California must learn from history. Forced mental health care harms more than heals

Progressive values and humane public policies are California virtues. But not for people living with serious mental illness. For people with schizophrenia, our treatment clings to an old, dangerous myth: “To save them we must take their autonomy.”

Some say people with schizophrenia have what is called anosognosia, meaning they lack insight that they have an illness and so require forced treatment.

Whether one believes in anosognosia or not, we must believe in people and their humanity. Rather than describing their objections as noncompliance, we must meet people where they are and hear their “no” as expressed autonomy, a desire to be heard on their own terms.

A French physician, Dr. Philippe Pinel, in the late 1700s famously unchained men and women in his asylums. Today’s chains look different. Reports from Disability Rights California detail widespread warehousing of people in psychiatric facilities after doctors have ordered them discharged and in jails despite them facing no criminal charges.

Lack of prevention and early intervention in outpatient care are major problems. 

Unhoused individuals experiencing mental health challenges require considerable outreach and engagement to build sufficient trust to bring them into the mental health system. Medicaid won’t pay for such concerted efforts, leaving them to fall deeper into the cracks of homelessness, incarceration or worse. 

Many people don’t fall — they’re pushed — into crisis. Pushed by poverty, racism and systems that criminalize illness and treat trauma with handcuffs. That’s not humane care; that’s control dressed up as care.

A person with “voluntary” court-ordered treatment without housing will be told they can live with their family. But families aren’t effective replacements for funded systems of care. They’re already stretched, grieving and navigating a maze of waiting lists and delays. 

Another missing piece in our system is the value of lived experience. 

When those with lived experience in mental illness try to collaborate with policymakers to develop voluntary, community-based services — especially for those who are unhoused or in a mental health crisis —  they are frequently rejected. In recent years, their testimony opposing several California bills that expand involuntary treatment often is ignored or dismissed, rather than being recognized as informed, valuable insight. 

Worse yet, this lived-experience perspective is framed as “letting people die with their rights on.” Nothing could be further from the truth.

I have experienced this. I have navigated coercive treatment approaches, systems that locked me up, traumatized me and caused me immense harm. 

Telling my story causes me further harm, even though my intention is to help others. I can’t escape the stigma. People make assumptions about “limited” abilities and “irrational” beliefs. Parts of my story can jeopardize future employment, housing opportunities and social connection. 

We can have education, professional careers and expertise from lived experience, but it’s all delegitimized through the discriminatory lens of a schizophrenia diagnosis. 

I survived. Many others do not. 

When I did not believe in myself, my providers, family and peers saw me as more than a set of symptoms; they saw a person with strengths and a deep need for connection, purpose and hope. 

I use my experience to heal and advocate for systems promoting dignity. We don’t want people to die. We want them to live with their rights on, free of shame, trauma and the system’s failures.

People with lived experience know the system’s chasms intimately, so we can help repair it. We know that true health care is not time-limited or transactional; it requires approaches that are noncoercive, rooted in dignity — such as peer-led programs, culturally competent supports and housing-first models. 

Media coverage, providers and elected officials assert that safety requires coercion. But coercion begets resistance. Humans reach for freedom. A diagnosis of schizophrenia doesn’t eliminate a person’s yearning for liberty. 

We’ve been here before: institutionalizing women for being “too emotional,” sterilizing those with disabilities “for their own good,” tearing Native children from their homes to “civilize” them, diagnosing enslaved Africans who fled bondage with drapetomania (runaway slave syndrome). 

Now concern for public safety seems to justify involuntary holds and forced treatment. We must learn from history; not repeat it. 

Providers, administrators, family members, elected officials and people with lived experience must work together. If any voice is missing, we miss the opportunity to create real healing.

People living with schizophrenia deserve support, freedom, dignity, and a system based on their potential, not just their pathology.

It’s time we stop mistaking force for humane care and start investing in what works: trust, time, families, housing, collaboration and the belief that recovery is possible on each person’s terms.