Recently a client came to our office with a very common problem. Her name was Jennifer and she has a severely mentally ill nephew named Tim. For more than 20 years Tim had shown the classic symptoms of Schizophrenia, but had never received any treatment. Just before Jennifer came to see us, Tim had decompensated. He started to act bizarrely and his behavior bordered on dangerous. The family decided that finally something must be done. Jennifer filed an application for involuntary evaluation. Tim was picked up and brought in to the hospital. An hour later he was discharged and sent home with a bus pass. The reason: he tested positive for street drugs.
When Jennifer came in she asked us point blank, “does drug use necessarily preclude the involuntary evaluation/treatment process?” Despite the actions and advice of many service providers in the greater Phoenix area who would say yes, the answer is no. Our law is very clear about when one may be involuntarily brought in for evaluation. The statute says a person may be involuntarily evaluated if, as a result of a mental illness, the person meets one of the four standards for involuntary treatment (danger to self, danger to others, persistently and acutely disabled, and gravely disabled) and is involuntary. Substance abuse is not mentioned because it has no role if the standard above is met.
And this makes sense. Our involuntary commitment laws, like so many others in our system of government, are a balancing of community and individual rights. Everyone has the fundamental individual right to have a mental illness and be free from involuntary commitment. Yet the community also has a right to keep its citizenry safe. At some point, if mental illness begins to infringe upon that community right, the scales tip. Our statutes define that point as danger to self, danger to others, persistently and acutely disabled, and gravely disabled. In those situations the community can step in and take action.
Understanding this basis for the laws, clearly it is nonsensical for drug use to be a stopping point for involuntary treatment. A mentally ill person could reach the tipping point, which is dangerousness, but then get out of involuntary evaluation by making the situation more dangerous through drug use. He or she could be so overtaken by mental illness that our community is threatened, but by threatening the community more (by using street drugs), the community could not act. This is obviously incorrect and the antithetical to the underpinnings of our laws.
Moreover, a law precluding involuntary treatment because of substance abuse would also be ignorant to the connections between mental illness and substance abuse. The Journal of the American Medical Association reports that 50 percent of individuals with severe mental disorders are affected by substance abuse. A great majority of the time the mental illness is the cause of the substance abuse; the substance abuse is secondary to the mental illness. So if substance abuse precluded involuntary evaluation, essentially our laws would be saying “because you are showing a symptom of your mental illness, we are not going to treat your mental illness. Go get clean and sober and then we will help.” Well, for many severely mentally ill persons, sobriety only comes when the mental illness is under control. This can't happen until treatment is commenced. Preclusion of involuntary treatment would stop mental health treatment. Again, this does not make sense; it is not how our law works.
For these reasons and many more, substance abuse does not stop an involuntary evaluation from taking place. So what happens? Why are applications denied for this reason? First, many mental health providers wrongly believe that a positive drug screen does rule out involuntary evaluation. We are working to change that contention. Second, many times the form that the family completes, does not clearly explain that the symptoms are a result of the mental illness. Therefore, when filling out the application, one must make sure this is explained.
When Jennifer came in to talk about Tim, we explained to her the paths which could be taken to strengthen the Application. We showed her how to be descriptive enough to get beyond the application stage and to the Petition for Involuntary Evaluation stage (please see Stages of Involuntary Treatment article if this process is unclear). In her case we even brought in a psychiatrist to be the Applicant to bolster the Application even more. This is one of many routes to make this process work like it should.
In the end, substance abuse does not preclude the involuntary treatment process. It does not stop the Application from being filed nor involuntary treatment process from moving forward. If you feel someone you know is in need of treatment but is not willing to get it, applications in Maricopa County may be filed at ConnectionsAZ in downtown Phoenix, Community Bridges in Mesa, or RI International on 99th Ave. and Peoria. If you have questions about this process or help in making it work, please do not hesitate to call us at 602.277.2010