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The effects of involuntary commitment and involuntary medication on individuals with serious mental illnesses - Backgrounder

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Patients with psychiatric disorders refuse medications for a variety of reasons, including experience with, or fear of, side effects. In other cases, the refusal is based on a lack of awareness of illness (anosognosia) or on delusional beliefs.

Backgrounder
Updated March 2011


SUMMARY: Some people have claimed that involuntarily committing or medicating individuals with serious mental illnesses causes devastating and long-lasting effects on the person and leads to widespread lack of cooperation with future treatment. Follow-up studies of such individuals do not support this claim. In most such studies, the majority of patients subjected to involuntary commitment or involuntary medication retrospectively agreed with the treatment or were neutral about it.

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  • In 2005, researchers conducted face-to-face interviews with 76 assisted outpatient treatment (AOT) recipients to assess their opinions about the program, perceptions of coercion or stigma associated with the court order, and quality of life as a result of AOT. After they received treatment, interviewed recipients overwhelmingly endorsed the effect of the program on their lives:

∙          75 percent reported that AOT helped them gain control over their lives

∙          81 percent said that AOT helped them to get and stay well

∙          90 percent said AOT made them more likely to keep appointments and take medication

Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment (New York: Office of Mental Health, March 2005).

  • In 2004, interviews were conducted with 104 individuals with schizophrenia and related disorders regarding their feelings about involuntary (assisted outpatient) treatment. Such mandated treatment was regarded as being effective by 62 percent and as being fair by 55 percent of these individuals. Those who had awareness of their own illness (insight) were much more likely to regard mandated treatment as fair.

Swartz MS, Wagner HR, Swanson JW et al. Consumers’ perceptions of the fairness and effectiveness of mandated community treatment and related pressures. Psychiatric Services 2004;55:780–785.

  • In 2003 in New York, 117 individuals with severe mental illness were followed up for 11 months after discharge from a psychiatric hospital. Those who perceived themselves as being forced to take medication (“high perceived coercion”) were compared with those who did not perceive themselves as being forced to take medication. At the end of 11 months, there were no differences between the two groups in their adherence to medication.

Rain SD, Steadman HJ, Robbins PC. Perceived coercion and treatment adherence in an outpatient commitment program. Psychiatric Services 2003;54:399–401.

  • In 1996, 30 patients who had been forcibly medicated during their psychiatric hospitalization were interviewed by telephone one to two weeks later by individuals who had not been involved in their treatment. Eighty-seven percent of the patients had been diagnosed with schizophrenia or bipolar disorder. Among the refusers, 30 percent recalled having refused the medication because they had believed there was nothing wrong with them, and 20 percent said they had refused because they had believed the medication was poison.

Retrospectively, 18 patients (60 percent) said that having medication forced was a good idea, 9 (30 percent) disagreed, and 3 (10 percent) were unsure. Most of those who disagreed had either paranoid schizophrenia or bipolar disorder with grandiosity. The authors concluded that "forced medication frequently restores the capacity to make competent decisions and often results in a more rapid return of freedom to be discharged from involuntary hospitalization."

Greenberg WM, Moore-Duncan L, Herron R. Patients’ attitudes toward having been forcibly medicated. Bulletin of the American Academy of Psychiatry and the Law 1996;24:513–524.

  • In 1995, 28 outpatients who "had felt pressured or forced to take psychiatric medications within the past year" were administered a questionnaire by their peers. Diagnostically, they were part of a larger group of users of psychosocial rehabilitation centers in which 52 percent of those with known diagnoses had schizophrenia or bipolar disorder. Only 2 of the 28 had actually been physically forced to take medication. In reply to questions about how they felt about having been pressured to take medications, 9 (32 percent) were positive, 9 (32 percent) expressed mixed views, 6 (21 percent) reported no effect, and 3 (11 percent) reported a negative effect. In addition, 12 patients (43 percent) said that "the experience gave them a sense that people were looking out for their best interest." The authors also noted that "only a few respondents said that past experiences of pressured or forced medication had had any effect on their subsequent willingness to take medication."

Lucksted A, Coursey RD. Consumer perceptions of pressure and force in psychiatric treatments. Psychiatric Services 1995;46:146–152.

  • In addition to the above American studies, there are numerous recent studies from other countries that also report that involuntary treatment does not have severe adverse effects for most individuals who have experienced it. Examples of such studies include:

Katsakou C, Bowers L, Amos T et al. Coercion and treatment satisfaction among involuntary patients. Psychiatric Services 2010;61:286–292.

Priebe S, Katsakou C, Amos T et al. Patients’ views and readmissions 1 year after involuntary hospitalisation. British Journal of Psychiatry 2009;194:49–54.

Opjordsmoen S, Friis S, Melle I et al. A 2-year follow-up of involuntary admission’s influence upon adherence and outcome in first-episode psychosis. Acta Psychiatrica Scandinavica 2010;121:371–376.

Owen GS, David AS, Hayward P et al. Retrospective views of psychiatric in-patients regaining mental capacity. British Journal of Psychiatry 2009;195:403–407.

McKenna BG, Simpson AIF, Coverdale JH. Outpatient commitment and coercion in New Zealand: a matched comparison study. International Journal of Law and Psychiatry 2006;29:145–158.

Steinert T, Schmid P. Effect of voluntariness of participation in treatment on short-term outcome of inpatients with schizophrenia. Psychiatric Services 2004;55:786–791.

Copyright 2011 Treatment Advocacy Center - reproduction permitted with attribution

 
 

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