Alaska Supreme Court Grants Mental Patients Constitutional Rights

State laws in the US sanctioning involuntary commitment of mental patients were passed under the influence of psychiatrist E. Fuller Torrey and his Treatment Advocacy Center. These laws allow psychiatrists to aggressively force mental patients to ingest highly toxic psychotropic drugs–mostly in unapproved, untested, toxic combinations.  Evidence links these drugs to severe adverse effects leading to life-shortening chronic diseases with little evidence of a therapeutic benefit.

The Alaska Supreme Court has just rendered a decision that significantly advances psychiatric patients’ constitutional due process rights when the state seeks to force them to take psychiatric drugs against their will.

Jim Gottstein, Esq. who spearheaded and argued the case has won a precedent-setting victory preventing the state from routinely obtaining court orders to force mental patients to take highly toxic drugs against their will without demonstrating a justifiable medical rationale.

State psychiatrists in Alaska will have to convince the court with evidence to justify forced pharmacological treatment.  In most cases, they will be hard pressed to do so, inasmuch as  a body of scientific evidence shows that the risks posed by antipsychotics–the drugs of choice–are not justified by demonstrable clinical benefits. Antipsychotics [previously called  neuroleptics, major tranquilizers] are chemical restraints–often used as punishment, not therapy.

Dr. E. Fuller Torrey and his posse of pharmaceutical funded mental illness "advocates" have made political headway by deliberately promoting unsubstantiated claims about mental patients’ predisposition toward violence which, they insist, must be addressed by forced treatment.  Much like all campaigns built on fear mongering, they often work by  diverting attention from legitimate problems.

In the case of mental patients, the issue is patients’ legitimate refusal to take drugs with intolerable adverse-effects. In the case of antipsychotics, the serious adverse effects are these drugs’  primary effects, they are not rare side-effects.

The evidence shows that the link between violence and schizophrenia converges only when such patients are substance abusers–mostly alcoholics and crack cocaine addicts. Non- abusers of mind-altering substances have not been been shown to pose a threat to the community.

Indeed, a new Swedish study published in the Journal of the American Medical Association confirms the findings of older studies that found mental illness NOT to be a predisposition to violence–as the irresponsible claims made by Torrey et al.

The first, most comprehensive study,  The MacArthur Violence Risk Assessment Study , and its updates contradict the predisposition to violence proponents’ claims, as does a British study. References below.

The problem is that psychiatry is welded to a harm-producing drug-focused paradigm of care which the majority of patients reject for rational reasons.
 
The fact is, schizophrenia outcome studies show that patients’ recovery rates have plummeted since the shift to drugs while mental health expenditures have skyrocketed.  There is a connection between chronicity and reliance on drugs.

REFERENCES

1. Seena Fazel, MD; Niklas Långström, MD, PhD; Anders Hjern, PhD; Martin Grann, PhD; Paul Lichtenstein, PhD.  Schizophrenia, Substance Abuse, and Violent Crime, JAMA. 2009;301(19):2016-2023.

2. Appelbaum, P., Robbins, P., & Roth, L (1999). A dimensional approach to the assessment of delusions. American Journal of Psychiatry, 156, 1938-1943.

3. Appelbaum, P., Robbins, P., & Monahan, J. (2000). Violence and delusions: Data from the MacArthur Violence Risk Assessment Study. American Journal of Psychiatry, 157, 566-572.

4. Monahan, J, Steadman, H., Robbins, P., Appelbaum, P., Banks, S., Grisso, T., Heilbrun, K., Mulvey, E., Roth, L., and Silver, E. (2005). An actuarial model of violence risk assessment for persons with mental disorders. Psychiatric Services, 56, 810-815.

5.  A. Mader’ et al., Offending in Psychiatric Patients After Discharge From Medium Secure Units: Prospective National Cohort Study, 328 BRITISH MED. J. 1534
(study of 959 patients discharged from medium secure units in England and Wales in 1997-98 found only six percent were convicted of violent offenses over two years, leading the researchers to conclude: "The rate of violent offending is so low that there is little scope for overall reduction and it would be better to concentrate on the identification of high risk patients.").

Posted by Vera Hassner Sharav

 PsychRights®

Law Project for Psychiatric Rights  

FOR IMMEDIATE RELEASE
May 22 2009

CONTACT:
Jim Gottstein
907-274-7686
jim.gottstein@psychrights.org

Alaska Supreme Court Grants Mental Patients Constitutional Rights

In an important decision issued today, William S. Bigley v. Alaska Psychiatric Institute, the Alaska Supreme Court significantly advanced psychiatric patients’ constitutional due process rights when the state seeks to force them to take psychiatric drugs against their will.

"One of the things they held," said Jim Gottstein, President and CEO of the Law Project for Psychiatric Rights (PsychRights) and the attorney who handled the case, "is that if the State is holding someone in a psychiatric facility, they must provide a feasible alternative to the forced drugging if the alternative satisfies the State’s asserted justification. The State’s only other option is to let the person go."

