The family of an Alzheimer patient may pursue involuntary commitment to a state institution when the patient’s behavior has become so disordered or disruptive that it becomes intolerable or unmanageable. Some nursing homes are unwilling to accept a patient who poses severe behavior problems and demonstrates a significant lack of personal care, as is sometimes the case with Alzheimer patients. For these reasons family members may want to consider the commitment process.Each state has some provision for the involuntary commitment of individuals who are mentally disturbed. In most areas of the country community mental health centers provide families with advice regarding commitment procedures. In larger communities there are specialized courts and court personnel who deal exclusively with such problems. The local mental health association is generally a good source of information on such matters.
There are generally three requirements that must be met before an individual may be involuntarily committed, although these requirements may vary from state to state -
(1) The individual must be determined to have a mental disorder
(2) He or she must require hospitalization (for example, the patient cannot manage in a less restrictive environment)
(3) The person is a danger to himself or others.
There must be at least clear and convincing evidence of these three requirements, generally based on recent overt acts, before an individual may be committed.
During the 1970s there were several landmark judicial decisions related to the return of mentally impaired individuals to community facilities. These decisions dealt with the right to refuse treatment, the right to less restrictive alternatives to institutionalization, and the right to treatment.
Right to Treatment
Once an individual has been hospitalized, what must occur? What is the obligation of the state to provide treatment? The U.S. Supreme Court, in its decision of Donaldson v. O’Connor, stated that the right of society to involuntarily hospitalize a person who is not dangerous is based on a quid pro quo. The right to hospitalize rests on a responsibility to provide treatment. In Donaldson’s fourteen years of hospitalization the court noted that all he received was “milieu therapy,” which, in his case, consisted of sitting in a room filled with other persons who were deemed mentally ill. Without more evidence that treatment was being provided, the Supreme Court declared Donaldson was unjustly hospitalized and ordered his release. The basic premise of this case is that a patient who is hospitalized must be treated or released provided they represent no danger to them selves or others.
Right to Refuse Treatment
Once a patient has been hospitalized, what is the right of the patient to refuse treatment? The United States District Court of New Jersey, in the case of Rennie v. Klein, set a precedent for determining the conditions under which a psychiatric inpatient has the right to refuse treatment. John Rennie was an involuntary mental patient who, at the time of the hearing, had been admitted to psychiatric hospitals twelve times. Although involuntarily committed, he had never been declared incompetent. Rennie brought a civil action against the hospital staff to prohibit them from administering drugs to him by force in the absence of any emergency. However, the court delineated four factors that must be considered in determining whether an injunction should be issued when a patient refuses medication.
These factors are -
(1) The patient’s capacity to decide on his particular treatment
(2) The patient’s physical threat to other patients and to staff at the institution
(3) Whether any less restrictive treatments exist
(4) The risk of permanent side effects from the proposed treatment.
The court held that an involuntary mental patient has a right to refuse medication in the absence of an emergency, as a legitimate exercise of his constitutional right to privacy. In the absence of an emergency, some due process hearing is required prior to forced administration of drugs. This decision, by enumerating the factors to be considered in cases when patients refuse treatment, reflects strides by the court toward establishing further civil liberties for involuntary mental patients. This is not a national standard, however, and a clear statement on refusal of treatment remains to be given by the Supreme Court. There is little doubt that the growth of civil liberties in this sphere will continue. The day may come when persons suspected of mental illness will have the same procedural and substantive protection as those accused of committing a crime.
Families who are considering having their Alzheimer relative committed should consider that state hospitals no longer warehouse patients. There is a duty to provide treatment to the extent that it can be provided. Consideration is also given to removing from state hospitals patients who do not need intensive types of care; such patients are placed in less restrictive environments. Many Alzheimer patients require an intermediate level of care that may be more efficiently provided in such less restrictive environments as nursing homes. Moving patients into the less restrictive alternative is the sensible course of action for the patients, the staff of institutions, and family members.
Tags:alzheimer patient, commitment procedures, involuntary commitment, Legal Consideration, mental disorder, mental health, mentally disturbed mentally impaired
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