Committed: The Battle over Involuntary Psychiatric Care

by Dinah Miller, Annette Hanson, Pete Earley (Foreword)

A compelling look at involuntary psychiatric care and psychiatry’s role in preventing violence. Battle lines have been drawn over involuntary treatment. On one side are those who oppose involuntary psychiatric treatments under any condition. Activists who take up this cause often don’t acknowledge that psychiatric symptoms can render people dangerous to themselves or others, regardless of their civil rights. On the other side are groups pushing for increased use of involuntary treatment. These proponents are quick to point out that people with psychiatric illnesses often don’t recognize that they are ill, which (from their perspective) makes the discussion of civil rights moot. They may gloss over the sometimes dangerous side effects of psychiatric medications, and they often don’t admit that patients, even after their symptoms have abated, are sometimes unhappy that treatment was inflicted upon them. In Committed , psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy―all within the context of civil rights―Miller and Hanson illuminate the personal consequences of these controversial practices through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it. The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions―mental health court, crisis intervention training, and pretrial diversion―that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public.

Genres: Nonfiction, Mental Health, Mental Illness, Medical, Psychology, Psychiatry, Medicine

328 pages, Hardcover

Published November 1, 2016

Reviews

[Sheri · Rating 4 out of 5]

This is another school book; quite approachable though for any interested reader. The authors dive into the policy of involuntary commitment and supposedly evaluate both sides of the question. While it is true that they do present some discussion in support of commitment and interview a few folks who were committed and came to see it as a good thing, ultimately the book is slanted in the direction of avoiding commitment when at all possible.

Personally, I agree with this sentiment and with their conclusions (more funding for mental health and make VOLUNTARY treatment actually an option), but was not convinced that they actually presented both sides of the argument.

I thought they did a good job of attempting to dispel the myth that all mass shootings could be avoided with involuntary commitment and that folks with severe and persistent mental health struggles are likely to be violent.

Overall it is a compelling (if at times a bit repetitive) and easy read full of lots of data and specific examples of the multitude of ways in which our mental health care system is fucked up.

[Ruby Li · Rating 3 out of 5]

A lot of good information not a lot of new information. Depressing to read given the current climate. Many of the resources that will minimize involuntary commitment and traumatic hospitalizations are currently being defunded. The largest provider of mental health treatment in America continues to be our prison system.

[Kazen · Rating 4 out of 5]

Involuntary care is a a minefield of ethical conundrums. How do you decide who needs treatment? What if the patient calmly refuses it? Will the treatment itself be more traumatizing than beneficial? How can you ethically hold people against their will? And when is it okay to let them go?

Miller and Hanson cover as many points of view as humanly possible, from pro-involuntary treatment groups like the National Alliance on Mental Illness to anti-anything-psychiatry groups like Scientology. (Yes, they managed to interview a Scientologist for this book. It's kind of amazing.) There are all kinds of opinions between the extremes that are also covered - those who would rather see outpatient commitment instead of inpatient, for example, and people who want to help patients recover with or without medication. They also speak with professionals that are involved in the civil commitment process, from judges and lawyers to police officers and ER doctors.

There is a ton of information but it never gets overwhelming. The narrative is loosely hung on the cases of two patients, one who had a positive experience with involuntary care and one who was traumatized by her time at the hospital. Though interviews with these patients, their families and doctors, and peeks at their medical charts, we see how forced care could be the best or worst thing to happen to someone. Their journey is covered from being picked up by police or brought in by a family member, through civil commitment trials and treatment, to how they were determined to be fit for release.

Laws widely vary across the United States and their differences are an illustrative example of what policies seem to work and which should be rethought. As a result Committed gives you a framework of possibilities that you can use to examine the laws that affect you, no matter where you live.

The thing that strikes me most about this book is the care and consideration that went into it. Miller and Hanson, psychiatrists, never deride anyone for their views. They sat across the table from people who think their profession is basically evil and held a civil, thoughtful conversation. If there's an outrageous factual error they'll mention it in passing with research to back them up, but otherwise everyone is allowed to say their piece exactly as they'd like in a non-confrontational environment. Mad props.

