Insufficient Protections Available for Patients Forced to Take Neuroleptic Drugs

A new study shows that even when there are mechanisms in place to question forced medication treatment, power imbalances favor mental health professionals.

Ana Florence, PhD
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A new study, published in the Indian Journal of Medical Ethics, assessed the records of thirty people who had received neuroleptic (antipsychotic) medication by force and disagreed with that decision. In their analysis, the authors found that the treatment team systematically used medical language to describe disagreements between client and physician; that frequently no other line of treatment had been offered as an alternative to neuroleptics; that little consideration was given to clients’ wishes and desires, and that neuroleptic medications continued to be provided regardless of severe and debilitating side effects.

“Forced treatment with psychiatric drugs is highly controversial. It violates basic human rights and discriminates against psychiatric patients,” the authors, Peter Gøtzsche and Anders Sørensen from the Institute for Scientific Freedom in Copenhagen write.

“The prisons” by Emiliano Grusovin is licensed under CC BY-NC-SA 2.0

Forced medication for persons experiencing psychological distress and extreme states is a common practice in the field of psychiatry. Predicated on the assumption that psychological distress impairs decision making, forced treatment is often supported by specific legislation, and, in some instances, there are no legal mechanisms in place to safeguard the rights of those in distress.

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) calls for the elimination of violence and coercion in psychiatric treatments. However, the CRPD has been criticized for failing to provide a clear way forward toward such a goal.

In Denmark, according to authors, clients who disagree with forced treatment can file a complaint with the Psychiatric Patients’ Complaint Board and appeal the decision with the Psychiatric Appeals Board. For this study, Gøtzsche and Sørensen were granted access to 30 records of appeals from the Psychiatric Appeals Board to assess whether the arguments for forced treatment were evidence-based and whether they took into account clients’ preferences and previous experiences with neuroleptic (antipsychotic) drugs.

The study authors found that in 21 of the 30 records, psychiatrists and clients disagreed on the benefits of neuroleptic drugs and the physicians failed to acknowledge harms directly related to treatment, such as tardive dyskinesia (irreversible, involuntary movements of the face caused by neuroleptic medications) and akathisia (a feeling of restlessness and anxiety also produced by these drugs), among others. Even when these debilitating conditions were acknowledged, forced medication was often upheld by the Board.

In five instances, the authors noted that clients expressed a fear of dying due to forced medication, and in five other instances, the purpose of forced treatment was described as a method for keeping the ward calm and quiet. Rarely were less intrusive forms of treatment offered, such as psychotherapy, or other classes of drugs with better side effect profiles. The authors noted that professionals in several instances described disagreements with clients around the need for neuroleptic medication and subsequent forced treatment as delusions.

In the records assessed, Gøtzsche and Sørensen found multiple situations where clients’ preferences, wishes, and concerns were neglected, and forced treatment was imposed, indicating a lack of respect for clients. Finally, the authors question whether psychiatrists act in good faith when forced treatment is employed, citing evidence that physicians and judges may be reluctant to comply with legislation that protects clients’ rights assuming they know what’s best for them. For Gøtzsche and Sørensen, this attitude violates clients’ rights and cause harm.

This study has a series of limitations. There is no clear description of how data analysis was conducted. Records were not obtained in full, and researchers had to take notes of the original documents as they were not allowed to make copies. This potentially introduces a bias in how and what information was extracted, and this is not acknowledged in the article.

Additionally, several claims about how the treatment was conducted and decisions were made seemed to reflect the authors’ opinions. In the discussion section, a set of professional experiences of the authors – not clear which one – is cited to support further some of the claims about harms and rights violations. However, these personal experiences were not described as part of the data in the methods section. Readers should therefore approach the conclusions with caution as there are several methodological issues.

The United Nations CRPD clearly outlines that violence and coercion should be eliminated from treatment and that legislation supporting these practices should be reviewed. However, this article suggests that even when there are mechanisms to safeguard clients’ rights and appeal forced medication, a power imbalance remains, and decisions tend to favor professionals. This structural problem has direct and harmful consequences to service recipients.

When the power to establish whether someone is impaired to make decisions or not lies with the same professional who can decide to force treatment, it places service-users at a perpetual disadvantage. These practices were compared to torture in a recent UN report.

