A tragic cost

This comes from a law blog that is part of the Wall Street Journal and was posted today.

Tragic Maine Case Shines Light on Little-Known Federal Program


Are advocates for the mentally-ill too aggressive in pushing for their clients' right to resist treatment? That's the tricky legal question at the center of a Weekend Journal feature by Elizabeth Bernstein and Nathan Koppel.

As context, they take the tragic story of William Bruce (pictured), who, two months after being released from a psychiatric center in Maine, approached his 47 year-old mother as she worked at a desk and struck killing blows to her head with a hatchet. Why had Bruce been released against the recommendations of his doctors? Because of government-funded patient advocates who appear to have fought for Bruce's right to refuse treatment, to have coached him on how to answer doctors' questions and to have resisted the medical staff's efforts to contact his parents.

Helen Bailey, one of Bruce's advocates and an attorney with Maine's Disability Rights Center, declined to discuss the details of his case but says the handling of it was consistent with her professional duties. "My job is to get the patient's voice into the mix where decisions are made. No matter how psychotic, that voice is still worthy of being heard. I have not had the person who is so out of it that they can't communicate what they want."

Congress created the national Protection and Advocacy for Individuals with Mental Illness program, or PAIMI, in 1986 to curb abuse and neglect of the mentally ill, primarily in institutions. The PAIMI program, operated by the Substance Abuse and Mental Health Services Administration, funds protection-and-advocacy agencies in each state.

"I don't know if they are doing people a service when they assert the right of mentally-ill individuals to remain psychotic," says Ron Honberg, director of policy and legal affairs for the National Alliance on Mental Illness.

Despite advocates' objections, Joe Bruce, William's father, along with Fulbright's Robert Owen, successfully lobbied the Maine legislature to pass three bills. One gives mental-health professionals greater leeway to disclose patient information to those who may be affected by that person's conduct. Another makes it easier to medicate involuntarily committed patients.

While Bruce the son believes patients deserve some protection, he said he understands the fight to strengthen commitment and treatment laws. That fight took another turn last month, when Bailey, the advocate who helped William get out of treatment, and another attorney, filed a lawsuit in Maine federal court that's directed at the law which makes it easier for hospitals to compel patients to take medication.

"There are times when people should be committed," said the younger Bruce. "Institutions can really help. Medicine can help." He said: "None of this would have happened if I had been medicated."

LB Film Trivia of the Day: The authors mention that the PAIMI program came about after abuses were uncovered, primarily in the 1960's and 1970's, at hospitals where patients were neglected or over-medicated. Frederick Wiseman, a law-professor-turned-filmmaker, was partly responsible for that increased awareness. In 1967 he made a documentary called "Titicut Follies," filmed inside the Massachusetts Correctional Institution at Bridgewater, a prison hospital for the criminally insane. The Massachusetts Supreme Court ruled that Wiseman's film constituted an invasion of inmate privacy and ordered its withdrawal from circulation.

Whose interest does this law truly serve?