End stigma by ending violence

According to a just released report by my friend, Dr. E. Fuller Torrey, individuals with neurobiological disorders (NBD, formerly known as 'mental' illness) are more violent than the general population. There are more people with these disorders in jails than their presence in the population would indicate. In otherwords, public fears of violence by individuals with NBD are not unfounded. They are based in a fact--a reality--many AMI families and consumers have been reluctant to admit.

Until we eliminate the reality of increased violence, efforts to eliminate stigma via P.R. campaigns will be doomed to failure. The on-going headlines about "Psychotic killers on rampage" will continue to tar all consumers, even those who have never been involved in acts of violence. The fear of violence will continue to cause communities to reject the very residential and community based treatment facilities that can prevent violence. The problem is not that newspapers report on violence, the problem is, the violence does exist. The question becomes what to do about it. Some would have us continue to deny it is a problem in spite of overwhelming evidence. Others would have us attack the media for reporting on it. I think it is time AMI advocates take steps to reduce acts of violence by people with NBD. The reduction in stigma will inevitably follow.

Partially to accomplish this, AMI/FAMI adopted a sweeping proposal based on the following reality: While individuals with NBD are more violent than the general population, individuals with NBD who are treated are not more violent. The question then becomes how do we see that these individuals get treatment. Two things are necessary. First we have to have laws that allow people to receive treatment before they become a danger to self or others. Secondly, we have to have treatment facilities. Laws to allow treatment Numerous studies show that individuals with neurobiological disorders (NBD) are no more violent than the general population, when treated. But because the brain is affected, individuals with NBD often don't have the capacity to recognize they need treatment. And recently adopted policies and laws won't allow these individuals to be treated involuntarily until they become a "danger to self or others". Hence it is not surprising that "Multiple murders by emotionally disturbed (sic) gunmen have become more common in America (New York Times Editorial 12/10/93)" .

We have to 'head 'em off at the pass'. Treat individuals with NBD before they become a "danger to self or others". AMI/NFAMI proposes four initiatives.

1. We must institute "need for treatment" and "gravely disabled" standards to suppliment NYS's "danger to self or others standard". The "need for treatment" standard allows someone to be treated over objection if they have lost so much control of their faculties, that they are unable to comprehend the treatment being proposed or it's likely courses and outcomes. For example, some individuals who become psychotic refuse treatment because they believe the medicines are poisons being administered by the CIA. A "need for treatment" standard would allow someone else to be assigned the right to decide on treatment for this individual until he/she regains the ability to reason. The decision to administer medicines could be made before the individual becomes a danger to self or others, thus averting needless violence. The "gravely disabled" standard allows someone to be treated over objections if, because of a 'mental' impairment, they have deteriorated to the point where they are no longer able to provide for their own welfare. It is important to note that these standards would suppliment, not replace, the 'danger to self or others' standard.

2. The second area addressed by the AMI/FAMI policy is the need to enact "outpatient commitment" legislation. These laws allow individuals with NBD to live in the community only if they agree to take the medicines, and follow treatment plans that can control the illness, much like we do with TB patients. It would cut down on the number of people who deteriorate to dangerousness because they have stopped treatment.

3. Another area addressed by AMI/FAMI, is that their must be a policy that allows judges to look at past behavior when making an involuntary treatment determination. While past course of the illness is the best predictor of future course, civil libertarians have prevented judges from considering this scientific information. Hence many individuals who should be involuntarily treated are not because the judge has inadequate information

4. Finally, AMI/FAMI believes that the decision to treat someone should be made at the same time they make the decision to involuntarily commit. Current laws allow someone to be committed, but not treated, a ludicrous proposition that prevents many people from bringing involuntary treatment proceedings in the first place. It is important for AMI/FAMI to take the lead in passing laws implementing the above policies they have adopted. Otherwise others will take the lead and the important judicial and procedural protections that must be in place for consumers may not be included in legislation proposed by others. In addition, from a marketing perspective, it may be necesary to capitalize on the fear of violence to get the law passed. For instance, some have sugggested calling the enabling legislation "The Hoag Law." It may be a bitter pill to swallow, but if it helps individuals with NBD,we should be for it. No one I know, self included is "for" involuntary treatment. We are all against it. Judy Pritchett, board member of AMI/FAMI said it best, "If it's involuntary, it's not treatment". But I believe, without this legislation, the battle against stigma will be a failure because it fails to address the underlying cause. It will also lead more communities to reject the services that can help. Obvioiusly we must support housing and treatment facilities right in the midst of our communities. Because laws mandating treatment are useless if the facilities to treat are non-existent.

The preceeding was posted by djjaffe on behalf of Alliance for the Mentally Ill/Friends and Advocate sof the Mentally Ill.




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