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Promoting Stigma
By Chance Martin
After decades of neglect, our state legislature is being aggressively
lobbied to restore California's mental health system. All of the treatment
enhancements and services that are being proposed are desperately needed
and would be welcome, with one exception: an attack on the civil rights
of mentally disabled people called involuntary outpatient commitment.
Involuntary outpatient commitment is the cornerstone of AB 1800, an assembly
bill sponsored by Assemblymember Helen Thompson.
Involuntary outpatient commitment is court-mandated
medication compliance. In some cases, it can mean a person is court-ordered
to keep regular clinic appointments to receive long-lasting injections
of powerful psychiatric drugs. The consequences of non-compliance are
hospital commitment and forced drugging. These proposed legal provisions
are termed "assisted treatment." In practice, its primary victims are
poor and homeless people, particularly African-American men. In some urban
areas, homelessness itself is interpreted as proof of "grave disability,"
creating the justification to drug homeless people against their will.
In states where this policy is law, forced medication coupled with a lack
of medical supervision has led to deaths due to toxic levels of psychiatric
medication.
At New York's Bellevue hospital, a pilot study testing the viability
of involuntary outpatient commitment failed to support its advocates'
claims. A three year study of its relative effectiveness found no statistically
significant differences between the experimental group, a control group,
and those who discontinued treatment in the areas of re-hospitalization,
arrests, violence, symptomatology, or quality of life. It concluded: "there
is no indication that, overall, the court order for outpatient commitment
produces better outcomes for clients or the community than enhanced services
alone." Alarmingly, it also noted that the court procedures themselves
became perfunctory, and accountability was so lacking that renewal orders
frequently occurred without a formal hearing, despite the fact that "the
court order itself had no discernible added value in producing better
outcomes."
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The betrayal of the de-institutionalization movement in California only
became apparent when the state-funded community-based mental health services
we were promised to replace the snake pits were themselves facing extinction.
Now we are faced with a proposal to criminalize an entire community of
people based on disability. Disability isn't a choice, it's something
each of us learns to accommodate as best we can. We need to ask ourselves:
how many violent acts committed by untreated mentally ill people, however
sensationalized, might have been prevented if a comprehensive range of
voluntary, culturally appropriate community mental health services were
available?
A look at twentieth century history gives the best illustration of how
far stigmatization, scapegoating and hate can go when misrepresented as
scientific authority.
Eugenics originated as a sub-discipline of psychiatry right here in the
United States. The first compulsory sterilization laws in Germany were
modeled on American sterilization laws enacted a decade before. In the
three years from 1941-1943, over 42,000 Americans were sterilized under
the Model Eugenical Sterilization Law. California led the nation with
over 10,000 forced sterilizations (mostly persons of color). The "mental
diseases" targeted by this law were "insane," "feeble-minded," "epileptics,"
and "idiots."
The Holocaust's first victims were "mentally ill" people. The first extermination
facilities were designed and operated by psychiatrists, who later trained
the SS how to use them. In a culture where ruling authority was maintained
in the name of a higher "biological" principle, psychiatrists weren't
ordered to murder people, they were simply empowered to do so by their
government, and so they did. In 1941, 90,000 German psychiatric inmates
were murdered, 71,000 in gas chambers at psychiatric institutions.
If our generation remembers no other lesson, we must remember that no
supposed biological marker - no stigma - is reason enough to deny anyone's
liberty. We must support fully funded, community-based, VOLUNTARY mental
health treatment before we consider discarding someone else's self determination.
ĦIf it isn't voluntary, it isn't treatment!
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