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Recovery Model: Mental Health Recovery Model Applied to Severely Mentally Ill; JH Rick Massimino MD

Individual Mandate & Serious Mental Illness

How does the recent SCOTUS ruling upholding the individual mandate apply to the issues of treatment resistant/defiant chronic mental illness?

On 6/28/12, the Supreme Court upheld the individual mandate as constitutional and the penalty for not buying health insurance would be a tax on earned income. In other words, one must be responsible or suffer a consequence if one chooses to not be responsible (consequence vs punishment or right vs privilege). Should this reasoning apply to all citizens who are mentally ill or not? Should this reasoning apply to all citizens who are employed or not? Should this reasoning apply to all citizens who are receiving entitlement benefits or simply unemployed yet disabled by mental illness?

If the law allows for the government to order responsible conduct and later apply a consequence for refusing to behave responsibly, then the law could order mental health treatment when necessary and enforce adherence with a consequence. The nuances of how this can be accomplished are not relevant for this discussion yet are very easy to implement. However, it is very clear that the issue of treatment non-adherence can be thought of as a responsibility issue and not as a “Rights” issue. If we accept treatment non-adherence in the seriously mentally ill in this new frame of thinking (responsibility vs right) then the great majority of those suffering from out of control psychosis can finally become healthier. This will reduce costs, save the lives of innocent bystanders and save the lives of those consumed by psychosis.