Forced treatment?

What good does forced treatment do in the first place????? Many as soon as they get out of the forced treatment stop the treatment anyway because they didn't want anything to do with it in the first place or they wouldn't have gotten to the point where someone felt it was necessary to force them in the first place.......JMO.

I encountered a person who followed me on the California freeway for 40 miles.....we ended up driving to a place where we could get help rather than home. He claimed that he recognized me & wanted to make sure I got home safely.......yep, that's why he tried to run of off the road. Turned out when the sheriff's arrived that this guy claimes that the Viet Nam war was because of him......we knew immediately it was either drugs or he was dealing with a mental illness.......& sure enough he had just been released from the state care facility 2 days prior to his following me.......he definitely didn't choose to continue any treatment that he might have been forced to have......but his actions caused the police to end up involved again & they took him back to the facility he had been released from.

There was no way I would have taken the chance that he wasn't dangerous........but there are always consequences to our behavior. No one likes the drugs that are given......but not taking any medications that could help aren't the answer either......there will just end up being more & more negative consequences for these people until something seriously BAD happens. My job is to protect myself, not worry about the consequences of someone I feel might be placing my life in danger.

It's obvious that any forced treatment he might have had did absolutely no good however. One usually doesn't get cooperation out of people who are forced to do anything.

Sadly, it's usually not until they are totally out of control that they give the massive level of tranq's. If they could work with a pdoc in the first place to find the right doesage of meds that help....it propably wouldn't get to the forced treatment point in the first place.

I am sure that some also have the bad side effects like I have to almost every med.....so it's impossible for me to take AD's but sometimes we need to choose between the least of 2 evils to protect from even worse consequences......but when the mind isn't able to make those kind's of decisions rationally?????? Where do then end up in the long run......they become a product of the consequences of their actions & hopefully those actions aren't as bad as those of the guy in Aurora Co......the theater which is only 1 1/2 blocks away from where my own daughter lives & could have very well been in there with everyone else.

No not every one becomes that violent.....but sadly, we seem to find out about their violence AFTER THE FACT. Interesting how we want to control guns......& we want to control the giving of meds.....but we don't want to control the person who has the problem in the first place.

Just many thoughts on this subject with NO SOLUTION.

Well, in America, we aren't supposed to punish someone for what they might do. Yet that's what goes on with some psych treatments. Usually, a person has to show signs of wanting to do harm, but that's not always the case.

And speaking of guns...most mentally ill people aren't violent. They are U.S. citizens (in the U.S., of course), and entitled to the same freedoms as anyone else, including the right to protect oneself, yet many want to keep guns out of the hands of the mentally ill, because people fear the mentally ill. Even if a person doesn't have a violent history, "normal" people want to prevent whatever crime they perceive will happen. But we're "innocent until proven guilty," right? I can tell you a lot of people who I have predicted (rightfully and wrongfully) would perform certain behaviors, including becoming violent. Some people make trouble for others because they try to get into everyone's business, and warn the cops, "Just wait! She's going to [whatever it is this person thinks she's going to do] and then it'll be too late!" There are a lot of crimes we could prevent if we just forced people out of the general society because we think they might do something wrong. What if they did a study, and it turned out that most gun crimes weren't committed by mentally ill persons, but black people instead? Are we going to take guns from black people, even if they legally own them? If they're more likely to commit a crime, doesn't that seem to be the thing to do? That's the logic used against the mentally ill.

One thing about medications: Besides side effects, there are potential future health risks. Many medications can raise blood sugar, making someone more likely to develop diabetes. Heart problems can arise. Kidney problems. Liver problems. On and on. Nobody should be able to make the choice to put someone on medication except for the person who will be taking the meds.

Main thing that bothers me is the idea of forced meds, so far no prescription psych meds work. I know some things that do help varioius herbs and plants including one that was made legal in my state I am sure plenty of people can guess which one that is.

Of course that sort of thinking might hurt pharmaceutical companies. But yeah I don't like all their nasty addictive pills especially the ones that cause nausea that is one of the most obnoxious side effects there is...if I wanted to feel nauseous and braindead I'd get wasted and wake up early to 'enjoy' the hangover.

