“Poor Insight”: A Capacity Perspective on Treatment Refusal in Serious Mental Illness

For several decades, a protection standard has prevailed in determining the conditions under which a mental health provider, in concert with state authority, might intrude upon the civil rights of a person with serious mental illness. This approach contrasts with a treatment standard that guides consideration and assessment of incapacity in all other branches of medicine. This Open Forum examines the rationale, goals, and limits associated with involuntary intervention in serious mental illness compared with the rest of medicine. The authors believe that reviving a treatment standard that focuses on capacity among persons with serious mental illness would help build bridges between psychiatry and general medicine, between patients and providers, and between illness and recovery.