Sunday, November 27, 2022

The battle between Autonomy and Beneficence for people with Mental Health disorders?

    There exists, in every social situation, a grey area where moral and ethical standards fall short of presenting an unambiguous response between righteousness and immorality, and the matter of involuntary treatment for the mentally ill is one of them. For a long time, the public’s support rallied behind dismantling forced and involuntary treatments in the fear of violating one’s autonomy, especially that of an individual with mental illness. However, as much as those decisions protect the rights of an ill person, the resulting consequences have generated many undesirable medical, social, and economic problems.

    Supportive of the perspective that involuntary psychiatric treatments can be beneficial to both the affected individuals and their community is the result of a 5 years longitudinal observation of the conditions of inmates with severe psychiatric conditions after their release (McDermot et al., 2020). It was found that those who were declared insane and let go from prison without the requirement of necessary psychiatric treatments are five times more likely to commit another serious crime, including homicide, than those that were conditionally released with the order to maintain continuous psychiatric treatments. In addition, there is a significant difference in the recidivism statistics of those that attended mandatory treatment sessions sporadically or for a short period of time and released inmates that do not receive any form of involuntary treatment. Despite the high relapse rate, the number of sporadic involuntary treated individuals is half of the number for those that are committed to no forced treatments. These numbers and facts are important because they show that forced psychiatric treatments are keeping those that are severely affected by mental disorders from committing another crime that can hurt others, especially those in their surrounding communities. The finding means that with mandatory treatments, released offenders can be considered safer for their community, which could help lower the stigma against people with mental illness, especially those that were actively seeking treatments and did not commit any crimes.

    When people are affected by a severe mental condition, they cannot think clearly or control their actions. Just shy of three months ago in New York, a woman was deliberately pushed onto the rail in front of an arriving train, which resulted in her immediate death (Closson & Newman, 2022). Michelle Go was killed by Simon Martial, a man with an untreated severe mental illness. It was not Martial’s first criminal offense. Before Go, Martial had attacked many and verbally assaulted those that he encountered when suffering psychotic episodes. Yet, in the past, when Martial was taken into custody, his status of having a mental illness shielded him from being convicted for petty crimes and he got released without mandatory psychiatrist treatments. In addition, the news article was updated just yesterday, after Martial had brutally killed Go, a random stranger that he attacked just because he felt the urge to, the court decided to send him to a psychiatric care facility indefinitely.

The news article prompted a question: How many people have to die before a mentally unstable man is forced into receiving treatment? It is unfair to wager the life and safety of many against the autonomy of a man. Moreover, the violent and untreated individuals might further fuel the public's stigma concerning mental health, deeming those with mental disorders as violent and incapable of performing regular tasks, which would, in turn, create prejudice, judgemental attitudes, and discrimination, actions that reflect their negative opinion in the population. The biases could appear in the form of restricted job availability, as people of power, such as managers and employers, had the belief that the stigmatized individuals were not capable of performing tasks that required complex skills or being predictable and stable enough for communicative work. Therefore, they were less likely to hire people with mental disorders to fill higher-paying positions. Being confined to lower-waging and unsecured jobs could further fuel other stereotypes and discriminations; for instance, with a limited fund, stigmatized people could only afford inadequate health insurance plans (that was if they could afford those at all!). Without a proper insurance plan, individuals with mental disorders would not be able to have access to the treatment options that they needed, resulting in possibly more severe mental conditions and the deepening of the prejudice that normal people had toward them, as well as potentially jeopardized their current employment (creating a loop of adverse side effects of stigma and discriminations). 


Closson, T., & Newman, A. (2022, January 15). Woman dies after being pushed onto subway tracks in Times Square. The New York Times. Retrieved April 21, 2022, from https://www.nytimes.com/2022/01/15/nyregion/woman-pushed-on-train-death.html 


McDermott, B. E., Ventura, M. I., Juranek, I. D., & Scott, C. L. (2020). Role of mandated community treatment for justice-involved individuals with serious mental illness. Psychiatric Services, 71(7), 656–662. https://doi-org.dml.regis.edu/10.1176/appi.ps.201900456



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