Thanks for the informative article...

That was always what my son did. As soon as he was out from under the thumb of the mhc, he quit his meds. And the mhc wasn't following up with him anyway. In all fairness, though, it's easy to avoid them. For a while they were sending someone out to his apartment every evening to watch him take his medication. He just made sure he wasn't home at the time they were scheduled to arrive. Easy.

It was when I realized that someone was going to have to stand guard over him for life - and that's just not possible - that my thinking on this issue evolved. Even if the meds worked great - and they don't - they can't work if the person doesn't take them. And frankly it's even worse when the person is constantly going on and off them.

Anyway I think the "treatment" DocJohn is focusing on in his article is AOT - assisted outpatient treatment - in which the patient is court-ordered to take the medication. Frankly, if the professionals, the family, and the friends of the patient can't make him take his meds, the judge likely won't be able to help either. They aren't going to send a policeman out to make him. I've seen enough people on forums talking about how they don't comply with the AOT. I'm sure my son would have been one of those. And my deepest concern was that in forcing him to run from "treatment," we were also forcing him away from the people who could protect him. The world is full of predators, and they all seem to find my son when he's psychotic. They find out he has an income from disability and that he's very confused, and they proceed to drain him financially and emotionally. The only way to keep him safe with family is to reassure him that we aren't going to force him to do things against his will.

This is a difficult subject for me. I've been "forced" in the sense that I was given the choice between 2 unattractive scenarios and in each case the best of the two bad options was agreeing voluntarily to treatment twice. In situation one, my addictions Dr. gave me the choice between going into the hospital every day to have supervised antabuse and agreeing to go into the psych hospital for a 4 week program, as soon as they had space for me, or she'd get my driver's license revoked. Since it can take up to a year to get your license back, I chose the supervised meds, and psych hospitalization. In situation two, I had to agree to do a 3 week IOP program or be put on a form which could have led to hospitalization for who knows how long. This again was by my addictions Dr. My psychiatrist didn't feel I needed to be in the hospital.

In hindsight, both treatments were good for me, as I was more out of control than I could really see at the time, so while I resented, hated, and to an extent resisted treatment, eventually I could see the point, cooperated, and got the help I needed.

Without those interventions I'd probably be dead.

In my last round of depression, where I did OD, my psychiatrist cooperated with me, to keep me out of the hospital unless it was absolutely a crisis situation. We adjusted my meds and went to weekly appointments. The reason for me wanting desperately not to be hospitalized, is that if you're hospitalized 3 times in a 3 year period you can become subject to a Community Treatment Order, and assigned to an ACT team. CTO's and ACT teams are reserved for the seriously mentally ill. Now I've always been meds compliant, so the likelihood of being given a CTO was low, but I've been closer to it in the past than I liked, so I didn't want to meet the official criteria, because the last thing I need as I try to rebuild my life, is someone from an ACT team paying me regular visits.

That being said, I do see the flip side. I have a cousin who like me is a recovering alcoholic with MH issues. She works as a peer support worker with an ACT team, in North Toronto. She views her role as helping people stay out of the hospital, and if that means ensuring that they are meds compliant that's what she'll do. She has one patient who keeps going off his meds because he believes that they're what's making him ill, and it's a revolving door in and out of the psych hospital. Is that good for him? no. But the fact is he can't function without medication. On meds he can function and have some semblance of a life. So what's the choice, try to keep him on meds and have a chance at a life, or give up on him, let him go off his meds, have him wind up on the streets likely to be dead in 6 months.

As I said it's a complicated issue for me. To me, forced treatment should be an absolute last resort, but I do think it has it's place.

splitimage

But how do we know how the person feels? Or do we judge that by "they are out of hospital, not troubling us"?

Maybe meds do make some ill on the long term (hint: Anatomy of Epidemy). Maybe instead of making sure person is "compliant", we should look into other ways of healing. The assumption people ditch their meds because they are too dumb to see how good they are for them... is kinda dangerous.

