DOCSLIB.ORG

Overriding Mental Health Treatment Refusals: How Much Process Is “Due”?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Overriding Mental Health Treatment Refusals: How Much Process Is “Due”? Saint Louis University Law Journal Volume 52 Number 2 (Winter 2008) Article 7 2008 Overriding Mental Health Treatment Refusals: How Much Process is “Due”? Samuel Jan Brakel Isaac Ray Forensic Group, LLC, [email protected] John M. Davis M.D. University of IL at Chicago, [email protected] Follow this and additional works at: https://scholarship.law.slu.edu/lj Part of the Law Commons Recommended Citation Samuel J. Brakel & John M. Davis M.D., Overriding Mental Health Treatment Refusals: How Much Process is “Due”?, 52 St. Louis U. L.J. (2008). Available at: https://scholarship.law.slu.edu/lj/vol52/iss2/7 This Article is brought to you for free and open access by Scholarship Commons. It has been accepted for inclusion in Saint Louis University Law Journal by an authorized editor of Scholarship Commons. For more information, please contact Susie Lee. SAINT LOUIS UNIVERSITY SCHOOL OF LAW OVERRIDING MENTAL HEALTH TREATMENT REFUSALS: HOW MUCH PROCESS IS “DUE”? SAMUEL JAN BRAKEL* and JOHN M. DAVIS, M.D.** ABSTRACT Getting mental health treatment to patients who need it is today a much belegaled enterprise. This is in part because lawmakers have a skewed view of the enterprise, in particular regarding the treatment of patients with antipsychotic medications. The properties and uses of these medications are misunderstood by many in the legal community, with the drugs’ undesirable side effects typically overstated and the remedial effects undersold when not outright ignored. One specific legal effect has been to accord to mental patients a substantively outsized right to refuse treatment that comes with a correspondingly action-stifling dose of procedural safeguards, this despite the patients’ frequent lack of capacity to exercise the right wisely and the bad personal and systemic consequences that flow from that. The purpose of this Article is to provide better balanced and accurate evidence of the properties of antipsychotic drugs so as to convince lawmakers and advocates for the mentally disabled that it is safe to roll back some of the more counterproductive legal strictures on the effort to provide mental health treatment. An analysis of selected cases and statutes is intended to illustrate that such a roll back can and should be applied to a variety of legal and institutional contexts. * Isaac Ray Forensic Group, LLC; Adjunct Professor of Law, DePaul University College of Law; J.D., 1968, University of Chicago; B.A., 1965, Davidson College. ** Gilman Professor of Psychiatry, University of Illinois, Chicago; M.D., 1960, Yale University; B.A., 1956, Princeton University. 501 SAINT LOUIS UNIVERSITY SCHOOL OF LAW 502 SAINT LOUIS UNIVERSITY LAW JOURNAL [Vol. 52:501 TABLE OF CONTENTS INTRODUCTION .............................................................................................. 502 I. OF TYPICALS AND ATYPICALS: THE OLD AND NEW MEDICAL DATA ........................................................................................ 506 II. ONCE AGAIN: WHAT IS THE LEGAL DEBATE ABOUT? ............................. 524 III. WHERE WERE WE IN 1991? .................................................................... 529 A. The Bad News in the Civil Commitment Context ........................ 531 B. Troublesome Criminal Competency Cases ................................. 541 C. Some Good News: Revised Judgments on Medicating the Restorable Accused and the Convicted ....................................... 545 IV. ZINERMON, RIGGINS, AND SELL: THE SUPREME COURT RETREATS? ....... 550 V. LEGISLATIVE PROCESS AND PROGRESS .................................................... 568 A. Increased Treatment Focus in Commitment Statutes ................. 571 1. Persistence of Dangerousness as the Sole Commitment Criterion and Four Deviations .............................................. 571 2. Secondary, Psychiatry-Focused Reforms ............................. 575 B. Outpatient “Commitment” Laws ................................................ 578 C. The ADA, Olmstead, and the “Conversion” Of Justice Kennedy ...................................................................................... 582 CONCLUSION .................................................................................................. 