Involuntary Commitment And Ethics

Despite the fact that my parents have worked in the criminal justice system for many years, I have never given much thought to the treatment of prisoners. As we learned from the readings, the current state of the United States criminal justice system is imperfect to the point of cruelty to those involved in it. This is truer for individuals with a mental illness. Due to a lack of psychiatric facilities throughout Alabama and overcrowding of those that do exist, many criminal offenders with mental illnesses are sent to prisons instead. State prisons are currently overcrowded, leading to substandard conditions such in almost every aspect.

Given the number of incarcerated inmates who suffer from some form of mental illness, there are growing concerns and questions in the medical field about treatment of the mentally ill in the prison system. When a person with a mental illness commits a crime or break the law, they are immediately taken to jail or sent off to prison instead of being evaluated and placed in a hospital or other mental health facility. “I have always wondered if the number of mentally ill inmates increased since deinstitutionalization” Since prison main focus is on the crimes inmates are incarcerated; the actual treatment needed for the mentally ill is secondary. Mentally ill prisoners on the surface may appear to be just difficult inmates depending on the

Doyle, Jim, and Peter Fimrite. "Caring for Mentally Ill Criminals Outside of Prison Is Dangerous." America's Prisons. Ed. Clare Hanrahan. Detroit: Greenhaven Press, 2006. Opposing Viewpoints. Rpt. from "Criminally Insane Taking over State Hospitals." San Francisco Chronicle 22 July 2001. Opposing Viewpoints In Context. Web. 26 Feb. 2013.

2. This criticism is on the moral basis and the consequences. This section suggests that the crime is of more importance, then the moral imperatives. It also addresses the way a criminal, who does plea insanity, should be trialed and punished for the crime. It is suggested, that the criminal should be convicted and the mental illness should be taken in consideration at the time of sentencing. If this method would be used by the court, it would allow the judge to determine the length of imprisonment, within a hospital prison, and the defendant would have to provide prove of improvement to the once dangerous behavior. Retrieved from; West's Encyclopedia of American Law, edition 2 (2008).

The United States criminal justice system has been continuously increasing incarceration among individuals who suffer from a sever mental illness. As of 2007 individuals with severe mental illness were over twice as likely to be found in prisons than in society (National Commission of Correctional Health Care, 2002, as cited in Litschge &Vaughn, 2009). The offenses that lead to their commitment in a criminal facility, in the majority of cases, derive from symptoms of their mental illness instead of deviant behavior. Our criminal justice system is failing those who would benefit more from the care of a psychiatric rehabilitation facility or psychiatric hospital by placing them in correctional facilities or prisons.

Olmstead vs. L.C., which is the case that led to the Olmstead Decision, is considered to be one of the most important civil rights cases during the 20th century (Zubritsky, Mullahy, Allen, & Alfano, 2006). The Olmstead Decision was put into place after two women with a diagnosis of mental illness and developmental disability were voluntarily placed in a psychiatric facility and remained institutionalized for years. Even after efforts made by the women’s staff members to move them into a community setting, they were not moved until the Supreme Court’s 1999 decision in the Olmstead case (Cashmore, 2014).

A lack of infrastructure and monitoring in correctional institutions leaves the public unaware of the aforementioned human rights violation of individuals diagnosed with mental health disorders (Mfoafo-M’Carthy and Huls 2014). In the case of Ashley smith, she was often confined for long periods of time without appropriate cause and were then subjected to conditions that included violence, substandard nutrition and cleanliness, torment, unconsented medical treatment, loss of dignity, and sedation as a control method. In addition, her diagnosis of personality disorder was used against her because she did not conform to the dominant cultural, moral, and religious standards of society.

