Proponents of Connecticut establishing a law that would allow the involuntary treatment of people with mental illness in the community have recently used two misleading ideas to support their case.
They acknowledge that voluntary treatment is preferable, but point out it doesn't work for everyone. Among the reasons they give for the failure of voluntary treatment is that some people with mental illness have a condition that makes them unaware they are ill, or they don't like the side effects of medication. Both assertions are highly questionable and neither does justice to the seriousness of the issue.
It is misleading, for example, to refer to people with mental illnesses as either "treated" or "untreated." The medications we currently have for these conditions do not come close to resembling the effective use of insulin for diabetes, for example. Only seven out of 10 people with a serious mental illness will derive any benefit from medications, and these benefits will typically be modest.
For most people, medications do not eliminate the illness but only lessen some of its more intrusive features. At the same time, side effects are not merely unpleasant or annoying. They may make it difficult for people to function at all and may contribute to the loss of fully a third of the person's expected lifespan, as those with serious mental illnesses die 25 years sooner than the American average.
This leads to the second issue of refusing treatment. There are no data of which I am aware that indicate that persons with psychotic disorders refuse treatment because they have a neurological condition that makes them unaware that they are ill. This theory assumes that if people were aware of their symptoms, then they would know and accept that those symptoms were due to having a mental illness. But no one is born knowing what mental illnesses are or how to recognize when they begin to experience the symptoms of one. How, then, are people to know that what they have is a mental illness?
If the only things people are taught about mental illnesses are the negative stereotypes held by our society — such as being "mental defects" — we can assume that many people will continue to "deny" that they have a mental illness. From their perspective, they are not "crazy" or "insane," so they could not possibly have a mental illness. They are just like you and me (because they are, after all, you and me).
Many people choose not to follow through with outpatient care once discharged from a hospital because they do not see themselves as the "madmen" that society has painted persons with mental illnesses to be. Treating such people as dangerous thus accomplishes exactly the opposite of what we intend. This attitude drives people in need away from the care that would be effective in addressing their concerns.
No one would willingly choose to adopt the identity of a "mental patient." This is why it requires considerable courage for people to seek mental health care. One consequence of this attitude is the shocking statistic that recently came to light about the war in Afghanistan: More American soldiers died from suicide in 2012 than from combat.
I know about what it takes to accept having a mental illness. I am a highly trained mental health professional who suffered for 17 years with an undiagnosed mental illness before getting effective treatment because of my own deeply held beliefs that I was not one of "them." This is the false dichotomy that we must break down.
If we want to make mental health care accessible, then we should stop scapegoating people with mental illnesses and focus instead on fixing the society, and system, that marginalizes them. We need to educate the public and youth in particular about what mental illnesses are, including how common they are (one in four Americans will have one), and, important, how possible it is to recover.
There are effective treatments other than medication that we can make available, such as outreach and peer support. These invite, rather than coerce, people into care that is respectful and responsive to their needs, so they need not suffer alone in silence, and so that mental health care is no longer something of which people are ashamed.
Larry Davidson is a professor of psychiatry at the Yale University School of Medicine.