Saturday, March 10, 2007

Isn't It Cute When The Academics Trump Reality

So a guy who won the right to refuse antipsychotic drugs in a landmark 2004 ruling later murdered his roomie and has now been charged with the crime.

From the story:

In a declaration quoted by the court, the Napa State Hospital medical director said that "without his antipsychotic medication, (Qawi) would pose a markedly increased risk to the safety and security of staff and patients."

The court also said psychiatric evaluators at the hospital had found that Qawi "consistently maintains that he suffers no mental illness and requires no medication or other forms of treatment."

In the 6-1 ruling, Justice Carlos Moreno said any competent adult, including a prison inmate, has the right to refuse medical treatment.

It was not clear what happened to Qawi as a result of the ruling.

Since the ruling, the state Department of Mental Health has gone to court hundreds of times for "Qawi hearings" to authorize involuntary medication of mentally disordered offenders on the grounds that they are either incompetent or potentially dangerous, spokeswoman Kirsten Macintyre said Friday. Macintyre said she couldn't provide information about Qawi or any other individual.

At Atascadero State Hospital, the only institution for which records are available, such requests have been almost uniformly granted by judges, Macintyre said. Records from Atascadero also indicate that patients who refuse antipsychotic medication commit assaults more often than patients who consent, Macintyre said. From January through June 2006, she said, the 204 patients who refused medication committed an average of 4.62 assaults on staff, other patients or themselves, compared with an average of 1.54 assaults by the 843 patients who consented to medication.
This is one of the many reasons my profession sometimes gets me down. At least the requests to involuntarily medicate seriously ill patients are usually granted. I hate it when jurists get all twisted up in the jurisprudence and forget to see what might happen outside their courtrooms.


Anonymous said...


Anonymous said...

Not exactly sure what you mean by "at least the requests to involuntarily medicate serious ill patients are usually granted" means. It seems along the lines of "it's good that most criminal defendents are convicted, since we are better off having them behind bars, we can sort out later if they are actually guilty."

Hate to sound like a dweeb, but if the courts stop balancing civil liberties with societal protection just because the petitioner might inflict harm in the future, we might as well elect Alberto Gonzales czar (which I know you don't want).

I also love the statistics. You know, I bet if we sedated all inmates, we would find those that ingested vicodin on a daily basis were 28% less likely to strike another inmate, and 45% less likely to complain about the food they were served.

I know the term "mentally ill" gives people the shivers, but it's pretty independent of the term "committed a violent crime". In fact, folks with a axis I diagnosis are no more dangerous than anyone else, so it makes sense for the court to treat them similarily.

Anonymous said...

Anon -

I think you're making some pretty faulty analogies here. The guy profiled in the article is a paranoid schizophrenic with a history of unprovoked violence toward others. He thought he was sane. So the crazy guy should get to decide he doesn't have to take his meds even though his track record says he'll beat up, stalk, and or kill someone if he ditches the pills?

No, I'm sorry, I don't think he gets to decide.

I think calling this a case of denied civil liberties strikes a blow against genuine battles against denials of civil liberties. It's necessarily a case-by-case evaluation, naturally, but here, I think the facts as presented in the article are fairly obvious.

You say "mentally ill" is independent of "committed a violent crime." Well, what about this case, where a paranoid schizophrenic committed a violent crime. They seem like dependent factors to me in this case.

Anonymous said...

btw: why stop posting under your regular name? i'm guessing the "test" comment was to check to make sure your usual handle doesn't appear?

Anonymous said...

The test was because the first time I wrote the comment, it disappeared when I hit publish your comment. I wasn't sure if that was user error, or because I use a Mac.

I don't have a handle, since I don't usually post and I have a job while blog posting is discouraged. However, mental health topics always get me going since the whole process is pretty misunderstood.

In this case, the Qawi case is being taken out of context. Medication hearings take place when folks are still in custody. Forcing medication on them while they are in a locked jail is a bit like insisting that convicted drunk drivers shouldn't be allowed to have their keys while in jail (not an exact analogy, I grant you, but they never are).

What the Qawi case stood for is that an inmate with mental illness should be allowed to refuse medication. If the doctor disagrees with the refusal, he has a pretty simple process for overriding the patients objections. In essence, their is some small amount of due process rather than letting the jailer decide to medicate people. He does not get to decide whether to take medicine in jail, the hearing officer makes the decision.

As to your last point, if they were dependent factors that would mean that but for the schizophrenia, the person would not have committed a violent crime. That is impossible to determine, and since research shows that people with schizophrenia are no more violent than "normal" people, I call them independent factors.

There are violent people, there are mentally ill people, and there are violent mentally ill people, just like there are violent people, tall people and violent tall people.

Ultimately, I think most folks just broadly define violent folks as mentally ill, since they can't imagine performing the deeds that they read about, but that is not the way it works. As I said before, they are independent factors. Being mentally ill does not make you more or less likely to commit a violent crime, and being a violent criminal does not make you mentally ill (at least according to standard definitions).

Anonymous said...

The drunk driver analogy is really ineffective. If the drunk driver were capable of ramming himself at over 40 mph at a guard - just on his own, without a car around him - and the key to reducing his ability to inflict bodily harm that way were to remove his keys, then that would work.

Okay, I'm pretty sensitive to stigmatization of the mentally ill and certainly don't encourage it, but this, makes my head spin: "There are violent people, there are mentally ill people, and there are violent mentally ill people, just like there are violent people, tall people and violent tall people."

This isn't a case of someone's violence being ascribed to mental illness where there is none - dude was sick. I'm guessing he's sicker than the article got into. And the violent mentally ill kind.

You're making it much too easy.

Anonymous said...

The point of the analogy, which it seems you missed is that taking away the keys of a drunk driver while they are in jail doesn't prevent them from getting drunk, driving and killing someone when they get out. Just like forcing medication down someone's throat while they are in jail doesn't do anything to keep them on medications once they are released. In other words, the court case could have come down the exact opposite way and nothing about this story would have changed. This is what makes the last point of your original post so off base.

The way you rephrase the analogy is only necessary to try and prove your point (forcing medication on someone in jail would protect the public), not mine. I am saying neither of them make sense.

The second point is simply that you should make sure you are treating the violent act and mental health diagnosis distinctly. Having a mental illness does not make someone more violent. Conversely, treating a violent person's mental illness doesn't make them non-violent.

You put the two points together and the Qawi case makes a lot more sense than you are giving it credit for. I am not a big fan of the current State Supreme Court, but even 6 of them saw that.