584 INTRODUCTION In 1991 we published an article in the Indiana Law Review entitled Taking Harms Seriously: Involuntary Mental Patients and the Right to Refuse Treatment.1 In it we argued that extending a legal right to refuse mental health treatment, at least in the sense of its being protected by potentially multiple judicial hearings, to involuntarily committed mental health patients was a legal and logical anomaly—one that had bad consequences for those patients who exercised the right, not to mention their fellow patients, the hospital doctors, and the institutions in which the patients were (ware)housed.2 We felt, somewhat naively perhaps, that the reason the law was askew stemmed from the lack of good medical information on the part of lawyers, judges, and legislators and that rectifying the situation required the presentation in an appropriate legal forum of such information.3 Everyone’s eyes would be opened and the law would change in the direction warranted by our confidence 1. Samuel Jan Brakel & John M. Davis, Taking Harms Seriously: Involuntary Mental Patients and the Right to Refuse Treatment, 25 IND. L. REV. 429 (1991). 2. Id. at 430 & n.6. 3. Id. at 437–41. SAINT LOUIS UNIVERSITY SCHOOL OF LAW 2008] OVERRIDING MENTAL HEALTH TREATMENT REFUSALS 503 in the medical facts—that the antipsychotic drugs predominantly used in treatment were highly efficacious and with nowhere near the negative side effect profiles portrayed by anti-psychiatric alarmists.4 There has been some success in the realization of this hope, though pinning much or any of it on the publication and dissemination of a legal academic article would be presumptuous.5 There has been progress in the law in the sense that the cases and statutes today are somewhat more likely than a decade or so ago to reflect an appropriate appreciation of what the medications can do, and what they will not do, in multiple contexts.6 Whether the issue is civil commitment and treatment (inpatient or outpatient), treatment in the criminal justice-mandated context of competency commitments (whether pretrial or pre- sentence), or post-conviction treatment in the prison setting, medical authority to medicate unwilling patients has expanded overall while judicial review has been relegated to a lesser and later “post-deprivation” role—a realignment of power that one would surmise has much to do with better knowledge of the large benefits versus relatively small costs in potential negative consequences of the medications.7 At the same time, however, there has been some jurisprudential backsliding as well, including at the U.S. Supreme Court, where a small number of decisions have been handed down and some language articulated that seems to give new life to what one had hoped was the moribund view of psychotropic drugs as predominantly harmful and the accompanying disbelief in the competence and integrity of doctors to appropriately prescribe them.8 Given the thus still uneven, not to say precarious, lay of the legal landscape on treatment refusals, we feel it is timely to do a reprise of sorts of our 1991 article and to present once again what we believe is a true picture of the risks and benefits of antipsychotic medications. It is a picture that in many respects is and can be more optimistic than before, consistent with another set of major advances over the last ten to fifteen years in psychiatric medicine, in particular, the development of the so-called atypicals, a new line of antipsychotic drugs with higher benefit potential and fewer risks than the “old” medications, and continuing improvement in their usage.9 4. Id. at 440–41. 5. Indeed, it would be demonstrably wrong: (1) what success there is has been slow in coming and uneven; (2) the article has not been cited with great frequency, its appeal apparently being limited mostly to the already converted; and (3) the achievement of significant legal change tends to require a combination of many factors and forces, among which academic writings may play a role but not usually a prominent one. 6. See infra Parts IV & V. 7. See infra Part III.C. 8. See infra Part IV. 9. See infra Part I. SAINT LOUIS UNIVERSITY SCHOOL OF LAW 504 SAINT LOUIS UNIVERSITY LAW JOURNAL [Vol. 52:501 Unlike last time when we avoided engaging the medication skeptics on their terms, this time around we will get into the legal arguments these skeptics are prone to advance. After all, most of the skeptics are lawyers and this is their game. Further, it is the law that rules what doctors can do, not their medical axioms, ethics, or habits. Also, whether an optimist by inclination or more of a realist, one can hardly hope to persuade the unpersuaded with “inconvenient” facts alone. The facts do matter, both qualitative and quantitative, but only in conjunction with a challenge to theoretical positions staked out and with an overt, that is, compensated for, appreciation of how readily the facts can be disregarded or manipulated by the theoretically pre- positioned and pre-disposed.10 Also unlike last time, when we limited our observations and conclusions to the civil commitment context leaving to implication the wider message that we knew was there, this time we are more willing to spell out the implications for other legal contexts. It comes with the territory of engaging
Load more

Recommended publications
  • A Guide for Implementing Assisted Outpatient Treatment
