IOC – A Simplistic Response to a Complex Problem

• The U.S. Surgeon General states, “The need for coercion should be reduced significantly when adequate services are readily accessible to individuals with severe mental illnesses who pose a threat of danger to themselves or others.”[1]
• The National Council on Disability recommends that “laws that use involuntary treatments such as forced drugging and inpatient and outpatient commitment should be viewed as inherently suspect, because they are incompatible with self-determination.”[2]
• Researchers of the Bellevue study in New York concluded that, “outpatient commitment played no apparent role in improved community outcomes.”[3]
• Despite negative press, people with a mental illness and no substance abuse symptoms are not any more likely to be violent than people without mental illnesses.[4]
• People with mental illnesses are more likely to be victims of violence than perpetrators.[5]
• The MacArthur Foundation confirms that many people with mental illnesses have the ability to make competent decisions about their treatment.[6]
• In many high profile cases where people have committed violence to themselves or others, individuals have often already sought care, but were turned away due to insufficient resources.

Real Solutions:  Invest in Mental Health and Empower ConsumersInvest in Community-Based Services

• Our mental health system is underfunded.  State mental health appropriations have dropped from 16.5% of the annual budget in 1955 to only 11.5% in 1997.[7]  Mental health and substance abuse spending has grown more slowly than all health care – averaging 3.7 percent compared to 5 percent for general healthcare.  State mental health expenditures have dropped to 7.8 percent of overall US healthcare expenditures in 1997, down from 8.8 percent in 1987.[8]
• We need to invest in mental health.  Creating a full continuum of community based, non-coercive treatment services will keep people from falling through the cracks, reduce expensive hospital stays, and help them lead full, productive lives.[9]
• Voluntary Treatment is an effective use of funds.  The Community Mental Health Treatment Program for homeless people in California has saved the state an estimated $7.3 million in hospital and jail costs.[10]

Pass and Enforce Advance Directives

• Psychiatric Advance Directives involve people in their treatment plans, and allow them to develop emergency plans in case of a mental health crisis.  Almost all states have advance directives laws, but not all include mental health advance directives, and few are widely enforced.
• Advance directives allow a consumer to provide a clear, written statement of his or her wishes in case of a mental health crisis so that their wishes will not be assumed to be irrational and overrided by healthcare providers.
• There are two types of advance directives:
  • Instruction Directive allows a consumer to express his or her wishes for mental health treatment, including: medication administration, seclusion and restraint, and other aspects of treatment.
  • Durable Power of Attorney allows a consumer to identify a person to be designated his or her representative in case the consumer is legally determined to be incompetent.
• Enforcement of advance directives includes: educating and training providers, state officials, and consumers about advance directives; informing consumers about advance directives upon release from psychiatric inpatient settings; and involving the protection & advocacy associations.

For more information, contact the Advocacy Resource Center at 1-800-969-NMHA (6642), Option 6.