The Battle Over Involuntary Psychiatric Care


Involuntary psychiatric treatment is regarded by many as essential in some settings, and there is evidence from some states that when appropriately administered it is effective. But it is not without controversy and some ardent detractors.

In a symposium at APA’s Annual Meeting this afternoon on “The Battle Over Involuntary Psychiatric Care,” proponents and opponents met for what symposium chair Dinah Miller, M.D., called “not a debate but a respectful presentation of conflicting opinions.”

“Involuntary treatment is an everyday event in the emergency department and on the inpatient unit, but for patients and advocates alike it is a distressing and controversial aspect of psychiatric care,” Miller said. “We all value medical autonomy, and, even when people may be too ill to make decisions about their own care, the issue of whether to force treatment gets sticky.”

(Miller is co-author with Annette Hanson, M.D., who served as discussant for the symposium, of Committed: The Battle Over Involuntary Psychiatric Care.)

APA Area III Trustee Roger Peele, M.D., said he believes it is inhumane to leave people with severe disorders untreated, and discussed the options available for preventing bad outcomes. Past APA President Paul Appelbaum, M.D., described the APA’s stance on involuntary hospitalization and treatment, including the standard that should be applied to determine when involuntary treatment is needed and the APA’s more recent support of legislation promoting outpatient commitment.

Attorney and patient advocate Elyn Saks, J.D., described her own experiences as an involuntary patient, which included being subjected to seclusion and restraint, and her work as a mental health law professor to promote the civil rights of people with psychiatric disorders. Al Galves, Ph.D., representing the patient advocacy group MindFreedom International (MFI), discussed the group’s opposition to involuntary treatment. (MFI is a group that traditionally demonstrates outside the APA’s Annual Meeting, and this year they were invited to present their viewpoint).

“Our hope is not to fuel the battle but to provide an arena where diverse viewpoints can be expressed and heard,” Miller said. “In our increasingly polarized world, we’d like to think that it is still possible to consider a variety of ideas without firing any artillery.”

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