    A Guide for Implementing Assisted Outpatient Treatment JUNE 2012 Created for mental health professionals to implement assisted outpatient treatment for individuals with severe mental illness 1 “A Guide for Implementing Assisted Outpatient Treatment” © 2012 by the Treatment Advocacy Center Written by Rosanna Esposito, Jeffrey Geller and Kristina Ragosta The Treatment Advocacy Center is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illness. The organization promotes laws, policies and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder. Comments on Assisted Outpatient Treatment FROM A PARTICIPANT I never knew I could feel so well. FROM A PARENT Without AOT, my son would either be in jail or dead … It alone has made a difference for him by helping him to stay on his meds. FROM A JUDGE [Assisted outpatient treatment] has provided life-saving services to individuals suffering from mental illness … and has reduced the need for action by law enforcement, medical emergency personnel, and the Courts, and lessens the trauma and anguish of family and friends. FROM A MENTAL HEALTH PROFESSIONAL The clients involved in [AOT] were given the opportunity to recover at home with the support of their families and, by doing so, avoided being sent to the state hospital … The successes achieved by these individuals are inspiring; watching these people move forward in their lives was one of the most rewarding experiences of my career. For additional testimonials please see pages 53-56.
    [Show full text]
  • The Use of Conservatorships and Adult Guardianships and Other Options in the Care of the Mentally Ill in the United States
    The Use of Conservatorships and Adult Guardianships and Other Options in the Care of the Mentally Ill in the United States By: Robert Barton, Esq., Stacie Lau Esq., and Lydia L. Lockett, Esq.* Family Members as Guardians for Mentally Ill Patients World Guardianship Congress May 29, 2014, Arlington, VA TABLE OF CONTENTS Page I. INTRODUCTION ...............................................................................................................1 II. PREVALENCE OF MENTAL ILLNESS IN THE UNITED STATES .............................1 A. Types of Mental Illness ............................................................................................1 1. Anxiety disorders .........................................................................................2 2. Schizophrenia ...............................................................................................2 3. Dementia ......................................................................................................3 4. Eating Disorders ...........................................................................................4 5. Addiction Disorders .....................................................................................4 B. Defining Mental Illness/Incapacity ..........................................................................5 1. Daily Activities v. Communicative Ability .................................................5 2. Undue influence ...........................................................................................6 3. Isolated
    [Show full text]
  • Title 35 Public Health and Safety
    TITLE 35 - PUBLIC HEALTH AND SAFETY CHAPTER 1 - ADMINISTRATION ARTICLE 1 - IN GENERAL 35-1-101. Local contributions; disposition. All monies paid to the state treasurer representing contributions by city councils, county commissioners, trustees of school districts, or other public agencies, for public health purposes, shall be set up and designated on the books of the state treasurer in a separate account, and shall be expended and disbursed upon warrants drawn by the state auditor against said account when the vouchers therefor have been approved by the department of health. 35-1-102. Sanitation of public institutions. It shall be the duty of the officers, managers, superintendents, proprietors and lessees of all hospitals, asylums, infirmaries, prisons, jails, schools, theaters, public places and public institutions to remedy any and all defects relating to the unsanitary condition of such institution, or institutions, as may be under their control, when such defects shall have been called to their attention in writing by the department of health. 35-1-103. Neglect or failure of officials to perform duty. Any member of the department of health, any county health officer, or any officer, superintendent, or principal of any city, town, county or institution named in this act, who shall fail or neglect to perform any of the duties herein required of them, shall be guilty of a misdemeanor and upon conviction thereof shall be fined in the sum of not less than one hundred dollars ($100.00) nor more than one thousand dollars ($1,000.00), or shall be confined in the county jail for a period of not less than six (6) months, nor more than a year, or both.
