Welcome to Part 2 of our educational series on Assisted Outpatient Treatment (AOT). For those of you unaware, AOT is a hot-button issue right now considering that the Helping Families in Mental Health Crisis Act, which drastically increases funding toward the practice, was recently passed nearly unanimously in the House of Representatives.
I’m arguing that the practice should be defunded entirely, and here’s one reason why:
AOT unfairly casts doubt on the reasoning capacity of people with mental illness.
There is a pervasive belief that people with mental illness, especially those with psychotic disorders, have been rendered incapable of making appropriate treatment decisions due to the nature of their illness. For example, Shari Lewinski, a program administrator for Denver’s mental health court, said that with “any other illness, you wouldn’t argue with the doctor about what the treatment is” (Brown). The underlying message here? Any resistance to treatment is a symptom of the illness, not the rational decision-making capacity of the individual involved. That message is dangerous.
Most people discontinue their medication for reasons other than delusional thinking. While the majority of first-time patients comply with recommended medication, and thus return to a more “rational” state of mind, the majority also make the conscious decision to stop at a later time. In fact, the more hospitalizations, and therefore courses of medications, a person has experienced, the more likely they are to refuse medication (Owiti, et al. 643). In most of these cases, the burden of side effects outweighs the potential benefit of the medication in question. And that is a perfectly logical reason to quit them.
Typical antipsychotics have really burdensome side effects like persistent agitation and restlessness, tremors, Parkinsonian symptoms, and tardive dyskinesia, which is an irreversible movement disorder. Atypical antipsychotics are usually thought to have fewer side effects, but the truth is that they are just different – excessive weight gain, metabolic syndrome, sedation, and sexual dysfunction (Danzer and Rieger 37). All of these side effects significantly impact a person’s ability to work, exercise, socialize, study, and otherwise function normally, and they may do that more than the illness itself. The side effects are so obviously disabling that even a third of psychiatrists report that they would reject psychotropic drug therapy because of them (Cherry 792).
Even if the side effects are tolerable, a lot of people are concerned about the long-term health implications of antipsychotic drug therapy. Long-term antipsychotic drug use has been linked to increased rates of age-related brain atrophy (Wood) and drug-influenced obesity can contribute to a shortened lifespan (Nauert). Considering that people with mental illness are chronically un- and under-employed, maintaining drug therapy can be financially difficult or impossible. In the well-known Clinical Antipsychotic Trials of Intervention Effectiveness, or CATIE study, a whopping 40% of people who quit antipsychotic medication did so because it just wasn’t effective in treating their symptoms (Danzer and Rieger 36).
There are a lot of really good reasons to take antipsychotic medication, but there are lot of equally good reasons for stopping them. Making blanket statements about the reasoning capacity of people who discontinue medication is dismissive and limits intelligent psychiatric practice. The solution to hordes of people refusing to take medication isn’t to sign laws that let you force it on them because “they don’t know better.” The solution is alternative therapy, treating the side effects, and working hard to find more acceptable drug treatments. Doing anything else is just adding to the resentment that people with mental illness already feel toward the behavioral healthcare system.
Cherry, Mark J. “Non-Consensual Treatment Is (Nearly Always) Morally Impermissible.” The Journal of Law, Medicine & Ethics 38.4 (2010): 789-98. Web.
Danzer, Graham, and Sarah M. Rieger. “Improving Medication Adherence for Severely Mentally Ill Adults by Decreasing Coercion and Increasing Cooperation.” Bulletin of the Menninger Clinic 80.1 (2016): 30-48. Web
Nauert, Rick. “Mental Illness and Metabolic Syndrome | Psych Central News.” Psych Central News. PsychCentral, 17 Feb. 2009. Web. 07 Aug. 2016.
Owiti, J. A., and L. Bowers. “A Narrative Review of Studies of Refusal of Psychotropic Medication in Acute Inpatient Psychiatric Care.” Journal of Psychiatric and Mental Health Nursing 18.7 (2011): 637-47. Web.
Wood, Janice. “Antipsychotic Drugs Linked to Decrease in Brain Volume | Psych Central News.” Psych Central News. PsychCentral, 20 July 2014. Web. 07 Aug. 2016.