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Mandated Meds: Yes or No?

Mandated Meds Yes or No Chris Geatch

Chris Geatch

William Van Ornum - published on 05/29/14

The Catholic approach to mental illness.

Yet another mass murder connected with mental illness. The shooting of seven people in California by a young man obsessed with what psychologists might call “overly valued ideas” brings back reminders of Columbine, Virginia Tech, the Colorado theater shootings, and Newtown.

Of all the interventions being talked about, enforced medication on people who show the definite premonitory signs, ideations, and behavior toward violence, is one of the easiest to implement as well as being an effective deterrent to acts committed by unstable, psychotic persons not receiving psychiatric care.

Enforced medication given to people likely to harm others also has a pro-life behavior dimension. It is something that would save many lives. Pope Francis has indicated that he would like the pro-life umbrella to include new activities that would widen the definition of “pro-life activity.”

To understand the efficacy of medication, it is important to know the history of the so-called psychotropic drugs used for severe mental illness.

In 1943, a psychotic person went in for an abdominal surgery. Thorazine was used as an anesthetic. Prior to the operation, this person suffered hallucinations and delusions and probably displayed what we would now call schizophrenia. After the operation, all of the psychotic behaviors stopped.

By the early 1950s, there were several powerful antipsychotic medications that could be used to treat and sometimes put into remission the so-called positive features of psychosis: hallucinations, delusions, and other distortions of thinking.

These medications worked so well that by the mid-1960s many of the large state hospitals, some holding up to 5,000 patients, had emptied or had a very low patient counts. As one response to this, theCommunity Mental Health Act that President Kennedy proposed was passed posthumously in 1964.

Instead of living years or a lifetime in an institution, many people who were psychotic were able to live in their communities. A mental health clinic was set up in each county of the United States as part of the Community Mental Health Act. In addition, many group homes were set up where people with psychiatric problems could live and where their treatment could be monitored.

An unintended consequence of the Community Mental Health Actand the emptying of large state institutions was the ignoring of the fact that some of the patients really did need institutionalization – the kind that lasted years and years or even a lifetime. These persons did not cooperate with outpatient therapy or group home placement. Instead they went to live on the streets, and this caused many problems–one of the most severe being that many persons discontinued their medicines.

Currently, there are very few places where a person – particularly a young person – can receive ongoing treatment at the level of long-term hospitalization for serious mental illness. In those “old days” they would have lived safely apart from society in a large institution. A number of mentally ill killers in past years, had they been able to receive this treatment, might not have acted out violently.

A procedure that could be utilized in lieu  of creating another long-term hospital system is mandated medication for persons with severe mental illness – notably schizophrenia– in those who show clear and imminent signs of becoming violent toward others.

New York State has such a procedure called Kendra’s Law. This legislation was enacted after a woman was pushed onto the subway tracks by a psychotic person who had not been taking his medication. Kendra’s Law has built-in legal safeguards to prevent mistakes in the mandated medication procedure.

R. Fuller Torrey is recognized as the nation’s expert on schizophrenia. His book, "A Family Guide to Schizophrenia," is a classic for both professionals and lay readers. Dr. Torrey went into the field because his own sister suffered from a debilitating psychosis. He has devoted his entire career to helping people with schizophrenia.

Dr. Torrey believes that many people who have schizophrenia and  display threats or plans toward violence would not show those tendencies if they were on the appropriate psychotropic medication. Regarding side effects: the older psychotropic medications had these– a person could develop  tremors not unlike those in Parkinson’s disease. However, many of the newer antipsychotics pose less of a risk and side effects.

Here are suggestions that would help to implement a fair system of mandated medication and would minimize any serious mistakes:

1.  The person who is making violent threats and gestures, or – most importantly – who has the means to carry these out or has been violent in the past must be monitored. When these threats are documented by family, therapist, and physician together, the decision is made by a team and not by one particular person.

2. The judges who handle the petitions for mandated medication should be specially trained to know about psychiatric illnesses, medications, and the kinds of behaviors most likely to lead to violence. Their decisions provide another level of  review to the suggestion of the medical team.

3. A  quality assurance system should be developed in which all situations involving mandated medication are reviewed by physicians and lawyers not connected with any of the incidents.

There is legal precedent in our society for mandated medications. Vaccines can be required for school, work, or travel. Persons in the armed services receive mandated vaccines. The side effects of these are worse than using mandated psychotropic medication. Some vaccines cause severe reactions in some people when they are given in dosages across a broad population. There are even a (small) number of deaths that occur.

Society accepts this danger in order to safeguard the entire society. When mentally ill persons kill innocent bystanders social and moral imperatives demand society do what can be done to protect itself.

There is a precedent in Catholic moral theology to approving medical procedures which can carry severe or deadly consequences, a risk much greater than would occur with mandated medication. Moral theologians in the early 1950s decided that lobotomies were an acceptable risk due to the violence that could happen if no treatment was given. (In fact, a few decades ago I noted a yellowed poster in one of the waiting rooms of a hospital. It said: “Approved lobotomy surgery may be done in this hospital; however, procurement of human sperm is prohibited.”)

Catholics, recognizing that mandated medication will lead to fewer murders committed by unstable and psychotic persons who have refused treatment, can help bring laws such as Kendra’s Law into effect where legal procedures do not exist. They can help monitor existing laws to help prevent present mistakes. I suspect the Pope Francis himself would view this as an extension of pro-life thinking.

William Van Ornum is professor of psychology at Marist College and director of research and development/grants at American Mental Health Foundation in New York City. 

Mental Health
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