Issues in NY Assisted Treatment Laws

“Assisted Treatment” is a phrase that is starting to replace ‘involuntary treatment’ and ‘involuntary commitment’.  It describes treatment that may be given in an inpatient or outpatient setting over a person’s stated objections.  The term recognizes that the purpose of such treatment is to assist, not harm, the individual.  Some people with neurobiological disorders like schizophrenia become psychotic or otherwise out of touch with reality.  During these periods they often maintain the ability to ‘give voice’ to an opinion, even if they lack the cognitive ability to formulate an opinion.

People are often asked if they are ‘for’ or ‘against’ Assisted Treatment.  The issue is much more complicated than that.  No one ‘wants’ to put limits on others in the same way no one ‘wants’ to pay taxes.  But Assisted Treatment, like taxes, is sometimes needed.  Individuals often differ on when and how. This leads to robust debate.  The Treatment Advocacy Center in Arlington, VA has looked at all sides of the issue and many believe it’s proposals properly balance the conflicting interests.

Making a determination as to whether or not someone needs Assisted Treatment requires consideration of numerous factors.  It involves, in some way, limiting what someone can do, and therefore is not a determination that should be made lightly.

NY, like other states, has laws that allow the state to offer assisted treatment to certain individuals.  Reform and modernization of these laws is the mission of the NY Treatment Advocacy Coalition.

Medical, Moral and Social Issues to consider:

Does requiring psychotic individuals to take medicines infringe on their civil liberties or free them from their psychosis so they can engage in a meaningful exercise of civil liberties?  Are some people with neurobiological disorders more likely to be violent than the general population? If so, is it those who comply with treatment or those who don’t?  Do people with neurobiological disorders always have the capacity to engage in rational thought?  If not, should they be left to fend for themselves?   Will communities be safer if people with neurobiological disorders were required to take their medications? Will individuals with neurobiological disorders be less likely to become homeless, needlessly psychotic, and suicidal if they had access to treatment?  Would fewer individuals with neurobiological disorders become incarcerated?

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Legal Issues to consider:

What ‘standard’ should be used to order Assisted Treatment?

  • ‘Danger to self or others’?
  • ‘Gravely Disabled’?
  • ‘In need of treatment’?

What is the most helpful form of Assisted Treatment?

  • Inpatient?
  • Outpatient?

What is the least restrictive form of Assisted Treatment?

What ‘burden of proof’ should the court require?

  • ‘Beyond a reasonable doubt’?’
  • ‘Preponderance of evidence’?
  • ‘Clear and convincing evidence’?

Should Assisted Treatment allow the individual to be treated, or only restrained?

Does the individual have the ‘capacity’ or ‘competency’ to make their own decisions?

Should ‘past history’ be considered when making an Assisted Treatment determination?

Who should be allowed to testify at Assisted Treatment hearings?

What court or administrative procedures are needed?

What is the best way to protect the rights of individuals subject to Assisted Treatment?

The NY Treatment Advocacy Coalition, in conjunction with the Treatment Advocacy Center in Virginia, is involved in an ongoing review of all these issues.  The relevant laws are presented elsewhere on this web site.

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(Posted 2/1999)

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