May 1998

   According to the record in the Supreme Court of Iowa, the patient was hospitalized on a voluntary basis for one week for depression, and discharged to an outpatient facility. She received counseling for her depression and was taking anti-depressant medication. The specific medication was not indicated in the court record.

   The patient became concerned over the possible side effects of the medication and discontinued its use. She informed her physician of her decision.

   Six months later she made the decision to remove herself and her two daughters from the home and go to a battered women’s shelter. Her husband contacted the daughter at school and found out what had happened. Then he initiated legal proceedings and obtained an order for an involuntary mental health commitment, on the grounds of serious mental impairment. The patient filed an appeal.

   The Supreme Court of Iowa ruled there were no grounds for involuntary commitment in this case.

The criteria for involuntary psychiatric commitment are:

1. A mental illness; and

2. The lack of sufficient judgment to make responsible decisions with respect to the person’s hospitalization or treatment, due to the mental illness; and

3. The likelihood of inflicting serious physical or emotional harm on self or others, or the inability to satisfy the person’s own basic physical needs, if allowed to remain at liberty.

   All three criteria must exist in order to hold a patient involuntarily for psychiatric treatment. The law is essentially the same in other states, due to the U.S. Supreme Court’s nationwide standards for the constitutionality of state mental-health laws.

  Refusal to take psychotropic medication by itself does not mean the patient is unable to make rational decisions, the court ruled. If the patient has a rational basis for that decision, such as a desire to avoid untoward side effects, a court should not substitute its subjective judgment for that of the patient, the court believed.

   The other ostensible reason for holding this patient against her will in a psychiatric facility was that she had subjected her family to emotional trauma by removing herself and her children to a shelter for battered women.

   The court expressed deep concern over this logic. According to the court, domestic abuse against women is a serious problem all over the nation. A woman who removes herself or her children to a shelter on the basis of an actual or perceived threat should not have to fear any negative repercussions from taking that step.