There’s an interesting story in today’s New York Times about an attempt to force treatment on people judged to be mentally ill. It’s in an article with the non-inflammatory title, “Killings Loom Over Debate on Treating Mentally Ill“. Here’s an excerpt:

Against the vivid backdrop of recent killings by mentally ill people, both sides in the national debate over whether mentally ill people who have not committed a crime can be forced into treatment are preparing for a showdown in the Legislature here.
…

Reviewing information from case managers from 1999 to 2004, the New York Office of Mental Health said people ordered into treatment under the law committed fewer crimes and were less likely to end up homeless or in psychiatric hospitals or harm themselves or others.

A little over one-third of the 10,000 cases referred to court, most of them in New York City, resulted in forced outpatient treatment, according to the report, which Gov. George E. Pataki cited in declaring Kendra’s law a success.

But Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, flew to New Mexico this week to dispute the state report’s findings.

Mr. Rosenthal cited a report by a legal advocacy group, New York Lawyers for the Public Interest, which asserted that blacks were five times as likely as whites to face court orders. In addition, he said, counties have unevenly applied the law, skewing the results of the study.

“New York’s law is not the model it is made out to be,” he said.
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In unrelated news, here is a list of murders and other crimes from the past month, also reported in the New York Times, which were committed by people who are considered sane. Perhaps we need a law to forcibly medicate sane people because they are very violent and dangerous.

Sobs and Hugs, but Not His Jailed Mother, at Abused Boy’s Funeral

One Year After Chemist’s Murder, a Stalled Inquiry Angers Relatives

The Tenafly Councilman and 40 Bags of Heroin

Man Appeals Conviction of Student’s Murder

Michigan Couple Charged in Son’s Death

Man Convicted in Two Pa. Shooting Deaths

BOROUGH PRESIDENT’S GRANDSON IS CHARGED

SUSPECT IN KILLING OF POLICE SERGEANT IS ARRESTED

Woman Gets Life in Texas Professor’s Death

Ohio Doctor Indicted in Wife’s Poisoning

No More Favors, Judge Tells Man Accused in Court Mayhem

Man Sentenced in ‘Girls Gone Wild’ Attack

Nichols May Be Tried in Atlanta Courthouse

Across the City, Gunfire and Stabbings Leave 6 Dead in 24 Hours

Murder Trial Ends, but the Mystery Doesn’t

Driver Shot on Bronx Street After Police Pull Him Over

Brooklyn Jury Gets Case of Killing of Detectives

Scotland has already legislated to include Deep Brain Stimulation with psychosurgery in section 234 of their Mental Health Act 2003. This means that it can be given to consenting patients only if a panel from the Mental Welfare Commission confirms that the patient’s consent is valid and that the operation is in the patient‘s “best interests“. (Section 234 also allows surgeons to carry out psychosurgical operations on incapable patients, as long as the patient is not objecting and the Court of Session approves the operation. However, no psychosurgery has been carried out in Scotland on non-consenting patients since the law came into force. Their previous Mental Health Act (1983) did not allow the use of psychosurgery on non-consenting patients in any circumstances, although before 1983 it was of course commonly used on patients without their consent.)

England and Wales meanwhile have done nothing. The recently published eleventh biennial report of the Mental Health Act Commission (paragraph 4.85) had this to say about DBS:

Insofar as it involves procedures that have strong similarities to techniques of Neurosurgery for Mental Disorder such as stereotactic subcaudate tractotomy (ie. The introduction under local anaesthesia and with the aid of a stereotactic frame of an object through burr holes in the skull), some mental health practitioners and lay persons have assumed that the safeguards of section 57 of the Act do or should apply to its use. However we do not take the view that DBS can fall within the description at section 57 of “a surgical operation for destroying brain tissue or the for destroying the function of brain tissue”.

The report goes on (just as the previous biennial report did) to urge the Secretary of State to legislate on DBS and to advise placing it in the ECT section, which would make it a treatment that could be given to non-consenting patients with the approval of a psychiatrist from the MHAC panel (or occasionally without). But the Secretary of State has done nothing even though experiments on patients are beginning and so DBS remains an entirely unregulated treatment which, in theory at least, can be given to patients without their consent and without involvement of the Mental Health Act Commission.

The psychosurgery team at Dundee have explained the Scottish position on DBS in their most recent biennial report to the Scottish Executive:

It is of course correct to state that some adverse effects associated with ablative procedures may be permanent. However, although less likely, similar issues can and do arise with DBS. It should not be forgotten that DBS procedures lead to the creation of lesions, although these are smaller than for ablative procedures, and, in some circumstances, may be temporary. (paragraph 81)

The report can be read here.

