Medication & Mentally Ill - What is an Important Government Interest?

By Tanner Bowen

Tanner Bowen is a rising freshman at University of Pennsylvania.

The issue of mental health in the legal system is one that has recently been brought back into the spotlight. While the overarching question of how to deal with the mentally impaired still looms over us, courts have recently begun to rule on a smaller aspect of the issue: whether the government can involuntarily administer medication to defendants declared incompetent.

The U.S. Court of Appeals for the Seventh Circuit recently heard the case United States v Breedlove, where a man named Norman Breedlove was indicted for heroin trafficking and felony firearm possession. After a plea deal was negotiated, Breedlove filed a “Notice of Ineffective Counsel”, believing that his counsel was trying to conspire against him. This led to a psychological evaluation where Breedlove was found to suffer from paranoid schizophrenia, his delusions preventing him from standing trial. This is when the U.S. Government requested Breedlove be involuntarily put on antipsychotics. [1]

This case was guided by the Supreme Court case of Sell v United States, where the majority, led by Justice Breyer, found that Charles Sell's 60+ accounts of Medicaid fraud did not warrant the government involuntarily administering antipsychotics so that Sell could stand trial. Additionally, the Rehnquist Court set out a stringent test for administering antipsychotics involuntarily, which asks:

1) Does it promote an important governmental interest?
2) Does involuntary medicine further the government’s interest?
3) Are there viable alternatives?
4) Is the treatment medically appropriate? [2]

Although this was just one of many Sell hearings since the Supreme Court set this standard, the Breedlove case came with uniquely interesting issues. For one, the defense counsel argued whether it was a “compelling governmental interest” to involuntarily administer medicine to a man indicted for heroin trafficking and felony firearm possession within the scope of a plea deal that would have shortened his sentence to ten years.

This case also serves as another example of the ongoing issues with the relationship between the courts and certified medical personnel. Although a psychologist and a psychiatrist both testified at the District Court hearing, the defense counsel pursued an argument that, despite the experts’ testimonies, he – as counsel – saw signs of improvement in Breedlove and requested a reevaluation.  

This odd counsel-client relationship, coupled with the persistence of the defendant in arguing that the experiment cited by expert Dr. Reardon was fallacious because it did not have a control group, resulted in Judge Cudhay citing in his opinion: "...the counsel's expertise is in law, not psychology..." [1]

This ruling reminds everyone that society has historically deemed "mentally impaired" persons as unable to function or make "correct decisions" on their own.  Although we have not forgotten the awful treatment of these individuals that Dorothea Dix advocated against for over a hundred years ago, society today seems to have pushed our mental patients under the rug. We hold the notion that almost anyone with a mental disease is dangerous and needs treatment in order to become "normal".  

Furthermore, patients are often subject to years of surveillance under clinicians, which seems cause for concern given the Sixth Amendment’s guarantee to speedy trial. Breedlove was no exception. He had to be surveyed for months in a clinic in North Carolina before he was transferred back to Illinois so he could begin his competency treatment and, ultimately, his trial.

The Seventh Circuit in this case ruled that the government was able to administer the antipsychotics with the statement that the drug Haloperidol could even improve the quality of Breedlove's life by alleviating the delusions that he currently suffered from. [3]

Despite this ruling and the ease at which the Seventh Circuit delivered its opinion, the legal concept of involuntarily administration is still mind-boggling to many. It can be so intrusive and life-altering that many wonder whether the subjection of medication could ever be the "least intrusive means". Determining what truly constitutes an important governmental interest as well as what constitutes a medically appropriate solution to a problem so that justice can be served is a complex and often subjective question.

Although the case is unlikely to make it to the Supreme Court, it poses the question of whether the "government's interest in bringing to trial an individual accused of a serious crime" warrants the potential infringement of a person’s rights – even if they are deemed “insane”.


[1] United States v. Breedlove, <http://docs.justia.com/cases/federal/appellate-courts/ca7/13-3406/13-3406-2014-06-30.pdf>
[2] Sell v. United States, 539 U.S. 180-82.
[3] Ronald Bassman, "Mental Illness and the Freedom to Refuse Treatment: Privilege or Right," American Psychological Association, 36, no.5 (2005): 488-497.


Photo Credit: Flickr user e-Magine Art