For the past decade increasingly insistent psychiatric hyperbole has been promising imminent breakthroughs in knowledge and treatments for a number of mental illnesses, particularly schizophrenia. These exaggerated claims have frequently been combined with drug company-funded ‘right to treatment’ campaigns run by support groups for the relatives of mental patients. The combined force of drug companies, psychiatrists and relatives' support groups has persuaded both the public and governments that mental health services and budgets should be expanded, and that civil liberties protections should be weakened, so that more people can be forced into treatment.
An example of the type of pressure arising from this situation can be found in the 1995 Annual Report of the New South Wales Mental Health Review Tribunal—a quasi-judicial body constituted under the New South Wales Mental Health Act with designated responsibilities for hearing appeals and reviewing the cases of detained mental patients. Scattered throughout the 1995 Report were repeated references to a perception by members of the Tribunal that involuntary commitment to mental hospitals was being unnecessarily restricted.
The Tribunal claimed that civil liberties protections were being interpreted in a way that was too restrictive of psychiatric practice and that a much wider net should be cast for coercive use of psychiatry. One of the Tribunal’s statements even went so far as to argue that the criteria for involuntary commitment should be expanded to include people with personality disorders ‘who would benefit from behavioural modification, rehabilitation, or drug and alcohol programmes’.[29]
Ironically, in the same report, the Tribunal also drew attention to the way the numbers of involuntary patients had been steadily increasing under the existing criteria.[30] The total number of involuntary hospital admissions in NSW rose from 5499 in 1992,[31] to 7370 in 1995,[32] a 34 per cent increase in three years. (By 1998 this number had risen to 10,078, almost double the 1992 figure.)[33]
This increase had been accompanied by an even more accelerated rise in the numbers of Community Counselling Orders (CCOs) and Community Treatment Orders (CTOs). CCOs and CTOs are legal devices which facilitate commitment of people as outpatients and allow for mobile treatment teams to enter peoples' homes and forcibly inject them with long acting drugs. The law provides for arrest and incarceration in a mental hospital for non-compliance. The combined total of CCOs and CTOs issued in NSW had risen from 510 in 1992 [34] to 1901 in 1995,[35] a 270 per cent increase in three years. (The 1998 figure was 2998, nearly six times the number in 1992.)[36] Strangely, even though the Tribunal was calling for a weakening of civil liberties protection, they still made the observation that there was a developing ‘trend towards coercive, as opposed to consensual treatment’[37] under the existing criteria.
Outpatients commitment is currently being introduced in the United States, state by state. The concept introduces a new dimension to mental health arrangements that worries many observers. One of the major concerns is the lack of restriction on the number of people who might eventually be controlled by forced drugging. Before the development of outpatients commitment, a person had to be incarcerated in a hospital to receive involuntary treatment. This requirement placed finite limits, in terms of the availability of accommodation and funding, on the total number of people who could be subjected to forced treatment at any given time. But outpatients commitment removes those limitations, and it remains to be seen how many people will eventually be diagnosed with mental illnesses such as schizophrenia and placed into forced treatment programmes, while still living in their own homes.
There are indications that drug company profits might be a factor. Involuntary patients are quite literally a captive market for psychiatric drugs. One analyst of the pharmaceutical market recently argued that the $1 billion a year US market for schizophrenia drugs could be expanded to $4.5 billion a year if all the people with identifiable symptoms of schizophrenia could be forced into treatment with the newer, more expensive drugs.[38]
On top of the market expansion promised by outpatients commitment in developed countries, a lot of attention has also been directed towards expanding psychiatric applications in developing countries. In 1997 psychiatric researchers claimed that schizophrenia was afflicting about 24.4 million people in low-income societies. This was said to be a 45 per cent increase since 1985.[39]
This increasing tendency to medicalise deviance in poorer countries might force mainstream human rights groups like Amnesty International to pay more attention to violations arising from psychiatric practices. To date human rights activists have under-rated the significance of psychiatric abuse despite the historical role psychiatric atrocities played in developing the concept of human rights.
Next: Human Rights and Psychiatry
[29] Mental Health Review Tribunal, Annual Report, pp. 13, 17, 20.
[30] Ibid., p. 20.
[31] Mental Health Review Tribunal, Annual Report, 1992, p. 91.
[32] Ibid., 1995, p. 58.
[33] Ibid., 1998, p. 70.
[34] Ibid., 1994, p. 41.
[35] Ibid., 1995, p. 28.
[36] Ibid., 1998, p. 47.
[37] Ibid., 1995, p. 20.
[38] Reuter Information Service, Drugmakers look for home-runs with schizophrenia drugs.
[39] Arthur Kleinman and Alex Cohen, ‘Psychiatry’s Global Challenge’, Scientific American, March 1997.