Pre-Medicated Murder: Violence and the Degree to Which the Mentally Ill Can Refuse Treatment

Abstract

Objective: As part of the expansive overhaul of the mental health system, many states have 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. This study measures the effect of various right to refuse medication laws on homicides.Method: Using a sample of the homicide rate of every US state between 1972 and 2001 (N=1,479), I compare the difference in homicide 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 the homicide rate, and while point estimates suggest that allowing for review of requests to refuse medication are associated with a decrease in the homicide rate, the estimates are imprecise and statistically insignificant.Conclusion: 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.