Involuntary Outpatient Commitment or Assisted Outpatient Treatment: Kendra’s Law

Please note that this post, while distinctly against such excuses for treatment as Involuntary Outpatient Commitment, AOT or anything like it, it intends no disrespect for unfortunate victims of crime like Kendra and others for whom these eponymous laws have been named.

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This afternoon, I testified against a bill raised in the Connecticut judiciary committee, which proposed Involuntary Outpatient Commitment. The provisions of this bill were so egregious, so outrageously discriminatory against those of us with psychiatric illnesses, and carried such potential to cause more harm and trauma than treatment, that despite my grief and exhaustion, I felt I had to write something for the judiciary members to read, and then to cut it down to a 3 minute oral presentation to read before them today…

First of all, let me recap the worse provisions of the bill, rather than making you read the whole thing (Though it is actually a revision of a bill, and so is not long, a paraphrase is always easier on the eyes, so to speak.) First of all, instead of the two psychiatrists needed to commit a person to the inpatient stay of 15 days observation — a PEC or physician’s emergency certificate, which is the first step of any inpatient stay — an outpatient commitment requires only a single psychiatric opinion, and the doctor need have one year’s post medical school experience to be considered competent enough to evaluate any patient for such purposes. Not only that, but he or she can evaluate a patient at much at 10 days before the hearing and that would suffice as valid, even though everyone knows much can change in 10 days. After all, people are admitted to hospitals inpatient these days and are expected to be discharged within 2-5 days on average, at least in Connecticut. Then, the next outrage against a psychiatric patient’s civil rights is that the treatment providers will be permitted to speak to ANY family member or anyone who knows the patient well, about the patient’s issues and treatment history. No matter that the provider may not know anything about this family or these friends, nor what their relationship with the patient is like!

Worst of all, get this: Once a conservator is assigned, and forced medication is arranged, the police or ambulance may be called and the patient transported to a location where he or she will be forcibly medicated against their will, i.e. restrained if necessary and injected in the buttocks (“dignity preserved” hah!) most likely with some depot drug like Prolixin or depot Risperdal that, no matter how horrible the side effects are, will remain in the patient for a long time.

Despite this, the provision remains that this can remain in effect at most 120 days. Go figger. You can forcibly medicate a person for 4 months, and presumably (I doubt it) get them well for that long by brutalizing them. But after that, they can do as they wish, which likely will be to NOT take the humiliating injections or the medication by mouth either. So what was the point? Usually, a person will take a drug that makes them feel better, barring painful side effects. So if the drug is rejected, 75% of the time it has been shown to be because of intolerable side effects or simply because the drug doesn’t work….So what good is IOC then?

So, in response to this proposed — well it is outrageous, ill-conceived, unjust, and just plain stupid… I wrote the next 2 pieces. The first is my oral testimony, which I cut out and edited from the second, my longer written testimony, which I had to leave with the judiciary committee as it went on much longer than the 3 minutes oral testimony time each person was allotted. Also, when I wrote the written testimony, I had not been aware that there was actually a proposal to physically restrain and inject an outpatient. So there are those differences between the oral and the written forms of testimony. Both were extraordinarily difficult to write and to read as you will see, and will no doubt understand why, especially if you are a long time reader and remember all that I have written about the traumas I have experienced at two hospitals in CT that begin with M…

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Oral Testimony before the judiciary committee

March 29, 2012

Opposing sb No. 452

an act concerning the care and treatment of persons with psychiatric disabilities

Good  Afternoon, members of the Judiciary Committee.  My name is Pamela Spiro Wagner. I am a lifelong resident of Connecticut, currently living in a suburb of Hartford. As a Brown University graduate, elected to Phi Beta Kappa in 1975, I  attended ____ Medical School until psychiatric difficulties, later diagnosed at schizophrenia, forced me to leave. In 2005, I co-authored  the memoir, Divided Minds: Twin Sisters and their Journey through Schizophrenia, which was a finalist for the CT book award. I also wrote a book of poems, published in 2009.  As a visual artist, my work has been exhibited in Norwich, Hartford, Wethersfield and on the internet. I am here today to oppose SB 452, an act concerning the care and treatment of persons with psychiatric disabilities. This bill  proposes to introduce involuntary outpatient commitment to CT.

