Comparing Aspects of Mental Health Legislation of Israel and Massachusetts
Mester, Roberto, Pinals, Debra, The Israel Journal of Psychiatry and Related Sciences
Abstract: This paper compares the manner in which two sets of mental health laws, that of Massachusetts, U.S.A., and that of the State of Israel, deal with specific areas of civil enforced commitment. The definition of psychiatric disorder that justifies commitment is broader in Massachusetts, in Israel psychosis alone is considered, excluding conditions such as severe non-psychotic depression, obsessive-compulsive disorder and anorexia. In Israel, commitment is possible only when there is a risk of danger that is immediate. In Massachusetts, only a judge can make decisions beyond the first four days, while in Israel they are made by a District Psychiatrist. Unlike Massachusetts, there is no possibility of enforced commitment of alcoholics or drug addicts in Israel, even in the presence of impaired judgement and severe family distress. The changing trends are presented, as Israel seems to be drawing slowly toward the Massachusetts position in some of these issues. The role of consumers in these processes is considered, as is the possibility of enforced commitment of people with severe personality disorders.
Mental health laws of different countries, as any other laws, are the result of the interaction of various vectors such as: 1. the sociological characteristics of the nation (e.g., tradition of democracy, level of respect for human life and citizen rights, cultural attitudes towards the mentally ill); 2. level of development of medical services and their availability; 3. the geography and size of the country; 4. the function and success of the economy.
The United States and Israel are both solid and stable democracies with a high respect for human rights. They differ in that the former has a large population, legislation which is often different from state to state, a constitution and a large and rich economy. Moreover, states within the U.S.A., including Massachusetts, have an expanding interest in the development of close and flexible collaboration between the psychiatric establishment and the legal system. Massachusetts, also called the Spirit of America and one of the oldest states of North America, has been the cradle of the process that led to the creation of the country, its constitution and other major historical developments, such as the abolition of slavery and the struggle to preserve the Union. It possesses highly sophisticated mental health laws.
The specific focus of this paper will be a comparison between the approaches of the Massachusetts and the Israel mental health legislation to some issues of importance such as: their definition of mental illness, consent to hospitalization and to treatment, reviewing procedures, involuntary civil commitment in general and commitment of substance abusers in particular.
The Definitions of Mental Illness and Their Relation to Involuntary Commitment
The Massachusetts Department of Mental Health's definition of the psychiatric condition which justifies involuntary civil commitment appears in section 3.01 of Chapter 104 of the Code of Massachusetts Regulations (M.G.L.c. 123, s.2) and states: "For the purpose of involuntary commitment ...'mental illness' shall mean a substantial disorder of thought, mood, perception, orientation or memory which grossly impairs judgement, behavior, capacity to recognize reality or ability to meet the ordinary demands of the life but shall not include alcoholism..." (1).
The Israeli equivalent definition states in its section 6 of the Israel Mental Health Act of 1991 that "a district psychiatrist may direct in writing that any person be brought urgently for psychiatric examination if prima facie evidence has been produced to him that the person concerned fulfills all the following conditions: 1. he is suffering from an illness as a result of which his capacity for judgement or for assessment of reality is severely impaired; 2. he is liable to endanger himself or other persons by immediate physical danger; 3. …