Improving patients’ rights to make choices in their treatment

The U.S. Supreme Court has seldom granted certiorari—the practice of reviewing the decision of a lower court—in cases regarding patients’ rights to mental health treatment, including their right to refuse treatment in either inpatient facilities or community settings. However, over two decades ago in Olmstead v. L.C., 527 U.S. 581 (1999), the Supreme Court opined groundbreaking criteria for patient rights, granting patients the right to receive state-funded supports and services in the community. In doing so, the court recognized the importance of personal autonomy and patient input in the treatment process.

Unfortunately, the quality and availability of both inpatient and community treatment continue to fall short, essentially precluding patients from accessing advances in research that could otherwise fulfill Olmstead’s promise of effective recovery in the least restrictive settings. Inadequate treatments may include cheaper psychotropics with serious side effects, often without improvement and yielding treatment resistance and cessation; lack of access to evidence-based therapies; nonadherence to prescribing guidelines; and disregard for patients’ and advocates’ treatment preferences.

However, there’s a movement toward a more holistic view of mental disorders focusing on mitochondrial brain function that could accelerate recovery and allow patients more say in their care if implemented. Presumably, Olmstead’s directives for patients’ rights to make choices in their treatment include continuing access to advances in therapy and treatment.

The key underpinning to this more holistic intervention lies in the belief that glucose intolerance and insulin resistance are crucial, but often overlooked, aspects of brain health. A theory recently presented by Harvard psychiatrist Christopher Palmer, MD, and others in metabolic psychiatry posits that when glucose metabolism fueling the brain is disrupted, the energy-starved brain may develop symptoms of schizophrenia and bipolar disorder. A promising treatment that redirects the brain’s default energy source from glucose to fat using a ketogenic diet allows patients to safely taper and or reduce the psychotropic medications that are administered in a restrictive environment. This significant breakthrough may provide patients with a meaningful choice to receive treatment in less restrictive settings, as imagined in Olmstead.

Evidence that mental health care professionals are successfully using this science to offer patients therapeutic choices using ketogenic diet nutrition represents a significant shift in treatment options and fulfills Olmstead’s promise. Currently, Stanford, Harvard, Columbia, and other major universities have received millions in funding for pilot studies and clinical trials assessing these low-carbohydrate interventions. This exciting paradigm may offer psychologists another significant role in providing supportive therapy and psychoeducation for patients with serious mental illness who may consider participating in these novel and promising interventions.