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Miscellaneous

Psychiatric Patients may be subjected to Involuntary Medication

Involuntary medication and treatment to psychiatric patients has been a contentious subject that has gotten broad attention and has been discussed for generations. With the severity of the patients’ psychiatric disorders and conditions, their lack of mental capability to make proper decisions makes it incredibly difficult for most of them to actively pursue the support they need. This common scenario of a patient with major mental illness who needs medical attention due to potential and even remote danger of aggression yet rejects the need for care. With proper guidance and certain medical treatments, medication from the health facilities, and other health sectors, any further complications could be minimized. Therefore, medication and treatment to psychiatric patients who are categorized as severe by their health professionals must be accepted even without a written consent.

According to the Philippine Statistics Authority (2010), 200,000 people were identified to have a mental disorder. In addition, the incidence of suicide has increased decade on decade, rising from 0.23 to 3.59 per 100, 000 in men and from 0.12 to 1.09 per 100, 000 in women between 1984 and 2005. It is only recently that mental health is being given importance in the Philippines. However, in most cases, Filipino patients are the ones who do not even consider the idea of being checked by a healthcare professional even if they know that something is wrong because they are afraid of the comments their relatives and friends may give. They highly object when they are given professional advice, medications, and treatment by psychologists or psychiatrists.

To facilitate the importance of mental health, the Philippines released a law on mental health. In 2018, Republic Act No 11036 which is also known as The Mental Health Act was enacted. The act establishes a National Mental Health Policy which aims to strengthen the delivery of mental health services while simultaneously protecting the rights of the individuals with mental health disabilities. Although, the significance of informed consent was heavily highlighted all throughout the Act, in Section 13 of the Act, it contains exceptions of informed consent. In case of psychiatric emergencies or impairments wherein the ability of decision-making is impossible, it states that any treatment, restraint and confinement may be administered for as long as it complies with the necessary conditions. Moreover, it is also stated in the Patient’s Bill of Rights that there are exemptions to a patient’s right to informed consent. These exceptions were made in order to protect and provide patients with right medical care and treatment. However, these are only allowed as long as it guarantees that it does not in any way cause risk or harm to the patient and to other individuals.

To tackle specifically, they may administer the medications or treatment needed by the patient if there are neurologic or psychiatric emergencies or the patient is impaired or experiencing temporary loss of decision making-capacity in accordance to the following:

(a) In compliance with the service user’s advance directives, if available, unless doing so would pose an immediate risk of serious harm to the patient or another person;

(b) Only to the extent that such treatment or restraint is necessary, and only while a psychiatric or neurologic emergency, or impairment or temporary loss of capacity, exists or persists;

(c) Upon the order of the service user’s attending mental health professional, which order must be reviewed by the internal review board of the mental health facility where the patient is being treated within fifteen (15) days from the date such order was issued, and every fifteen (15) days thereafter while the treatment or restraint continues; and

(d) That such involuntary treatment or restraint shall be in strict accordance with guidelines approved by the appropriate authorities, which must contain clear criteria regulating the application and termination of such medical intervention , and fully documented and subject to regular external independent monitoring , review, and audit by the internal review boards established by this Act.

However, by doing this, freedom is taken away from the patients as they are controlled by other people. Forced medication in psychiatric patients however, can be a traumatic experience, primarily for those who have suffered past trauma or abuse. The use of force can trigger memories of preexisting traumas, exacerbate feelings of powerlessness and vulnerability, and evoke strong negative emotions such as anger, fear, and mistrust. This can potentially lead to retraumatization and further mental distress, hindering progress towards recovery and aggravating mental health symptoms. The long-term repercussions of forced medication might result in avoidance of treatment, withdrawal from society, and a worsening of symptoms. It is imperative for healthcare practitioners to be aware of the potential risks in forced medication situations so that they can guarantee that patients receive the best possible treatment, while respecting their fundamental human rights and promoting their overall well-being in order not to reflect adverse reactions to medication and distrust of healthcare practitioners and medications.

Conducting meetings with the patient, their psychiatrists and nurses are important and should always be done for mental health professionals to further understand the patients’ needs, to increase patients’ engagement in their treatment plan, and to improve their understanding of the situation. In addition, they should have developed training courses involved in a patient’s treatment which will improve the knowledge of the staff on clinical characteristics of mental disorders and on its legal and administrative aspects. It will also develop their communication skills and their ability to manage different behaviors of patients using various techniques. Most importantly, improving the viewpoint of patients toward the involuntary treatment of psychiatric patients by educating them for this leads to an also improved treatment as patients who accept and agree with the medication believe that involuntary treatment can be a way to avert further harm to themselves and an opportunity to recover in a safe place.

The media coverage of mental illnesses is also influential in forming the public’s image of such treatment to psychiatric patients. The majority of the public’s opinion pays attention to the viewpoint of the media as they believe that the media sets the agenda and determines what issues are “important”. With the opposition of this paper being accepted, it shall lessen the number of deaths worldwide that is due to a psychiatric disease either dying intentionally or unintentionally. Forced medication may seem as a negative connotation, but when needed and given to such patients, it could save lives.

By Grade 12 students from the University of Santo Tomas Senior High School

References:

Lally, J., Samaniego, R. M., & Tully, J. (2019). Mental health legislation in the Philippines: Philippine Mental Health Act. BJPsych international, 16(3), 65–67. https://doi.org/10.1192/bji.2018.33

Luciano, M., De Rosa, C., Sampogna, G., Del Vecchio, V., Giallonardo, V., Fabrazzo, M., Catapano, F., Onchev, G., Raboch, J., Mastrogianni, A., Solomon, Z., Dembinskas, A., Nawka, P., Kiejna, A., Torres-Gonzales, F., Kjellin, L., Kallert, T. W., & Fiorillo, A. (2018, October 1). How to improve clinical practice on forced medication in psychiatric practice: Suggestions from the EUNOMIA European multicentre study. European Psychiatry; Elsevier BV. https://doi.org/10.1016/j.eurpsy.2018.07.002

Pandarakalam, J. (2015, December). Formal Psychiatric Treatment: advantages and disadvantages | British Journal of Medical Practitioners. British Journal of Medical Practitioners. https://www.bjmp.org/content/formal-psychiatric-treatment-advantages-and-disadvantages

Republic act no. 11036. The LAWPHiL Project. (n.d.). Retrieved April 8, 2023, from https://lawphil.net/statutes/repacts/ra2018/ra_11036_2018.html

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