According to the National Alliance on Mental Illness (NAMI), 18.5 percent of Americans experienced mental illness in the past year, 4.2 percent of which interfered with their daily lives. Moreover, NAMI states adults in the United States living with serious mental illness die on average 25 years earlier than others with treatable medical conditions. Recently, Norman J. Ornstein wrote to the New York Times about his son who he believed suffered from bipolar disorder and was particularly afflicted by anosognosia, a condition that prevents a person from recognizing that he or she is ill. Ornstein felt that if he had forced his son, Matthew, to get treated for his psychotic breakdown sooner, the likelihood of him dying from the disorder would have been much lower. However, since his son was over 18, no one but Matthew had the legal authority to decide the medical treatment; and Matthew did not want to be treated. Eventually, Matthew died from carbon monoxide poisoning. The death was accidental caused by a propane lantern in his tent, but it was shaped by what Ornstein believes a lack of judgement caused by his long struggle with mental illness. In the UK, the government allows for concerned members to reach out and provide treatment for their family members or close friends. The United States does not have such policies. Here, stronger emphasis is placed on human rights, which involuntary treatment violates. Only in emergency cases in which the victim and others around would be subject to danger does the court rule involuntary treatment. Matthew’s death was the tipping point in the much-needed change in to how mental illnesses should be faced in US policy. His case did not make him a violent or dangerous individual to others, and his death did not occur in an expected or voluntary way. However, his condition was chronic and recurring, and there needs to be a more patient and less coercive way for him to be treated.
What steps should his parents have acted and what steps could they have taken in order to save their son? Mental illness can be more difficult to diagnose than physical diseases, and often we are unable to notice the symptoms. Physical illness tends to be more easily recognizable, because it limits our movement and is more visible. When a victim refuses to seek help, especially an adult victim, we may be barred from intervention because the individual holds his or her own rights. However, when one is mentally ill, we may think he or she is not capable of making responsible individual choices. Yet, the MHA (Mental Health America) organization states regardless of the illness and conditions that individuals suffering mental illnesses “deserve the same degree of personal autonomy as other citizens with disabilities when it comes to receiving services.” It also suggests that the most effective way for patients to be treated is by embracing the treatment, not through force. However, it goes farther, the MHA states “all medications pose some risks and many pose quite serious risks to health of the persons who take them, particularly when medications are taken for extended periods to treat chronic illnesses.” Therefore, it is important to exercise precaution in treating mental illnesses, and ensuring that the patients are not put at risks particularly if they are reluctant to be treated. Gabriella, a friend and sophomore at NYU believes that “we have the right to intervene, but only when it gets serious.” But how serious should a disease be for intervention? Matthew was never formally diagnosed with his illness, which makes it even worse because that further prevents him from being treated.
In the United States, the law does require mental health examinations under some situations. In order to make a will legally binding, US law requires proof of mental competence through a test provided by a psychologist. The phrase “being of sound mind and body” is frequently used in this process. In the last will and testament of the signer, the person must sign that they are fully understanding and conscious of their decision as they are in a current healthy shape in the mind and body. Accessing mental competence, as used in US law is essential to determine whether a person is able to participate in legal proceedings or transactions. It concerns whether the individual will be in a condition to be responsible for his or her decisions or acts. In England, the equivalent of this act is known as “fitness to plead” and in the United States “competence to stand.” The test in the United States in mental competence is only required for legally binding activities such as writing contracts and wills, but not for mental treatment unless under emergency conditions. In 1975, the US Supreme Court ruled in O’Connor vs. Donaldson that involuntary hospitalization and/or treatment violates the individual’s civil rights. The only conditions in which the individual exhibits dangerous behaviors result in which they are detained for 72 hours and must be treated in a the least restrictive setting possible. This ruling had severely prevented involuntary treatment in the United States. However, many states have grown to adapt Assisted Outpatient Commitment (AOC) Laws, a way to provide services for those who refuse treatment. This allows court to order individuals with mental illnesses to comply with treatment while living in the community. All but four states in the U.S. comply by the AOC laws and criterias vary by state. According to the Mental Illness Policy Organization, individuals subject to the AOC Laws are those who “often commit suicide; become homeless; end up in jail; or, on rare occasions, are involved in acts of violence,” which “family members and caregivers often must stand by helplessly and watch their loved ones and patients decompensate to actual ‘dangerousness’ before they are allowed to facilitate treatment.” Ornstein’s son, Matthew, did not commit suicide, his death was ruled to be an accident.
In the UK, the Mental Capacity Act of 2005 allows for the victim of mental illness to be treated for their illness under the Mental Health Act of 2007, and under this act bipolar counts as a mental disease as it does in the United States. According to the UK government, the act provides legal framework for treatment on behalf of adults who lack the capacity to make decisions for themselves. If the patient is not cured from chronic mental illness, the family should appoint a court to rule a non-evasive, non-restrictive and non-coercive environment for the victim to be treated. The UK strict code of conduct is to provide early stage treatment and care to those that cannot themselves. The United States, however, encourage treatment at later stages, and only so when cases are deemed to be an emergency. Matthew was not an emergency, but his father and people that cared for him should have intervened to force him to be treated. Therefore, the United States should maintain policies in reaching out and treating those with chronic and recurring mental illnesses even if it is not dangerous, or when the person does not express desire to be treated. The treatment protects the individual, their family and society from being subject to the illness. Currently a new bill introduced earlier in 2015 called the Murphy Johnson bill, provides Ornstein with hope in “financing, treatment and delivery of services across the range of mental illnesses, and in particular it has provisions aimed directly at helping those like my son (Matthew).” The bill hopes to expand funding for the AOT, but AOT needs expansion and development and more reinforcement as it had not been in Maryland, where Matthew resided. It is only a stepping stone to creating better resources for mental health, but as Ornstein said “Action by Congress would help keep other parents and siblings from suffering as we have.”
Photo courtesy of Cliff