May 24, 2024 | Dr. Joel L. Young

There's no denying that people with mental health challenges can frequently make poor decisions. However, so does everyone else. One of the basic rights we all have is the right to make mistakes, and people struggling with mental illness – no matter how severe their condition – are no different from the rest of society. If you or a family member is struggling with mental health challenges, you need to know your rights, because you can't depend on anyone else to advocate on your behalf.

Integration Into the Community

In generations past, people with mental health challenges sometimes were stuck spending their entire lives in restrictive institutional settings – particularly if the government was paying for a portion of their care.

In 1999, two Georgia women sued for the right to live in a non-restrictive community setting. The two women had been diagnosed with a series of mental health disorders, and their clinicians had said that living in an unrestrictive setting would help them. However, the state worked to keep them institutionalized. The case, now known as the Olmstead decision, made its way to the Supreme Court. The Court ruled that keeping the women institutionalized was a form of disability discrimination, and that people with mental health disabilities have a fundamental right to live in the least restrictive setting possible.

For years now, mentally ill people have used this decision to gain access to greater independence and freedom, and research suggests that Olmstead can actually improve mental health outcomes. The two women who sued for the right to live in a community setting both saw improvements in their conditions when they no longer had to live in a restrictive institution. To claim your Olmstead rights, you have to know about them, and many people with mental health disabilities report that government agencies routinely still ignore the Olmstead integration mandate.

Freedom From Discrimination

The Americans With Disabilities Act protects the right of all Americans with disabilities to be free from discrimination. Under the law, mental health disorders are considered disabilities. You don't even have to have a diagnosed mental illness. Simply being regarded as having a mental health disability is sufficient for you to be protected under the law. Your rights under the ADA include:

• Freedom from discrimination. An employer cannot refuse to hire you because of your mental health disability. Colleges can't discriminate against mentally ill students by, for example, denying them housing or refusing them admission.

• The right not to have to answer questions about your mental health. You're under no obligation to tell your employer or university that you have a mental health condition or to reveal the details of that condition.

• Freedom from discriminatory comments or harassment because you have a mental health disability. 

• The right to “reasonable accommodations'' that allow you to attend class or do your job. However, these accommodations must not fundamentally alter the nature of the job. 

Informed Consent

Informed consent is a sacred right. Under the law, you have the right to:

• Ask questions about your treatment and to receive accurate information about its risks and benefits.

• Switch treatment providers (though insurance may limit the care or the number of providers for which it will pay).

• Decline treatment, even if declining treatment causes your condition to get worse.

Because mental health conditions can undermine your judgment, there are limits to informed consent. A court may appoint a loved one as your guardian and give him or her the right to make decisions on your behalf. And if you are a threat to yourself or to others, you can be hospitalized against your will. These are extreme cases, though, and even in these cases, you can seek legal counsel and obtain a hearing to determine whether you're competent enough to make decisions about your own treatment plan.

Rarely, a court may order specific treatment. In this case, you must only comply with the court-ordered treatment, and such situations only arise after a court ruling.

Confidentiality

When you struggle with mental health concerns, it's easy to feel ignored and mistreated. Well-meaning friends and relatives may become quite insistent about the right treatment protocols or how best to manage your condition. This does not undermine your fundamental right to medical confidentiality, though. Your treatment provider legally cannot reveal your medical information to friends, family, or even your spouse without your permission. Similarly, your school or employer can't gain access to your treatment records unless you authorize such access, and a court can't get your treatment records without a subpoena. Even then, clinicians frequently object to testifying against their clients.

If you want to share information with your loved ones, you'll need to sign a release of information with each and every provider you use. You can revoke permission at any time by notifying your treatment provider.

In extreme cases, such as when a court orders specific treatment or determines that you are incompetent, a third party – usually a family member – will be given access to your treatment records and the right to make decisions on your behalf. Even in such a case, though, your treatment information can't be disclosed to people not authorized to see your records.

If you struggle with mental health issues, know that gaining control over your own life and treatment is a prerequisite to achieving wellness. By knowing your rights, you're better prepared to protect them, and in so doing, may also protect your emotional well-being.

References:

1. Americans With Disabilities Act and mental illness. (n.d.). Retrieved from https://www.womenshealth.gov/mental-health/your-rights/americans-disabil...
2. Confidentiality. (n.d.). Retrieved from http://www.integration.samhsa.gov/operations-administration/confidentiality
3. Informed consent issues. (n.d.). Retrieved from http://www.dhs.wisconsin.gov/clientrights/informdconsent.htm
4. Olmstead: Community integration for everyone. (n.d.). Retrieved from http://www.ada.gov/olmstead/olmstead_about.htm