New book by USC law and psychiatry professor Elyn R. Saks proposes major limits on forced treatment of the mentally ill

LOS ANGELES (Jan. 6, 2003) -- Contrary to popular belief, the majority of the nation's psychiatric patients are mentally capable of making decisions when it comes to their own health care -- and they should be granted the right to make such decisions as a matter of course, argues USC Law and Psychiatry Professor Elyn Saks in her latest book.

Refusing Care: Forced Treatment and the Rights of the Mentally Ill (University of Chicago Press, 2002) is the result of a careful analysis of numerous case histories and empirical studies, but also comes out of Saks's personal experience with the mentally ill. Saks is a research clinical associate at the Los Angeles Psychoanalytic Society and Institute who has trained as a psychoanalyst and has represented many psychiatric patients in court cases involving such issues as medication refusal, civil commitment and special education. She also has volunteered in hospitals and has witnessed the kind of treatment that the mentally ill typically receive in U.S. institutions.

In her new book, Saks suggests a new approach to caring for the mentally ill: Be more protective of their rights and autonomy yet allow for greater intervention in some cases, such as following a first episode of psychosis. Years of teaching and studying mental health law, as well as her training in psychoanalysis, has led Saks to believe that the forced treatment of the mentally ill should be severely limited as a common practice.

"In most cases, talk is better than force," says Saks, who has written extensively on standards of competency for the mentally ill. "I found that when I represented psychiatric patients, most of them were pretty reasonable contrary to popular opinion. They could listen and, even though some people may be somewhat in denial about their situation, most ended up agreeing to seek help."

Among her conclusions in Refusing Care, Saks argues that:

• Mentally ill people are much more competent than most caregivers realize and the majority of psychiatric patients can make reasonable decisions about their own welfare, including their own treatment.
• Civil commitments, or forced hospitalizations, should be reserved only for those who pose a serious danger to others or are very disabled.
• Most patients should be allowed to refuse medication or other treatment, absent an emergency.
• Psychiatric hospitals in the U.S. should do away with their frequent use of seclusion and mechanical restraints because the psychological and bodily injury done to patients far outweighs the limited benefits.

These findings have important implications for the policies that currently determine the health care and management of the mentally ill in America.

"Our treatment of the mentally ill frequently swings between over-intervention and utter neglect," Saks says. "We sometimes force treatments on those who do not want them, and at other times, discharge mentally ill patients who do want treatment without providing adequate resources for their care. In a world of limited resources, it makes sense not to impose treatment on those who should not be treated against their will. Dollars inappropriately spent on these people cannot be used to deliver services to people who truly want them or ought to get them."

Saks is the Orrin B. Evans Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at USC Law and has published widely on such subjects as multiple personality disorder in criminal law, psychoanalysis, mechanical restraints and competency standards. She is a widely regarded expert in mental health law, and psychiatry and criminal law.