Treatment Advocacy Center

The Treatment Advocacy Center (TAC) is a United States nonprofit organization dedicated to promoting laws allowing Assisted Outpatient Commitment (AOC) "for individuals who, due to the symptoms of untreated severe mental illness, become either dangerous or in need of treatment and incapable of making rational medical decisions." According to their website, TAC advocates "elimination of legal and clinical barriers to timely and humane treatment for Americans diagnosed with severe psychiatric disorders who refuse care." Founded in 1998 by schizophrenia researcher E. Fuller Torrey in collaboration with other family members of people with mental illness and people with mental illness, TAC seeks to expedite involuntary treatment for people with severe mental disorders who refuse treatment.

Current federal and state policies, according to TAC, hinder treatment for individuals with mental illness who are most at risk for homelessness, arrest, violence, hospitalization or suicide.

Justifications for involuntary treatment
TAC asserts there are three primary reasons assisted treatment is justified:


 * 1) Schizophrenia and bipolar illness can severely impair an individual’s self-awareness, causing many to believe they are healthy and not in need of medical care (anosognosia). This condition impairs their brain function, and since they do not think they are sick, many of them do not actively seek treatment and often refuse it.
 * 2) Civil rights advocates have changed state laws and practices to such an extent that it is now virtually impossible to treat such individuals unless they first commit a violent act.  TAC believes this is a ludicrous and cruel barrier to treatment.  Basically the law requires individuals to be well enough to recognize their illness before they can be treated.  Otherwise, treatment has to be denied unless patients become violent.
 * 3) Public psychiatric services have deteriorated significantly in recent years with the closure of state psychiatric hospitals.  While these much needed hospital beds have been eliminated, there has been no increase in outpatient services.  In addition, the failure of for-profit managed care companies to provide services to these individuals who need them most has only further exacerbated the situation.
 * 4) Statistics used by TAC (disputed by its critics), show 40 percent of the 4.5 million individuals with schizophrenia and manic-depressive illness (bipolar disorder), an estimated 1.8 million people, are not being treated for their mental illness at any given time.

Activism
TAC is working on the national, state, and local levels to educate civic, legal, criminal justice, and legislative communities on the benefits of assisted treatment in an effort to decrease homelessness, jailings, suicide, violence and other devastating consequences caused by lack of treatment.

Principle areas of activism include:
 * Education of policymakers and judges regarding the nature of severe brain disorders, advanced treatments available for those illnesses, and the necessity of community ordered treatment in some cases;
 * Assisting individuals in states working to promote laws that enable individuals with the most severe brain disorders to receive involuntary treatment;
 * Promoting innovative approaches to diverting the psychiatrically ill away from the criminal justice system and into appropriate treatment; and
 * Ensuring individuals receive adequate psychiatric services and maintain medication compliance upon release from hospitals.

Beginnings
For many years, psychiatrists and families of the mentally ill advocated for involuntary assisted outpatient commitment for people with severe mental illnesses who suffer from anosognosia: lack of awareness of their illness. In these individuals, the organ that provides awareness (the brain) is unable to provide it's regulatory function. Instead, it generates hallucinations, delusions, paranoia and worse. Individuals with anosognosia are so disabled they cannot understand, or refuse to acknowledge, their mental disorder. Laws in some states require these individuals who lack awareness of their illness to become a "danger to self or others" before they can be treated. As a result, in a direct vote by the membership of the National Alliance on Mental Illness (NAMI, the largest consumer/family organization in the country), the membership adopted a thoughtful policy on how laws could better balance the need to protect individuals with mental illness while not infringing on their civil liberties.

The many experiences of NAMI consumers and their families left them profoundly distressed by the increase in episodes of violence associated with treatment refusal. These advocates concluded that what was needed was a concerted effort to address state treatment laws that prevent the treatment of people with severe mental illnesses, before they commit acts of violence on others or themselves. Mr. and Mrs. Theodore Stanley, generous supporters of research on schizophrenia and bipolar disorder, shared the advocates' concerns and agreed to partially support a modest effort to improve the treatment system - which soon emerged as the Treatment Advocacy Center. Originally founded as part of NAMI, it was later spun off as an independent organization with many members of the NAMI board serving on the TAC board.

TAC is now supported by a host of additional individual donors and grants, and does not accept funding from pharmaceutical companies or entities involved in the sale, marketing or distribution of their products.

As Torrey says, "Until we find the causes and definitive treatments for schizophrenia and bipolar disorder, we have an obligation to those who are suffering to try to improve their lives. Except for biological chance, any one of us might today be there, living on the streets or in jail.  TAC is the only organization willing to take on this fight, and I am very proud to be part of it."

The Treatment Advocacy Center has support from Ralph Nader and other leftists as well as members of the American Enterprise Institute on the right. It is a truly bipartisan effort to take away the civil rights of a specific group of American citizens. In New York, for example, the TAC sponsored Kendra's Law garnered support from the right wing New York Post and the Daily News, and from the New York Times, Newsday, and Albany Times Union. It had support from public safety groups like the Attorney General, and advocates who claim to advocate for individuals with mental illness like NAMI, NYS Department of Mental Health, and others.

The case for involuntary treatment of psychiatric outpatients
"People care about public safety," TAC publicist D.J. Jaffee told attendees at a 1999 National Alliance on Mental Illness (NAMI) conference. "Once you understand that, it means that you have to take the debate out of the mental health arena and put it in the criminal justice/public safety arena." Jaffe went on to point out that efforts by NAMI to enact 'assisted' treatment laws as a way to provide better care for the mentally ill had failed because the public doesn't care about the seriously ill. He said that when the media does focus on mental illness (e.g., following an act of violence), it provides an opportunity to communicate policies which can simultaneously help individuals with mental illness and protect the public.

"Schizophrenia is a cruel disease. The lives of those affected are often chronicles of constricted experiences, muted emotions, missed opportunities, unfulfilled expectations.  It leads to a twilight existence, a twentieth-century underground man... It is in fact the single biggest blemish on the face of contemporary American medicine and social services; when the social history of our era is written, the plight of persons with schizophrenia will be recorded as having been a national scandal." E. Fuller Torrey, Surviving Schizophrenia

At a psychiatrist's meeting in Baltimore, Maryland in 1993, Torrey expressed his concern that "the public stereotype that links mental illness to violence is based on reality and not merely on stigma."

Criticism
The Treatment Advocacy Center has critics due to the human rights implications of coerced treatment, what critics describe as 'forced drugging', who also point out that psychiatric drugs can be dangerous and disabling. Because of these drawbacks, many patients refuse to comply with prescribed psychotropic drug treatment. Some advocates for the mentally ill believe it is stigmatizing to portray the mentally ill as violent, because they contend such a conclusion is not supported by scientific research. Some religions disapprove all treatment for mental illness (other than that offered by the religion). The Church of Scientology has been particularly outspoken in its opposition to involuntary treatment.

Critics also dispute the use of the term anosognosia in mental illness. Anosognosia was previously only used in specific stroke patients that lost the ability to recognize their disability. Critics, including some psychiatrists contend that while medical illness has objective signs that can be used to identify the reality of the disease, in psychiatric illness these objective parameters do not exist, therefore the term anosognosia is inappropriate and misleading and can be used to justify treatment for anyone who disagrees with the diagnosis.

Critics believe that TAC uses fear tactics to win support for assisted outpatient treatment..