    [Show full text]
  • Paternalism, Civil Commitment and Illness Politics: Assessing the Current Debate and Outlining a Future Direction
    Journal of Law and Health Volume 7 Issue 2 Article 3 1993 Paternalism, Civil Commitment and Illness Politics: Assessing the Current Debate and Outlining a Future Direction Bruce A. Arrigo University of Delaware Follow this and additional works at: https://engagedscholarship.csuohio.edu/jlh Part of the Health Law and Policy Commons, and the Law and Psychology Commons How does access to this work benefit ou?y Let us know! Recommended Citation Bruce A. Arrigo, Paternalism, Civil Commitment and Illness Politics: Assessing the Current Debate and Outlining a Future Direction, 7 J.L. & Health 131 (1992-1993) This Article is brought to you for free and open access by the Journals at EngagedScholarship@CSU. It has been accepted for inclusion in Journal of Law and Health by an authorized editor of EngagedScholarship@CSU. For more information, please contact [email protected]. PATERNALISM, CIVIL COMMITMENT AND ILLNESS POLITICS: ASSESSING THE CURRENT DEBATE AND OUTLINING A FUTURE DIRECTION BRUCE A. ARRIGO 1 I. INTRODUCTION .................................... 132 II. HISTORICAL BACKGROUND ........................... 135 II. WHEN THE COURTS AND PSYCHIATRY SPEAK FOR THE CITIZEN/ O UTSIDER ........................................ 142 A. On The Meaning of Mental Illness ................ 142 B. Pitfalls in PredictingDangerousness .............. 144 C. The Gravely Disabled Criterion ................... 145 IV. CAUGHT IN THE CROSSFIRE: PSYCHIATRIC TREATMENT AND A PREFERENCE FOR LIBERTY ........................... 148 A. The Right to Refuse Antipsychotic Medications ...... 148 B. The Least Restrictive Alternative Doctrine .......... 151 C. Involuntary Outpatient Civil Commitment ......... 154 V. THE POLITICS OF ABANDONMENT ........................ 157 VI. THE THREE FORMS OF PATERNALISM ..................... 157 A . Social Control ................................ 157 B. Custody ..................................... 159 C. Treatment ................................... 160 VII. RECOMMENDATIONS .................................. 161 A .
