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Psychiatric patients are people with mental disorders because they experience serious mood disturbances and major cognitive disturbances, which push them to act dangerously to an extent that they may harm themselves or others (Bell, 2005). Psychiatric patients have different definitions and are handled differently in diverse countries, but in general, they are bound by legal Acts that grant them treatment rights just like other patients. However, this Act is not wholly recognized, which is why there exists a controversy of whether psychiatric patients have the rights to refuse treatment or not. The controversy exists under the involuntary outpatient commitment (IOC) framework, where many argue that if these patients are allowed to refuse treatment, they pose a danger to the public (McKenzie, 2008). Others perceive that forcing mentally ill people to take medication improves their mental stability; hence, the forceful act is necessary. The irony of the controversy is that patients that are allowed to refuse treatment still remain in the institution because releasing them pose dangers, and forcing them to take treatment is a violation of their rights (Bell, 2005). This further raises the debate of balancing the rights of the patients with the rights of the public. For this reason, this paper will review the rights of psychiatric patients in relation to forceful treatments and at the same time outline whether there is any circumstances that allow psychiatric patients to be forced to take treatment.

Forceful medication to psychiatric patients

Ideally, medical ethics bear principles like the beneficence principle, which urges that physicians’ aims should be to benefit the sick by reversing their state to good health and lessen their suffering. More so, ethics define that a patient is the one to decide about his medication and treatment procedures irrespective of their state. Psychiatric cases are quite challenging in terms of ethical context because as much as their freedom to treatment is protected by law and medical ethics, psychiatric patients pose dangers to themselves and people around them (Bell, 2005). This is the case because the illnesses foster serious mood disturbances and lack of self control. For this reason, medication becomes the cornerstone of treatment to curb mental disorder because lack of compliance with medication associates with faster lapse and chaotic lifestyle. This necessity has pushed some countries like UK to ensure that mentally challenged individuals forcefully undergo treatment. UK’s department of health in collaboration with the Welsh Office allows individuals who pose such risks to be detained and treated even without their consent (Jarrett , Bowers. & Simpson, 2008). More so, the new UK Great Britain ‘treatment resistant’ patients within the society are forcefully admitted to hospital for compulsory treatment. This act is supported by the Nursing and Midwifery Council (UK’s nurses and midwives regulatory body). This contradicts with other rights given to other patients like physically disabled patients, who have the right to refuse treatment despite that their disorders put them to risk. A deeper perspective on UKs abolition of psychiatric patients’ rights to refuse treatment depict that the country outweighs the risk posed to the public by mentally ill patients; thus, the rights of the public surpasses the rights of the patients (Jarrett, Bowers & Simpson, 2008).

Other nations like New Zealand does not either grant psychiatric patients the right to accept or refuse treatment, but rather it grants the family court discretion on the type of compulsory treatment to make. This is in accordance to the Mental Health Act 1992 also referred to as (Compulsory Assessment and Treatment Act). This Act ensures that the family courts determine the type of compulsory treatment granted to mentally ill patients, and such court’s decision is final. Despite that New Zealand has given all the authority to family courts, the rights of psychiatric patients are still not considered because the court’s decision on the type of compulsory treatment to grant such patients could be influenced by second parties like family members and medical practitioners (Zhang et al, 2015). This is the case because these participants may end up convincing the family courts that the patients need forceful medication, which in return deprive the psychiatric patients the rights to decide what they want to be done unto them medically.

Independent medication to psychiatric patients

Contrary to New Zealand and UK, many other countries around the globe have amended their health Acts in order to encompass the rights of the mentally challenged patients (Gratzer & Matas, 1994). This depicts that the psychiatric patients’ rights have evolved over the decades because many nations did not realize its significance until recently due to an in-depth review of patients’ rights between medical and legal sources. Prior to medical and legal sources, civil rights movements and the entrenchment of charter of rights and freedoms of Canadian institution help in raising the voices for change of how patients in psychiatric facilities should be treated.  Currently, the international human rights have come up to intensify the advocacy by emphasizing that psychiatric patients had rights to decide and that such decisions are not just wishes but expressions of rights. Among the main advocates of the mentally ill patients’ rights are The Declaration of Hawaii and the Ten Basic Principles for Mental Health Law, Principles for the Protection of Persons with Mental Illness (or MI Principles, 1991), the European Convention for the Protection of Human Rights and Fundamental Freedoms (1950). The principles of these bodies were published by the World Health Organization (WHO).