Icarus Project's publication asked question about why we measure impact of MI by the person not turning up in their job... and we don't ask if they wanted to do this job in a first place.

Why is there so many pill dispensing programs, quite a few feel good programs (art therapy can be helpful, but will not solve big scale problems), but very few "let them find place in life" programs? Maybe if we offered people real alternatives, they'd use them. Forcibly showing pills down their throats so they don't do trouble... is not a solution. And may allienate them even more.

Yeah. There are degrees of force, aren't there? My son has been 'voluntarily' sent to the hospital on several occasions where ... hmmm ... he pretty much had his arm twisted or he was roped into agreeing. And once you go 'voluntarily,' you can't just voluntarily check yourself out.

Elyn Saks has an interesting take on this subject. She advocates forcibly medicating the psychotic person during the first episode. Then once they're thinking clearly they can say whether they'd like to be forcibly medicated the next time - unless they're a danger to self or others, of course. Their wishes can be recorded in some kind of advance directive.

Some people are grateful that someone else got them to a hospital and medicated them. My son has never been grateful. He's been through this several times now, and he's pretty clear that he doesn't want to be involuntarily hospitalized and forcibly medicated. He never sees any up side to it.

I see this with my son too. Even in retrospect, he often doesn't understand how out of control he was and how others were perceiving him. From his point of view he was fine, and everyone should have left him alone. From everyone else's view, he was not able to care for himself.

It must be difficult for the professionals. They have to choose one of the options available to them, and the options are sometimes all "bad." As a family member, I think I have a little more choice. I can provide my son a home, make sure he eats, etc., while he's still in psychosis and not medicated. But for a professional trying to keep an unemployed, homeless person who is living in an alternate reality safe, it must be challenging. For example, the mental health transitional housing alternatives in this area require that the person be taking medication. No medication means the homeless shelter.

The last time my son was staying in transitional housing, he was very delusional. He was leaving the house barefoot and coatless in extremely cold weather. He fished an empty pizza box out of the trash at 2 am one time and tried to bake it in the oven - set the fire alarm off and woke the whole house. He clearly needed supervision. But the mhc required he be medicated, and he strongly objected.

I don't know what the answer is. I can imagine a world where people in a psychotic episode who can't care for themselves would have a safe place to stay. But the world I imagine and reality are two different things.

I long for real alternatives too. I haven't found anything that doesn't cost an arm and a leg. (Windhorse cost $15,000 per month when I checked a couple of years ago! That's not covered by insurance or any gov't programs. And the stays are like 6 to 18 months long.) It disturbs me that medication seems like the only option on the table - at least for people with really serious MI like my son has.

So my son and I muddle along, doing our best. The medication has to be part of the mix right now. We have to play the hand we were dealt with the resources available.

Seems to me like me need a real "mental health revolution." One to combat the era of over-drugging people that came out of the rebirth of psychiatry. One that respects dignity and encourages self-fulfillment and not just getting by. This is a real problem.

It's interesting that you bring up how professionals have to view the matter compared to us, Costello. Generally speaking, their mandate is ultimately keeping people alive, and otherwise keeping everyone out of harm's way. Good on paper, not so good when it has to be enforced.

Venus - The biggest problem is that alternatives, effective or not, are currently not accepted by the medical community, due to what I just pointed out. It's almost ironic how the Western idea of life first is ruining just as many lives.

Yep. Everyone brings his or her own issues to the table. What I see with sz (don't know if other MI's are the same) is that everyone is driven by fear. You can almost taste it.

IMO sz is fear gone wild for the person at the center of concern.

Then the family is so afraid. Afraid they'll be blamed. Afraid for their loved one. Afraid of their loved one.

The professionals are afraid too. Afraid they won't know what to do. Afraid their authority will be questioned. Afraid they'll be sued. Afraid of their clients. (The case workers at the mhc were very afraid of my son. I'm not really clear about why, but there was definitely a sense that they had to medicate him in order to neutralize some perceived threat. We don't really medicate psychotic people for their own good. We medicate them for our own good.)

