Opinion: Psychiatric detentions unlikely to improve anyone’s mental health

Another mental health bill is before the California Senate, passed by the judiciary committee on April 25. This bill, backed by some urban mayors, would make it easier to forcibly treat more people. It comes on the heels of CARE Court, a program rolling out this year that broadened state powers to impose psychiatric care.

Promoters of forced treatment often push a well-known tale: Since the 1950s, many state hospital asylums have closed, and strict, rights-protecting mental health laws emerged. Today, the story goes, practically no one gets compelled into psychiatric care even if they’re extremely dangerous. As a result, streets overflow with mentally ill people.

That narrative makes it seem reasonable to broaden laws to forcibly treat more people for mental disorders as a way to reduce homelessness. But this story disguises the fact that rates of detentions and forced treatment have been rising in the United States for decades without achieving measurable improvements on mental health or homelessness.

California passed its Lanterman-Petris-Short Act in 1967 to establish danger to self or others or grave disability as criteria justifying involuntary psychiatric interventions — terms that in practice can be interpreted flexibly. In a 2019 review, the State Auditor found no need to expand the Lanterman-Petris-Short criteria to help Californians. Yet there have been repeated efforts to do just that, sometimes to shocking degrees — under California’s latest bill, a person would be a potential candidate for forced treatment if they’re not “adequately clothed” or not performing necessary “personal” care.

In addition to objecting to existing laws, some pro-force advocates argue that asylum closures created a shortage of beds for detentions. But a 2017 study found that, since 1970, beds in places such as general hospital psychiatric wards, private psychiatric hospitals and residential treatment centers have doubled or tripled.

State tracking of psychiatric detentions is incomplete and inconsistent. But the data indicate that involuntary commitments have risen around the country for many years. And studies show that California detains people at a rate even higher than the U.S. average.

As psychiatric detentions increase, and officials clamor for more, it’s not at all clear that they help people more than they harm. As summarized by a 2019 review of scientific literature on coercive care: “there is little evidence [coercive interventions] confer any clinical benefits,” making it “paradoxical” that these interventions “continue to be used extensively.” Worse, the authors wrote, forced interventions are “often associated with negative outcomes” and experienced as “highly distressing and even traumatic.”

It’s not difficult to understand why. While some detentions evolve into a collaborative process between patient and doctor, forced treatment is often brutal, involving threats, security guards, stripping, restraints and heavy tranquilization. For some people, forced sedation and severe adverse drug effects — such as diabetes and movement disorders — can continue torturously for years under Assisted Outpatient Treatment or conservatorships. There are many people who want help but choose homelessness over such “care,” which is why many researchers advocate for noncoercive, supportive housing.

This reality runs counter to the argument — a popular one in California, given the state’s housing crisis — that involuntary treatment will help unhoused people with mental health issues get off the street. Homelessness began worsening after deep cuts to affordable housing, and homelessness itself can cause and exacerbate mental disorders and addiction. Unhoused people need homes, not forced treatment.

Nevertheless, during the research for my book, I found that involuntary psychiatric interventions get widely imposed, including on unruly schoolchildren, distressed seniors, disability benefits recipients, workplace whistleblowers, callers to mental health helplines and pregnant women.

Truly caring public health responses — and ones in line with the data and evidence — would mean reducing or eliminating, not expanding, coercive mental health interventions.

Rob Wipond is an investigative journalist and author of “Your Consent Is Not Required: The Rise in Psychiatric Detentions, Forced Treatment, and Abusive Guardianships.” ©2023 Los Angeles Times. Distributed by Tribune Content Agency.