The Court also held that in order to allow the person a realistic opportunity to prepare a defense, when filing a forced drugging petition, the State must provide a written statement of the facts underlying the petition, including the reasons for the forced drugging, information about the patient’s symptoms and diagnosis; the medication to be used; the method of administration; the likely dosage; possible side effects, risks and expected benefits; and the risks and benefits of alternative treatments and nontreatment. "This is very important," Mr. Gottstein said, "because up until now, they just checked a box that said the person was incompetent to decline and the facility wants to drug the person. Then the State comes in with a witness who testifies untruthfully and there is no way to have been prepared to rebut it."

Equally important, the Court ruled the person’s lawyer must be given access to the person’s medical and psychiatric records in advance of the hearing and adequate preparation time. "The problem is judges have been misled for years that these drugs increase safety and are beneficial to patients," according to Mr. Gottstein, "The truth is they decrease safety, are ineffective for most, are physically very harmful, and prevent many people from recovering. The evidence on this is clear, but the way these cases have been rushed through without allowing adequate time for a defense, these facts have not normally been revealed to the judges."

The Law Project for Psychiatric Rights is a public interest law firm devoted to the defense of people facing the horrors of forced psychiatric drugging and electroshock. PsychRights is further dedicated to exposing the truth about psychiatric interventions and the courts being misled into ordering people subjected to these brain and body damaging drugs against their will. Extensive information about these dangers, and about the tragic damage caused by electroshock, is available on the PsychRights web site: http://psychrights.org/.
# # #

406 G Street, Suite 206, Anchorage, AK 99501 ~ psychrights.org ~ contact@psychrights.org
(604) 936-8940 Vancouver Phone ~ (907) 274-7686 Anchorage Phone ~ (907) 274-9493 Fax

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Schizophrenia, Substance Abuse, and Violent Crime
Seena Fazel, MD; Niklas Långström, MD, PhD; Anders Hjern, PhD; Martin Grann, PhD; Paul Lichtenstein, PhD
JAMA. 2009;301(19):2016-2023.

Context  Persons with schizophrenia are thought to be at increased risk of committing violent crime 4 to 6 times the level of general population individuals without this disorder. However, risk estimates vary substantially across studies, and considerable uncertainty exists as to what mediates this elevated risk. Despite this uncertainty, current guidelines recommend that violence risk assessment should be conducted for all patients with schizophrenia.

Objective  To determine the risk of violent crime among patients diagnosed as having schizophrenia and the role of substance abuse in mediating this risk.

Design, Setting, and Participants  Longitudinal designs were used to link data from nationwide Swedish registers of hospital admissions and criminal convictions in 1973-2006. Risk of violent crime in patients after diagnosis of schizophrenia (n = 8003) was compared with that among general population controls (n = 80 025). Potential confounders (age, sex, income, and marital and immigrant status) and mediators (substance abuse comorbidity) were measured at baseline. To study familial confounding, we also investigated risk of violence among unaffected siblings (n = 8123) of patients with schizophrenia. Information on treatment was not available.

Main Outcome Measure: Violent crime (any criminal conviction for homicide, assault, robbery, arson, any sexual offense, illegal threats, or intimidation).

Results  In patients with schizophrenia, 1054 (13.2%) had at least 1 violent offense compared with 4276 (5.3%) of general population controls (adjusted odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2). The risk was mostly confined to patients with substance abuse comorbidity (of whom 27.6% committed an offense), yielding an increased risk of violent crime among such patients (adjusted OR, 4.4; 95% CI, 3.9-5.0), whereas the risk increase was small in schizophrenia patients without substance abuse comorbidity (8.5% of whom had at least 1 violent offense; adjusted OR, 1.2; 95% CI, 1.1-1.4; P<.001 for interaction). The risk increase among those with substance abuse comorbidity was significantly less pronounced when unaffected siblings were used as controls (28.3% of those with schizophrenia had a violent offense compared with 17.9% of their unaffected siblings; adjusted OR, 1.8; 95% CI, 1.4-2.4; P<.001 for interaction), suggesting significant familial (genetic or early environmental) confounding of the association between schizophrenia and violence.

Conclusions  Schizophrenia was associated with an increased risk of violent crime in this longitudinal study. This association was attenuated by adjustment for substance abuse, suggesting a mediating effect. The role of risk assessment, management, and treatment in individuals with comorbidity needs further examination.

Author Affiliations: Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, England (Dr Fazel); Centre for Violence Prevention (Drs Fazel, Långström, and Grann) and Department of Medical Epidemiology and Biostatistics (Drs Långström and Lichtenstein), Karolinska Institutet, Centre for Epidemiology, National Board of Health and Welfare (Dr Hjern), and Department of Psychology, Stockholm University (Dr Grann), Stockholm, Sweden; and Department of Children’s and Women’s Health, University of Uppsala, Uppsala, Sweden (Dr Hjern).

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