On Involuntary Commitment and Informed Consent

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A Wall Street Journal article about a Los Angeles lawyer’s slide into psychosis and homelessness called on Social Welfare Professor David Cohen for insights on effective paths of mental health care. The article described a conundrum for society: how to balance the rights of individuals who may not feel they need any help with a desire to protect their basic physical and mental health. California is one of a number of states that have expanded laws allowing involuntary commitment for reasons other than violence. But evidence that civil commitment helps people recover is lacking, and many doctors are too quick to use medication to subdue patients, Cohen said. “We try to deactivate people with antipsychotic drugs,” he said. “We’ve lost the art of trying to figure out how to tackle this with the person in front of us.” Cohen also spoke to the Wildflower Alliance about the professional and moral obligation to obtain informed consent from patients.

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Ballot Measure to Change Mental Health in State Could Backfire, Cohen Says

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In a story about the potential impact of Proposition 1, UCLA Luskin’s David Cohen discussed the implications of an effort to reform California’s mental health system. The statewide ballot measure is backed by Gov. Gavin Newsom as a step in solving the state’s homelessness crisis. But opponents say it would siphon money away from preventative mental health to add psychiatric institutions and promote involuntary treatment. Researchers like Cohen see involuntary or coerced care as counterproductive. “Few who review the existing evidence conclude that on balance, involuntary treatment improves the lives of those who experience it,” said Cohen, a professor of social welfare and associate dean. People contending with mental health issues can be traumatized by enforced treatment. “Being deprived of freedom is maddening. Being robbed of credibility is humiliating.” Plus, studies show that suicidal people who are institutionalized may actually be at heightened risk of self-harm upon discharge.

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Cohen on Coerced Care That ‘Retraumatizes People Who Have Often Been Traumatized’

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UCLA Luskin Social Welfare Professor David Cohen spoke to PBS NewsHour about new laws and policies that would make it easier to detain or hospitalize the severely mentally ill against their will. In California, mental health emergencies combined with a rise in homelessness have set the stage for Senate Bill 42, which would allow the state to compel more mentally ill patients into care. However, said Cohen, there is not much data on the success of forced mental health treatment, which “retraumatizes people who have often been traumatized.” People suffering from serious mental illness may need a form of asylum, but one that’s voluntary, he added. “We do need a place for people who can’t take care of themselves,” Cohen said. “What is asylum? It’s shelter. It’s space. It’s books. It’s drugs, if they want them. Probably, 80% of it is just finding shelter for people.” The PBS NewsHour segment on coerced care begins at minute 30.

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Cohen on the Rising Rate of Forced Psychiatric Detentions

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David Cohen, UCLA Luskin professor of social welfare, was cited in a Los Angeles Times op-ed about a California bill that would expand the state’s ability to impose psychiatric care on people. Research on involuntary psychiatric detention has shed light on the harsh realities of policies that claim to help those struggling with mental illnesses. Forced detentions have been found to have negative outcomes, with people experiencing severe trauma and distress from brutal methods such as stripping, restraints and heavy tranquilization. A landmark 2020 study by Cohen and Gi Lee found that detentions in the U.S. increased at a rate three times faster than the country’s population growth. It is estimated that the U.S. has about 1.2 million forced detentions under civil law every year. This rate is drastically higher than for countries in Europe, which have two or three times fewer forced detentions.

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Cohen on the Unethical Detainment of Psychiatric Patients

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David Cohen, professor of social welfare, was cited in a book excerpt published by The Walrus about the forcible detainment of many psychiatric patients. In his five-year study, Cohen found that at least 600,000 detentions took place in 2014 under mental health laws. In addition, between 2012 and 2016, psychiatric detentions increased every year at a rate three times faster than population growth. Cohen discussed how there were apparent gaps in the data, even though medical records are electronic and should be easily accessible. He said many government and treatment providers apparently do not want to expose the reality that our mental health system has been used to incarcerate and control people. “There’s nothing pleasant about that. There’s nothing beautiful and pretty. It’s just exclusion: ‘Please take them away from me.’ And because we’re saying we’re doing it to help them, there’s a kind of systemic dissonance,” Cohen said.

