Required mental health treatment?

In the United States we live in a country that tries to support free-will with regard to health care. When you no longer have the ability to make choices about your physical abilities, however, you can have a designated person choose for you. You trust that the designated person understands your desires for life support or not and under what circumstances that you want to continue to live. In many cases family members must make difficult decisions about a loved one's continued treatment from incurable physical illnesses.

But what about mental illnesses, especially those associated with psychotic thinking like schizophrenia? In many states if someone is at imminently at risk of harming themselves and others, they can be temporarily hospitalized. They could be referred for further treatment, but unless they have a record of harming others the referral is only a suggestion with no legal weight. The idea is based on the premise that we should have free will to seek treatment for ourselves unless there is “proof of harm.”

But the question is “what is considered harm, when you have a brain disease like schizophrenia?” Symptoms of untreated schizophrenia can include disordered thinking, disorganized behavior, delusions, and hallucinations. In addition most have negative symptoms such as low energy, low motivation, and apathy. These symptoms, unless treated, usually get worse with time. Early interventions are important to reduce neurological damage. While some individuals with schizophrenia have insight and seek treatment early, many do not either have the insight that something is amiss or do not have access to helpful treatment. Should we let people who are unable to care for themselves fall prey to their illness and surroundings and not get the help that they need?

Research has shown that individuals with a brain disorder like schizophrenia are 65 to 130% more likely to victims of violence that the general population. This means the those with untreated schizophrenia not only are at risk of continued brain deterioration but they are socially vulnerable when living in a community. Many of the homeless population suffer from untreated mental illness. If you or someone that you loved were in this predicament, would you say, “Oh well, if they want treatment they can get it. It is their choice.”? Is it truly their choice if their brain is not functioning in a way that would help them make good health care decisions for themselves?

Some individuals with psychotic thinking have made violent attempts to harm others or themselves. When that happens, most states have required treatment interventions that may be helpful, especially if follow-up treatment is required or encouraged. Many with schizophrenia, however, are more passive rather than aggressive and may not act in violent ways. Even so, they may not be able to care for themselves. They may wander the streets or may make risky decisions for themselves. But because they are not violent or imminently threatening, they are overlooked. Their brain can continue to deteriorate but there is nothing legally that healthcare professionals or family and friends can do. Is this fair to those with a brain disease?

It is my belief that family members and those who care about people diagnosed with mental illness should be able to help them get the treatment that they need, even if it means some form of required inpatient or outpatient interventions. If someone you love has dementia, do you let them live alone as their brain functioning worsens and they are no longer able to make safe decisions? Hopefully not.

I am interested in your thoughts.