White Paper Presents Case Against Forced Treatment

Alaska Attorney Jim Gottstein, together with Faith Myers, Susan Musante, Peter Gøtzsche, David Healy, David Cohen, and the International Society for Ethical Psychology and Psychiatry (ISEPP), have published an in-depth “white paper” on improving psychiatric patient outcomes.

While it was written in response to a legislative initiative in Alaska, Gottstein hopes that it will provide an evidence-based resource for all to use. “I think it presents compelling evidence for abolishing unwanted psychiatric interventions in favor of non-coercive approaches, such as Soteria Houses, peer respites, Open Dialogue, warm lines, the Hearing Voices Network, emotional CPR (eCPR),” and so forth.

Last year, Gottstein explained, as the Alaska legislature considered bills to implement a “Crisis Now” initiative, which was part of a settlement over the state’s illegal detention of people waiting for court-ordered psychiatric evaluations in emergency rooms and jails for an extended period of time, it decided to require the state to submit a report to the legislature about aspects of Alaska’s mental health system, including keeping track of patient injuries and how well the patient grievance process works. Gottstein suggested the legislature add “improve patient outcomes,” which it did. Gottstein is a member of the legal subcommittee providing guidance to the “advocacy team” that is expected to make decisions about what will go into the report submitted to the legislature.

The white paper describes psychiatric incarceration and forced drugging as violence perpetrated against psychiatric patients that violates international law under the United Nations Convention on the Rights of Persons with Disabilities (CRPD). While the United States has not ratified the CRPD, the papers argues that Alaska’s mental health program should not violate international law.

“I see the white paper as the culmination of my 40+ years of advocacy for people diagnosed with serious mental illness and subjected to psychiatric incarceration and forced drugging, compiling much of what I have learned into this one document,” Gottstein wrote in an email. “It presents the compelling evidence our so-called mental health system is massively counterproductive and harmful, reducing recovery rates from a possible 80% to 5% and reducing life spans by 20 years or so. Then it presents non-coercive alternatives with the overriding theme of asking people what they want; what they would find helpful, which is heretical in the current system. It is the citation of evidence and authority all in one place (with links) that I think makes the white paper so potentially useful around the world.”

Gottstein added: “The report is also required to make recommendation on the practical ability of patients to avail themselves of those rights. The white paper addresses this issue with the obvious point that the legal representation of people accused of being mentally ill and as a result a danger to themselves or others is totally ineffective and the most important step to take for patients to be able to avail themselves of their rights is effective representation.”

However, Gottstein doesn’t think the other members of the legal subcommittee and advisory team will be receptive to the evidence presented in the white paper.

“I expect they will want to largely ignore this and the other issues raised in the white paper,” he wrote. “The legal subcommittee and advisory team has representatives from the Alaska Public Defender Agency, which represents almost all the psychiatric respondents, the psychiatric hospitals, and the court system; NAMI (the National Alliance on Mental Illness); Adult Protective Services; and the Public Guardian, all of whom are invested in and support the current coercive system. I told the legal subcommittee and advisory team when I submitted the white paper that if the report is to seriously meet its charge it needs to grapple with the issues raised in the white paper. I doubt they will, but I will be pressing them and then the Alaska legislature to do so.”

Gottstein added: “I have gotten to the stage in my life where I am no longer able to carry PsychRights-type litigation by myself the way I did when I defended psychiatric respondents at the trial court level, making a record for appeal, and then taking them to the Alaska Supreme Court where I won five cases holding Alaska’s coercive psychiatric regime illegal in various respects, including being unconstitutional. However, as my new hero, Cherene Caraco of the Promise Resource Network in Mecklenberg, North Carolina says, ‘There is no alternative if there is no alternative,’ and I am now focusing my efforts joining with many others on creating such non-coercive alternatives.”

He and others are pursuing this goal through the ongoing work of the International Peer Respite/Soteria Summit. “Independent of that,” Gottstein wrote, “the purpose of the white paper is that it can be useful in efforts around the world to end unwanted psychiatric interventions.”

In addition to his legal fights against forced treatment in Alaska, Gottstein helped create several alternative programs in Alaska, including a Soteria House that operated from 2009 to 2015. In his book The Zyprexa Papers, he detailed how his litigation efforts ultimately led to a court case in which Eli Lilly threatened him with criminal charges for obtaining and releasing documents that told of how the company had hid from the public evidence of how its antipsychotic drug could cause diabetes and other metabolic adverse events.

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