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Cohen on Why Forced Institutionalization Goes Unchallenged

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David Cohen, professor of social welfare, was cited in an article by Mad in America about the non-consensual institutionalization of people for psychiatric treatment. Cohen said that a lack of discussion on social media regarding the issue of involuntary treatment is part of a vacuum of inquiry that has allowed such practices to continue unnoticed. He discussed how coercion is still socially accepted because people justify the use of force against certain people although it cannot be justified by contemporary science. “The desire to coerce others makes the theories of psychiatric science acceptable, even though the theories are so full of holes that they can’t be accepted,” Cohen said. “It gives everything the sense that we can trust psychiatrists to do this thing which is otherwise distasteful to our democratic norms, our rules of law, our sanctity of the individual and our respect for privacy.”

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Cohen on the Marketing of Psychiatric Disorders and Drugs

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Social Welfare Professor David Cohen spoke to the science podcast Mind & Matter about the growing use of psychiatric drugs, marketing tactics used by major pharmaceutical companies, and what we are learning about long-term health effects on adults and children. Cohen linked the widespread use of anti-depressants such as Prozac to a multi-pronged effort by the “psycho-pharmaceutical medical industrial complex” to convince people that their struggles in life are due to a brain disorder. “We have created and trained generations of people to think that their distress, their misbehavior, their difficult choices, their oppression, all the problems of living as a human being are probably medical problems that have a medical solution,” he said. “That’s the dominant view today, that we are surrounded by mental illnesses.” Drugs can be a legitimate way for some individuals to function well in life, Cohen said, but he cautioned that patients should understand the medical risks and profit motives surrounding powerful prescription drugs.

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Cohen on Social Impact of Psychiatric Medication

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Professor of Social Welfare David Cohen joined the podcast “Courageously.U” to discuss mental health, medication and involuntary confinement. Despite advances in scientific research and medication, most indicators show that the burden of mental health in society has worsened in the last few decades. “Mental illness is not like any other illness,” Cohen said. “We don’t [actually] know what a balanced brain is.” As a 21-year-old clinical social worker, Cohen became interested in the social impact of psychiatric medication, including how medication contributes to stigmatization and stereotypes. “Besides being a scientific failure, the mental health system is a runaway commercial and cultural success,” he said. He explained that there is not enough research available on the side effects and consequences of psychiatric medication, especially in children. “Drugs sedate and quiet people, but we still don’t know if we are curing anything or even treating anything,” Cohen concluded.

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Cohen Highlights Trauma of Involuntary Commitments

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Research by Social Welfare Professor David Cohen was cited in a Cut article about the legal consequences for individuals deemed mentally ill in the United States. Britney Spears’ conservatorship has highlighted the way that psychiatric diagnoses can be used to strip individuals of their rights to voting, medical decision-making, financial decisions and more. Cohen’s research shows that patient privacy laws and lack of data collection pertaining to human rights violations of the mentally ill make it difficult to estimate exactly how many people have experienced involuntary commitment. Last year, a study by Cohen found that involuntary commitments over the previous decade outpaced population growth three to one, and another estimate extrapolated that over 1 million Americans a year are involuntarily committed. “This is the most controversial intervention in mental health — you’re deprived of liberty, can be traumatized and then stigmatized — yet no one could tell how often it happens in the United States,” Cohen said.

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Cohen on the Disempowerment of Patients

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Professor of Social Welfare David Cohen was featured on the Mikhaila Peterson podcast as a guest speaker on the dangers of psychiatric medication, dependency and withdrawal. Cohen pointed out that the prescription rates for psychoactive drugs have quintupled in North America in the last 40 years. Prescriptions for children have increased even more, even though the long-term effects of psychoactive drug use not fully understood. “No one seems to be responsibly investigating these questions, despite the large number of citizens who take psychoactive drugs,” Cohen said. While psychoactive drug use is not new, the avalanche of modern synthesized psychotropics and corporate pharmaceutical promotion have served as converging factors increasing societal dependence on psychoactive drugs. “The cautions that we might feel as ordinary citizens about long-term use are short-circuited by the ideas that many of us are deficient or suffer from some pre-existing brain abnormality that requires treatment with drugs,” he said.

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