Treatment Over Objection Working Group (Friday lunch roundtable discussion)

Arthur Baer

I. Background
The forced administration of drugs, electroconvulsive therapy, and other medical procedures, over a patient’s objection, implicates the fundamental rights of persons who are involuntarily committed in psychiatric hospital, or under involuntary outpatient commitment orders. Such treatment typically involves medication over objection but can also involve the administration of electro convulsive therapy or shock treatment, and even highly personal and intrusive medical treatment such as amputations.

Treatment over objection, effects, or has effected, numerous individuals who are, or have been, involuntarily committed, and can have severe short and long term adverse consequences on those subject to such orders. It is a regular subject at NARPA conferences. Given the extraordinary liberty interests involved; the thought is, that it is time that NARPA consider taking proactive steps to prevent involuntary medication, ECT and medical procedures, forced treatment which is predicated on psychiatric grounds, e.g, lack of capacity.

II. Goals The goal of this informal session is to discuss the nature of the working group, its work, how it is structured, and its work implemented, and possible future projects. A preliminary list of possible projects includes:

  1. Undertaking a comprehensive survey of the law in the area, with the goal, over time, of having a summary of the legal standards for ordering treatment over objection in each jurisdiction;
  2. Undertaking empirical research; for example, assessing how often such orders are sought in each jurisdiction, by which institutions, and in what circumstances;
  3. Undertaking research (or compiling existing research) on the adverse effects and efficacy (or lack thereof) of such treatment;
  4. Undertaking research on the financial incentives for different treatment modalities, for example, do insurance payments for hospital stays end, thus, result in orders for treatment over objection rather than less intrusive forms of treatment; how are the costs for such treatment financed; for another example, how much does each State spend on psychotropic medications or ECT for those who are involuntarily committed;
  5. Drafting policy proposals for reform based on the information gathered; and/or
  6. Setting up an emergency response team to publicize cases and mobilize sport, when an individuals seeks assistance;
  7. Completing a survey of organizations that provide legal representation and/or advocacy on behalf of those facing involuntary treatment.

As part of this session, we will discuss how the working group currently functions in practice, any changes we might make in the future as to how it does its work to make it more effective, and possible next steps, keeping in mind that we will act in phases, undertaking a small subset of possible tasks, and build incrementally from there, so that our efforts are sustainable.