Involuntary treatment doesn’t work, period; it usually causes more harm than good.

In 2009,  deemed psychotic and dangerous to self, I was hospitalized against my will at Manchester Hospital.  Instead of my usual medications, I was given  Zyprexa, which has severe side effects. I refused it and decompensated. The psychiatrist decided a judge would force me to take Trilafon, a drug that made me miserable. If I refused I would get  an injection of Haldol in the buttocks.

Nonetheless, I refused. I also refused to take down my pants for a needle full of Haldol, so I fought them when they approached. After a few such encounters they started calling a code — “Dr Strong” — to bring in the security team of men and women who invariably assaulted, subdued, then stripped my clothing off, restrained and injected me, despite my terrified screaming and fighting. These confrontations along with liberal use of 4-point restraints to shackle me to the bed, or solitary confinement in a locked and freezing seclusion room without even a mat on the floor, happened so often that I literally lost track of time. As a result of these traumas I now suffer from PTSD.

This is what involuntary treatment leads to. According to SB 452 , police could be called to transport a patient to a location where she could be restrained and forcibly injected. That is inhumane. Involuntary Outpatient Commitment is just coercion and brutality masquerading as help.  This is not how Connecticut should be delivering its mental health care.

Thank you for your time and attention.  I would be more than happy to answer questions.

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Note: I wrote this before I learned that the SB 452 bill actually proposes to permit the involuntary transportation and forcible restraint and injection of an OUTpatient…

Written Testimony before the judiciary committee

March 29, 2012

Opposing sb No. 452

an act concerning the care and treatment of persons with psychiatric disabilities

Good morning members of the Judiciary Committee. My name is Pamela Spiro Wagner. I am a lifelong resident of Connecticut, currently living in a suburb of Hartford . As a Brown University graduate, elected to Phi Beta Kappa in 1975, I  attended  _____Medical School until psychiatric difficulties, later diagnosed at schizophrenia, forced me to leave. In 2005, I co-authored  the memoir, Divided Minds: Twin Sisters and their Journey through Schizophrenia, which was a finalist for the Connecticut book award. I also wrote a book of poems, published in 2009.  As a visual artist, my work has been exhibited in Norwich, Hartford, Wethersfield and on the internet. I am here today to oppose SB 452, an act concerning the care and treatment of persons with psychiatric disabilities. This bill  proposes to introduce involuntary outpatient commitment to CT.

Involuntary treatment does not work.  Over the short run, you can make a person take medication (which is what this is all about). You can threaten to hospitalize her “or else” and frighten her into swallowing a pill for a while. And you can medicate her forcibly if she ends up in an inpatient setting.  You can do so despite the horrendous side effects she may experience – from intolerable sedation or enormous weight gain and diabetes to the agonizing restlessness known as akathisia, the potential development of a disfiguring movement disorder like tardive dyskinesia, or just seemingly minor problems such as increased dental caries resulting from a chronically dry mouth. Not to mention a score of other severe side effects I haven’t even mentioned.  It may be that in the short run, the patient will break down in the face of such measures and begin to accept treatment “voluntarily” – or seem to. Perhaps she may even seem to “get better.” But I am here to tell you that despite appearances of success, involuntary treatment is the worst possible thing you can do to a person with a chronic psychiatric condition. Symptom improvement is usually temporary.  For any number of reasons, as soon as you cease forcing a person to take pills, she is more than likely to stop taking them, especially if side effects are objectionable or coercion a major factor in her decision to take them in the first place. If she has been treated against her will, either as an in-patient or in an outpatient setting, the effects of the trauma involved  may be permanent. I know, because I have been there.