They're also forthcoming about the circumstances surrounding their reporting. Getting an inpatient unit to agree to Miller observing was harder than they thought, and they are upfront with the fact that the only hospital that would agree has one of the best psychiatric departments in the country. And try as they might they couldn't get anyone to talk about guns and mental illness on the record.

Doctors, [the gun club representative] noted, are seen by gun owners as an extension of the government. ...people were happy to engage in casual conversation, but before they would speak in depth, they wanted reassurance that we were not in favor of gun control, regardless of whether that was relevant to the topic of the book.

Any time I thought there might be a hole in the reporting or an odd circumstance it was covered in this thorough, thoughtful manner. The authors have earned all of my respect.

Committed is a must read for anyone whose job brings them in contact with people with psychiatric illness as well as anyone with an interest in civil rights. And if you're curious about how mental hospitals work (aren't we all?) it's a fascinating look at this "hidden world, open only to those who are in enough despair to gain admittance".

Thanks to Johns Hopkins University Press and Edelweiss for providing a review copy.

[Fry Morgan · Rating 3 out of 5]

As with most writing by medical professionals/academics, this book does a great job laying out the problem and summarizing what we know so far. Then it makes broad, generic suggestions about what should be done, leaving you with the thought, "Well, duh."
I'm a psychiatry resident halfway through my training. I came to this book with a lot of high hopes, after seeing how involuntary commitment (IVC) is a cause of distress for some of my patients. I was hoping to find in this book recommendations by two physicians in my field with much more experience. There wasn't much. Sure it was good to see that two big names in my field shared my concerns and then some, but they didn't really have much to offer about how to do what we all know needs to be done better.
I think this is a good book for the layperson, but for anyone already working in mental healthcare who sees its underside on a daily basis, this book doesn't do much other than tell them more of what they already know.

[Rachel · Rating 4 out of 5]

This is an excellently written look at the pluses and minuses (mostly minuses) of involuntary hospital commitment for psychiatric care, with a little about involuntary outpatient care. The authors look at all the angles; the person's experience, opinions from prominent practitioners and advocacy groups, hospital staff's (mostly doctors) experiences, laws and court systems in various states, customs in various hospitals, and (they seem to think this is most important to the public) the prevention of mass murders by people with mental illness. While being sure to present the opposing views, they come down firmly for using involuntary commitment as sparingly as possible.

Everything in the book is well considered and presented as factually and scientifically as possible. The authors cite a number of studies, but, as they point out, very few meet the gold standard for study design.

Unfortunately, I am familiar with the mental health care disaster that is the regional situation here, and is likely not worse than most regions in the US. The major mental health care provider is the jail system. They have few options of where to send mentally ill people who are picked up for ranting on the street or whatever, so they keep them, and medicate them, often for months. It was three months for our family member. Though it's absolutely the wrong setting, they try to do it well. They even had a counseling group for families, where they talked about what might ideally happen, but didn't happen for most of the group. Our person was finally accepted into a non-jail program (500 miles away) because they had private insurance, but that wasn't possible for most. Even once out in the community, people who don't have a family with the resources to navigate a complicated yet inadequate system don't have good prospects. Another family member in another state recently received negligent "care" that could have killed them.

So. I liked this book. I agree with almost all of the authors' observations and viewpoints. They gave a lot of space to the sad state of psychiatric care in this country and offered a lot of recommendations. And what happens with those? I'm not hopeful.

[Hannah Stokes]

My complete review including notes and such for teaching this content is in my Zotero account, sorry Goodreads! This book is a phenomenal introduction to some of the issues with involuntarily committing someone. The authors really do both sides of the argument justice. If you are going to read nothing else then read the last chapter to get a summary of their opinions. I found myself agreeing with a lot of them so I'll highlight a few.

