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Mandated Meds: Yes or No?

Chris Geatch
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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, the Community 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 Act and 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.

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