Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 19, Issue 3, 2016. Pages: 141-154
Published Online: 1 September 2016

State Right to Refuse Medication Laws and Procedures: Impact on Homicide and Suicide

Griffin Edwards

Collat School of Business, The University of Alabama at Birmingham, Birmingham, AL, USA

* Mailing to: Griffin Edwards, Collat School of Business, The University of Alabama at Birmingham, BEC 209B, Birmingham, AL, 35294, USA.
Tel.: +1-404-313 8744;
E-mail: gse@uab.edu

Source of Funding: None declared.

Abstract

In the early part of the 20^th Century, many states passed laws that allow, under certain conditions, voluntary and involuntarily committed patients to refuse medication. While some predicted the consequences of these laws would be dire, the effect on violent behavior remains untested. Using the homicide rate of every US state between 1972 and 2001, and the suicide rate between 1981 and 2001, I use a difference in differences model to test the effect of right to refuse laws on homicide/suicide rates. Laws designed to allow voluntarily committed patients to refuse medication are associated with a 0.8 increase in homicides per 100,000 of the state population, and while point estimates suggest that allowing for review of requests to refuse medication are associated with a decrease in the homicide rate.

Background: As part of the expansive overhaul of the mental health system that occurred in the latter half of the 20^th Century, many states passed laws that allow, under certain conditions, voluntary and involuntarily committed patients to refuse medication. While some predicted the consequences of these laws would be dire, the effect on violent behavior remains untested.

Aims of the Study: The aim is to decipher any differences state right to refuse medication laws may have on violence.

Method: Using the homicide rate of every US state between 1972 and 2001 (N = 1,479), and the suicide rate between 1981 and 2001 (N = 1,071). The study compares the difference in homicide/suicide rates before and after a law change to that same difference in a set of control states to estimate the effect of laws aimed at extending the right to refuse medication to both voluntary and involuntarily committed mental health patients.

Results: Laws designed to allow voluntarily committed patients to refuse medication are associated with a 0.8 increase in homicides per 100,000 of the state population while laws dictating an involuntarily committed patient's right to request refusal of medication are negative but statistically insignificant using standard t test. Laws designed to allow voluntarily committed patients to refuse medication have no statistically significant effect on suicides while laws dictating an involuntarily committed patient's right to request refusal of medication, specifically when the request is reviewed by independent mental health professionals, are associated with a statistically significant reduction in suicides.

Implications for Health Policies: Allowing voluntarily committed patients to refuse medication may entice some to enter in-patient facilities, but the brief and optional exposure to medication and their side effects may actually discourage treatment and increase violence.

Supplementary materials

Received 27 June 2015; accepted 29 June 2016