Last week, my blog was posted under the title, “Understanding Mental Illness.” It was not my original title, so I understand the frustration some of you felt after reading it. My apologies. I was not trying to present a blog in understanding. The main point was simply to move us away from all the political discourse regarding the Arizona shootings and to focus on mental illness.
This week, I want to present a few options of what can be done when someone with mentally illness refuses treatment. Many of you have asked about options for a relative or friend.
Let’s begin with a short note about schizophrenia, a likely diagnosis of the Arizona shooter. Treatment refusal is often due to the fact that the person does not believe he or she is ill. The reason for this is linked to the frontal lobe dysfunction of the brain where the ability to self-analyze is located. Schizophrenics are not in denial; they are brain-disordered.
So, what do you do with a person who needs but refuses treatment? Here are options to check into:
Need for Treatment (NFT): About half of the states allow involuntary commitment under what is called, “A need for treatment” policy. A patient can be hospitalized and evaluated if it can be shown that he or she will mentally deteriorate without treatment.
Assisted Outpatient Treatment (AOT): Most states have this law. A patient may live at home, but must be treated for his or her condition, usually by community-based mental health services.
Outpatient Commitment: This is court-ordered, requiring a patient to comply with treatment from a hospital in order to be released. The court sets the penalties for non-compliance.
Conditional Release: The hospital has authority to judge whether someone complies with treatment and should be released or returned to the hospital.
Representative Payee: If a patient is receiving government aid such as SSI or SSDI, a court-assigned representative handles distribution of checks to the patient. Treatment compliance can be a condition of getting paid.
Guardianship: The court can appoint someone to permanently make decisions for the patient. The road to declaring legal incompetence, however, is not easy.
Benevolent Coercion/Court Ordered: If the patient has been arrested, the judge may order compliance to a treatment program. The likelihood increases if the patient is tried in a mental health court.
Assertive Case Management: This is only available in some states, but a team of professionals manages the treatment of a client and assists in compliance. The team can also be appointed the representative payee.
Residential Treatment: Treatment compliance is a condition of staying.
Psychiatric Advance Directive (PAD): This is a legal document that the patient can establish in order to outline treatment options if he or she becomes incompetent. The forms of PAD differ from state to state and may fall under Advance Directives. PAD should be established before a crisis and when the person is judged to be competent.
Not all of these options are available in every state, and even when they are, they may not be enforced. So check the laws and see if any of these will assist you in getting help.
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