Fear makes us shut down, and we lose access to our resources. It makes us inflexible and risk-averse. And fear feeds fear - both in ourselves and in those in contact with us. It makes us want to seek safety by clamping down and taking control. That leads to forced treatment and overmedication. The person at the center of concern is forced into a state of medicated "anti-psychosis" (in Pat Deegan's words). That's not a life.

If you want to help a person suffering from sz, you have to master your fear. You have to learn to ride it or stay open despite it. It's hard. It's much easier to shut down and seek safety.

These links discuss many of the issues raised in this thread:

http://www.bazelon.org/Where-We-Stan...rmination.aspx
http://www.treatmentadvocacycenter.org/problem

Joseph D. Bloom, MD, provides his incites in Thirty-Five Years of Working With Civil Commitment Statutes.

The Current Battleground: Outpatient Commitment

There appear to be various conceptions of what is actually meant by outpatient commitment.Again using the Oregon statutes to illustrate, there are different statutory routes leading to an outpatient commitment.leading to an outpatient commitment. First, in the commitment hearing itself, a judge may find that an individual meets commitment criteria; but, instead of hospitalization, the judge may immediately place the individual in an outpatient setting on a type of conditional commitment.

Second, individuals in Oregon are committed to the jurisdiction of the Oregon State Mental Health Division rather than to a specific state facility. The Division then has the authority to place the individual in a setting of its choice. Over the years, the Division has placed a small percentage of those committed directly into an outpatient setting. Finally, state hospitals in Oregon may place hospitalized individuals on “trial visit” for the remaining time of their commitment, up to the 180-day limit. Trial visit is a release from the hospital into the community. It is a designation dating back many years to the time when there was no statutory limit to the length of commitment, and individuals were often on trial visit for extended periods. Now the term remains, but the 180-day limit to commitment applies to the length of the trial visit.

The current national controversy focuses on direct commitment to outpatient settings mostly designed for chronically mentally ill individuals who have been noncompliant with treatment and are deteriorating in their functioning. In Oregon, there are no separate criteria for these commitments. Instead, an individual must meet inpatient criteria. In many areas of the country, there are separate criteria for outpatient commitment. Oregon’s approach partially solves the problem of revocation of the outpatient commitment, because the committed individual has already met criteria for inpatient commitment.

It is this direct outpatient commitment that has generated the current controversy, and it is in this area that we see the most polarized views of the subject. The following describes two contrasting views of mandatory outpatient treatment.

In 1999 the APA published a document, “Mandatory Outpatient Treatment.” 20 The opening paragraph states:

Mandatory outpatient treatment refers to court-ordered outpatient treatment for patients who suffer from severe mental illness and who are unlikely to be compliant with such treatment without a court order. Mandatory outpatient treatment is a preventative treatment for those who do not presently meet criteria for inpatient commitment. It should be used for patients who need treatment to prevent relapse or deterioration that would predictably lead to their meeting the inpatient commitment criteria in the foreseeable future [Ref. 20, p 3].

I cited earlier the Bazelon Center’s view on inpatient civil commitment. Here is their view on outpatient commitment:

The Bazelon Center also opposes all involuntary outpatient commitment as an infringement of an individual’s constitutional rights. Outpatient commitment is especially problematic when based on a: (1) prediction that an individual may become violent at an indefinite time in the future; (2) supposed “lack of insight” on the part of the individual, which is often no more than disagreement with the treating professional; (3) the potential for deterioration in the individual’s condition or mental status without treatment; (4)an assessment that the individual is “gravely disabled.” These criteria are not meaningful. They cannot be accurately assessed on an individual basis and are improperly rooted in speculation. Neither do they constitute imminent, significant physical harm to self or others, the only standard found constitutional by the Supreme Court. As a consequence, these are not legally permissible measures of the need for involuntary civil commitment—whether inpatient or outpatient—of any individual. 2

Again, there is a contrasting view from The Treatment Advocacy Center:

