Introduction
One of the dilemmas many mental health practitioners experience is whether or not to force a patient into psychiatric care. For some of these patients, they may not even be aware of their conditions and the need for professional intervention. However, the fact is that just letting (some of) them be, which means not to force them into psychiatric treatment, poses a significant risk not only to the patient but also to the other people surrounding the patient. At the same time, there’s no denying that the patient also has a right to make decisions about their medical care – the concept of patient autonomy. With this scenario in mind, it’s imperative to find a balance on the issue of involuntary mental health commitments. That’s the purpose of this discussion – to provide a detailed argument on the “involuntary mental health commitments” topic. The essay starts with a brief description of the problem, continues to highlight the arguments for and against the practice of involuntary mental health commitments, after which a conclusion ensues.
Origin/Description of The Problem
The issue of involuntary mental health commitments is as old as the psychiatry profession. However, the earliest known official psychiatric commitment took place in Philadelphia in the 1750s. But, before then, there are applications of civil commitments by Hippocrates back in the 4th century B.C. proposing that psychiatric patients should be confined in an isolated and comforting space (Fariba and Gupta).
In the recent past, this topic has received a lot of attention following incidences that have necessitated stakeholders to affirm the need for involuntary commitments. For instance, in July 2012 when a gunman walked into a movie theatre in Colorado and opened fire, leading to the lives of 12 and injuring 70 others. It was discovered that the gunman was a psychiatric patient who’d probably not have engaged in the ordeal if he was under treatment. Less than a year later, another psychiatric patient killed his mother and went on to shoot 26 people dead at the Sandy Hook Elementary School (Miller and Hanson).
With such ordeals, the discussion about involuntary psychiatric treatments has been on the rise in a bid to not only keep these patients safe, but to also protect the rest of the society. For instance, laws have since been enacted to allow mental health professionals to share information about certain categories of psychiatric patients with law enforcement departments. Although the regulations differ based on the jurisdiction, in most places, individuals can be held to involuntary psychiatric commitment if they’re a danger to themselves or to others.
Arguments For Involuntary Mental Health Commitments
One of the main arguments in support of involuntary mental health commitments is to protect psychiatric patients as well as the society. For one, individuals with severe mental illnesses are at risk of harming themselves, or even committing suicide. These psychiatric patients are at times not even aware of their health issues. As such, leaving it to them to exercise autonomy over their treatment means they’ll not be making informed decisions in the first place. Take the examples of the Colorado and Sandy Hook gunmen. The pain and devastation caused by these two psychiatric patients would have been avoided if they were subjected to involuntary psychiatric commitments, with or without their knowledge.
Another argument in support of involuntary psychiatric commitment is the access to treatment. As mentioned previously, in many cases, psychiatric patients have no awareness of their condition. Many of them cannot tell what is right or wrong especially when they’re having a psychotic episode. Unfortunately, some choose to ignore the treatment plans altogether, leading to more frequent psychotic episodes with disastrous effects. The patients’ condition continues to worsen over time, yet the resources for many of these conditions are easily accessible. Interestingly, when such patients are subjected to involuntary commitment, by intensively monitoring and adhering to treatment plans, mental health practitioners are able to get most of them to a point of stability, even those experiencing acute symptoms. For this reason, involuntary commitment improves the mental health of psychiatric patients by increasing access and adherence to treatment.
There are also legal safeguards in support of involuntary psychiatric commitments. The fact that patients can be subjected to involuntary commitments does not mean that they have no right as legal persons. Most jurisdictions subject such commitments to legal safeguards to ensure there’s clarity on the due process and that the rights of the individual are prioritized throughout the entire process. For instance, the Fourteenth Amendment’s Due Process Clause outlines the process requirements for involuntary commitment. According to this clause, the patient has a right to counsel, a jury trial and an expert witness at trial (Congressional Research Service, 6). As such, the implementation of involuntary commitment has been structured in a way that the rights of the patient – as a legal person – remain a priority, and therefore no cause for alarm.
The principle of beneficence, as it pertains to healthcare practitioners, can also be applied to support the practice of involuntary psychiatric commitments. Physicians have an obligation to act for the benefit of their patients. They’re expected to defend the rights of others and prevent harm (Varkey). In view of this, physicians working with psychiatric patients would be acting for their benefit by subjecting them to involuntary commitment – albeit as a last resort measure. In such a case, the physician will be acting in the best interest of the patient. What’s more, the physician’s effort will also benefit the patient’s families as well as the wider society. Because of this, it’s evident that physician’s involvement in involuntary commitments is a benefit for all parties involved, which is therefore an argument in favor of such commitments.