Although I am in outpatient therapy, I have not always been and am not now always compliant with medications, especially those that make me feel deadened or bad, even when they seem to alleviate the worst of my symptoms. If a medication makes me feel horrible or worse, makes me feel nothing inside, I usually refuse to take it. I tend to agree with those who say that sometimes the treatment can be worse than the disease. Still, while in-patient, I have  often been subjected to “forced medication hearings,” which I lost, the deck being inevitably stacked against me. In 2004, at the Hospital of St Raphael’s in New Haven, I was not only forced to take Zyprexa, a drug that induces severe obesity, high cholesterol and diabetes, but in addition, the probate judge, on the instigation of the in-patient psychiatrist, ordered that I undergo involuntary ECT, otherwise known as electro-shock treatments. All of this was in the name of  “helping me.” No matter that I did not want it, nor that my neurologist was completely against it, fearing brain damage. Nothing mattered but the wishes of that one psychiatrist. That single psychiatrist, whose word and opinions counted far more than anyone’s though she had known me all of 3 weeks.

One of my most recent experiences with involuntary treatment was at Manchester Hospital. This was so horrendous that in combination with an even more brutal experience, 6 months later, at Middlesex Hospital in Middletown, I developed PTSD, posttraumatic stress disorder. Because Middlesex Hospital has already been investigated and cited by the Office of Protection and Advocacy and the Department of Public Health for improper use of restraints and seclusion because of what they did to me, I would like to tell you about the Manchester Hospital experience, as I believe it will give you a better “taste” of where Involuntary Outpatient Commitment, when taken to its logical conclusion, can and must lead.

I was  hospitalized against my will at Manchester Hospital in 2009 on a 15-day physicians emergency certificate (PEC).  In the first few days there, I was summarily taken off the two-antipsychotic drug combination, plus the anti-seizure meds and an anti-depressant I came in on. This  “cocktail” had worked for me since 2007 without side effects so it was one that I was willing to take. I also felt it helped me function better than I had in years. The psychiatrist at this hospital decided, however, that “since you are here, your current meds aren’t working, so I am going to put you on something else.” Did it matter to him that I had already been tried on nearly every other antipsychotic drug on the market, old and new, and none worked as well and with as few side effects as the two I had been taking? No, he was the doctor and he knew better than I what was what. Moreover, whatever he said became law.

So the “offending meds” were removed and I was again told I had to take Zyprexa, a drug that I hated because of the severe side effects. Over the next few days, I continued to refuse it, and naturally, I decompensated further, especially since by then I was taking no antipsychotics at all. A hearing with the judge was scheduled and the psychiatrist decided at the very last minute that they would force me to take one of the oldest neuroleptics in the PDR, Trilafon, a medication he had no reason to believe worked for me. Had he asked I would have readily explained to him it made me exquisitely miserable, even at the lowest dose. Instead, he said only that if I refused it, I would be given an IM injection of Haldol in the buttocks –as punishment. Or so I felt.

It may seem that I am making unfounded statements about this psychiatrist’s intentions, but think about it: when one is told that the “consequences” of refusing to take a pill will be an injection of another awful drug, how else is one to “read” it but as a threat of punishment? How would YOU read it?

Well, I was not going to take Trilafon, not when I knew how horrible the side effects were that I would suffer as a result. So I refused the pills. I also refused to lower my pants for a needle full of Haldol, so I fought them when they approached. After a few such encounters they started calling a code — “Dr Strong” — to bring in the security team of men and women who invariably assaulted, subdued, then stripped my clothing off, restrained and injected me, despite my terrified screaming and fighting. These confrontations along with liberal use of 4-point restraints to shackle me to the bed, or solitary confinement in a locked and freezing seclusion room without so much as a mat on the floor, happened so often that I literally lost track of time. As a result of these traumas I now suffer from PTSD.

Why do I tell you this? Because this is what forced medication and involuntary treatment can lead to much more often than you want to believe. If sb 452 passes and Involuntary Outpatient Commitment is instituted, how do you propose to treat someone who does not want outpatient treatment? You cannot assault an outpatient and brutally medicate them using 4-point restraints and IM injections. All you can do is bully and threaten. Involuntary Outpatient Commitment only serves to re- traumatize those with psychiatric disorders.  In my opinion it is just coercion and cruelty masquerading as treatment. But it won’t help anyone.  It will only drive the would-be consumer as far away from so-called  “treatment” as they can get. This is not how Connecticut should be delivering its mental health care.

Thank you for your time and attention to this matter.

