've touched on this topic before, in Dangerous O...We've touched on this topic before, in <A HREF="http://psychiatrist-blog.blogspot.com/2006/06/dangerous-on-outside.html" REL="nofollow">Dangerous On The Outside</A> and in <A HREF="http://psychiatrist-blog.blogspot.com/2006/06/side-effects-possible-death.html" REL="nofollow">Side Effect: Possible Death</A>.<BR/><BR/>The appellate court was concerned that the standard for dangerousness for involuntary medication was the same as the dangerousness standard for civil commitment. They didn't think that everyone who was committed should by definition be at risk of forced medication. Leaving someone ill and untreated, in addition to the obvious clinical risks, can leave criminally committed pretrial forensic patients in a legal limbo---never wholly free but neither guilty. In the Federal system this was addressed in Sell v. U.S., 539 U.S. 166 (2003), which developed the four Sell criteria for involuntary medication:<BR/><BR/>1. There must be an important government interest in treating the defendant<BR/>2. Medication would further that government interest<BR/>3. The medication is necessary<BR/>4. The medication is medically appropriate<BR/><BR/>Treatment of criminal defendants can also occur involuntarily if the defendant is at risk of dangerous clinical deterioration without it. This was what allowed the Feds to treat Russell Weston, the capitol shooter.<BR/><BR/>Here is a concise summary of the issues on <A HREF="http://writ.corporate.findlaw.com/cassel/20030703.html" REL="nofollow">FindLaw</A>.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-82846875183821440762008-01-09T22:10:00.000-05:002008-01-09T22:10:00.000-05:00This comment has been removed by the author.Keep Breathinghttps://www.blogger.com/profile/12787525839951616086noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-63890280500087822852008-01-09T13:36:00.000-05:002008-01-09T13:36:00.000-05:00My gut tells me everyone should have a choice. In...My gut tells me everyone should have a choice. In this case maybe the choice is psychiatric medication or jail? Maybe even solitary confinement if he/she is violent in jail.<BR/><BR/>I'm not familiar with the Kelly case, but in Canada there was a big ruling a few years back where a man with severe manic symptoms won his case against forced treatment.<BR/>...aquaAquahttps://www.blogger.com/profile/16230285017033299419noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-20531625122314235072008-01-09T12:56:00.000-05:002008-01-09T12:56:00.000-05:00YES??YES??Midwife with a Knifehttps://www.blogger.com/profile/04309579302399381913noreply@blogger.com