Canada is among the renowned countries that embraced and granted mentally ill patients the rights to choose whether or not to accept medication.  This evidence is backed up by the fact that Canada has 12 Mental Health Acts (MHAs), which determine the manner in which mentally ill patients are admitted, the rights to refuse treatment and the authorizers of the treatment. Prior to numerous Acts, Canada has a famous directive called PAD (Psychiatric Advance Directives). These are Canadian legal documents that permit mentally ill individuals to declare their treatment choices in advance (Ambrosini & Crocker, 2007). These documents began appearing in literature in 1998, which means that Canada’s psychiatric patients have been exercising treatment for over a decade. The manner in which PAD (Psychiatric Advance Directives) works is exceptional because it allows mentally ill patients to express the preferences of their treatment either through a proxy directives that grants authority to someone else to make decisions on behalf of the mentally ill patient, or through instructional directives, where the ill patient outlines instructions in  advance. This means that should the mental illness becomes critical, the wishes of the patient is respected irrespective of the situation at hand. Prior to having 12 Mental Health Acts that protect the rights of mentally ill patients, Canada has also set the pace in terms of judicial setting because its courts rule in alignment to the rights of the psychiatric patients (Browne, 2010). Many courts in Canada have witnessed cases where mentally ill patients’ wishes to refuse treatment have been refuted by either medical practitioners or family members. For this reason, the courts have stood firm to protect the rights of such patients by allowing them to refuse treatment if they so wish. Therefore, Canada depicts that the liberty of mentally ill patients in regards to treatment is a crucial right that these individuals deserve, and patients, who foresee their treatment wishes being halted are advised to embrace PAD’S instructional directives so that they can state their wishes in advance (Ambrosini & Crocker, 2007).

Under what circumstances should psychiatric patients be forced to take treatment?

The circumstances through which a psychiatric patient should be forced to undergo treatment do not exist in the current literature because these patients are legally protected by law and medical ethics. This means that they should undertake medication willingly irrespective of their state of mind because just like any other patients, Psychiatric patients have rights to decide what medical practitioners should do unto them. Therefore, at no given time should Psychiatric patients be forced to treatment because doing so is violating their rights, except for critical cases, where a substitute decision-maker is required to decide on behalf of the patient. Such a situation arises when the patient is suffering from other illnesses that need to be treated alongside the mental disorders.  More so, such decisions could be made when the patients lack capacity to make decisions about treatment or even do not recognize that they are ill. Such substitute decision-makers could be immediate family members and their decisions should align with the Health Care Consent Acts. The Act outlines a first consideration to any prior written or orally expressed wishes of the sick patient that could have been made when the patients was capable. If evidence of prior expressions is not available, the decision maker can proceed to decide on behalf of the patient by putting into account the patients values and beliefs. Therefore, as much as psychiatric patients posses the right to decide when to acquire medication and when not to, there arises critical moments when decision makers chip in to decide on their behalf.