16 thoughts on “Involuntary Outpatient Commitment or Assisted Outpatient Treatment: Kendra’s Law”

  1. Hi Pam,

    The medications aren’t ideal and the side effects are real and I can certainly see why some people would want to either lower their medication or find some alternate route. I also know that some people don’t respond to the medications and others only partially. I am one of the fortunate ones in that my worst positive symptoms (delusions and paranoia) are mostly gone, I believe due to the medications. For those people suffering from acute psychosis I would urge them to commit to taking the medications for at least a year. The first year I committed to taking the anti-psychotic medications was the hardest because my psychiatrist only gradually increased my medication and during part of that time of waiting I was suicidally depressed. Quite frankly, it took a while to start to recover…years. I think it took a while because I had had three psychotic breaks in three years before taking the medications full time and I had a lot of trauma to mend from.

    Oh, it’s such a hard decision to make. Personally, I don’t believe a person should be forced into a hospital and forced to take the medications. If it had happened to me, I would be traumatized by it too and apt to distrust “help” offered by others. It’s back to judging whether a person is a harm to themselves or others. But who does the judging and what criterions are used? And if a person is deemed to be of potential harm, how do you treat them then? The treatment you received was abusive. The system sounds broken, but I have nearly no experience with hospitals and so I am not the best judge.

    The wave of the future has to be community outreach programs along with more online outreach programs. The focus on medication alone is too narrow. People in recovery, whether they are on medications or not, are such a valuable resource that is not being utilized enough. In mental health support groups for people with addiction and/or codependency issues such as AA and Al-Anon, there’s the practice of becoming a sponsor and sponsoring someone who is early in his or her recovery. I think this is the model that should be used in mental health support groups for people with psychotic disorders. We need community organizers for mental health in every community — city, suburb and country. A sponsor is neither a doctor, a therapist, a lover or family member. A sponsor is not going to try to control your behavior. A sponsor is a person who’s been through acute psychosis, survived it and found ways to cope in the wake of it. A sponsor is a trustworthy person who takes the time to get to know the person who is either still in acute psychosis or in early recovery from acute psychosis.

    On another note, I just wanted to say thank you for putting yourself out there trying to help others not go through the abuse that you endured.

    Kate : )

  2. HI Ing and Rossa,

    First thing, Ing, I am actually not at all against involuntary hospitalization, inpatient (only OUT patient commitment of the sort proposed by the Connecticut Legislature. I am especialy for involuntary hospitalization in cases where it can and will keep a person safe from herself or from harming others. I myself have been in grave danger and though I did not want to be admitted, agreed afterwards that I should have been. In fact, even when I agreed to go to the emergency room, all too often they committed me on a 15-day physician’s emergency certificate simply because they felt I was in too much danger of leaving on my own, or because I changed my mind once there. However, that said, I do not believe that I was properly treated by Manchester Hospital when they brutally and forcibly restrained, stripped and injected me time and time again with a drug that objected to. Not only that but I was ALWAYS willing to take the drugs I came in on, Abilify and Geodon, and said so over and over. I was NOT non-compliant, I simply did not want to take Trilafon or Zyprexa, because of their horrendous side effects. Why? Mostly because they made me feel so terrible that I knew I would NEVER continue to take them when released, so what on earth was the point of taking them for a short time in the hospital. Talk about an exercise in futility! Furthermore, do you know what eventually happened? The sadistic doctors who did that to me were finally removed from my care after keeping me in 4 point restraints for 18 hours, waking and sleeping, without food or bedpan, and the doctor who took over immediately put me BACK on the drugs I wanted…and I began from that day on to recover again. Drugging someone to the hilt, so they cannot function, serves NO ONE, except the doctors who believe that the quieter a patient is, the easier their job is.

    Rossa, I know you always understand, and I thank you for it. I have come to believe that not only are meds NOT the only treatment modality or the first one that ought to be tried, but that if a hospital is not run on a philosophy of person-centered compassion and care, it will never treat patients with anything less than brutality in the end.

    Look into the history of Soteria House…I think that is an interesting model, though impossible to hope for in this day and age.

    Thank you both for your comments, I appreciate all points of view, and understand where you are coming from.

  3. Thank you, Pam for outlining very explicitly the hypocrisy of forced treatment. What forced treatment demonstrates is how the psychiatric system has failed to help human beings develop ways of understanding their behavior. Whether forced or not forced, the only remedy psychiatry has pushed is drug treatment. This is no remedy at all, as you have pointed out. It is merely a containment strategy. Maybe that’s all Connecticutt is looking for?

