Involuntary Outpatient Commitment
In 1955, over 559,000 individuals resided in inpatient psychiatric hospitals. By 1995, however, the number had drastically diminished to 69,000, (National Health Policy Forum, 2000). This drastic reduction was largely due to the discovery of antipsychotic medications in the 1950s, and the deinstitutionalization movement of the 1960s, wherein several thousands of mentally ill individuals were released from psychiatric institutions to return to their communities for treatment. Mental health centers (MHCs) were conceptualized during deinstitutionalization to provide treatment to these newly-released mentally ill persons in their communities. Although efforts were well-intended, the MHCs failed to serve the neediest subset of individuals. Instead, they served those who had minor psychiatric diagnoses and needed little treatment. As a result, the United States experienced an increase in the number of homeless individuals, most of whom still exhibited psychotic symptoms. Involuntary Outpatient Commitment (IOC) was created to serve those “forgotten” mentally ill individuals without placing them back in institutions. Ideally, IOC will increase community tenure for the severely mentally ill, decrease the likelihood of decompensation, and provide the necessary treatment by means less restrictive than hospitalization, (Borum et al., 1999).
IOC is a civil procedure whereby a judge orders a person with a mental illness to comply with outpatient treatment within the community, or risk sanctions such as being forcibly brought to treatment by law enforcement officials, (Swartz et al., 2003). The legal authority in IOC is the state’s parens patriae power, which provides for the protection of disabled individuals, and its police power, which involves the protection of others. IOC is commonly used for persons with schizophrenia, bipolar disorder, or other psychoses, especially if there is a history of medication non-compliance or repeated inpatient psychiatric admissions, (Torrey & Kaplan, 1995). The national Department of Mental Health receives a certain amount of money each year from the federal government. From this, state mental health departments draw a significant amount of their funds. It is through the state mental health departments that IOC is largely funded. Although IOC is delivered at the local level, those municipalities...
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...IOC as it is currently stated.
As discussed above, I feel that IOC would be most effective if other components were combined with it, if there was a way to ensure that treatment staff wholeheartedly attempts to rehabilitate individuals, and if treatments last longer than six months. Additionally, more money needs to be supplied to local mental health centers to ensure that treatment is adequate. Although many might oppose more money going into a service sector that they believe is already receiving too much money, I believe if social workers and other mental health advocates could show the public how necessary IOC is, getting an increase in resources would not be difficult to procure.
In closing, IOC was created to serve those mentally ill individuals who need treatment, but not necessarily in an inpatient setting or through voluntary treatment. IOC possesses several strengths that exhibit its utility in today’s society. As social workers, although we may disagree with the coercion element of it, we should endorse IOC, as it only betters the lives of mentally ill individuals who are largely misunderstood, largely under treated, and largely deserving of our support.
During the 1960’s, America’s solution to the growing population of mentally ill citizens was to relocate these individuals into mental state institutions. While the thought of isolating mentally ill patients from the rest of society in order to focus on their treatment and rehabilitation sounded like a smart idea, the outcome only left patients more traumatized. These mental hospitals and state institutions were largely filled with corrupt, unknowledgeable, and abusive staff members in an unregulated environment. The story of Lucy Winer, a woman who personally endured these horrors during her time at Long Island’s Kings Park State Hospital, explores the terrific legacy of the mental state hospital system. Ultimately, Lucy’s documentary, Kings
The fight for improved health care for those with mental illness has been an ongoing and important struggle for advocates in the United States who are aware of the difficulties faced by the mentally ill and those who take care of them. People unfortunate enough to be inflicted with the burden of having a severe mental illness experience dramatic changes in their behavior and go through psychotic episodes severe enough to the point where they are a burden to not only themselves but also to people in their society. Mental institutions are equipped to provide specialized treatment and rehabilitative services to severely mentally ill patients, with the help of these institutions the mentally ill are able to get the care needed for them to control their illness and be rehabilitated to the point where they can become a functional part of our society. Deinstitutionalization has led to the closing down and reduction of mental institutions, which means the thousands of patients who relied on these mental institutions have now been thrown out into society on their own without any support system to help them treat their mental illness. Years after the beginning of deinstitutionalization and after observing the numerous effects of deinstitutionalization it has become very obvious as to why our nation needs to be re-institutionalized.
