>>>And as to mental health outpatients with conditions controllable on meds : failure to comply with med restrictions obviates any insanity plea for crimes committed
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>>The only problem with this is that, AIUI, the disease itself sometimes is the reason people go off their meds. That is, the medication regime doesn't fully overcome the disease yelling that the meds are unnecessary.
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>>Tamar
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>It is ironic that some of the meds are so sucessfull that the patient really starts to think they don't need them ( and expecially with bipolar disorders there is a nostalgia for the highs) We recently went through a very rough period in our family when a treasured neice, already a mother of three, had some very very bad reaction in the post partum period to no being on her normal meds during the fourth pregnancy. Thankfully, with a lot of patience on everyone's part, a very loving husband and good medical care she is now back to being the beautiful loving woman we all know her to be. But many do not have that support net, or are even properly diagnosed and treated to begin with.
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>But it is a problem when it is considered a civil liberty to be able to go off the drugs - a decision made when the patient is most rational - and society is expected to make accommodation for this decision which may have distinctly anti-social consequences.
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>Like all issues of individual rights and freedoms vs social responsibilities it is not a simple thing. but since the struggle for patient rights and protections was so hard in the 60s and 70s ( some of my very close friends were on the barricades on that one ) some advocates became absolutists and lost sight of the part that mean protecting both the patient and the world in which they interacted.
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>Involuntary commitment and treatment is a scary thing in both practice and principle and certainly has a history of abuse. (even int the 'best' of families with political aspirations) The Soviets showed us the Orwellian side.
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>But it is like "homelessness" being seen as poverty issue when anyone who has worked with the homeless realizes it speaks more to inadequate mental health treatment options and a failure to have research and strategies to combat the symptom of substance abuse.
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>I just hate to see these decisions in the hands of politicians and special interest zealots. I think the President is just the guy to be able to put together a group of people who have clinical, legal, and street experience in this area to at least attempt to define the problem in a way that might be productive. That would be fine addition to his legacy and I think he has the intellect to understand why such a thing would be a good idea.

I think we're pretty much in agreement here. For sure, these are hard questions and hard issues, but it's about time we tackled them.

Tamar