Other mechanisms should be in place to guarantee the rights of persons going through experiences of distress and ensure that violations do not occur. At the same time, offering medications alone may be ineffective. There is significant evidence that suggests that there is a need to weigh the potential harms of neuroleptic drugs for psychosis with what may be the limited improvements provided by these drugs.

The elimination of violence and coercion needs to be accompanied by a set of clinical practices that are rights-based and responsive to the needs of those in distress. This article shows that even in developed countries, appropriate safeguards to uphold people’s rights are not in place, and harmful treatments are still employed.

 

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Gøtzsche PC, Sørensen A. (2020) Systematic violations of patients’ rights and safety: Forced medication of a cohort of 30 patients. Indian J Med Ethics. Published online on August 12, 2020. DOI: 10.20529/IJME.2020.085. (Link)

14 COMMENTS

  1. Everyone being forced or coerced to take chemicals should undergo a chemical imbalance test and genetics
    testing and also scans, and metabolical testing.
    I doubt anyone can choose to receive chemo unless there is proof of cancer. No one can in fact receive or opt for drugs unless there is proof that it helps. And most of all, it should always remain a choice.
    If a person says that their distress is uncomfortable, let them decide what to ingest. If they need safekeeping, this could obviously be done without chemical brain damage, until the episode is over.

    Psychiatry can admit that of course any chemical can be created to render a person incapable of movement or thought. In surgery, drugs are also used to render a person unconscious and paralyzed.

    Psychiatry should not have the ability or freedom to make any human ingest dangerous chemicals.

    • That’s why I frequently compare psychiatrists to Dr. Farid Fata. He sold lengthy rounds of chemo to people without cancer. Killing some and crippling even more. Because of his gutless professional colleagues he got away with it for a very long time. The whole story makes me despise the medical profession.

  2. Peter Gøtzsche’s example should be rolled out everywhere because the evidence of lies, abuse and drug torture are in the patients notes worldwide.

    Consider getting behind this as well everyone:

    Ending Interminable Declared Emergencies Under COVID-19 and Restoring our Freedoms and Lives.

    https://www.youtube.com/watch?time_continue=9&v=2-kinConljk&feature=emb_logo

    Read Dr. Breggin’s Report @ https://breggin.com/dr-breggins-covid-19-totalitarianism-legal-report/

    You must all, by now, be realising something is not right with all this never ending lockdown and masks.

    I posted this back in March and it is still up on the UK Govt website:

    Status of COVID-19

    https://www.gov.uk/guidance/high-consequence-infectious-diseases-hcid#status-of-covid-19

    Status of COVID-19

    “As of 19 March 2020, COVID-19 is no longer considered to be a high consequence infectious diseases (HCID) in the UK.

    The 4 nations public health HCID group made an interim recommendation in January 2020 to classify COVID-19 as an HCID. This was based on consideration of the UK HCID criteria about the virus and the disease with information available during the early stages of the outbreak. Now that more is known about COVID-19, the public health bodies in the UK have reviewed the most up to date information about COVID-19 against the UK HCID criteria. They have determined that several features have now changed; in particular, more information is available about mortality rates (low overall), and there is now greater clinical awareness and a specific and sensitive laboratory test, the availability of which continues to increase.

    The Advisory Committee on Dangerous Pathogens (ACDP) is also of the opinion that COVID-19 should no longer be classified as an HCID.

    The need to have a national, coordinated response remains, but this is being met by the government’s COVID-19 response.

    Cases of COVID-19 are no longer managed by HCID treatment centres only. All healthcare workers managing possible and confirmed cases should follow the updated national infection and prevention (IPC) guidance for COVID-19, which supersedes all previous IPC guidance for COVID-19. This guidance includes instructions about different personal protective equipment (PPE) ensembles that are appropriate for different clinical scenarios.”

    What is going on in Australia:

    Pregnant Mother Arrested in Front of her Children in Authoritarian Australian Covid Crackdown:

    https://www.youtube.com/watch?v=_atNlQuweIA

    A switched-on teenager does some research and speaks her mind:

    https://www.youtube.com/watch?v=uPxjW8o7Kls

    • POSTING AS MODERATOR:

      I have allowed a lot of off-topic remarks regarding COVID on threads that have nothing to do with COVID. I think it is time to stop this. We are not a site about COVID, and it is a very controversial subject that goes very far afield from rethinking or ending the practice of psychiatry. I am not going to allow any more COVID posts that are not directly relevant to the article at hand. There are plenty of other forums where such discussions are more appropriate to conduct.