Perhaps the single most important reform needed to prevent the need for repeated hospitalization and to prevent the consequences of non-treatment is to encourage the use of assisted outpatient treatment. When appropriate, assisted outpatient treatment fosters treatment compliance in the community through a court-ordered treatment plan. Moreover, not only does the court commit the patient to the treatment system, it also commits the treatment system to the patient. 21

In outpatient commitment, it appears that we have come full circle.We have in the outpatient commitment debate what appears to be a recapitulation of the earlier inpatient debate, with the new statutory provisions becoming political footballs between opposing interested parties. Those in favor of outpatient commitment see it as an important tool in a range of options that are potentially useful in managing severely mentally ill individuals in a community setting. Those who oppose outpatient commitment see it as an infringement of liberty and as a financial drain on a mental health system already in crisis. They argue that dollars should be invested in proven intensive community treatment methods, not into further use of coercive approaches to treatment. This is the current state of affairs. Monahan et al. 22 summarized the current situation: “In many states a take-no-prisoners battle is under way between advocates of outpatient commitment—who call this approach assisted outpatient treatment— and its opponents—who use the term ‘leash laws’ ” (Ref. 22, p 1198).

Discussion

The evolution of modern civil commitment statutes is the story of interactions over time among state legislatures, lay and professional interest groups, and courts. The result, a functioning civil commitment statute, is a political statement that reflects compromises that exist at a particular moment. There is little doubt that these statutes raise passions along a philosophical spectrum ranging from those who view mental illness as the free expression of ideas and involuntary commitment as equivalent to a prison sentence, to those who see mental illness as a serious brain disease and involuntary commitment as the only means of obtaining treatment for those whose insight and judgment are greatly impaired by their illnesses. Another aspect of this long-standing debate is a focus on the availability and expenditure of funds for treatment programs. The underlying policy question of whether it is best to invest precious mental health dollars in implementing laws that confine the mentally ill or in much-needed intensive and voluntary services is always part of the discussion. There appears to be little room for compromise for many in this debate, and the options are often presented as either/or choices, rather than compromises.

It should be a given that a focus on law alone is not sufficient. On the one hand, few can argue with the premise that civil commitment without decent hospital and community mental health services is a situation that should not be tolerated. On the other hand, commitment laws remain an absolutely necessary component of a mental health system, if only for the smallest number of mentally ill in the community.

Years ago, I had the opportunity to observe a self- contained Native American community where there were no effective commitment laws. I evaluated a homicide offender from this community, which was governed by federal and tribal law, neither of which included a commitment statute. Prior to the homicide, the young man in question exhibited deteriorating mental functioning and was clearly becoming more violent. These facts were known to most everyone in his community. Significant attempts were made to have him enter voluntary treatment in an off-reservation psychiatric unit of a general hospital. All attempts failed, and the almost inevitable violent
event, a homicide, occurred.

This experience led us to investigate more fully the legal situation that exists on many Native American reservations not covered by state law, where the option of civil commitment did not exist or where it only existed by informal agreement between tribal and local or state government. 23 This situation existed (and may still exist) in many reservation communities. Ultimately we were able to solve the situation in Oregon with a statutory change to state law that gave the tribal government authority to access the Oregon commitment statutes through a provision permitting rural counties in Oregon to use “emergency commitment” as a method of entry into the civil commitment system. 24

This experience demonstrated to me that, no matter what could be provided in the way of services, there still will inevitably be situations in which civil commitment laws are absolutely necessary. A responsible position would advocate an approach to civil commitment that recognizes the need for such statutes, yet aims to reduce the necessity for their use. I understand that few responsible people would argue with me about the need for such statutes for situations similar to the one described in the Native American community—a situation that was clearly one of imminent dangerousness. However, I also believe that, in less dramatic-appearing situations, credible arguments can be made for outpatient civil commitment when a person’s life history clearly demonstrates the individual’s incapacity to care for himself or herself in a community setting. This means having statutes that are not so narrowly drawn as to be limited to imminent dangerousness.

