Treatment Complex

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Among the current administration’s many alarming big-government initiatives is universal healthcare. There are many arguments, both familiar and meritorious, against the government’s taking over the health care of the citizens, but a tangential aspect to think about is what might be called the legal-medical-state complex. This is an expanding entity, with which I became familiar when I was a prosecutor.

It seemed that no matter what the infraction, juvenile defendants were always funneled into “treatment” by the cooperative efforts of defense counsel and the state. For light matters such as school fistfights, the sort of episode in which one or two punches settle adolescent frictions, defendants were offered diversion programs (anger management counseling and the like). For more serious offenses, treatment inevitably included a state-funded mental health report compiled by a state-employed psychiatrist or psychologist, recommending medication, monitoring, and an extended stay at a for-profit facility.

For first-time offenders, the counseling programs were often accepted by defendants’ parents in order to keep the kids’ records clean. More serious offenders had no choice. Mental health measures were simply part of plea agreements and part of sentencing.

This never sat well with me. There were indeed a few defendants who had fairly obvious “mental issues” that were not just odd behavior the state considered aberrant, but behavior that was dangerous to everyone. Mental health intervention mayor may not have been helpful, but it couldn’t hurt. But, for the rest, two things raised my concern.

First, I was surprised at the ease with which the legal-medical-state arrangement worked. Mental health evaluation, diagnosis, and treatment, including medicating and monitoring, were part and parcel of the state’s handling of criminal matters. No questions asked. It was expected. All professionals and bureaucrats were invested in the arrangement.

Second, I was struck by the ease with which defendants opted for treatment instead of punishment. As this was juvenile crime, punishment – depending on the infraction – consisted mainly of paying costs of property damages, losing a driver’s license, undergoing probation, doing “community service,” or sometimes going to boot camp. Not pleasant, but nothing anyone would consider hard time. And, with certain exceptions, juvenile records were routinely expunged upon petition once a certain time period passed. Neither parents nor defendants nor defense attorneys balked at, or even seemed to consider, the amount of control being ceded to the state and its mental health workers when choosing treatment (at any level) over punishment. Everyone simply accepted the joint presentation by the state attorneys, defense attorneys, and counselors that “treatment” was the best course.

Frankly, it seemed dangerous. Once the state took over diagnostic duties, there was no turning back. What might have originally seemed like a good idea in some cases turned into the way in which all cases were handled. Once the state, the legal professionals, and the mental health professionals hit upon a propitious relationship, there was no getting rid of it.

As I said in the beginning, this discussion may be tangential to the universal healthcare issue, but it is instructive. If we cede to the government the ability to control health provision, this will quickly become an irreversible event. It is reasonable to foresee that as with the arrangement I witnessed as a prosecutor, once government bureaucrats, medical professionals, and legal professionals hit upon a cooperative relationship, there will be no getting rid of it. Too many will be inclined simply to accept the presentation by a legal-medical-state complex of the best course of “treatment,” no questions asked. The amount of control “treatment” over young citizens’ lives now offered by the state through the court system is alarming. The potential amount of control over citizens’ lives that is offered by the state within a universal healthcare system should be no less alarming.

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