    [Show full text]
  • Antipsychiatry Movement 29 Wikipedia Articles
    Antipsychiatry Movement 29 Wikipedia Articles PDF generated using the open source mwlib toolkit. See http://code.pediapress.com/ for more information. PDF generated at: Mon, 29 Aug 2011 00:23:04 UTC Contents Articles Anti-psychiatry 1 History of anti-psychiatry 11 Involuntary commitment 19 Involuntary treatment 30 Against Therapy 33 Dialectics of Liberation 34 Hearing Voices Movement 34 Icarus Project 45 Liberation by Oppression: A Comparative Study of Slavery and Psychiatry 47 MindFreedom International 47 Positive Disintegration 50 Radical Psychology Network 60 Rosenhan experiment 61 World Network of Users and Survivors of Psychiatry 65 Loren Mosher 68 R. D. Laing 71 Thomas Szasz 77 Madness and Civilization 86 Psychiatric consumer/survivor/ex-patient movement 88 Mad Pride 96 Ted Chabasinski 98 Lyn Duff 102 Clifford Whittingham Beers 105 Social hygiene movement 106 Elizabeth Packard 107 Judi Chamberlin 110 Kate Millett 115 Leonard Roy Frank 118 Linda Andre 119 References Article Sources and Contributors 121 Image Sources, Licenses and Contributors 123 Article Licenses License 124 Anti-psychiatry 1 Anti-psychiatry Anti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing, Thomas Szasz and, in Italy, Franco Basaglia. The term was first used by the psychiatrist David Cooper in 1967.[1] Two central contentions
    [Show full text]
  • Mental Health Commitment Laws: a Survey of the States
    Mental Health Commitment Laws A Survey of the States February 2014 Research from the Treatment Advocacy Center 1 Mental Health Commitment Laws A Survey of the States Brian Stettin, Esq. Policy Director, Treatment Advocacy Center Jeffrey Geller, M.D. Professor of Psychiatry Member of the Board, Treatment Advocacy Center Kristina Ragosta, Esq. Director of Advocacy, Treatment Advocacy Center Kathryn Cohen, Esq. Legislative and Policy Counsel, Treatment Advocacy Center Jennay Ghowrwal, MHS Research and Communications Associate, Treatment Advocacy Center © 2014 by the Treatment Advocacy Center The Treatment Advocacy Center is a national nonprofit organization dedicated exclusively to eliminating barriers to the timely and effective treatment of severe mental illness. The organization promotes laws, policies and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder. 2 TACReports.org/state-survey EXECUTIVE SUMMARY The tragic consequences of ignoring the needs of individuals with the most severe mental illness who are unable or unwilling to seek treatment are on vivid display nationwide: on our city streets, where an estimated quarter million people with untreated psychiatric illness roam homeless; in our jails and prisons, which now house 10 times as many people with severe mental illness than do our psychiatric hospitals; in our suicide and victimization statistics, where individuals with psychotic disorders are grossly overrepresented; and in our local news, which reports daily on violent acts committed by individuals whose families struggled vainly to get them into treatment. In the U.S., primary responsibility for treatment of this vulnerable and at-risk population falls to state and local governments.
    [Show full text]
  • Involuntary Outpatient Commitment and Related Programs of Assisted Outpatient Treatment 1
    APA Resource Document RESOURCE DOCUMENT ON INVOLUNTARY OUTPATIENT COMMITMENT AND RELATED PROGRAMS OF ASSISTED OUTPATIENT TREATMENT 1 Prepared by the Council on Psychiatry and Law: Marvin S. Swartz, M.D. Steven K Hoge, M.D. Debra A. Pinals, M.D. Eugene Lee, M.D. Li-Wen Lee, M.D. Mardoche Sidor, M.D. Tiffani Bell, M.D. Elizabeth Ford, M.D. R. Scott Johnson, M.D. Approved by the Joint Reference Committee, October 2015 "The findings, opinions, and conclusions of this report do not necessarily represent the views of the officers, trustees, or all members of the American Psychiatric Association. Views expressed are those of the authors." -- APA Operations Manual. Involuntary outpatient commitment is a form of court-ordered outpatient treatment for patients who suffer from severe mental illness and who are unlikely to adhere to treatment without such a program. It can be used as a transition from involuntary hospitalization, an alternative to involuntary hospitalization or as a preventive treatment for those who do not currently meet criteria for involuntary hospitalization. It should be used in each of these instances for patients who need treatment to prevent relapse or behaviors that are dangerous to self or others. Executive Summary, Conclusions and Recommendations In 1987, the American Psychiatric Association’s Task Force Report on Involuntary Outpatient Commitment endorsed its use under certain circumstances (1) and reiterated its endorsement in the 1999 Resource Document on Mandated Outpatient Treatment (2). During the decades since publication of the 1987 Task Force Report, outpatient commitment has received a great deal of 1 Outpatient court-ordered treatment may be referred to as ‘assisted outpatient treatment’, ‘involuntary outpatient commitment’, ‘mandated community treatment’, or ‘community treatment orders’.