The gradual development of dangerousness as the main focus for commitment has, in my opinion, had very negative consequences. The standard, “gravely disabled,” has been recognized for many years as a legitimate reason for civil commitment. The original Oregon commitment statute of 1862 defined a mentally ill person for the purposes of commitment as one who “is suffering from neglect, exposure or otherwise, or is unsafe to be at large, or is suffering under mental derangement” (Ref. 4). Were we a more caring society then than we are now? Probably not, although it is hard to argue against a statute that seeks to protect people from “suffering from neglect, exposure or otherwise.” The point is that society has long had an interest in protection of its vulnerable citizens,and there are few reasons to deviate from this long-held tradition.

Further, statutes that are written with broad language that allows holding allegedly mentally ill persons for a short time at the front end of the commitment process provide additional safeguards for individuals and for society. I have seen many situations in which individuals are in the midst of emotional crises and are hospitalized for short periods in precommitment status and in which these short hospitalizations have defused potentially inflammatory situations.

I have also seen the opposite. For example, I evaluated another homicide offender who, shortly after being informed by his wife that she was going to divorce him, was brought to an emergency room. He was very distraught but was not interested in voluntary admission, and, because of a strict interpretation of the statute, he was not considered appropriate for entry into civil commitment. Shortly after leaving the emergency room he killed his wife and attempted to kill himself. My point is that civil commitment statutes that are broadly drawn, at least at the front end, allow for the interplay of law and professional judgment, and it is this interplay of law and judgment that provides wider options and perhaps a better chance for good outcomes.

Outpatient commitment is now the major battleground in the civil commitment arena. Again, as this debate settles down, I hope we can come to view outpatient commitment more dispassionately—simply as another option, one among many available to psychiatrists and other mental health professionals.

Based on my experience and some of the empirical literature cited in this article, I argue for the usefulness of a well-structured approach to outpatient commitment. I have had personal experiences with several forms of structured outpatient treatment: a form of outpatient commitment related to the Oregon Psychiatric Security Review Board in its management of insanity acquittees 25 and the system of close monitoring and supervision of drug- and alcohol-dependent physicians carried on by the Oregon Board of Medical Examiners. 26

These are obviously different programs conceptually but they are similar in regard to the principles that define structured outpatient programs. There are restrictions in regard to what an individual in each program can do in the community. There are consequences for failure to adhere to the program, and there are positive outcomes that have resulted from these programs. Outpatient civil commitment can be viewed as the same approach, with the particular rules governed by the controlling statutes. If interested parties approached the concept from a more neutral position—that outpatient commitment is neither inherently good nor bad—there would be situations in which having this legal option would be quite beneficial.

Conclusion

We appear to be living at a time when civil commitment statutes are losing or have lost much of their former prominence. There are multiple reasons for this, not the least of which is the loss of inpatient psychiatric beds in state and local facilities, resulting in the greatly increased use of the criminal justice system as a major repository for many seriously mentally ill individuals. Focus has now shifted in many areas of the country away from civil commitment to a focus on jail diversion and court clinics. 27 Aside from outpatient debate, reform in civil commitment statutes now seems stagnant. I believe that, as we attempt to rebuild our mental health system capacity, it will again be time to have a major focus on the design of effective, and more up-to-date commitment laws.

Over the years, I have come to believe that those who toil in civil commitment are like those who tried to build the Tower of Babel and were cast into the wilderness, condemned to wander and to be unable to communicate.

And the LORD said, “Behold, they are one people and they all have the same language. And this is what they began to do, and now nothing which they purpose to do will be impossible for them.”

“Come, let Us go down and there confuse their language, that they may not understand one another’s speech.”

So the LORD scattered them abroad from there over the face of the whole earth; and they stopped building the city.

Therefore its name was called Babel, because there the LORD confused the language of the whole earth; and they stopped building the city. 28

Perhaps we will have another chance.

http://jaapl.org/content/32/4/430.full.pdf

Alive, yes but at what cost, at what quality.

