The Treatment Review Panel: A Solution to Treatment Refusal?

During the last ten years, forensic psychiatry has witnessed a sharp inversion of one of its most thorny problems from the "right to receive treatment" to the "right to refuse treatment." Judicial decisions such as Rogers I in Massachusetts and Rennii in New Jersey have created clinical dilemmas for mental health professionals; the courts' recognition of the psychiatric patient's right, albeit qualified, to refuse antipsychotic drug therapy complicates treatment even if ultimately enhancing the treatment process. Adopting the model of in-house peer review suggested by some of the decisions, the Minnesota Department of Public Welfare with assistance from the Attorney General's office has developed a Treatment Review Panel (TRP) to evaluate the merits of involuntarily medicating committed patients in both acute (emergency) and nonemergency situations. This article presents an overview of the evolution of the Minnesota Treatment Review Panel process, emphasizing judicial events and administrative responses, and summarizes activities of the TRP during its initial twenty months of operation. A discussion details the clinical significance and the administrative and legal implications of the trends suggested by the findings.