Who is involuntary commitment for?

First Opinion is STAT’s platform for interesting, illuminating, and provocative articles about the life sciences writ large, written by biotech insiders, health care workers, researchers, and others.

To encourage robust, good-faith discussion about issues raised in First Opinion essays, STAT publishes selected Letters to the Editor received in response to them. You can submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.

The story

“I’m a neurologist. My brother has schizophrenia. I support making involuntary commitment easier,” by Shaheen E. Lakhan

The response

While I do not share the optimism that the author does with regard to the current administration providing the needed resources and infrastructure required to properly care for those with severe mental health illness, I wholeheartedly agree that involuntary commitment should be easier to provide. My schizophrenic adult son lost his life because of this illness. He never accepted or had any insight into his diagnosis and consistently refused all treatment for it. When faced with a cancer diagnosis in his 40s, his paranoia about the medical profession kept him from seeking treatment that could have saved his life. Since he lived in another state, we had no recourse to pursue guardianship or any forced treatment for our son. We will spend the remainder of our lives wishing there had been a better system.

— Margaret H.

The response

You write: “I am optimistic that the Trump administration will follow through with the resources, infrastructure, and policy needed to make this work because safer, healthier communities depend on it.” This is a fantasy because he does not care about safer, healthier communities or people in need. He just wants to warehouse these people, so others are not inconvenienced. I can’t imagine anything he has done that makes you believe he would do as you recommend.

— John Pippin, physician and nonprofit worker

The response

I was disturbed by Shaheen Lakhan’s essay supporting involuntary commitment for people with serious mental illness. As someone with mental illness who has experienced and observed coercive psychiatric systems, I must respond.

Lakhan argues that people like his brother are “trapped” by brain disease and should be forcibly treated, even against their will. But what he describes is not compassion, it’s control. Framing psychiatric lock-up as equivalent to treating someone for a stroke obscures a long, brutal history of pathologizing people’s pain and stripping away their autonomy in the name of treatment. It also ignores that people with mental illness, especially unhoused, poor, and racialized people, are routinely criminalized, abused, and silenced in institutional settings.

However, I understand Lakhan’s urge to help. Several years ago, a loved one of mine expressed a desire to end their life, and I didn’t know what to do. So I brought them to get an assessment at a psychiatric hospital — outpatient, I thought. But they were quickly institutionalized, even without insurance to cover their very expensive stay. When they got out, they described to me the horrifying treatment they received. Staff told them to pray their mental illness away. It took days longer than it should have to receive much-needed psychiatric medications. Group “therapy” sessions were poorly run and deeply stigmatizing. The only thing truly offered was a loss of autonomy, not real care, but control. That’s not treatment. That’s survival under duress. Worse, racism and homophobia were rampant. My friend was queer and didn’t feel safe in that space.

I still don’t know what I would do in that situation again; I was scared. But I know I would not force them back into a place like that. I understand the heartbreak of watching someone you love spiral. But compassion cannot mean locking people up because we find their suffering uncomfortable. We must fight for care that heals without cages, and support that doesn’t require surrendering one’s rights. Mental illness is not a crime. And forced treatment is not care.

 — Jacob Shomali

the response

I have represented people with psychiatric disabilities for over 40 years. I sympathize with Dr. Lakhan, but he understandably only sees through the lens of his brother’s suffering. He has never had to live in a psychiatric facility himself — never been in restraints, or not allowed to go outside, or been forcibly held down to be injected. I’ve never met a client who wanted to be homeless, but I rarely met clients who preferred hospitalization to homelessness — that’s how bad the hospitals are. Also, in my long experience, meds do work with some people, but a considerable segment of people are made to take health-threatening medications that actually don’t help their conditions. My clients get diabetes and gain huge amounts of weight on Zyprexa. For the people it helps, it’s worth it. But meds are given/forced on everyone, one size fits all, whether they help or not. The housing first initiatives under President Biden were working. Locking everyone up away from the rest of us will not.