Belluck’s New York Times article describes a study that ordered mentally ill patients to receive treatment instead of being hospitalized. The study found that the patients were less likely to be placed in psychiatric hospitals or arrested, and outpatient treatment and medication refills increased. This also proved economical, because the mental health system and Medicaid costs were reduced by at least fifty percent. This program doesn’t only apply to the patient to accept treatment, it also requires the mental health system to provide it, making the program more effective
Pollack, Harold. "What Happened to U.S. Mental Health Care after Deinstitutionalization." Washingtonpost.com. N.p., 12 June 2013. Web. 13 Nov. 2013.
Continuing budget cuts on mental health care create negative and detrimental impacts on society due to increased improper care for mentally ill, public violence, and overcrowding in jails and emergency rooms. Origins, of mental health as people know it today, began in 1908. The movement initiated was known as “mental hygiene”, which was defined as referring to all things preserving mental health, including maintaining harmonious relation with others, and to participate in constructive changes in one’s social and physical environment (Bertolote 1). As a result of the current spending cuts approaching mental health care, proper treatment has declined drastically. The expanse of improper care to mentally ill peoples has elevated harmful threats of heightened public violence to society.
In Le Guin’s “The Ones Who Walk Away from Omelas,'; we find ourselves faced with a moral dilemma. What is it that we as people base our happiness on? The idea of societal and personal happiness is played out through the analogy of Omelas and the abandoned child. In this story, we are drawn into Le Guin’s world by use of her vivid descriptions.
...f those who walk away, the fundamental notion that Le Guin and her narrator favor the walkers does not ultimately stand true based on the reading of the text. Instead, readers are pushed to rise above our limited perspectives of what is right and wrong, and make the uncomfortable decision to stay in Omelas. What “Omelas” proposes is that utopia is not achieved via a perfect social science. Humanity progresses when it learns by means of its inherent differences and oppositions. Happiness does not necessarily mean a comforting conclusion that answers all the questions and ties up all the loose ends. Rather, happiness is not a fixed and realized end in itself. The world of the Omelans is one of subjective and socially constructed truths that sometimes exist without logical explanation and in direct contradiction of one another. Coincidentally, it is our world as well.
...s a bigger and harder step not very many citizens of the world today are willing to do. Loosing the happiness that one gets in exchange from injustice in the world is an action that is unthinkable to humankind. The right ethical decision has to be made to entirely resolve the issue, but making that right ethical decision is impossible with the other factors of life such as personal happiness. In “The One Who Walks Away From Omelas” the reader is taught the importance of making the right ethical decision and can relate these morals in their own community. One cannot just choose to ignore, one cannot just choose to observe and still do nothing, and one cannot just simply walk away. The reader is taught the momentous moral of not being a bystander, the importance of moral responsibility, and the great significance in learning to overcome the ethical issues in society.
Wolff, N. & Pogorzelski, W., 2005, ‘Measuring the effectiveness of mental health courts – Challenges and recommendations’, Psychology, Public Policy, and Law, vol. 11, no. 4, pp. 539-569.
The United States has the highest incarceration rate in the world and of that over sixty percent of jail inmates reported having a mental health issue and 316,000 of them are severely mentally ill (Raphael & Stoll, 2013). Correctional facilities in the United States have become the primary mental health institutions today (Adams & Ferrandino, 2008). This imprisonment of the mentally ill in the United States has increased the incarceration rate and has left those individuals medically untreated and emotionally unstable while in jail and after being released. Better housing facilities, medical treatment and psychiatric counseling can be helpful in alleviating their illness as well as upon their release. This paper will explore the increasing incarceration rate of the mentally ill in the jails and prisons of the United States, the lack of medical services available to the mentally ill, the roles of the police, the correctional officers and the community and the revolving door phenomenon (Soderstrom, 2007). It will also review some of the existing and present policies that have been ineffective and present new policies that can be effective with the proper resources and training. The main objective of this paper is to illustrate that the criminalization of the mentally ill has become a public health problem and that our policy should focus more on rehabilitation rather than punishment.