Neurological problems, thyroid problems, diabetes, worsening of depression, emotional liability,weight gain and all of the associated health problems of being over weight, the meds also render many apathetic and sedentary which is now proving to be a serious health problem(even if you work out on weekends).many of those with serious MH issues and who are complied to take forced medications often die 25 years before their peers. If they choose to live on the street unmedicated, what right have we to say other wise?

Kudos to those(like Costello) who give their loved ones support without conditions attached. A safe environment to battle the mental monsters without additional fears of coercion and lies. The thoughts that the meds are causing them to be ill is not an illusion but a reality. Perhaps if Dr's and others stop saying that the meds are not hurting them or that it is all in their head advancements could be made. The truth is there are no long term studies on these meds especially for kids. Only now has there been reluctant acknowledgment of the side effects. How ever the down economy has cut backs in social services increasing the use of meds w/o therapy and barely the minimum follow up. Peer support is great, as an adjunct, but they are not doctors and 5 min every 3 to 6 months is not adequate.

That is often all those who are forced to take medications here in this state, see doctors. At the beginning there might be SW or others who try to pop around to see them swallow the pills, but as other postings have stated the person simply isn't home. Sometimes they force a person in a semi-independent living situation to monitor their pill compliance but those are not licensed in this state so the care ranges from good to really poor. That is a worse case scenario as those places often take a person's money and leave them with little to nothing. The streets would be attractive alternative to that, but on paper it looks good to doctors and politicians alike.

So what is the cost to those forced to comply? What is their quality of life?

My only concern with this is for those who are mentally ill and could potentially cause harm to others. If someone is just feeling depressed, lonely, sad, is eating too much, whatever. It's thier feelings, their body, their only hurting themselves. If they want to refuse treatment, let them. But you can't just let those people who have mental illness where they may think someone is out to get them, so they kill them first. Those people truely do need help! I think the doctors should have to assess the individual before making the decision to "force" treatment upon them or not. If they don't seem to be a danger to other people, let them do as they please. But if they do, treatment! Just my opinion.....

But as Maven pointed out before, we don't "punish" someone on what they might do. Is it really fair to put someone under forced treatment just because they MAY be a harm to others?

Look at the huge controversy in New York, and other areas where police are practicing stop and frisk. Statistically speaking, they are stopping those that are most likely to be hoodlums, who may be a danger to society, but there's a huge public outcry because it is seen as a civil violation.

How is it any different, when the group targeted in preemptive action, are those with mental health, rather than coloured youth in ghetto type neighbourhoods? After all, even our police is designed to be reactive by nature, rather than protective. So why is it any different at all when it comes to mental health, despite the fact that it is on a smaller scale?

United States v. Comstock:

In a broad endorsement of federal power, the Supreme Court on Monday ruled that Congress has the authority under the Constitution to allow the continued civil commitment of sex offenders after they have completed their criminal sentences.

The 7-to-2 decision touched off a heated debate among the justices on a question that has lately engaged the Tea Party movement and opponents of the new health care law: What limits does the Constitution impose on Congress’s power to legislate on matters not specifically delegated to it in Article I?

The federal law at issue in the case allows the government to continue to detain prisoners who had engaged in sexually violent conduct, suffered from mental illness and would have difficulty controlling themselves. If the government is able to prove all of this to a judge by “clear and convincing” evidence — a heightened standard, but short of “beyond a reasonable doubt” — it may hold such prisoners until they are no longer dangerous or a state assumes responsibility for them. http://www.nytimes.com/2010/05/18/us/politics/18offenders.html?_r=0

The Court has the power to detain:

Justice Stephen G. Breyer, writing for himself and four other justices, said the clause provided Congress with the needed authority as long as the statute in question was “rationally related to the implementation of a constitutionally enumerated power.”

Congress has the undoubted powers, Justice Breyer said, to enact criminal laws in furtherance of its enumerated powers and to create a prison system to punish people who violate those laws, though neither power is explicitly mentioned in the Constitution. “The civil commitment statute before us represents a modest addition,” he added, comparing it to medical quarantine.