Arguments Against Involuntary Mental Health Commitments
Even with the above-discussed arguments in favor of involuntary commitments, there are also opponents of this practice, and they raise several valid points as well. One of the main arguments is the violation of patient autonomy. Advocates of patient autonomy emphasize the right of every patient to make an informed choice about their health care issues devoid of undue influence from outside parties – including healthcare providers (Ubel, Scherr and Fagerlin, 11). This is a sharp contrast to how involuntary commitments are implements. Such commitments strip off the patient’s right to make decisions regarding their own care and treatment. The decision rests on the healthcare providers. The patients receive treatment and are forced to adhere to treatment plans against their will, and also minus their consent. What’s more, as previously mentioned, laws have since been enacted to legalize the sharing of information between mental health practitioners and law enforcement departments regarding certain categories of psychiatric patients, and them being subjected to involuntary commitments. This could also be perceived as a violation of the patient confidentiality principle. In view of this, one could argue against the implementation of involuntary commitments.
Another argument against involuntary commitment is the potential for abuse. When the patient has no right over what happens to them – as pertaining the treatment plan – there’s a loophole that unscrupulous practitioners can exploit when handling individuals with severe mental illnesses. Some can use it as a means of control or even to punish the patients by keeping them confined just to punish them as opposed to providing genuine care. As such, this has the potential to raise subsequent concerns of discriminations against people with mental illnesses because there’s a very thin line between those that are genuine about the practice and those that are out to punish and control people with mental illnesses. This is especially the case when law enforcement gets involved in the provision of care for certain mental health categories. For this reason, there’s reason to be hesitant to support the practice of involuntary commitment of psychiatric patients.
Stigmatization is another factor that acts against involuntary commitments. For one, mental illnesses are associated with a lot of stigma since the early years. For many, they’d rather have lifestyle diseases such as hypertension and diabetes than have to deal with mental health issues such as depression. As such, introducing involuntary commitment of people with psychiatric disorders only works to worsen the stigma. It would not be unexpected that with more public awareness on the practice of involuntary commitment, many psychiatric patients would fear to even seek help voluntarily. There’s always that concern that if they show up at the hospital, they might be subjected to treatment plans they don’t support, and some might even be confined. This fear of being forced to such circumstance acts as a barrier for some wanting to seek psychiatric treatment voluntarily. The end result is even worse health outcomes for psychiatric patients.
Conclusion
From the above discussion, it is evident that the issue of involuntary commitment is not a new one. It’s been in existence since the time of Hippocrates, only that the modern-day events – such as the shooting events identified herein – have necessitated increased calls for action to ensure that psychiatric patients receive treatment, voluntarily or involuntarily. There are arguments on either side of the divide. The arguments in favor of involuntary commitment have been identified as to protect the individual patients as well as the society from harm, to ensure these patients access treatment as a right to healthcare to keep them stable and the fact that there are legal safeguards to support the practice of involuntary commitments. The principle of beneficence, as it pertains to healthcare practitioners, also supports the practice of involuntary psychiatric commitments. Focusing on the arguments against involuntary commitments, the main one is the violation of patient autonomy, although the potential for abuse as well as stigmatization also support the fight against this practice.
Works Cited
Congressional Research Service. Involuntary Civil Commitment: Fourteenth Amendment Due Process Protections. 24 May 2023. 1 March 2024. https://crsreports.congress.gov/product/pdf/R/R47571.
Fariba, Kamron and Vikas Gupta. Involuntary Commitment. Treasure Island: StatPearls Publishing, 2020. https://www.ncbi.nlm.nih.gov/books/NBK557377/.
Miller, Dinah and Annette Hanson. Committed: The battle over involuntary psychiatric care. Baltimore : John Hopkins University Press, 2016.
Ubel, Peter A., Karen A. Scherr and Angela Fagerlin. “Autonomy: What’s shared decision making have to do with it?” The American Journal Of Bioethics 18.2 (2018): W11.
Varkey, Basil. “Principles of clinical ethics and their application to practice.” Medical Principles and Practice 30.1 (2021): 17-28.
