New: ON MENTAL ILLNESS:Addressing the Problem of Noncompliance Among People with Schizophrenia

By Jack Bragen
Saturday March 03, 2012 - 06:59:00 PM

Noncompliance of people with schizophrenia with treatment including not taking medication has been a problem for a very long time that adversely affects many people's quality of life. The dilemma between protecting someone's civil rights (which we fought for in order to improve the conditions of our lives and which was intended to prevent inhumane treatment in mental health facilities) versus protecting a person essentially from their own folly (because of the willingness of many people with schizophrenia to let a mind-altering disease go untreated) has been a major issue of contention for decades. 

When someone is given a 5150, and subsequently a 5250, that person is under a court order that they will be given treatment, by force if needed, for up to two weeks. The court has traditionally been liberal about deeming a person not a danger to one's self or others and not gravely disabled such that many who should be forcibly treated are not. 

The first change I would suggest is to somewhat extend the criteria for a 51 or 5250. An additional criterion that can be added would be to "50" a person if unable to provide for his or her basic needs [such as going to the store and buying a loaf of bread] due to a mental illness. Such a criteria would be less offensive than the one Laura's Law provides which says they are subject to forced treatment if refusing medication due to the lack of judgment caused by their illness [not in those exact words]. The problem I have with the Laura's Law criteria is that the patient is presumed incompetent based on making the choice to refuse treatment. The fact that I take medication to an extent by choice and not because a law is mandating it makes a huge difference to me, to my quality of life, and to my attitude toward treatment practitioners. 

The second change that I would introduce is to create a 5350, which would mandate treatment for two or three months, a long enough time period for someone to get over his or her delusional system and come to the realization of needing treatment, but not such a long time that it resembles a six-month jail sentence. At the end of the 5350 time period, if someone is still unable to provide for basic needs, conservatorship could be considered. The 5350 could be used if someone has a track record of noncompliance and resultant relapse, and if currently unfit to survive in society. 

My proposal resembles Laura's Law in some respects. However, it takes into account quality of life issues for a person with mental illness and does not resemble a punitive action. The 5350 plus the loaf of bread idea would make it seem more like the law is here to help persons with mental illness and is not here to punish people for wanting to be free. The new law could be called the "Loaf Law." This proposal, I believe, is a good compromise between the position of merely protecting our civil rights and our basic freedoms, versus the position of creating across the board restrictions because of someone's diagnosis. 

When making the change in the law that I propose, there ought to be additional requirements that mental health treatment facilities provide humane treatment and quality of care. If we are to be forced into treatment by a governmental mandate, it becomes the responsibility of that government to make that treatment humane, free of malpractice, and respectful of basic human dignity.