Proposals to Force More Involuntary Treatment Stir Debate
By Tom Jackman
Washington Post Staff Writer
Thursday, February 7, 2008; B04
In the debate over Virginia’s mental health system, they’re called
“consumers.” Some of them call themselves survivors.
They are mentally ill people who have been through the system and
didn’t like it. They criticize the humiliation of being handcuffed,
the forced administration of antipsychotic drugs or the debilitating
side effects of the drugs. And they don’t think the government is
best suited to choose their treatment.
Rather than forcing more people into involuntary treatment by
lowering the legal criteria or enforcing outpatient treatment —
approaches that Virginia’s General Assembly is considering —
consumers and their supporters say they think the money for those
approaches would be better spent on counseling, housing and jobs for
the majority of the mentally ill, who aren’t dangerous or helpless.
Since the Virginia Tech shootings in April, which were committed by a
mentally ill student who did not receive mandated treatment, many
mental health advocates have called for a lower standard for
involuntary treatment and easier access to patient records for
determining a person’s treatment. Under Virginia laws, some of the
most stringent in the country, a mentally ill person can be committed
only if he poses an “imminent danger to self or others” or
demonstrates an “inability to care for” himself.
But a group of consumers is fighting back. They say they think that
changing the imminent-danger standard is a bad idea and that opening
patient records will discourage people from seeking treatment.
As the debate heats up in Richmond over how to fix Virginia’s mental
health system, consumers are lobbying legislators and testifying at
hearings. A consumers’ rally outside the state Capitol last week
attracted more than 650 supporters and a number of legislators, said
organizer David Mangano of Chesterfield County.
“The problem has much more to do with the system’s failures, not with
the language of the law,” said Mangano, a consumer and family
advocate for Chesterfield Mental Health Support Services. “The actual
number of people who are great safety risks and great risk to the
community are very small compared to the number who need services. If
you start changing practices, changing the code, to try to catch
those people [who are risks], what really have you done with all the
people who don’t belong there and have really good reasons not to
comply with treatment?”
Consumers say that providing counseling, peer support, housing and
jobs should take precedence over forced treatment. Michael Allen, a
lawyer formerly with the Bazelon Center for Mental Health Law in
Washington, said: “The problem in Virginia is not [revising] what
standard is used to treat people against their will. The question is,
do we make mental health services available in a timely fashion? Do
we make it comprehensive and holistic or wait until they fall to the
Some consumers have had positive experiences with treatment and are
also fighting to revise Virginia’s system. Jonathan Stanley said that
in his 20s, he spent three years in a cycle of increasingly psychotic
episodes, ending with an incident in which he stood naked in a New
York City deli and was forcibly hospitalized for seven weeks.
He said doctors determined the proper medication for him. He finished
college and law school, and now works for the Treatment Advocacy
Center in Arlington County. He is lobbying for change in Richmond,
including modifying the existing imminent-danger criteria, which he
called “the most restrictive in the country.”
Stanley is seeking support for more mandatory outpatient treatment,
modeled after New York’s Kendra’s Law. He said that 80 percent of
people emerging from such programs “say their coerced treatment has
helped them get and stay well. Those are the consumer voices that I
listen to the most.”
Most mentally ill people are functional and want to make their own
choices but need help, many consumers say.
Yaakob Hakohane of Arlington had been through decades of legal and
mental health experiences. In the early 1990s, he helped create a
group to advocate on behalf of the mentally ill. But even he said he
was amazed by how easily he was involuntarily committed to a mental
hospital last summer.
Hakohane, who suffered a brain injury as a teenager, said he fell and
hit his head on a sidewalk one afternoon in July in Crystal City. He
became disoriented and said police and paramedics who responded “were
kicking and poking me,” so he decided not to talk to them.
Hakohane was also suspicious of the people who treated him in the
emergency room. He remained silent and was temporarily detained. When
he went to a civil commitment hearing two days later, despite the
testimony of two people who said he was perfectly rational, he was
ordered into treatment for up to six months.
“It seems obvious from this experience [that] it’s not hard to commit
people,” said his friend Diane Engster, who attended the hearing.
“It’s easy,” Hakohane said. “Anybody can commit anybody else.” He
said he cooperated with his doctors and was released in a week.
Consumers such as Engster, who founded the Northern Virginia Mental
Health Consumers Association with Hakohane, are also troubled by
attempts to open up patients’ records. Special justices who decide
whether to commit a person typically do not have access to
psychiatric histories, and legislation is pending to allow that.
Alison Hymes, a Charlottesville consumer advocate who served on a
state Supreme Court task force on mental health law reform, writes a
blog about such issues. She wrote that if the state requires mental
health providers to turn over patient records, “mental health
practice in this state will never be the same. Patients/clients/
consumers will not be able to trust their secret thoughts and
feelings with their clinicians. Clinicians will not be able to abide
by the ethical standards of their professions. People will not seek
help and those who are already receiving therapy, such as myself,
Virginia is going through an unprecedented examination of its mental
health system after the slayings at Virginia Tech. This is one in an
occasional series of reports about problems in the system.