(1) patients should be allowed to develop their own de-escalation plan/educate staff about their triggers for violence
(2) Crisis intervention training should be mandatory for state and city police
(3) Every jurisdiction should have a mobile crisis team with trained mental health professionals
(4) Communities need more support including crisis centers, housing options, patient directed care
(5) Increased government support for training psychiatrists and student loan forgiveness for those working in underserved areas
(6) Funding for psychiatric research is currently from for-profit entities. This biases the medical literature to show that medications work. We need more non-profit entities supporting psychiatric research.
(7) Restriction of gun rights of anyone with history of violent behavior, including suicide attempts and active alcohol and drug abuse. Laws that require safe storage of firearms, limitations on assault weapons/stockpiles of ammunition/arsenals of firearms, requirements for licensing, registration, and training. Perhaps the most interesting part of the book was research showing people with a history of violence are more likely to engage in mass shootings rather than people with a mental illness.
(8) Involuntary treatment should only happen when all other options are exhausted. It can be inhumane and we should all do it with caution.

[Erin Whittaker · Rating 3 out of 5]

I really wanted to love this book because I am a HUGE fan of the author's blogs and I find the subject absolutely fascinating. And I liked it, but considering how long it took me to finish it (months) I can't say it kept my attention. I did learn a lot though and the book itself was extremely well researched and written. The passion of the authors about the subject was clearly evident. I liked the first half better. Sharing stories has always been a way I have learned best and so hearing from real people was the most helpful part of the book.

[Elise · Rating 4 out of 5]

School book! Had very low expectations going in bc I figured it would be written like a textbook; however, the authors took a journalistic approach to writing the book. If you have an interest in mental health policy, especially for individuals with severe mental illness, I definitely recommend. The book is structured into decently short chapters on different related topics and presents a variety of viewpoints as well as real patient experiences which is great and allows the reader to come to their own conclusions on the topics.

[M · Rating 5 out of 5]

A subject near and dear to my heart. The worst part was the final chapter where the authors were so hopeful about the future of mental health with the Affordable Care Act. An informative and incredibly easy to read book. I learned so much but with their narrative style, I also had a hard time putting it down and flew through several chapters in a day. I read it in two bigs chunks with a long break in between, but it was worth it. Highly recommended.

[Lauren · Rating 3 out of 5]

Mental health under a microscope- no good answers, no good options, why? because its difficult to find a provider who cares- kick the patient to the emergency room - NOT THEIR PROBLEM, toss the person to in-patient . oops only 2 days, meds cant work, OR keep them forever inpatient and ignore them sucking all finances dry.

welcome to mental health in america.

if you want care you cant get it , if you dont want care- its shoved down your throat.

[Nina · Rating 3 out of 5]

One my courses for my MSW, mental health care policy, required us to read this book for a discussion today. I'm really not sure what I think about it--it was published in 2016 and yet only 27 other sources have cited it according to Google Scholar. The authors are psychiatrists, and they do interview a wide variety of people. And yet. The perspective is very normative and seems to lack a critical gaze/perspective.

[Rodney Burr · Rating 2 out of 5]

This was a hard read for me but I got through it. Lawyers and the government are the cause of the amount of homeless in the country. We need to pay more attention to the mentally ill and spend more money on it and not send it to other countries. We have problems in America that need to be fixed first

[Paradise · Rating 4 out of 5]

As someone who works in psych, I really enjoyed reading this book but at times it seemed like the authors were out of touch and did not really understand what happens on inpatient units or the safety measures we have to follow to ensure everyone's safety (both patients and staff)

[Michael Simonson · Rating 5 out of 5]

Wonderful book that lends insight to forced psychiatric treatment - as very few books do. The authors clearly did their best to give voice to both sides of this story. Most notably, they spoke to patients who have undergone forced treatment and whose voices are often muted in this debate.

[Phillip · Rating 4 out of 5]

This was a great overview of all types of psychiatric care and involuntary commitment. The authors sought out respected experts on the topics at hand and were extremely descriptive while providing thoughtful commentary. I only wish they were slightly more philosophical about the prospect of letting patients go. While I understand the focus on two people in particular to contrast voluntary and involuntary commitment, it was a tad limiting. I would recommend this to anyone wanting to learn more about psychiatric treatment or who faces the prospects of involuntary commitment in their work.

[Mills College Library]

362.2 M6477 2016