I’m going to let this story speak for itself:
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Family sues after creative writing assignment lands teen in psych ward By Lisa Sweetingham, Court TV

(Court TV) — Minnesota high school student David Riehm bristled at his creative writing teacher’s stinging comments at the bottom of his assignment.

“David, I am offended by this piece. If this needs to be your subject matter, you’re going to have to find another teacher,” Ann Mershon’s critique began.

The 17-year-old’s satirical fable concerned a boy who awoke from a wet dream, slipped rear-end first onto a toy cone, and then had his head crushed “in a misty red explosion” under the tires of a school bus.

“I’m actually a little concerned about your obsessive focus on sex and potty language. Make a change — today!” Mershon warned.

David did not make a change. The poetry, scripts and songs he loved to write typically earned him praise from friends and family. Mershon’s rebuke only roused him to rebel against her in two more essays over the course of the term.
“Bowling for Cuntcheson,” a vivid dream-within-a-dream about a boy who finds a gun under a church pew and shoots his teacher, “Mrs. Cuntcheson,” so frightened Mershon that she alerted the school administration.

“I felt threatened and violated by this thinly veiled fictional account of revenge against me,” Mershon wrote in a statement to authorities. “I immediately had anxieties, which I have struggled with since reading the story. It scared me, it hurt me, and it also makes me very concerned for David.”

David was suspended on Jan. 24, 2005. The next night, three men — a Cook County deputy sheriff, a state trooper and a social worker — showed up at Colleen Riehm’s home on the Grand Portage Indian Reservation with a court order to seize her son and commit him to a psychiatric ward 150 miles away in Duluth. (David’s stepfather is Native American, but David is not enrolled in any tribe.)

With no room at the juvenile facility, David was temporarily placed in the adult unit.

“He was scared to death,” David’s attorney told Courttv.com. “He didn’t know what was going to happen from one minute to the next.”

A physician later determined David was neither mentally ill nor dangerous, and more than 100 letters of support, written by classmates, faculty and parents, were presented at a court hearing, his attorney said.

David was ordered released from the hospital 72 hours after he had been taken into custody. His mother received $6,000 in medical bills.

Colleen and David Riehm filed a civil suit last month against his former teacher, the principal, and other county officials alleging numerous violations of David’s constitutional rights, including freedom of speech, due process, and protection from unreasonable seizure, false imprisonment, and negligent confinement.

“Throwing a kid into a mental hospital for what he writes and not for what he does is unconscionable and unacceptable,” Riehm’s attorney Peter Nickitas told Courttv.com. “I would expect to see something like this in a book by George Orwell or Franz Kafka or an excerpt from the ‘Gulag Archipelago,’ but this happened in Minnesota in 2005.”

It has also happened in Texas, Kansas, Louisiana and public schools across the nation. link

OCD-UK, the leading British charity for people who are affected by Obsessive-Compulsive Disorder, have made some interesting comments about DBS (Deep Brain Stimulation) and psychosurgery more generally.

“August 23, 2005

Deep Brain Stimulation - Our Comment

With news that research into the use of Deep Brain Stimulation (DBS) to treat OCD is to be trialled here in the UK, we felt it appropriate and important for the public interest that we comment.

OCD-UK is against any treatment that will potentially cause long term or permanent damage.

While the procedure has readily reduced symptoms associated with Parkinson’s Disease, many other more severe symptoms often appear in their place. Arguably, in the case of young sufferers, the long-term cognitive and behavioural effects cannot be known at this stage.

The risks associated with brain surgery are damage to the blood vessels (for example, causing stroke), confusional states, epilepsy and severe personality changes.

Previous work using this technique in Parkinson’s disease indicates a death rate of around 1% of people, with another 2% suffering from a stroke or other serious complication. Very serious complications may occur in 1 in 30 people undergoing this operation.

It is claimed that DBS is reversible, however OCD-UK questions this due to the very nature of the operation which involves drilling two holes into the skull and inserting electrodes (which are “about the size of a piece of spaghetti”).

OCD-UK wishes to make it clear to the public and medical community that the continued use of psychosurgery for the treatment of OCD should be subject to further rigorous reviews to determine if its use can be justified. We believe that there is a need for a broader debate which should consider the balance of benefits and costs (in all respects).

OCD-UK will not support this experiment when the dangers to vulnerable sufferers are so great.

We hope to publish details of past research findings later this week.”

In 2003, Datamonitor published a report on “Medical Devices in CNS disorders: opportunities in developing markets” which contained the following advice for DBS manufacturers:

“Deep brain stimulation (DBS) has been shown to be truly effective in treating Parkinson’s disease (PD) but with numerous companies having drugs in development, this could potentially reduce the number of patients needing DBS. Therefore, DBS manufacturers should focus on niche sectors of the market.”