An editorial published in The Wall Street Journal recently by D.J. Jaffe, one of the founders of the Treatment Advocacy Center (TAC), caught my interest. You can read the article here.
I write about TAC and assisted outpatient treatment laws, commonly called AOT laws, in my book. Put simply, AOT laws require a person with a history of mental illness to take their medication regardless of whether or not they want to take it.
D. J. Jaffe
Most states that have passed AOT laws have very stringent criteria about when a person can be ordered by a judge to take medication. First, there has to be evidence that medication actually helps control a person’s symptoms. In addition, the person also has to have a history of either going off their medication several times or of violence.
AOT laws, such as Kendra’s Law, in New York, have proven to be highly effective at helping persons who have chronic illnesses and often end up in our jails, prisons or are homeless.
Of course, ordering a person to take medication when they don’t want to take it is controversial and if you want to start a heated discussion in mental health circles — just mention AOT. Both sides feel passionately about the issue.
Jaffe is one of AOT most eloquent advocates and he frequently writes insightful Op Ed pieces pushing AOT legislation.
But what interested me about his recent editorial is how he would apply AOT to help a specific group of persons.
Jodie Foster in Taxi Driver
Jaffe points out that Andrea Yates and John Hinckley were both found to be Not Guilty By Reason of Insanity (NGBRI.) You might recall that Yates suffered from postpartum psychosis that caused her to drown her five children in a bathtub. Hinckley shot President Ronald Reagan during a schizophrenia-fueled attempt to secure a date with actress Jodie Foster. Both have been confined in psychiatric hospitals ever since and have been given medications to help them regain their sanity.
Jaffe reports that Yates has been confined for 8 years, Hinckley has been locked up for 29 years, and both are no longer legally insane because they have gotten meaningful treatment.
Still, they remain in locked mental hospitals.
Jafee asks: “What kind of society keeps sane individuals involuntarily committed?” Then he answers: “Russian circa 1955 comes to mind.”
Jaffee explains that some states take a person who has been found NGBRI and simply transfer him from a state forensic hospital into a prison once his sanity has been restored. That’s wrong, of course, because it is punishing a person for a crime that was committed when he was not in his right mind. After all, a jury found that this person was not culpable because of his mental illness. 
It is illogical for a society to find someone not guilty because he is insane and then turn around and punish him after he regains his sanity, Jaffe argues.
What then, do you do with Yates and Hinckley? You release them but require them to remain on their medication for the rest of their lives and you assign them a case manager to monitor them because of the severity of their crimes — at least that’s Jaffe’s solution.
I hadn’t thought about Yates and Hinckley, or others who received NGBRI verdicts because that defense rarely works.
Because my son, Mike, broke into an unoccupied house to take a bubble bath while he was psychotic, most people who hear our story feel sympthetic toward him. They wonder why he was charged with two felonies instead of simply being taken to a crisis care unit and provided with treatment for his disorder.
But when a psychotic person drowns her children or a young delusional man fires shots at a president, then the public is not nearly as forgiving — even though the underlying cause of the crime is the same — a severe mental disorder.
I think Jaffe’s argument makes sense and I would guess that if Yates and Hinckley were given a choice, they would want to be free from a hospital to spend the rest of their lives on medication rather than being locked on a ward (where they would be taking medication anyway.)
I’m sure D. J. Jaffe can articulate his points better than I have here if he chooses to add a comment. I’m also certain that those who oppose AOT will not be persauded and will want to argue.
Now you know where Jaffe and I stand. Let me know what you think?
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In addition to the Washington Post, I sent my blogs about Burger King’s offense advertisements to AOL News and late Tuesday night, AOL began running a story under the title Ad Rant. I know that some readers think that my fuss was a waste of time, but the fact that the Washington Post and AOL both did stories about the ad, I believe shows that we are making progress in calling attention to stigma and the need to stop demeaning persons with mental illness.
At least, I hope the chairman of Burger King gets the message. Yesterday I sent him a copy of my book inscribed: Words without actions are meaningless.
About the author:
For once, Pete Early is wrong: he described the proposal much more eloquently than I. One technical point: To my knowledge no AOT law allows judges to order individuals to accept treatment merely because they've gone off medications. They only allow it if the medication refusal had negative consequences such as arrest, incarceration, or multiple hospitalizations.
For once, Pete Early is wrong: he described the proposal much more eloquently than I. One technical point: To my knowledge no AOT law allows judges to order individuals to accept treatment merely because they've gone off medications. They only allow it if the medication refusal had negative consequences such as arrest, incarceration, or multiple hospitalizations.
they should never get out, they crossed the line and there is no return
I liked reading your article Pete, but I have a few problem’s with it. In Andrea’s case, I imagine sterilization would have to be a included as part of her treatment plan because pregnancy has been shown to exacerbate her psychosis. Also, life stressors, (In Andrea’s case her dad died shortly before she murdered her children) can also derail a person who may be “stablilized on their meds.” I think once someone with a mental disorder has murdered they can never be entirely trusted again. Life is too full of variables and unforeseen stressors.
Our criminal justice system gives no justice to those with mental illness. As is mentioned in this piece those with metal illness are brought back to sanity only to be sent to prison. This practice is forcing our prisons into serving as mental asylums. It is one of the cruelest practices in America today.
She planned the murders. She waited till Rusty left because she knew he would stop her. She locked the dog up because she knew he would stop her. She chased down and drowned her children. No forgiveness either here or in heaven for her. Or for Rusty. The doctor said they shouldn’t have any more children, it would exacerbate the psychosis, so two months later they conceived Mary. Another doctor told Rusty not to leave her alone with the children. Accessory to murder, it seems to me. Regardless of whether or not she “recovers,” there is no life left for her. She should have been executed, if she recovers she should get life in prison. She tried to kill herself several times before, it’s a shame she failed before the murders. Suicide is really the only answer for her.