What Motivates Public Support for Legally Mandated Mental Health Treatment

The use of legal coercion to compel individuals to participate in mental health treatment is expanding despite a lack of empirical support for many of its forms. Policies supporting mandated treatment are made by legislators and judges, often based on perceptions of public concern. Using data from the MacArthur Mental Health Module contained in the 1996 General Social Survey (N = 1,444), the authors examined the impact of political ideology, attributions about the cause of mental illness, and perceptions of dangerousness in determining public support for legally mandated mental health treatment. Perceived dangerousness and attributions about the cause of the mental disorder were significant predictors of support for legally mandated treatment. Conservative political ideology was related to attributing the vignette problem to bad character, indirectly affecting support for legal coercion. KEY WORDS: attribution theory; coercion; mandated treatment; mental illness ********** The use of coercion to impose mental health treatment has been legally and morally debated for centuries. The discourse has moved from the use of involuntary hospitalization, to forced medication and the right to refuse treatment, to the current focus on the use of coercion in the community (Dennis & Monahan, 1996). Proponents of legally mandated mental health treatment argue that because of their illness, many individuals with mental disorders are unable to make rational decisions about treatment (Torrey & Zdanowicz, 2001). Research indicates that many people who are hospitalized lack decisional competence in at least one area related to treatment (Grisso & Appelbaum, 1995). Thus, legal leverage may be necessary for some to receive the benefits of treatment. Opponents question the therapeutic effectiveness of legally mandated treatment and rightfully argue that research supporting its use in many forms is lacking. They also argue that mandating treatment may discourage people from seeking voluntary services out of fear that they will be committed and held indefinitely (Allen & Smith, 2001). Many ideological and empirical questions about mandated treatment remain (Draine, 1997), but its use is expanding (Halpern & Szmuckler, 1997). For example, in considering the reauthorization of the Substance Abuse and Mental Health Services Administration, the U.S. Senate included a proposed amendment requiring states to use outpatient commitment in response to homelessness among people with mental illness (Draine). This type of policy tends to be applied disproportionately to populations marginalized by race and poverty. Policies supporting mandated treatment are made by legislators and judges, often based on perceptions of public concern (Pescosolido, Monahan, Link, Stueve, & Kikuzawa, 1999).Thus, it is important to understand the process by which members of the public judge the appropriateness of legal means to coerce individuals into a range of mental health treatments. Several recent studies have examined public views of legally mandated treatment and found that when respondents perceived that a hypothetical individual was dangerous, they were more likely to endorse forced treatment for that individual (Corrigan, Markowitz, Watson, Rowan, & Kubiak, 2003; Pescosolido et al., 1999). These studies also suggested that perceived competence to make treatment decisions (Pescosolido et al., 1999), attributions about the cause of the condition, and affective reactions (Corrigan et al., 2003) play a significant role. Consistent with this earlier research, we believe that both attributional processes and concerns about dangerousness motivate support for legal coercion, particularly when mandated treatment is viewed more as a method of social control than a means to deliver help. Building on earlier work, we examined the relative impact of attributions about the cause of mental illness and perceptions of dangerousness in determining public support for legally mandated treatment, and how political ideology shapes this process. …