Conservatorship: Mental Health Care’s Last Resort

TOXIC –

June 29, 2021 – “As troubling and extreme as Britney’s circumstances may seem,” Erica Schwiegershausen wrote in The Cut, “much of what she recounted — such as being medicated without consent and subjected to involuntary psychiatric evaluations and institutionalizations — likely feels familiar to anyone with experience of mental illness.”

What broader lessons can be drawn from Spears’s story about the way Americans with serious mental illnesses can be stripped of their rights, and how should the system change? Here’s what people are saying.

For some people struggling with a serious mental illness, involuntary commitment can be salutary, even life saving. One 2003 study, for example, found that involuntary outpatient treatment can decrease hospital recidivism and increase patient quality of life, in part by improving adherence to treatment. Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center, has estimated that more than 90 percent of people with psychosis could be stabilized and discharged within a few weeks or so.

But the history and ethics of involuntary commitment in the United States are extremely fraught. The first mental hospitals in the United States were created in the 1800s with the intention of providing a humane, protective environment where patients could receive adequate care. But by the early 20th century, as funds and staffing shrank, many asylums had effectively become warehouses for people whom society had judged “unfit” — a determination shaped by the eugenicist politics of the day.

“Historically, many have been deemed insane for simply having unpopular opinions, or for behaving in ways that were offensive to common attitudes and contrary to convention,” Moira Donegan writes in The Guardian. “This is particularly true of women, who have a long history of being deemed insane for trivial reasons by those who are either committed to misogyny or interested in their money.”

The abuses wrought by institutionalization were in many cases profound and irreversible: From the 1920s and to the 1950s, some 20,000 people in California alone were sterilized in state institutions.