    [Show full text]
  • Involuntary Commitment to Outpatient Treatment © American Psychiatric Association, All Rights Reserved Page 1 of 10
    TABLE OF CONTENTS Involuntary Outpatient Treatment . 1 Surveys of Outpatient Commitment Statutes . 2 Studies of Outpatient Commitment . 2 The Impact of Recent Statutory Changes . 4 Implications for the Future Use of Outpatient Commitment . 5 Proposed Supplement to American Psychiatric Association . 6 Guidelines for Legislation on the Psychiatric Hospitalization of Adults References . 9 26 INVOLUNTARY OUTPATIENT TREATMENT Prior to the late 1960’s, involuntary treatment of the mentally ill was INVOLUNTARY COMMITMENT TO provided almost exclusively in long-term inpatient facilities. The majority of patients suffered from chronic illnesses for which there were no effective OUTPATIENT TREATMENT treatments which could permit many of them to be discharged into the community. Although the legal authority for commitment emanated from state statutes, the process, essentially dominated by clinicians, held few REPORT OF THE TASK FORCE ON procedural protections for patients facing commitment (1). INVOLUNTARY OUTPATIENT With the growing availability of effective treatment for chronic mental illnesses in the 1960’s, the community mental health movement and COMMITMENT advocates concerned with patients’ civil rights worked for the deinstitutionalization of as many hospitalized patients as possible (2,3). David Starrett, M.D., Chairperson Legislators were attracted to the movement by the prospect of saving Robert D. Miller, M.D. money through hospital closure and less expensive community treatment Joseph Bloom, M.D. (4). The combination of stricter commitment laws (most of which William D. Weitzel, M.D. incorporated the criterion of treatment in the least restrictive environment Robert D. Luskin, Esq., Consultant (5)) and the establishment of federally-supported community mental health centers led to a massive depopulation of the public mental hospital Publication authorized by the Board of Trustees, June 1987 system.
    [Show full text]
  • Durham Research Online
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Durham Research Online Durham Research Online Deposited in DRO: 04 September 2012 Version of attached file: Accepted Version Peer-review status of attached file: Peer-reviewed Citation for published item: Laws, Jennifer (2009) ’Reworking therapeutic landscapes : the spatiality of an ’alternative’ self-help group.’, Social science medicine., 69 (12). pp. 1827-1833. Further information on publisher’s website: http://dx.doi.org/10.1016/j.socscimed.2009.09.034 Publisher’s copyright statement: NOTICE: this is the authors version of a work that was accepted for publication in Social science medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Social science medicine, 69, 12, 2009, 10.1016/j.socscimed.2009.09.034 Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-profit purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full DRO policy for further details.
    [Show full text]
  • The Electroshock Quotationary®
    The Electroshock Quotationary® Leonard Roy Frank, Editor Publication date: June 2006 Copyright © 2006 by Leonard Roy Frank. All Rights Reserved. Dedicated to everyone committed to ending the use of electroshock everywhere and forever The Campaign for the Abolition of Electroshock in Texas (CAEST) was founded in Austin during the summer of 2005. The Electroshock Quotationary (ECTQ) was created to support the organization’s opposition to electroshock by informing the public, through CAEST’s website, about the nature of electroshock, its history, why and how it’s used, its effects on people, and the efforts to promote and stop its use. The editor plans to regularly update ECTQ with suitable materials when he finds them or when they are brought to his attention. In this regard he invites readers to submit original and/or published materials for consideration (e-mail address: [email protected]). CONTENTS Acknowledgements Introduction: The Essentials (7 pages) Text: Chronologically Arranged Quotations (146 pages) About the Editor ACKNOWLEDGEMENTS For their many kindnesses, contributions and suggestions to The Electroshock Quotationary, I am most grateful to Linda Andre, Ronald Bassman, Margo Bouer, John Breeding, Doug Cameron, Ted Chabasinski, Lee Coleman, Alan Davisson, Dorothy Washburn Dundas, Sherry Everett, John Friedberg, Janet Gotkin, Ben Hansen, Wade Hudson, Juli Lawrence, Peter Lehmann, Diann’a Loper, Rosalie Maggio, Jeffrey Moussaieff Masson, Carla McKague, Jim Moore, Bob Morgan, David Oaks, Una Parker, Marc Rufer, Sherri Schultz, Eileen Walkenstein, Ann Weinstock, Don Weitz, and Rich Winkel. INTRODUCTION: THE ESSENTIALS I. THE CONTROVERSY Electroshock (also known as shock therapy, electroconvulsive treatment, convulsive therapy, ECT, EST, and ECS) is a psychiatric procedure involving the induction of a grand mal seizure, or convulsion, by passing electricity through the brain.
