Compassion, Safety, and Rights

By Patrick Hendry, Vice President of Consumer Advocacy, Mental Health America

Download the Paper (PDF)

For many years I have thought that it would be interesting to take an in-depth look at the intersection of compassion, safety, and rights and how they apply in mental health advocacy, practice, and law.  They are certainly reoccurring themes in the advocacy work I have done for twenty-four years.  I knew that they frequently overlap and often seem to be in conflict with each other, but I had no idea how complex the intersection was until I began my research.

These three issues are shaped by perspective, legal interpretation, medical ethics, and ideology.  They can both unite and divide us and they are a part of the lives of every person who lives with a psychiatric disorder, every family who strives to protect and provide for their loved ones, and every professional involved in the mental health system. 

One person’s idea of compassionate treatment may feel like an infringement of rights to another.  Safety is important but it must be well defined when we talk about taking away someone’s freedoms, and rights should be sanctified except in the most extreme situations.  So the question arises, how does one fit these three essential elements together?

Compassion is the emotion of caring for another’s wellbeing. Safety applies to the individual, families, caregivers and society. Rights are legal or ethical principles of freedom—that is, rights are the fundamental rules about what is allowed of people or owed to people, according to some legal system, social convention, or ethical standard.

Many issues arise when you look closely at each one.  Compassion is from the perspective of the person feeling it, so it is not unusual for families, and caregivers to intercede in an individual’s life when they believe that the person requires treatment even if they don’t want it.  Compassionate people often find it difficult to stand back while another person’s quality of life deteriorates due to a psychiatric condition.  Often they are compelled by fear for the person’s safety, perhaps the individual is isolating, not taking care of themselves, or living on the streets.  Intervention might provide the person with a better quality of life.  But what if they don’t want the help?  When does compassionate intervention in these conditions become legal when the freedom of the person is involved?

This is where safety is so often cited.  Most states provide for involuntary treatment for a person with a psychiatric disorder when they are an imminent danger to themselves or others.  But how do we determine dangerousness?  A Supreme Court ruling on involuntary commitment allows for a lower standard of burden of proof than in criminal cases.  Danger to self or others is determined in different ways by different mental health professionals and courts.  The individual is at the mercy of widely ranging opinions that can determine their right to control their own lives depending on where they live or who they are evaluated by.  Society’s view of the link between mental illness and violence is not substantiated by statistics.  A large percentage of Americans believe that most people with serious psychiatric disorders are dangerous, yet research shows a much lower correlation.

My research took me down many unexpected paths and had me constantly re-evaluating my personal beliefs.  I interviewed many people, read numerous articles and papers, and wrote and rewrote the paper several times.  Some of the information is from my personal experience. In the end I have my personal interpretation but it is clear that the only thing that will ever truly unite compassion, rights, and safety is a complete overhaul of our system of care to one that provides for prevention, early intervention, compassionate treatment, uniform legal procedures for taking away the rights of an individual in only the most serious situations, and comprehensive societal support for people in recovery.

The purpose of this paper is to inspire thought about how we think and act in the ways we provide assistance to people living with psychiatric disorders. I hope it opens a deeper conversation and re-evaluation of our personal perspectives.  I realize that many will not agree with my personal conclusions, but that is all right, I’m open to your comments.  I’m always open to learning.