SUMMARY:

The majority of individuals who refuse treatment accept it after being told that they must, and do not have to be forcibly medicated. And the majority of patients who initially object to hospitalization or medication retrospectively agree with the decision to hospitalize or treat them. Finally, contrary to popular belief, legal status is not an accurate measure of perceived coercion.

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Individuals with severe mental illnesses, such as schizophrenia and bipolar disorder, who have a deficit in awareness of their illness often refuse treatment because they do not believe that they are ill. The majority of individuals who refuse medication subsequently agree to take it in oral form when informed that they must. Therefore, forcible injections are used only in a small minority of cases in which an individual refuses treatment.1

Moreover, the majority of patients who initially refuse medication retrospectively agree with the decision to coercively medicate them.1,2 The majority of patients who are involuntarily treated afterwards report that they will be more likely to voluntarily accept treatment in the future.1 Similarly, a majority of involuntarily hospitalized patients retrospectively agree with the decision to do so.3 Also, the majority of patients who are court ordered to comply with treatment in the community remain treatment compliant after the orders expire.4

Researchers with the New York State Psychiatric Institute and Columbia University conducted face-to-face interviews with 76 assisted outpatient treatment (AOT) recipients to assess their opinions about the program, perceptions of coercion or stigma associated with the court order, and quality of life as a result of AOT. After they received treatment, interviewed recipients overwhelmingly endorsed the effect of the program on their lives:

• 75 percent reported that AOT helped them gain control over their lives;
• 81 percent said that AOT helped them to get and stay well; and
• 90 percent said AOT made them more likely to keep appointments and take medication.

Additionally, 87 percent said they were confident in their case manager’s ability to help them – and 88 percent said that they and their case manager agreed on what is important for them to work on.5

Studies show that legal status (voluntary vs. involuntary hospitalization) often does not correlate with patients’ actual perception of coercion. In a major study on coercion, more than one third of involuntarily hospitalized patients did not perceive that they had been coerced into the hospital and nearly half believed that there were no reasonable alternatives to hospitalization. In contrast, nearly half of voluntarily hospitalized patients indicated that someone else had initiated the process and 25 percent said there were reasonable alternatives to hospitalization.6

ENDNOTES

1Greenberg, W.M., et. al. (1996). Patients’ attitudes toward having been forcibly medicated. Bulletin of the American Academy of Psychiatry and the Law, 24, 513–24.

2Seide, M., et. al. The reluctant psychiatric patient: Ethics and efficacy around the issue of forced medication (Session 2219). American Public Health Association 117th Annual Meeting, Chicago (October 24, 1989).

3Gardner, W., et. al. (1999). Patients’ revisions of their beliefs about the need for hospitalization. American Journal of Psychiatry, 156, 1385-91.

4Van Putten, R.A., et. al. (1988). Involuntary outpatient commitment in Arizona: A retrospective study. Hospital and Community Psychiatry, 39, 953–8 . and Rohland, B.M. (1998, May). The role of outpatient commitment in the management of persons with schizophrenia. Iowa Consortium for Mental Health, Services, Training, and Research.

5N.Y. State Office of Mental Health (March 2005). Kendra’s Law: Final report on the status of assisted outpatient treatment. New York: Office of Mental Health.

6Treffert, D.A. (1999). The MacArthur coercion studies: A Wisconsin perspective. Marquette Law Review, 82, 759-85.

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