Unable to make a free choice
With the eyes of your heart enlightened
The issue and the difficulty
One of the difficulties within the problem of addiction and mental illness is whether to make it easier to force treatment on people. One of the lenses I have used in consultations with parish churches - which at times feels like I’m dealing with some form of addiction or mental confusion - is Chris Argyris’ Intervention Theory. In short the theory says that what we desire for a client is that they can make a decision to which they have internal commitment. A commitment that can last under pressure and over time. And that in order to have such commitment the decision needs to rise out of a high degree of free choice. And to have true free choice the client needs an adequate amount of valid and useful information.
Here’s a video on the theory. Here’s a one page overview of the variation I’ve used.
So, that theory helps me understand one of the legal and ethical issues we face in every large city.
What can we do when a person is unable to take in information or to make a free choice?
Some views on the issue
Opposes forcing help
A Google summary on the position of the ACLU: “The ACLU generally opposes forcing help on the mentally ill, advocating for a system where individuals experiencing mental health crises receive care from trained mental health professionals, not primarily law enforcement, and only resorting to involuntary treatment in extreme cases where there is a serious and immediate threat to themselves or others; they believe that forced treatment can violate individual rights and should be used sparingly.”
He died because he wasn’t forced to accept the care he needed
Found on the Dispatch, In his Substack Very Serious, Josh Barro reflected on the life of Jordan Neely, the homeless man who died in the New York subway last year after a bystander, Daniel Penny, put him in a chokehold.“Through police, courts, jails, homeless outreach, and treatment facilities, New York’s taxpayers spent lavishly on an effort to keep Neely alive, in mental health care, and not posing a danger to the public or himself. But it didn’t work because he was insane and he was not forced to accept the care he needed—except during a stint he spent in jail on Rikers Island, when he was successfully medicated. … I do think it would behoove progressives with pat takes about how what Neely really needed was housing and care to know that he was offered these things over and over again by that extremely well-funded apparatus. If you wanted him to have housing and care, you needed to be prepared to force them upon him; and if you weren’t, then you don’t have a solution to the problems of people like him.”
Involuntary commitment is often traumatic
From the AMA on medical ethics: “Experiencing homelessness is traumatizing and can exacerbate mental illnesses and substance use disorders. When persons experiencing homelessness are a danger to themselves or others, petitioning for involuntary placement is clinically, ethically, and legally indicated. The process of involuntary commitment is often traumatic and can fracture already fragile relationships that persons experiencing homeless have; involuntary commitment should be used only when necessary. It is society’s obligation to prevent crises but, when needed, to support persons in crisis by responding with care to their health needs.”
Some would be forced into care
The Debate Surrounding Court-Ordered Mental Health Treatment for the Homeless: “Mental illness is common within the homeless population. In fact, studies have shown that up to a third of unhoused individuals have a serious mental illness, including schizophrenia, depression, bipolar disorder, anxiety, and substance abuse disorders.California Governor Gavin Newsom recently rev ealed his plan to create mental health courts in every county of his state—which has one of the largest homeless populations in the country. This would allow treatment for more homeless people with severe mental health and addiction disorders but it would also force some of them into care—a move that many homeless campaigners see as a civil rights violation.”
They aren’t aware, or are in denial, of their illness
The Banyan Center website says this: “Some people with mental health disorders like schizophrenia and bipolar disorder refuse mental health treatment, usually because they aren’t aware of their illness or they’re in denial of their mental illness. … But the question lies in how to get someone mental help when they refuse. Can you force someone to get mental health treatment? … While you generally can’t force someone to get mental help, there are resources set in place to assist in a moment of crisis and needing involuntary commitment support. Getting Mental Help for Someone Who Doesn’t Want It - An overview of the issue plus information on the practices in several states.
Thoughts
The issues of homelessness, addiction and mental illness are intertwined. In such situations an objective might be to undo the knot by making strategic interventions that lessen the problem. For example, more housing will certainly help people who are able to make free choices. Increasing the percentage of mentally ill and addicted people we are willing to force into treatment would decrease homelessness. Both solutions have high costs in taxes, the need for trained caregivers, and the limiting of civil rights.
To what extent do we need short term results versus waiting until we address root causes? What are the ethical and legal considerations? How about the political realities?
One of the difficulties is often our pre-existing mental models. Do we have a lens, a way we look at this, that doesn’t allow us to consider viable options. This is from “Faith, hope and love abide”: “Lens, mental models; all the work of the past decade about how cognitive therapy was the most effective form of therapy — it all comes into play here. Cognitive therapy helps patients identify thought patterns (lens, mental models) that are not helping the person and change those thought patterns and related behaviors. People can think more clearly. APA says, "Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness."The emergence of organizational psychology and organization development are in part about lenses that assist us in seeing organizational dynamics we often miss. We are helped to see things “hidden” and under the surface. We then test our lenses by disciplined reflection on our experience. If the lens is false or simply overstayed -- in time many of us will see it because of the experiences we are going through as a result of our existing lens. As some conservatives, and now more liberals, have said about our political mental models, "we get mugged by reality."
so that, with the eyes of your heart enlightened, you may know what is the hope to which he has called you, what are the riches of his glorious inheritance among the saints (Ephesians 1: 18)
This abides,
Brother Robert, OA
The Feast of Lucy (Lucia) of Syracuse, Martyr, 304