[Hpn] Promoting Stigma - by chance martin

Coalition on Homelessness, SF coh@sfo.com
Sun, 23 Apr 2000 16:57:52 -0700


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Promoting Stigma
by chance martin

After decades of neglect, our state legislature is being aggressively 
lobbied to restore California's mental health system. All of the 
treatment enhancements and services that are being proposed are 
desperately needed and would be welcome, with one exception: an 
attack on the civil rights of mentally disabled people called 
involuntary outpatient commitment. Involuntary outpatient commitment 
is the cornerstone of AB 1800, an assembly bill sponsored by 
Assemblymember Helen Thompson.

Involuntary outpatient commitment is court-mandated medication 
compliance. In some cases, it can mean a person is court-ordered to 
keep regular clinic appointments to receive long-lasting injections 
of powerful psychiatric drugs. The consequences of non-compliance are 
hospital commitment and forced drugging. These proposed legal 
provisions are termed "assisted treatment." In practice, its primary 
victims are poor and homeless people, particularly African-American 
men. In some urban areas, homelessness itself is interpreted as proof 
of "grave disability," creating the justification to drug homeless 
people against their will. In states where this policy is law, forced 
medication coupled with a lack of medical supervision has led to 
deaths due to toxic levels of psychiatric medication.

At New York's Bellevue hospital, a pilot study testing the viability 
of involuntary outpatient commitment failed to support its advocates' 
claims. A three year study of its relative effectiveness found no 
statistically significant differences between the experimental group, 
a control group, and those who discontinued treatment in the areas of 
re-hospitalization, arrests, violence, symptomatology, or quality of 
life. It concluded: "there is no indication that, overall, the court 
order for outpatient commitment produces better outcomes for clients 
or the community than enhanced services alone." Alarmingly, it also 
noted that the court procedures themselves became perfunctory, and 
accountability was so lacking that renewal orders frequently occurred 
without a formal hearing, despite the fact that "the court order 
itself had no discernible added value in producing better outcomes."

The betrayal of the de-institutionalization movement in California 
only became apparent when the state-funded community-based mental 
health services we were promised to replace the snake pits were 
themselves facing extinction. Now we are faced with a proposal to 
criminalize an entire community of people based on disability. 
Disability isn't a choice, it's something each of us learns to 
accommodate as best we can. We need to ask ourselves: how many 
violent acts committed by untreated mentally ill people, however 
sensationalized, might have been prevented if a comprehensive range 
of voluntary, culturally appropriate community mental health services 
were available?

A look at twentieth century history gives the best illustration of 
how far stigmatization, scapegoating and hate can go when 
misrepresented as scientific authority.

Eugenics originated as a sub-discipline of psychiatry right here in 
the United States. The first compulsory sterilization laws in Germany 
were modeled on American sterilization laws enacted a decade before. 
In the three years from 1941-1943, over 42,000 Americans were 
sterilized under the Model Eugenical Sterilization Law. California 
led the nation with over 10,000 forced sterilizations (mostly persons 
of color). The "mental diseases" targeted by this law were "insane," 
"feeble-minded," "epileptics," and "idiots."

The Holocaust's first victims were "mentally ill" people. The first 
extermination facilities were designed and operated by psychiatrists, 
who later trained the SS how to use them. In a culture where ruling 
authority was maintained in the name of a higher "biological" 
principle, psychiatrists weren't ordered to murder people, they were 
simply empowered to do so by their government, and so they did. In 
1941,
90,000 German psychiatric inmates were murdered, 71,000 in gas 
chambers at psychiatric institutions.

If our generation remembers no other lesson, we must remember that no 
supposed biological marker - no stigma - is reason enough to deny 
anyone's liberty. We must support fully funded, community-based, 
VOLUNTARY mental health treatment before we consider discarding 
someone else's self determination.

ĦIf it isn't voluntary, it isn't treatment!





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