In a 9-2 vote on Tuesday, the San Francisco Board of Supervisors approved Laura's Law, which allows judges to order involuntary outpatient treatment, including forced medication, for certain patients with a history of psychiatric illness. While adopted in 2002, Laura's Law requires authorization by local jurisdictions, so this vote made San Francisco the third jurisdiction and first major city in California to approve it. Los Angeles County is slated to decide on full implementation in the coming week.
Currently 45 states have so-called assisted outpatient treatment (or AOT) laws on the books, with varying degrees of implementation and enforcement. Some insist that such legislation is a wonderful way to "assist" people living with serious mental illnesses who refuse treatment because they lack insight into the severity of their circumstances. Others insist that such laws infringe on civil rights and further criminalize mental illness in a country where jails and prisons already serve as the largest mental health facilities.
As someone living with a serious mental illness who has been hospitalized in the past, not to mention as an attorney with a Masters in public health policy, I find these laws even more troubling for other reasons. In fact, I'd be willing to step back a bit on civil rights if such legislation truly helped people who otherwise would have sought treatment were they of sound mind. But I'm not convinced that it would. Given the current state of psychiatric medicine, such laws could very well cause more harm than good.
While the past century has brought revolutionary advances in the treatment of serious mental illnesses like bipolar disorder and schizophrenia, when it comes to medication there is still no magic bullet, and finding the right cocktail can take years. Unlike insulin for diabetics, for example, there is no single medication that will work for every patient with a given psychiatric diagnosis. Far from it.
We still know very little about how and why certain psychopharmaceuticals work for certain individuals, and given the fact that clinical psychopharmacology is still far more art than science, forcibly medicating someone could easily worsen their condition. This is especially true given the fact that that some of the medications used to treat these illnesses can actually cause the same symptoms they're intended to remedy.
Furthermore, misdiagnosis is a serious problem with psychiatric disorders, which are still generally arrived at by talking with patients, without any other physiological tests to confirm. I know this firsthand.
Like many with bipolar disorder, I was misdiagnosed for years, and as a result, I was prescribed medications that actually exacerbated my condition. As a mental health advocate, I have met countless others with similar stories, and studies confirm our experiences.
This danger, more than any other, accounts for my opposition to so-called AOT statutes like Laura's Law. It's one thing when your doctor misdiagnoses you and prescribes a medication that aggravates your condition, but it's quite another when your government forces you to comply with that doctor's misguided orders.
In addition to concerns surrounding possible civil rights violations and the potential to discourage people from seeking help voluntarily (lest that qualify them for court-ordered outpatient treatment down the line), we must also take the high risk of misdiagnosis and bad medicine into account when considering legislation that would forcibly medicate innocent individuals who represent no immediate threat to themselves or others.
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