Other states have enacted similar laws. In my state:

8. "Sexually dangerous individual" means an individual who is shown to have engaged in sexually predatory conduct and who has a congenital or acquired condition that is manifested by a sexual disorder, a personality disorder, or other mental disorder or dysfunction that makes that individual likely to engage in further acts of sexually predatory conduct which constitute a danger to the physical or mental health or safety of others. It is a rebuttable presumption that sexually predatory conduct creates a danger to the physical or mental health or safety of the victim of the conduct. For these purposes, mental retardation is not a sexual disorder, personality disorder, or other mental disorder or dysfunction.

9. "Sexually predatory conduct" means:
a. Engaging or attempting to engage in a sexual act or sexual contact with another individual, or causing or attempting to cause another individual to engage in a sexual act or sexual contact, if:
(1) The victim is compelled to submit by force or by threat of imminent death, serious bodily injury, or kidnapping directed toward the victim or any human being, or the victim is compelled to submit by any threat that would render an individual of reasonable firmness incapable of resisting;
(2) The victim's power to appraise or control the victim's conduct has been substantially impaired by the administration or employment, without the victim's knowledge, of intoxicants or other means for purposes of preventing resistance;
(3) The actor knows or should have known that the victim is unaware that a sexual act is being committed upon the victim;
(4) The victim is less than fifteen years old;
(5) The actor knows or should have known that the victim has a disability that substantially impairs the victim's understanding of the nature of the sexual act or contact;
(6) The victim is in official custody or detained in a treatment facility, health care facility, correctional facility, or other institution and is under the supervisory authority, disciplinary control, or care of the actor; or
(7) The victim is a minor and the actor is an adult; or
b. Engaging in or attempting to engage in sexual contact with another individual or causing or attempting to cause another individual to have sexual contact, if:
(1) The actor knows or should have known that the contact is offensive to the victim; or
(2) The victim is a minor, fifteen years of age or older, and the actor is the minor's parent, guardian, or is otherwise responsible for general supervision of the victim's welfare http://www.lawserver.com/law/state/n...ode_25_03-3_01

North Dakota Code 25-03.3-08 - Sexually dangerous individual - Procedure on petition - Detention

Current as of: 2009 Check for updates

1. Upon the filing of a petition pursuant to this chapter, the court shall determine whether to issue an order for detention of the respondent named in the petition. The petition may be heard ex parte. The court shall issue an order for detention if there is cause to believe that the respondent is a sexually dangerous individual. If the court issues an order for detention, the order must direct that the respondent be taken into custody and transferred to an appropriate treatment facility or local correctional facility to be held for subsequent hearing pursuant to this chapter. Under this section, the department of human services shall pay for any expense incurred in the detention or evaluation of the respondent.

2. If the state's attorney knows or believes the respondent named in the petition is an individual with mental retardation, the state's attorney shall notify the court in the petition and shall advise the court of the name of the legal guardian of the respondent or, if none is known, the court may appoint a guardian ad litem for the respondent. Before service of the notice required in section 25-03.3-10, the court shall appoint an attorney for the respondent. An individual with mental retardation may be detained in a correctional facility before the probable cause hearing only when no other secure facility is accessible, and then only under close supervision. http://www.lawserver.com/law/state/n...ode_25_03-3_08

And so it is, a person may be "punished" for what he/she might do.

This has been a very very interesting thread. Seems like everyone has their own opinion on the matter at hand. Thanks for such an interesting read.

Di meliora, that's a very good report you posted. I stand corrected, in that there is at least one type of dysfunction where we punish someone who may have never committed a crime in the first place. I don't fully agree with this law, for the record. If someone has already shown harmful behavior or committed a violent (sexual or otherwise) act, I believe they should be punished. And if someone makes a violent or sexual threat, it's understandable to take action to prevent them from acting out that threat. I'm not sure pedophiles and sexual predators can change, but I think it's important to remain open to the possibility. That does not mean I think they should be forgiven; that is up to each and every person to decide.

If we start (and we already have) making it ok to lock up someone because they "might" do something, we are taking a very treacherous road.