They may feel sympathy for the child at first, but then this grows into a sickness that overcomes them. The people who choose to leave Omelas are possessors of a strong human emotion that cannot exist in a utopia. That emotion is guilt. With guilt, a person cannot be completely happy. Therefore, the people who experience guilt are faced with a problem and must do something to solve that problem. They can walk away from the town and ensure the happiness of the people, or they can help the child, knowing the town of Omelas will forever change. In the story, everyone who experiences guilt walks away, leaving the town intact. It is obvious that no option in this situation is without flaw. To leave the town would mean self-sacrifice for the benefit of Omelas. To stay would mean self sacrifice for the benefit of the child. To do nothing would be impossible, because one cannot stay in Omelas unless one is perfectly happy. It is certainly not an easy
A very debatable question arises when analyzing this, and the upsurge of homelessness. Is the increase of homelessness due to deinstitutionalization? I believe that homelessness is not a result of deinstitutionalization, but rather in the way it has been implemented. Approximately 20-25% of the single adult homeless population suffers from some form of severe and persistent mental illness (Website 2). According to the Federal Task Force on Homelessness and Severe Mental Illness, only 5-7% of the mentally ill homeless need to be institutionalized (Website 2). A majority of mentally ill can live within the community with the appropriate supportive housing options (Website 2). That is where the problem lies. The mentally ill individuals, who have been dependent on all aspects of an institution, are being thrown into a community with little help or guidance. The importance of the distribution of psychoactive medication and financial support were perceived, but the significance of helping to create a community status role for the mentally ill was overlooked. Once this became apparent, community mental health centers were very resistant to providing services for them. States were also extremely reluctant to distribute funds for these community-based servi...
In the short story The Ones Who Walk Away from the Omelas, Ursula Le Guin illustrates a community that is joyous. However, the community is torn because the source of their happiness is due to the choosing of an unfortunate child that resides in a basement under of the beautiful public buildings of Omelas neglected and barely ever eating. Le Guin explanation that although the people of the community are very happy, they are also very well aware of what is providing them that happiness. He writes, “all know [the child] is there… They all know that it has to be there. Some of them understand why, and some do not, but they all understand that their happiness, the beauty of their city, the tenderness of their friendships, the health of their children, the wisdom of their scholars, the skill of their makers, even the abundance of their harvest and the kindly weathers of their skies, depend wholly on this child’s abominable misery” (257). This unjust and cruel punishment this child must endure for the sake of the community causes an ethical dilemma that tears apart the community. The ethical dilemma forces the community to acknowledge their living situation and ask themselves: What is more important? Their happiness or this child? Thus, they must make a choice to either walk away from the life and community they have lived in for their whole life because their source of happiness is at the cost of a young boys life. Or, do they continue to live in Omelas and ignore the harsh conditions that this young boy is exposed to. In the story the boy is described as a six-year-old boy that is neglected, locked away in a dirty room, abused mentally and physically, and alone(Le Guin, 257). He barely has any fat on him because all he is fed is “hal...
The truth is that no one enjoys being abused, no matter what kind of emotional state or self-image they may have. Some of the emotions that I experienced in this kind of relationship are isolation, paranoia, shame and embarrassment. As a victim of abuse, I, like many victims, didn’t rea...
In the short story, “The Ones who walk away from Omelas”, by Ursula K Le Guin, it maintains, “Do you believe? Do you accept the festival, the city, the joy? No? The let me describe one more thing,” (Guin, 36). This is a perfect example of how with all good, there is always some sort of catch, some sort of evil. The story is about a utopian society that is purely joyous and wonderful. The reason everything runs so smoothly in the society is due to the fact there is a little six year old kid who is starved to death below the city. The young child plays a gigantic role in their society because his sorrow as well as suffering allows everyone else to be joyful, and these people understand this. The young child must is forced to live down