Last week, I explained why I believe the “dangerousness” criteria is an impediment to getting people the help that they need. One reason why civil rights activists pushed hard in the 1970s to get “dangerousness” established was because forcing someone into a state mental hospital was a draconion move. Being committed was often a de facto life prison sentence. Barbaric treatments, such as forced lobotomies, destroyed lives.
What happens today if someone is forcibly committed?
In Virginia, on average, you will spend five days or less in a locked mental ward. Your “treatment” will be medication and, if you are willing, therapy in groups where the topic will center almost exclusively on the importance of taking medication. After your five days end, you will be discharged. If you are fortunate, you will be linked to community services. But there’s a good chance that you will be released without any serious follow up.
In short, your life will have been disrupted — not only by your illness – but by the state. Yet, little will be done to actually help you recover from your disorder or help you better handle your symptoms.
This is not meaningful treatment. It explains why some critics are so adamant about clinging to the “dangerousness” criteria. Deep down, they do not believe involuntary commitments benefit anyone.
In 1959, Dr. Morton Birnbaum was studying public policy and mental illness at Harvard University in a post-doctorate program when he hit upon an idea. His proposal later became known as the “right to treatment” argument. Put simply, Dr. Birnbaum argued that if the state decided to deprive a citizen of his liberty, the state was then obligated by the U.S. Constitution to provide that individual with real and effective treatment. 
I interviewed Dr. Birnbaum for my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, and he told me that his goal had been to force state legislatures to provide meaningful services to patients in mental hospitals. Unfortunately, the civil rights lawyers – who initially teamed-up with Birnbaum and then took over the legal cases that Birnbaum [who was both an attorney and medical doctor] had filed — had a different agenda. They wanted to close down all state hospitals.
Dr. Birnbaum eventually broke away from these legal activists who went on to play a key role in the deinstitutionalization movement.
I believe that the best way to rid ourselves of the ill-conceived “dangerousness” criteria, is by actually offering meaningful help to people who need it. If we accomplished that in our communities, the number of forced commitments would drop and the commitment process would be seen more as a gateway to recovery than a punishment.
What we need is a national, legal standard that would define meaningful treatment.
Let me give you an illustration. Before I wrote CRAZY, I spent a considerable amount of my career writing about jails and prisons. I was a reporter in Tulsa, Oklahoma, in the 1970s when a federal judge took control of the state’s poorly funded prisons and forced the state legislature to spend tax dollars to improve living conditions in them. I also wrote about class actions lawsuits that activists filed on behalf of inmates. Over time, a national standard was adopted. Prisoners won the right to attend religious services, live in a minimum amount of square feet, have access to medical and dental care, eat well balanced meals and regularly shower and exercise.
The civil rights movement in mental health that happened in the 1970s and 1980s was geared — not at winning patients the right to better treatment — but in protecting them from being forced to accept any treatment. At that time, that may have seemed sensible. Is it now?
Why, I wonder, can’t Dr. Birnbaum’s “right to treatment” theory be used to guarantee specific rights to anyone who is involuntarily committed? Why is there no national standard that spells out what services an ill person MUST be provided?
I’m not only talking about access to medications. I’m talking about requiring states to provide evidence based practices, such as excellent case management, access to assertive community treatment teams, Housing First opportunities, peer-to-peer support, transportation and other wrap-around services.
Since writing CRAZY, I have seen dozens of successful recovery programs and I have come to believe that most people who show the symptoms of a serious mental disorder can get better — especially when they get meaningful treatment. Is there a way that we can use Dr. Birnbaum’s “right to treatment” claim to force states to provide the best — not minimal – services to persons who are committed? Can’t we argue that to do anything less is to deny that patient’s legal right to treatment?
What I am proposing it not a new idea. In fact, it is what Dr. Birnbaum’s hoped would happen decades ago when he first coined the term. It’s about time we listened to him.
What do you think? What sort of national standard would you envision?
About the author:
About the author: Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.
