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Committing a Loved One Can Be the Best Medicine

By Eve Kupersanin

Psychiatric News September 7, 2001
Reprinted with permission by Psychiatric News. Copyright 2001 American Psychiatric Association. All rights reserved.

When planned ahead of time, commitment can be an empowering process for people with mental illness, advocates maintain.

Hindsight is always 20/20, according to an old adage. Anna-Lisa Johanson now knows thatcommitting a loved one with mental illness can be a lifesaving act inspired by love-butshe learned this lesson the hard way.

Johanson’s mother made headlines when she took her own life at the age of 46 bykneeling before a speeding train in October 1998. In her lifetime, Mary Margaret Raygained notoriety in the media because of her bizarre delusional behavior and stalking ofcomedian David Letterman. Ray was diagnosed with schizophrenia and schizoaffectivedisorder.

“I lost my mother because I didn’t know how to commit her,” Johanson told aroom of mental health professionals, family members, and people with mental illness at the2001 convention of the National Alliance for the Mentally Ill (NAMI) in Washington D.C.,in July. The only psychiatric treatment her mother received was through the criminaljustice system during repeated incarcerations, she noted. Now, however, Johanson is wellon her way to becoming an expert in commitment law.

Johanson is finishing a joint program in law and public health at Georgetown Universityand Johns Hopkins University and is interested in pursuing a career in mental healthadvocacy.

She also has a new daughter and works part time at the Treatment Advocacy Center (TAC)in Arlington, Va., where she helps people with mental illness and their family membersunderstand commitment laws.

TAC is a nonprofit advocacy organization dedicated to removing legal and clinicalbarriers to psychiatric treatment for people with severe mental illness.

Johanson also co-authored the book I Am Not Sick, I Don’t Need Help: Helping theSeriously Mentally Ill Accept Treatment with Xavier Amador, Ph.D., published by Vida Pressin 2000.

“My father is an old Swedish socialist,” said Johanson. “The reason henever committed my mother was that no matter what, he would never violate her independenceor her rights.”

Johanson said that she grew up believing that personal freedom and self-determinationwere sacred. But now she thinks differently.

“There is a certain point where a brain disorder takes over, and you no longerpossess free will-it has been obliterated because of a chemical imbalance,” saidJohanson.

After taking an informal poll of NAMI members in the room, Johanson found that manyfelt dread at the thought of committing a loved one, and many feared being committedthemselves. Johanson empathized. “I suffer from bipolar disorder. It has never beenfar from my mind that a week or two beyond medication and I could be at a point where myloved ones would have to commit me.”

Johanson advised family members and people with mental illness to research thecommitment process and have all the necessary steps taken care of ahead of time, so thatthe commitment process is less traumatic if it ever needs to be used.

For instance, people with mental illness can shop around for a psychiatrist they trustand can talk with openly. People can also call the emergency room or psychiatric unit oftheir local hospital and ask if they have a partnership with the police department,Johanson suggested.

She also said that it is useful for people to find out if the police department has anofficer who is specially trained to work with people with mental illness, and if so, keepthe number of that officer handy.

Beyond this, there is one crucial measure that people with mental illness should take.”See if your state has something called an advance directive for mental healthcare,” said Johanson.

This is a legal document that allows people with mental illness to exert some controlover the terms of their commitment prospectively through written instructions aboutpsychiatric care. The advance directive also appoints an agent to ensure that theinstructions are carried out (Psychiatric News, December 15, 2000). This legal document isuseful, Johanson emphasized, for people who may want to plan ahead for their own possiblecommitment.

In this scenario, someone might first choose a psychiatric hospital where he or shewould prefer to be treated. Then, he or she can go with a loved one to an attorney andsign an advance directive specifying that if two doctors decide that he or she needs help,this is the person’s hospital of choice.

“It is empowering to set up this safety net for yourself,” Johansonemphasized.

As of last count, 13 states recognize psychiatric advance directives, according to BobFleishner, J.D., who is an attorney at the Center for Public Representation inNorthampton, Mass. Fleishner said that all states do have general advance directive lawsthat allow for instructions for mental health care, however.

“It is a little late now, but had I been able to, I would have committed mymother,” said Johanson. “It would have been the greatest service to her, and shewould be here today to meet her granddaughter.”