Day 25: What is your opinion on forced/coercion in mental health treatment? Can be legal (law enforcement or psychiatric holds) or a “helping” friend/family member?
I find this to be a ‘double edged sword’ kind of situation. I tend to view mental illness like I would a physical illness and in doing so I consider whether or not a cancer patient would be forced to undergo chemotherapy? There are several instances where a person who is diagnosed with an illness with a difficult or low cure rate treatment has decided to try alternative methods or just forgo treatment all together and instead enjoy the time they have left with loved ones and/or hope that the illness doesn’t manifest further. If you compare the two situations using these examples:
Patient 1 – Moderate to Serious Cancer tumor detected
Doctor recommends immediate hospitalization; which requires alternate care for patient’s children, hiatus from work (FMLA, but patient has no paid/sick time), invasive treatment known to be painful.
Prognosis with recommended treatment – 50-60% cure rate within one year.
Patient 2 – Admitted to ER after having a friend finding her after a ‘breakdown’ in which she is in an anxious and near catatonic state, has not been eating/ sleeping in spite of describing immense exhaustion/and is isolating herself from friends, and has been found to have items with which could cause serious or fatal harm. The friend suspects a suicide attempt is imminent.
Doctor suspects clinical depression, generalized anxiety disorder, suicidal ideation and recommends immediate hospitalization; which requires alternate care for patient’s children, hiatus from work (FMLA may be available, but patient has no paid/sick or vacation time), daily therapy treatment and start of several medications known to have many harsh side effects which if not immediately effective – ECT (electroconvulsive treatment) may also be implemented.
Prognosis with recommended treatment – Possible chance of some relief of symptoms, no known cure. Patient likely to relapse. (75% chance in one year for reoccurrence of depression, 100% for anxiety, 1 out of 5 women who attempt suicide will succeed (the ones that don’t have a 30% chance of attempting again in their lifetime and studies show that each attempt has a higher rate of completion))
Imagine in both instances, the patient decides against hospitalization for fear of losing children and job and almost guaranteed financial ruin and instead asks for options for outpatient treatments in which the job can be maintained and children can be tended to. Patient 1 is given these options whereas Patient 2 is visited by a “behavioral health representative” (case worker) and told that they will seek to have patient involuntarily committed if patient doesn’t agree to check in on her own right then.
Obviously both patients are in probable danger of loss of life; they each are impacted greatly by their diagnosis and as such are feeling confused and displaying signs of denial, and want the opportunity to go home to their family to discuss their options and weigh their possibilities. Patient 2 will not be given this opportunity.
Patient 1’s condition will be met with compassion and offers of assistance. Their church, friends and family will reach out to help by sending notes/gifts/flowers/food and offers of help with the children. Their place of work will offer to set up a ‘vacation time donation’ program with the Human Resources Department so Patient can afford to take off work for treatment and a campaign will be launched with a fundraising account set up in their name and a benefit held in their honor…after all she is a contributing member of the community and would have and even has done the same for others. Patient 1 recovers and returns to work to a cheerily decorated office and pats on the back for her strength and resilience.
Patient 2’s condition was largely kept a secret for a time for fear of removal of her children and loss of job, not to mention embarrassment and shame to all who know her. Patient 2 was forced to check into a hospital and had to burden her already overworked sister in law to watch her children. Patient 2 woke up at 6am every morning to stand guard over the phone to begin making phone calls as soon as allowed to her place of work and insurance companies to try to get treatment covered, her bank to try to implement payment arrangements for upcoming bills, and some clients to let them know she would have to postpone meetings due to a ‘family emergency’. Some trusted friends and family were told of hospitalization and reactions ranged from anger to fear and a few were confused yet compassionate as could be. One even visited her during her hospital stay. Patient 2 received no get well cards or insurance benefits. Patient 2 was threatened with removal of children and ended up losing her job. Patient 2 had to move in with her (supportive) yet also burdened parents after hospitalization and had to sell mostpossessions in order to pay for treatment and to keep remaining bills paid on time. Patient 2 committed herself to recovery and treatment, in spite of financial hardship and near ruin and does get words of support from a few caring friends but has lost many more. Patient 2 will not be cured and continues expensive treatment, multiple medications and any other (low cost) therapy she finds beneficial including writing and speaking out about defeating mental health stigma and oppression.
(*Patient 1 example taken from published case studies and I am Patient 2)