Assisted Outpatient Treatment

by Joseph Merlin Bowers

One of the more controversial parts of much legislation being considered in Congress currently is assisted outpatient treatment. It’s even been a source of a disagreement between one of my sons and I. Some of the trouble is that it doesn’t mean exactly and only what is says. It also means involuntary outpatient treatment and sometimes forced medication.

As anyone who knows me might expect, I have a lot to say about this issue as someone who has experienced psychosis, involuntary commitment and at least coerced medication.

In the West we greatly treasure civil liberties and freedom of choice as I think we should. So taking that away from an adult should never be done lightly or routinely. All of us in fact no matter our competency sometimes make bad choices and we should have the right and freedom to do so in a free society. Taking this freedom away should be very rare indeed. But civil liberties and freedom of choice are not just privileges. They are also a responsibility if sometimes only to ourselves.

Because of this responsibility, we don’t allow small children to make important life altering decisions or so burden them if that is how one looks at it. Nor should we allow or so burden someone who is mentally incompetent.

Who is and how do we decide who is mentally incompetent? Clearly this should be done on as limited a basis as is humane. I would say only those currently psychotic should be so deprived of freedom of choice. This should be determined, I think, by a licensed psychiatrist.

We are getting into gray areas here.

Should someone competent but extremely depressed be allowed to choose suicide? I think not. But I think most of the time involuntary commitment and forced medication shouldn’t be necessary to stop them.

I’ve been in a situation where the only way to gain my release from an institution was to convince a psychiatrist that I was fully competent. It is an extremely unpleasant feeling of complete helplessness that few need ever experience. However, having been psychotic and convinced at the same time that I was fine, I must say the following: If I ever get in that state again, please force me into treatment. It might save my life and I will thank you later.

The issue of forced medication and antipsychotics in general is nuanced and complicated. I may set forth my views on that in another blog one day. I’ll just say for now that I favor it when appropriate.

There is another legitimate question about forced commitment. When I am psychotic and someone else needs to be  given the power to make decisions for me how  do I know that when I become competent again he will give that power back to me? This to me is a real concern. Not a deal breaker but a real concern.

I am not a big believer in faith as the be all and end all of existence. I think blind faith is a very dangerous thing. But little can be done in life without exercising some faith in something or someone. Here I think we have to exercise some faith in competent professionals. It should not be without checks. There should be a reasonable time period for regular reevaluations by at least three psychiatrists, I think.

I don’t know exactly how the proposed legislation is written, but it’s entirely doable to address all legitimate concerns anyone may have. Even if the legislation is imperfect, I would strongly support it.

The alternative is the status quo which leaves incompetent people to their own devices. This has resulted in tens of thousands of needlessly wasted lives on the streets and in our jails and prisons.

No one competent chooses a life sleeping out of doors with cardboard blankets eating out of garbage cans. I’ve been arrested because of what I did while and because I was psychotic. I’ve been strip searched and body cavity searched in full view of a female guard. I’ve been put in jail house restraints lying on my belly on the floor with my wrists and ankles bound together behind my back. I’ve spent days in solitary confinement in a four by eight foot cell with only a peep hole to see out of while in a manic state and out of cigarettes. No one in his right mind would choose this over treatment. Take it from me.




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