  4. Hello Pam,

    This is a subject I struggle with as I have seen my daughter very psychotic and delusional and the first time she was hospitalized it was forced on her. The forced hospitalization kept her safe. On her own she would have made very bad choices that may have led to her death. I was not going to allow that to happen. With my own daughter it’s been a bumpy ride. I have seen her overmedicated and zombie like and this went on and off for many years. My daughter matured and learned to advocate for herself. She recently decided she cannot tolerate the heavy medication and Cassie is now only on one medication. She is a mother and understands that her job is to care for her children’s wellbeing and safety and is aware that if her psychosis returns that those who love her will take her to a doctor. She understands that we have her best interest at heart as well as her children’s safety. She is willing to listen to the people who love her.

  5. Thanks, Karen.

    I would love to hear from anyone who actually felt that forced meds, esp the sort of administration I experienced, made them better, one, and two persuaded them to keep taking it once they were medicated! I mean, that once they “got better” on the forced medications, they “saw the light” and decided the drugs were actually good for them. It would be very interesting to hear from those people…Anyone out there?

  6. Hi Aimer,
    PTSD is definitely more CON than pro. I cry nearly every day and suffer from trembling and increased BP and heart rate whenever the memories are brought back to me. Ask any vet with PTSD if what he or she experienced was “worth it”. Also, I have found that at Natchaug Hospital, NONE of it is necessary. In fact, I have gone without any increases or changes in meds there and have gotten well over time. The problem is that insurance companies want to push people out of hospitals, one, and two, there are no proper in-community resources for caring compassionately for the mentally ill outside of hospitals. That said, the IOC bill was not about hospitalizing someone but about forcibly medicating someone who is an OUTpatient. About removing their civil rights and escorting them, involuntarily, to a hospital ER if necessary, forcibly subduing them if necessary, and restraining them in order to inject them. That is the logical conclusion that this bill would lead to. NOT hospitalization, because in their view that would be too expensive. But is not the trauma of such measures as they propose way too expensive mentally as well as economically as well? IN any event, there is absolutely no proof that meds work for everyone, or that the side effects are not worse for any person than the disease, and frankly no one has the right to medicate any citizen or resident of this country who has been deemed fit to live in the community by a hospital. If that is the case, then they are fit enough to decide whether or not to take meds period. IF they are not, then they should not “be at large.”

    Thanks in any event for your comment. And I see no reason in this case why your heart should not rule. You need not agree with your abusers just because they TELL you they have your best interests at heart. A child who is abused and beaten by her or his parents is often told just that, and begins to say that he or she is loved and well-treated, but truly, are they right?

    Thanks again.

    Pam

  7. Dear Pam,
    I am so glad that you spoke for the other mentally ill persons who were not well enough to defend themselves. I see your gifts helping others. Whatever this may have cost you, it was worth it. I’m proud to know you.
    Forcible medication rarely works. It does sometimes, when it restores sanity in extreme cases where the person was suffering terribly from psychotic voices, hallucination, delusions. But you are right – most will go off meds as a knee jerk reaction, especially if the low quality of the stuff they were given made them feel terrible. I know this is true in my case. Medication was not always my friend. I did not always see it as an aid to better thinking. That is a conclusion you can only come to with experience, and maybe, experimentation.
    Take care of yourself, and again, I’m really proud of you.
    Karen

  8. Even though I want to agree with you, with all my heart, I am compelled to disagree with you, with all my mind. There are cases of mental illness that require this brutal kind of treatment. Many patients are not in a state of mind fit to decide whether or not they should be hospitalized or receive treatment. And those who are indeed fit, alerting them of the decision of hospitalization may cause more harm than benefit, for e.g. may lead the patient to escape the authorities in fear. Perhaps, and this is my idea, that a mental evaluation can be given in the form of an oral and written test upon admission, so that the length of the visit, its causes, and the medication given, may be discussed with the patient.
    Of course we who have been forcefully hospitalized have some sort of PTSD and mistrust of those who caused it. But did it really have more cons than pros?

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