Involuntary treatment

Involuntary treatment (also referred to by proponents as assisted treatment and by critics as forced drugging) refers to medical treatment undertaken without the consent of the person being treated. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual's objections. These are typically individuals who have been diagnosed with a mental disorder and are deemed by a court or by two doctors to be a danger to themselves or to others. A 2014 Cochrane systematic review of the literature found that compulsory community treatment 'results in no significant difference in service use, social functioning or quality of life compared with standard voluntary care.' A 2006 review found that as many as 48% of respondents did not agree with their treatment, though a majority of people retrospectively agreed that involuntary medication had been in their best interest. The UN Convention on the Rights of Persons with Disabilities, General comment No. 1 (2014) on Article 12: Equal recognition before the law, specifies that forced treatment, among other discriminatory practices must be abolished in order to ensure that full legal capacity is restored to persons with disabilities on an equal basis with others. All states in the U.S. allow for some form of involuntary treatment for mental illness for short periods of time under emergency conditions, although criteria vary. Since the late 1990s, a growing number of states have adopted Assisted Outpatient Commitment (AOC) laws. Under assisted outpatient commitment, people committed involuntarily can live outside the psychiatric hospital, sometimes under strict conditions including reporting to mandatory psychiatric appointments, taking psychiatric drugs in the presence of a nursing team, and testing medication blood levels. Forty-five states presently allow for outpatient commitment. In 1975, the U.S. Supreme Court ruled in O'Connor v. Donaldson that involuntary hospitalization and/or treatment violates an individual's civil rights. The individual must be exhibiting behavior that is a danger to themselves or others and a court order must be received for more than a short (e.g. 72-hour) detention. The treatment must take place in the least restrictive setting possible. This ruling has severely limited involuntary treatment and hospitalization in the United States. The statutes vary somewhat from state to state. In 1979, the United States Court of Appeals for the First Circuit established in Rogers v. Okin that a competent patient committed to a psychiatric hospital has the right to refuse treatment in non-emergency situations. The case of Rennie v. Klein established that an involuntarily committed individual has a constitutional right to refuse psychotropic medication without a court order. Rogers v. Okin established the patient's right to make treatment decisions.