Some die with their rights on

By Robert Landauer – editorial columnist for The Oregonian, May 4, 1999. Not available elsewhere online.

It’s too late in the session to start dealing with mentally ill persons who reject treatment

Just say no to drugs is a watchword of faith. But making that stand might someday get you locked up in Oregon.

The issue here is not street pushers, zoned-out addicts and shooting galleries of the sleazy narcotics trade. The controversy is about how to help mentally ill people who won’t accept treatment.

A task force led by by Mark Gardner, special counsel to Attorney General Hardy Myers, has been searching for ways to require treatment for people who appear to be heading toward serious breaks with reality but who can’t be shown at the moment to be dangerous to themselves or others. That is the threshold of dangerousness the state must show the person has crossed before it can force mental -health services on someone who hasn’t broken any law.

Gardner, a former circuit judge, understands the importance of the civil-liberties protections. He also knows the burdens families, schools, jails, prisons, employers, hospitals, service agencies and taxpayers bear when people who need help reject it or can’t get it.

Family members are pushing hardest to lower the threshold under which people could be locked up for evaluation and the state be required by judges to put them under intensive case management. In practice, this means that many, possibly most, would be pressured to “take their meds.”

The relatives argue that the state intervenes too late, long after their loved ones are able to make informed choices. The relations cite tragic cases of their sons, daughters, spouses and siblings deteriorating to the point of irreversible damage before help is given.

Strenuously opposing forced treatment are persons who call themselves psychiatric survivors. They particularly fear anything that might lead to forced use of mood-altering drugs. Some dwell on disagreeable side effects of certain medications — major weight gains, overwhelming drowsiness, loss of creativity. Others say that forced drugging reflects a conspiracy of the pharmaceutical industry, organized psychiatry and institutionalized mental health to gain clients, profits and power.

Forcing people into court because they might become committable in the future, and threatening to lock them up for failure to appear for evaluation by judges, disturbs civil libertarians. They object to invasions of privacy, intrusions on liberty and singling out this class of people for detention. They worry, too, that many judges with low literacy about mental illness will be making these decisions.

Passions run high. There is no chance for task-force agreement except for the need for more resources, Gardner reports.

That’s a strong signal that the proposals should not go to this Legislature. At best they would get an end-of-session swift swipe.

The problems and remedies need public airing. Oregon’s conversation should include more evaluations from states that force treatment. More consumers — there was only one on the task force — need to testify about approaches that engage the mentally ill instead of coercing and frightening them.

Cost analyses need to explore how alternative approaches would affect the Oregon Health Plan, jails, prisons and other public and private agencies, as well as consumers’ ability to live independently, hold jobs and become taxpayers.

Let’s take the task force findings to statewide hearings during the legislative interim.