In the book, Crazy, by Pete Earley, provides a detailed overview of the mental health system in the United States, as it presents a first hand narrative of Earley’s family journey through the system. The author’s major premise and arguments, in the book, is to highlight the history of mental health, navigation through the judicial system with mental illness, the bureaucracy and policies of hospitals, society views on human rights and client safety, and the impact on the individual, family, and community. The content suggests that human service workers and public health workers should extend their professional lens to advocate for change in the mental health system in the United States.

Although there are many people who support involuntary commitment, there are also those who do not. Despite all of the support for involuntary commitment of dangerous, mentally disturbed individuals; there will always be people in opposition to this practice. In America especially, it is currently a very controversial topic. Those against involuntary commitment of the mentally disordered argue that it “is an extraordinary exercise of paternalism and the police power of the state” (Morse 58).

The theory of ‘deinstitutionalization’ began arising with the theory of providing more freedom to the mentally ill and less spending on full time care facilities. The widespread use of drugs to control the mentally ill in the 1900s led to a mass release of patients and an emptying of asylums. Outpatient Psychiatric Clinics were established. Case Law in the United States began to be generated to provide the mentally ill with greater rights. Shelton v. Tucker 1960 provided that the mentally ill should receive care in the “least restrictive alternative”, which is a practice still utilized. O’Connor v. Donaldson 1975 ruled that non-dangerous mental patients have the right to be treated or discharged if they have been institutionalized against their will. This new approached permitted the mass exodus

Involuntary commitment or civil commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in

Hagan, Claire. “Sheltering Psychiatric Patients from the DeShaney Storm: A Proposed Analysis for Determining Affirmative Duties to Voluntary Patients.” Washington and Lee Law Review, Jan. 2013, vol. 70, issue 1. EBSCOHost, http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=87120180&site=ehost-live.

Jails have been described as “de facto mental hospitals” because they have filled the void created when state psychiatric hospitals began closing in the early 1960s through a process known as deinstitutionalization. Supporters of deinstitutionalization thought the process would help individuals suffering from a mental illness live more self-reliantly while being treated by community mental health programs. However, the federal government did not provide the necessary funding to meet the mounting demand for these programs, leaving numerous untreated. Individuals with serious mental illnesses are often poor or homeless and are likely to have substance abuse problems. Therefore, when they are left untreated, they are more likely to commit minor crimes that have been the focus of law enforcement in recent years (H. Richard Lamb and Linda Weinberger).

The use of restraints for psychiatric patients has been in existence for a long time. In the 17th and 18th centuries, the use of mechanical restraints was deemed acceptable and required in the asylum environment (Carr 2012). However, there has been ethical dilemma on the usage of any form of restraints in caring for patients. Hughes, Zammit and Cordina (2014) explained that there has been a long discussion about restraint methods in health care settings, the usage of both physical and chemical forms of restraint in clinical practice, and to whom such methods would be appropriate

“A suicide attempt predicts a 20 percent risk of another attempt” (Amidov par. 9) However, those 80 percent of suicide attempters who will not make another attempt will lose their liberty and be involuntarily hospitalized though unnecessary. Despite modern-day developments and innovations, doctors still cannot accurately predict who will make a suicide attempt in the future, so locking up individuals when evaluation and prediction of their danger to themselves are uncertain does not benefit the liberty and prosperity of numerous people in society. Some may argue that involuntary hospitalization may be necessary as they could have impaired judgment regarding their state. While this is certainly true as one’s ability to assess their own state of mind can be debilitated, there are better alternatives to involuntary hospitalization which protect the mentally ill and others in society. For example, “Assisted Outpatient Treatment is a court-supervised treatment in which people can live outside psychiatric hospitals under close care...80% of AOT recipients reported that AOT helped to get and stay well” (Assisted Outpatient Treatment par. 5). Mentally ill patients receiving AOT are not confined to a small hospital room and can experience liberty while under close supervision. It is difficult to determine whom involuntary hospitalization will benefit, but other alternatives such as Assisted Outpatient Treatment exist to provide care to mentally ill patients without severely restricting their lives as hospitals