Saturday, August 16, 2008

Whose Rights Were Really Being Protected?

A recent article in the Wall Street Journal titled A Death in the Family tells the story of a son who murdered his mother after being discharged from a psychiatric hospital.

William Bruce had been committed to an inpatient psychiatric facility and diagnosed with paranonid schizophrenia after multiple incidents including attempting suicide, threatening two men with a loaded assault rifle, and assaulting both his mother and father. During his hospitalization, he refused to take medication and sought discharge from the facility by working with a government-funded patient advocacy group. According to the Wall Street Journal article, Bruce's medical records indicate that his doctor's thought he posed a threat to himself and to others if he was not medicated and treated for his psychiatric illness. The patient advocates fought for his right to remain psychotic and untreated, if that was his choice, and to be discharged. Unfortunately, after his court-ordered commitment term for assault ended, Bruce no longer met Maine's legal criteria for involutnary commitment, so he was released.

When Bruce was releasd, he returned home to live with his parents. Two months later, he murdered his mother by repeatedly striking her in the head with a hatchet while his father was at work. Bruce was found not criminally responsible by reason of insanity and committed indefinitely to the same psychiatric hospital where he'd been previously. Faced with the possibility of being restrained and medicated against his will, Bruce agreed to take a prescribed antipsychotic drug. Within a matter of weeks, his mental status had improved. Now, he says, "The advocates didn't protect me from myself unfortunately." At the time, he was just happy to have someone help him to get discharged from the hospital, but at that point he hadn't yet acknowledged that he had a mental illness and needed help. He went on to say, "There are times when people should be committed. Institutions can really help. Medicine can help."

Whose rights were the advocates trying to hard to protect? In addition to a patient's right to make their own decisions regarding medical treatment, patients also have the right to receive the appropriate treatment for their condition. According to superintendent at the psychiatric hospital where Bruce is committed, "...the advocates overstepped their bounds. William was relying on the people whose purpose it was to ensure his civil rights were being exercised, and unfortunately that interfered with his other right, which was to get medical care."

Now at least three lives have been ruined--William Bruce's, his mother's, and his father's, as well as other relatives and friends affected by his mother's death. If only Bruce had received the treatment that he needed during his first hospitalization, perhaps these life-altering events would never have happened.

1 comment:

Gabi said...

I think the doctors weren't doing their job.

Maine's Mental health standard for involuntary commitment is pretty easy to meet as far as I can tell:

"E. In addition to proving that the patient is a mentally ill individual, the applicant shall show:

(1) By evidence of the patient's actions and behavior, that the patient poses a likelihood of serious harm; and

(2) That, after full consideration of less restrictive treatment settings and modalities, inpatient hospitalization is the best available means for the treatment of the person."

The burden of proof is clear and convincing evidence, as it is in most states.

If they had real evidence that he might hurt someone, it is unlikely that this would fail to meet that standard of proof; particularly given the fact that the patient is often (in spite of the way things are supposed to play out) presumed insane and dangerous once they show ANY signs of it.

I guess my point is that the advocates seem like easy targets to pin this one on, but a closer look reveals that the hospital clearly didn't do its job in pushing for the man to be committed.

What MIGHT have been going on, because I know this is what goes on in Illinois, is that the legal standard for commitment is lower than the actual standard for commitment in a mental hospital due to lack of space - and it may be the case that the doctors didn't bother fighting this one because of space/resource concerns to begin with - that's a side effect of the movement to de-institutionalize combined with normal budget cuts. Even if the standard is judged to be too difficult to meet by legislators (unlikely) and lowered, funding is going to limit who is going to get admitted to begin with.

I'll reveal my bias and note that I have worked as a law student in a pro bono mental health advocacy project; however, I think that's what tripped my BS meter on this article - it stated that the standard was too rough without citing it, blamed advocates because the doctors failed to file a commitment petition (which would have at least bought them more time even if it wasn't successful), etc.