Battle lines have been drawn over involuntary treatment. On one side are those who oppose involuntary psychiatric treatments under any condition. Activists who take up this cause often don’t acknowledge that psychiatric symptoms can render people dangerous to themselves or others, regardless of their civil rights. On the other side are groups pushing for increased use of involuntary treatment. These proponents are quick to point out that people with psychiatric illnesses often don’t recognize that they are ill, which (from their perspective) makes the discussion of civil rights moot. They may gloss over the sometimes dangerous side effects of psychiatric medications, and they often don’t admit that patients, even after their symptoms have abated, are sometimes unhappy that treatment was inflicted upon them.
In Committed, psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy—all within the context of civil rights—Miller and Hanson illuminate the personal consequences of these controversial practices through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it.
The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions—mental health court, crisis intervention training, and pretrial diversion—that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public.
"A highly informative and surprisingly balanced book that should be read by anyone with a personal or professional stake in how the mental health system provides care to those with chronic severe illnesses and those in acute crisis... Although Committed explores a complex subject, Miller and Hanson make a great effort to humanize this discussion."
— Washington Post
"Exceptionally intelligent, clear, readable and well researched."
— Psychology Today
"This fact-filled, open-minded, and straightforward survey will interest students of the subject and those serving mentally ill clients."
— Library Journal
"Committed is a very informative and thought-provoking book... Highly recommended. All readers."
"A compelling, exceptionally well-researched and written analysis of the immensely complicated, multifaceted issues faced by families, physicians, psychiatrists, police, the courts and society when mental illness endangers patients and those around them."
— Johns Hopkins Medicine
"It is refreshing—indeed therapeutic—to encounter a thoughtful, balanced treatment of this contentious and important topic."
— Psychiatric Times
"This is quite a feat in 265 readable pages. I applaud the authors for their work."
— Mad In America
"I would recommend [Committed] to every clinician."
"A very well-written review of the current state of involuntary treatment for persons with mental illness in the United States."
— Anita Smith Everett, MD, Johns Hopkins University School of Medicine, President-Elect of the American Psychiatric Association
"Reading this book is like attending a seminar, with each chapter representing the best guest speakers from around the country on that particular issue. To have brought together all of these points of view through direct interviews in a single text is a great achievement."
— Bruce J. Cohen, MD, University of Virginia School of Medicine
"While practical information gives Committed its spine, it is the emotions that we feel in reading patients’ firsthand accounts that prick at the conscience."
— Pete Earley, author of Crazy: A Father’s Search through America’s Mental Health Madness
"In Committed, the voices of people with mental illness, family members, and clinicians paint a picture of the ethical complexity of involuntary psychiatric treatment. The authors show that the system for helping individuals with serious mental illness remains broken, and policy makers would be well advised to read this book before offering one-dimensional solutions."
— Dominic A. Sisti, director, Scattergood Program for Applied Ethics of Behavioral Health Care, Perelman School of Medicine, University of Pennsylvania
Table of Contents:
Foreword by Pete Earley ix
Before We Get Started xv
Part I The Patients 1
1 Eleanor and the Case against Involuntary Hospitalization 3
2 Lily and the Case for Civil Commitment 9
Part II The Battleground 17
3 In Favor of Involuntary Treatments 19
E. Fuller Torrey and the Treatment Advocacy Center 20
Ronald Honberg and the National Alliance on Mental Illness 24
Paul Summergrad and the American Psychiatric Association 29
4 Against Involuntary Treatments 34
Citizens Commission on Human Rights 34
Celia Brown, Janet Foner, and MindFreedom International 36
Daniel Fisher and the National Empowerment Center 42
Ira Burnim and the Bazelon Center for Mental Health Law 46
Part III Civil Rights 51
5 Eleanor, Lily, and the Process of Civil Commitment 53
6 Christina Schumacher and the History of Civil
Commitment Laws 61
Part IV The Hospital 75
7 Scott Davis on Law Enforcement and Crisis
Intervention Teams 77
8 Leonard Skivorski and the Emergency Department 95
9 Eleanor’s Hospital Experience 113
10 Ray DePaulo and Inpatient Psychiatry at a
University Hospital 122
11 Steven Sharfstein, Bruce Hershfield, and Free-Standing
Psychiatric Hospitals 133
12 Annette Hanson and the Use of Seclusion and Restraint 141
13 Anthony Kelly and Involuntary Medications 151
14 Jim and Involuntary Electroconvulsive Therapy 164
Part V Involuntary Outpatient Commitment 177
15 Marsha and Outpatient Civil Commitment 179
16 Outpatient Commitment on the Books 186
17 Jack Lesser and Mental Health Courts 200
Part VI A Danger to Self or Others 213
18 Dan, Guns, and Mental Illness 215
19 Bryan Stanley, Violence, and Psychiatric Illness 228
20 Amy and Involuntary Treatment for Suicide Prevention 239
21 Will Forcing Treatment on People with Psychiatric Disorders
Prevent Mass Murders? 247
Part VII Future Directions 255
22 Transforming the Battleground 257
About the Author:
Dinah Miller, MD, is a psychiatrist in Baltimore, where she is an assistant professor of psychiatry at Johns Hopkins School of Medicine.
Annette Hanson, MD, is an assistant professor of psychiatry at the University of Maryland School of Medicine and Johns Hopkins University School of Medicine. Drs. Miller and Hanson are coauthors of Shrink Rap: Three Psychiatrists Discuss Their Work.