    [Show full text]
  • An Analysis of Psychologist Postdoctoral Psychopharmacology
    Antioch University AURA - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Theses Dissertations & Theses 2016 An Analysis of Psychologist Postdoctoral Psychopharmacology Training Materials for Critiques of Neurobiological Hypotheses of Depression's Etiology, Critical Analyses of the DSM's Rigor, and for Consumer/Survivor/Ex- Patient Content. Chris William Nicholas Rowe Antioch University Seattle Follow this and additional works at: http://aura.antioch.edu/etds Part of the Educational Assessment, Evaluation, and Research Commons, Other Pharmacy and Pharmaceutical Sciences Commons, and the Psychology Commons Recommended Citation Rowe, Chris William Nicholas, "An Analysis of Psychologist Postdoctoral Psychopharmacology Training Materials for Critiques of Neurobiological Hypotheses of Depression's Etiology, Critical Analyses of the DSM's Rigor, and for Consumer/Survivor/Ex-Patient Content." (2016). Dissertations & Theses. 305. http://aura.antioch.edu/etds/305 This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch University Repository and Archive. For more information, please contact [email protected], [email protected]. AN ANALYSIS OF PSYCHOLOGIST POSTDOCTORAL PSYCHOPHARMACOLOGY TRAINING MATERIALS FOR CRITIQUES OF NEUROBIOLOGICAL HYPOTHESES OF DEPRESSION’S
    [Show full text]
  • Involuntary Outpatient Commitment1 Myths and Facts
    Involuntary Outpatient Commitment1 Myths and Facts Under Involuntary Outpatient Commitment (IOC), a person with a serious mental health condition is mandated by a court to follow a specific treatment plan, usually requiring the person to take medication and sometimes directing where the person can live and what his or her daily activities must include. Proponents of IOC claim that it is effective in reducing violent behavior, incarcerations, and hospitalizations among individuals with serious mental health conditions.2 However, repeated studies have shown no evidence that mandating outpatient treatment through a court order is effective; to the limited extent that court-ordered outpatient treatment has shown improved outcomes, these outcomes appear to result from the intensive services that have been made available to participants in those clinical trials rather than from the existence of a court order mandating treatment. In addition, studies have shown that force and coercion drive people away from treatment.3 “By its very nature, outpatient commitment may undermine the treatment alliance and increase consumers’ aversion to voluntary involvement with services,” according to a study cited in “Opening Pandora’s Box: The Practical and Legal Dangers of Involuntary Outpatient Commitment,” published in Psychiatric Services.4 There is ample evidence that intensive services provided on a voluntary basis can bring tremendous improvements in outcomes such as reduced hospitalizations, reduced arrests, longer tenure in stable housing, and reduced symptoms; there is no evidence that mandating outpatient services through a court order has any additional benefit. Involuntary outpatient treatment has high costs with minimal returns, is not likely to reduce violent behavior, and there are alternatives that are more effective and efficient.
    [Show full text]