      • “We are not a site about COVID, and it is a very controversial subject that goes very far afield from rethinking or ending the practice of psychiatry.”

        Will stick to your rule but I have to respectfully disagree Steve. All this has directly affected peoples psychological state of mind and Psy is very much involved. The SAGE group in the UK which advises the UK Govt on SARS-CoV2 is made up of very many psychologists. The ‘health’ service and MSM is taking over our lives and destroying very many more. We can’t separate psychiatry from all this – it’s involved.

        • I don’t disagree with your assessment that psychologists and psychiatrists are involved with the COVID response, and not in a particularly helpful way, and discussion of this connection or similar material relating to our mission here is more than welcome. The issue becomes unclear when we are talking about whether or not COVID is a serious risk, whether or not masks help prevent infections, whether or not there is some international conspiracy to use COVID to accomplish some other political goals and so on. These are certainly legitimate areas of concern and valid for conversation, but threads have been completely hijacked and gone way off topic when I have allowed this kind of discussion to expand beyond the boundaries of the effects on behavior and emotions and the way that the psychological/psychiatric industries have tried to capitalize on COVID to convince us that a “wave of mental illness” is occurring instead of recognizing that being afraid of a pandemic virus is a normal thing, or comments of that nature. There is a moment when it stops being about the psych industries and it starts being about political issues that transcend psychiatry/psychology by a very large distance. For instance, arguing about whether or not COVID cases are overcounted or undercounted or whether or not “shutdowns” were needed or whether the Democrats are fear mongering to help their election chances or Republicans downplaying it to appeal to their base and so on have nothing to do with the psych industries. Those kind of posts are not going to be allowed without a direct connection to the material in the blog/article in question.

          Hope that clarifies things.

          • I suggested before the MIA institute a running thread for people to discuss COVID issues, as “the virus” is the elephant in any discussion right now, in a way for which I can’t come up with an adequate historical comparison. Then Steve could tell people to “take it to the COVID thread.”

  3. When it takes a legal representative 3 months to get access to a ‘clients’ records to ensure that the rules and procedures were followed, and in the meantime the ‘client’ can be “chemically restrained” and then ‘treated’ with the same drugs used to chemically restrain for the illness caused by those drugs what chance do you have?

    There is an Operational Directive put in place to protect citizens from being denied access to legal representation in this manner, while doctor does a little brain damage to silence them, but unfortunately the Chief Psychiatrist who is responsible for that protection, simply doesn’t enforce it.

    Imagine if police could lock you away for unspecified crimes and then torture confessions out of you for months before you were even allowed access to a lawyer? Oh wait, they can if they use the mental health system.

    Sounds unbelievable? Ask me to prove it.

    Application for documents relating to my detention on the 30 Sept made in Oct.

    “edited” (fraudulent) documents provided to Law Centre end of Jan next year. “spiking’ with benzodiazepines removed along with the procured police referral (criminal offence under s. 336 of the Criminal Code). This attempt to pervert the course of justice by the Clinical Director clear in the Memo authorising the fraudulent documents provided to the Law Centre.

    Three months of drugging into unconciousness before they are even allowed to check if it was lawful, and then they provide fraudulent documents to conceal that it wasn’t? (this is more than possible given the way these people neglect their duty to conceal criminal offences for their colleagues. And when I explained to them that they had a duty to report? I was told by the operations Manager I would be “fuking destroyed” and they did, and continue to do so for nothing more than reporting misconduct by public officers kidnapping and torturing citizens) And look at the people who supported them in that criminal conspiracy. You’d be shocked but …… your family would also be in danger.

    Imagine providing criminals with months to tamper with evidence, threaten and intimidate witnesses, distribute fraudulent documents (including peoples medical records which were NOT requested by the lawyers, and which were both misleading AND slanderous), and have a little ‘accident’ in an Emergency Dept because police were assisting in the process of getting the victim the help they didn’t need for an illness they didn’t have.

    Imagine they handed a victim back to Jeffrey Dahmer too. Only difference was he didn’t have a licence to practice.

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