When patients visit the doctor’s office, they typically have the power to make their own medical decisions and follow through with what they think works best for them. The ability to control these personal decisions has long been a cornerstone of healthcare. But what happens when that choice is taken away? As research continues to examine the clinical and psychological effects of forced treatment, a pressing question remains: At what point does necessary care become invasive? While forced treatment is designed as a safety net, it often functions as a source of trauma that undermines the medical trust required for a patient’s long-term recovery.
In California’s healthcare system, adults have the right to refuse treatment. However, in cases where a treatment is deemed absolutely necessary, as defined by the Lanterman-Petris-Short Act and Laura’s Law, forced treatment is permitted when an individual is considered a danger to themselves or people around them, or cannot take care of their basic needs. Still, allowing long-term forced treatment requires a court order, making the process complex and often subjective.
The Lanterman-Petris-Short Act enables authorized personnel — such as peace officers, members of mobile crisis teams or designated county clinicians — to place ill patients under a 72-hour involuntary hold known as a 5150. In order to do so, they must complete paperwork stating the circumstances that led them to believe a person could be a danger to themselves or others, or that they are gravely disabled due to a mental disorder.
Additionally, Laura’s Law is a California state law allowing hospitals to permit court-ordered Assisted Outpatient Treatment for individuals with severe mental illnesses. These patients include people who have histories of hospitalization, incarceration or violence, and who refuse medical care due to a condition called anosognosia, which renders them unable to recognize the severity of their condition. The treatment involves community-based care such as medication management, therapy and support services.
The ethics behind forced treatment are complex. One main concern is whether such intervention is a violation of individual autonomy. Critics argue that it is a violation of human rights, a dehumanizing process and a source of trauma. However, this is often countered with the argument of “beneficence,” or the idea of acting in the public’s best interest by maximizing benefits and prioritizing the patient’s well-being.
While many medical professionals view forced intervention as necessary to protect the patient’s well-being, some studies point out that it may lead to poorer long-term clinical outcomes — such as higher rates of treatment non-adherence and increased psychological trauma — than voluntary treatment. Many patients under forced treatment experience extreme distress, fear and humiliation, which can lead individuals to develop post-traumatic stress disorder or lose trust in the healthcare system.
In a 2024 PubMed Central study researching the effects of involuntary psychiatric hospitalization among youth, three-fourths of the participants experienced lower trust in healthcare officials and an increase in non-disclosure of suicidal ideation — a situation where patients deliberately hide thoughts of self-harm or suicidal feelings from doctors to avoid further forced treatment. The study found that the medical staff seemed more judgmental than empathetic toward their situation, overall failing to meet their therapeutic needs.
California’s Community Assistance Recovery and Empowerment Court works to address these concerns. The CARE Court initiative is a civil program that provides court-ordered housing and treatment plans for people with untreated psychotic disorders. Its goal is to help thousands of homeless people receive the health treatment they need, allowing them to stabilize and exit homelessness in community-based support programs before forced treatment becomes necessary.
While programs such as California’s CARE Court attempt to find a middle ground, legislation alone cannot bridge the gap between necessary medical intervention and a patient’s right over their body. Forced treatment often backfires by destroying the trust required for a patient to remain in care.
If California truly wants to address the mental health crisis, it must prioritize the patient’s dignity over legal compliance. A system where we treat mental illness with empathy rather than force will ensure that care is a collaborative journey toward recovery rather than a traumatic experience.
