(Feb. 4, 2013) The merits and drawbacks of involuntary treatment have received extraordinary attention in the nearly two months since the Newtown, Connecticut, tragedy as lawmakers, mental health professionals and the public ponder how to prevent violence associated with untreated severe mental illness. 
The New York Times a week ago published a detailed letter from psychiatrist Christopher Gordon of Framingham, Massachusetts, who described court-ordered treatment as “a blunt instrument that may drive more people away from seeking care than it compels into care.” On Sunday, the Times published seven responses to Dr. Gordon’s letter reflecting a range of viewpoints – family member, consumer, physician, counselor, prosecutor - and his rejoinder to them.
Because the Treatment Advocacy Center works to eliminate barriers to treatment – including civil commitment laws and standards that make it harder for people with acute or chronic untreated mental illness to get care – we are devoting this week’s blog to the viewpoints contained in the letter and its responses.
Dr. Gordon’s letter, which sparked the dialogue, provides a timely opportunity to address common criticisms from opponents of inpatient and/or outpatient commitment and to provide caregivers and advocates with information they can use to foster a better understanding of court-ordered treatment.
Gordon: Recent tragic events have linked mental illness and violence. Some people — I, for one — consider this link dangerously stigmatizing.
Both of these statements are true.
Many studies have documented a link between untreated mental illness and violence, and many of those studies have been in the news because of recent tragedies. Research has also consistently found awareness that some individuals with mental illness are dangerous to be a major course of stigma. (See our backgrounder, “Stigma and Serious Mental Illness”). Since individuals who receive effective treatment for mental illness are no more dangerous than the general population, we maintain the way to break the link and reduce stigma is to make sure that people with untreated psychiatric disease get timely and effective treatment. Ignoring or denying there’s a link perpetuates stigma by minimizing the need for such treatment.
Gordon: People with mental illness are far more likely to be victims of violence than perpetrators.
True but irrelevant to the issue. Just because people with untreated severe mental illness are more likely to be victims of violence than perpetrators doesn’t mean they don’t perpetrate violence. People are vastly more likely to die in a car accident than walking across a street, too, but that doesn’t mean some don’t die crossing the street. Victimization and violence are not either/or conditions; they are both outcomes of untreated mental illness, and both could be reduced with treatment. (See our backgrounder “Victimization and Serious Mental Illness”).
Gordon: Moreover, psychiatrists have limited capacity to reliably predict violence.
True but only part of the story. Studies have identified several risk factors for violence in individuals with mental illness. Prominent among them are previous violence, substance abuse, non-treatment of the mental illness and paranoid delusion. Being male is another one. The presence of these factors does not predict that a specific individual with mental illness will be violent, but it does describe circumstances that heighten the risk for dangerousness. We all know that high levels of “bad” cholesterol, high blood pressure and a family history of heart attack are risk factors for heart disease and take measures to prevent it. Red flags for violence are identifiable, too, can be monitored and do offer an opportunity for prevention. (See our backgrounder “Risk Factors for Violence in Serious Mental Illness”
We’ll address whether coercion creates more problems than it solves, self-directed treatment and other topics in Part II. Click here to read all of Dr. Gordon’s letter in the Times.
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