— Susan Stefan

The story

“Learning to say no in a medical system that always asks physicians for more, more, more,” by Cara Poland

The response

This was a lovely article. I see doctors speaking about balance, disabilities, caregiving, and self-care very infrequently, and the best physicians burning out of medicine well before their time. I lived with chronic pain through most of my medical training, and I thought this was the rite of passage. It took me years to realize that it was the system that was flawed. It creates doctors who doubt, dismiss, and, worse yet, gaslight their patients when they’re at their most vulnerable. We lose many physicians entirely to disabilities and long Covid because creating meaningful boundaries and accessibility just doesn’t exist in the U.S. health care system. We dive deeper into a health care provider shortage, and the political answer to bring more doctors in seems to be to make medical school more accessible. The bigger question is, how do we keep them there?

— Shimi Sharief

the story

“We are mothers of Duchenne patients. Recent setbacks with Sarepta must not stop progress,” by Jennifer Handt and Kelly Maynard

The response

Authors and mothers Jennifer Handt and Kelly Maynard issue an impassioned and emotional plea to the FDA to not “remove risk from the equation entirely”; “to sustain and multiply progress”; and to not be on a “search for absolute safety guarantees,” largely in regards to Elevidys.

No one is asking the FDA to “remove risk from the equation entirely” or to embark on a “search for absolute safety guarantees.” Rather, those affected by devastating progressive, incurable diseases are only asking that the FDA fulfill its stated mission by “protecting and promoting public health by ensuring the safety and efficacy of human drugs [has been abbreviated],” which sadly does not appear to have occurred in the case of their Elevidys approval. The Elevidys approval was not recommended by the FDA Review Committee, as they did not find substantial evidence of effectiveness for Elevidys even when using the surrogate endpoint of micro-dystrophin under the accelerated approval pathway, which is arguably a far more lax and “flexible” standard for substantial evidence of effectiveness than the evidence required for traditional approval. Two deaths have occurred in non-ambulatory patients with Duchenne muscular dystrophy, a population for which the FDA Clinical Review Team especially did not find evidence of efficacy for Elevidys.

Tragically, it appears these patients assumed all of the risk without evidence that the surrogate endpoint used in Elevidys trials would be “reasonably likely to predict a drug’s intended clinical benefit.” A third death has now occurred in a clinical trial using Sarepta’s same platform technology that the FDA swiftly withdrew its approval of on July 18, 2025. The authors bemoan the FDA’s request that Sarepta “stop shipment of Elevidys because of the recent deaths,” describing this as “another grief.”

Those in the MS community, which my organization represents, are well-acquainted with many types of grief as well, as we grieve the countless “things” that MS, also a progressive and incurable disease, has taken from us. However, I do not believe that the MS community would benefit from an approval like Elevidys. Those with MS and those who love them have more than enough grief from what this MonSter of a disease has taken from us. We do not need a “therapy” that will give us even more reasons to grieve like Elevidys.

— Kaylin Bower, founder and executive director of On a MiSsion for Multiple Sclerosis

The response

Kudos to the two women who wrote this article. I am old enough to remember the polio epidemic of 1953 and the horrors it wrought on my family and friends. I escaped, thankfully. The point is someone had to take the first polio shot (yes, shot, not sugar cube), not knowing for sure the outcome. Where would we be without that willingness in regards to polio?

Early organ transplants were an adventure into the unknown, with many failures and deaths. Think Christiaan Barnard in 1967 with the first heart transplant, not all that long ago, and now the incredible successes of organ transplant, almost unbelievable. Think Leonard Bailey in 1984 and 1985 with the first human infant heart transplants.

The mothers who wrote this article are incredibly courageous in that they were willing to try to give their child a chance to maybe not wind up as previous children did, knowing full well the treatment may fail. We must not let bureaucracy, politics, money, failure, mistakes, and even jealousy stifle those who dive into the seemingly impossible. We would never have made it to the moon and the space station if we had. God bless these patients and their families, as well as the researchers and doctors who care for them.

— Warren Ellison, M.D., retired

The story

“My mother refused treatment for her breast cancer. Her doctors should have respected her choice,” by Joy Lisi Rankin

the response

It is now 50 years since I was in medical school. As a hospital and community-based family physician and geriatrician, I often saw firsthand the denigration by the majority of my colleagues of patients and their families whose choices were maligned and ignored, with incalculable needless suffering the consequence. Every time I could, I stepped into that breach on the side of those whose irreducible suffering required doing so. Some of the most humbling and meaningful work of my profession. Primum non nocere?

— Barry Farkas