Recommendations

Irrespective of the advocacy from vast international bodies, many countries still force the mentally ill people to acquire treatment due to differences in diversity aspects like cultures, economies tradition and other aspects. More so, involuntary admission varies between countries because different definitions of mental disorders and intensity of the disease.  Other tactical forceful acts happen in homes because such families perceive that forcing the mentally ill to take their medications by putting them in their food or drinks is the best way to go (Latha,  (2010).  What these families do not understand is that as much as they are secretly forcing the patients to take medications, they are at the same time depriving them their rights to choose whether or not they want to be treated. For this reason, despite the nations or backgrounds that individuals hail from, they should not force psychiatric patients to undertake medication because such patients have the rights to accept or decline treatment. However, these individuals, who can act as decision makers should wait for appropriate time to apply their decisions concerning the treatment of mentally ill patients (Kadri, Blackmer, & Ibrahim, 2014). Therefore, countries that have not amended their medical rights should review their constitution on behalf of patients that include the mentally ill, because doing so, will grant the psychiatric patients a chance to practice their medical decisions. More so, immediate families or friends, who feel that the mentally ill patients should be forced to take medication in order to improve their state, should respect the patients’ decisions. More so, these individuals should wait for appropriate time when their decisions are needed.

Conclusion

Psychiatric patients are individuals who experience mental disorders that occur subsequently in their lives. This means that such patients are in the right state of mind at most times; thus, the society should not label them as “mad” people. This is the reason why many international bodies recognize the plights of these patients by protecting their voluntary treatment rights. The society should back up the psychiatric patients’ Acts by allowing these individuals to freely decide when, how and whom to treat them because the constitution especially in Canada grants them the permission. The society should also encourage such patients to visit local concerned bodies, where they can utilize (Psychiatric Advance Directives) PAD’S instructional directives and state their wishes in advance through writing. This is the best option because it grants the psychiatric patient the platform to exercise their wishes especially when these patients lack capacity to make decisions about treatment or even do not recognize that they are ill. In this regard, psychiatric patients’ expressions concerning treatment should be respected at all times and they should not be subjected to forceful medication or treatment.

References

Ambrosini, D. L., & Crocker, A. G. (2007). Psychiatric Advance Directives and the Right to Refuse Treatment in Canada. Canadian Journal of Psychiatry; 52, (6) CBCA Complete pg. 397

Bell, S. (2005). What Does the Right to Health Have To Offer Mental Health Patients? International Journal of Law and Psychiatry 28 (2005) 141–153. doi:10.1016/j.ijlp.2005.03.002

Browne, A. (2010). Mental Health Acts in Canada.  Cambridge Quarterly of Healthcare Ethics, 19, 290–298

Gratzer, T. G, & Matas, M. (1994).

Gray, J.E, McSherry, M.B, Weller, J.P, & O’ Reilly, R.L. (2010). Australian and Canadian mental health Acts Compared. Australian and New Zealand Journal of Psychiatry, 44:1126–1131

Jarrett M., Bowers L. & Simpson A. (2008). Coerced Medication in Psychiatric Equality Rights, Family Rights and Community Rights. Inpatient Care: Literature Review.  Journal of Advanced Nursing 64(6), 538–548 doi: 10.1111/j.1365-2648.2008.04832.x

Gray,J.E,  McSherry, B.M , O ’ Reilly, R.L, & Weller, J.P. (2010). Australian and Canadian mental health Acts Compared. Australian and New Zealand Journal of Psychiatry, 44:1126–1131

Kadri, A., Blackmer, J., & Ibrahim, M. (2014). Obtaining Consent to A Life-Sustaining Treatment for a Patient With a Major Psychiatric Illness. Canadian Medical Association, 186 (14). DOI:10.1503/cmaj.130714

Latha, K.S. (2010). The Noncompliant Patient in Psychiatry: The Case For and Against Covert/Surreptitious Medication. Mens Sana Monogr, 8(1): 96–121. doi:  10.4103/0973-1229.58822

McKenzie, J.I. (2008). The Delicate Dance in Canadian Mental Health Policy: Balancing the Right to Refuse Treatment: Recent Canadian Developments. Journal of Ethics in Mental Health, 3(2)

Zhang L.S, Mellsop, G., Brink, J., & Wang, X. (2015). Involuntary Admission and Treatment of Patients with Mental Disorder. Neurosci Bull, 31(1): 99–112. http://www.neurosci.cn DOI: 10.1007/s12264-014-1493-5

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