On June 4th news came out about a new proposed legislation in San Francisco which would bring about two things. 1) The first universal mental health system in the country, and 2) the ability force individuals with severe mental illness and drug abuse into treatment for up to one full year.
The first article I read focused on the universal mental health coverage and the increase in access to much needed care. All of which sounds great in a climate in which the need has become common knowledge even among those who do not follow mental health related topics.
The next article I read focused on the involuntary treatment. As I drive around my city, I often wonder why there isn’t a program to help people get off the streets and into the appropriate treatment(s) – and for San Francisco this is their answer. My concern is the involuntary nature of it, with which I see two issues. As the title of my blog lets on, stigma is a huge concern for people with mental illness and drug abuse and I fear that by being able to force these people into treatment, and out of the public eye, there is the risk of increasing the stigma 10-fold. How can it not increase stigma when it is publicly being said that these people cannot make a decision for themselves and the life they currently live is so wrong that we are going to take them out of their community and lock them up despite committing no crime?
My other issue with this is a simple one that you run into with voluntary treatment as well, but likely to a lesser degree. That issue is compliance post treatment. Someone has to continue taking their medication and/or stay clean and sober. After treatment, unless they provide people a place to live and transportation to their appointments it is setting them up for failure. And a failure which can prove fatal, especially where drugs are concerned. Time off of drugs decreases a person’s tolerance, and no one can guarantee that someone in the midst of a relapse is going to adjust their does for this. In addition, people becoming clean and sober are told to change people and places, something which is hard to impossible when a person is homeless.
In the book Committed (which I wrote about in more detail here and here), Drs. Miller and Hanson state “Involuntary treatment needs to be limited to situations where the only agenda is the best interest for the patient after other options to engage the patient have been exhausted.” I don’t know what the authors would think of what is going on in San Francisco, but I do know that all other options have not been exhausted. Involuntary treatment is traumatizing and so unless this is exercised with care this new policy could do much more harm than good.
But as for universal access – yes please!