 Shield program advocates for individuals subjected to psychiatric intervention without consent.){kind=link}
“We need the MindFreedom Shield to have someone in our corner when we are told that it doesn’t matter what we want, that someone else can make a choice about our bodies that we will have to live with for the rest of our lives.” —Sarah Price Hancock.
David Russell’s most recent virtual civil commitment review hearing, originally set for July 31, had been twice rescheduled over the summer before finally taking place on August 19.
As the hearing began, attendees in the Zoom waiting room were granted admission to the virtual courtroom. District Court Judge Carmaine Sturino presided from the top left hand corner, and Russell’s court-appointed representation appeared towards the top right.
Russell, logged into Zoom from the facility he’d been committed to, occupied a rectangle in the second row, looking as nervous as might be expected of anyone in this situation. By the time of this hearing, the 44-year old programmer from Minnesota had been subjected to involuntary electroconvulsive therapy (ECT) at the Mayo Clinic in Rochester 14 times, and was scheduled for a 15th. Even after he’d suffered a potentially fatal blood clot following one of the procedures on June 19, the ECT continued all summer long
Russell’s supporters occupied a number of Zoom rectangles, renaming themselves as “Friends of David.” They were with MindFreedom International’s (MFI) Shield program, describing itself as “a volunteer-driven mutual aid network through which we organize public campaigns to advocate for the rights of individuals who are being subjected to psychiatric intervention without consent.” Much as the court-watching movement shines a light on the unjust workings of the criminal-legal system, Shield activists show up to virtual hearings like Russell’s as witnesses to the injustices of the civil commitment system.
Russell is one of hundreds of individuals who have reached out to MFI for a Shield over the last two decades. “They’re good people and they give a shit,” he said of the volunteers. “I don’t think there’s enough actual oversight, whether civilian or governmental, of the mental health system, and it does a ton of harm.”
His most recent troubles began back in 2022, when he was funneled from the criminal system to the civil system, and ordered to take neuroleptic drugs on an outpatient basis, which the court notes he refused to do because of their adverse effects. The county then petitioned to confine him at Mayo Clinic, and a physician there filed what is known as a Jarvis petition for the right to forcibly medicate him with neuroleptics. That same year, a Minnesota Court of Appeals upheld the state’s right to civilly commit him on the basis that he posed a “substantial danger to himself.”
“I have never disagreed with my need for help or that I have mental health issues,” Russell said in a prepared statement at his August hearing. “I have disagreed with the traumatic and abusive system and damaging treatments forced on me.”
He told Mad in America that he discovered the program years ago online while researching related topics. When he was forced into a guardian-conservatorship overseen by Catholic Charities of Southern Minnesota last year, and then faced the looming threat of forced ECT in the spring, he felt he had to take drastic action and activate his Shield. “I’ve got nothing to lose because I have absolutely no say over anything,” he said.
How the Shield Operates
David Oaks, who directed MFI from its inception until 2013, told Mad in America that he started the Shield program with MFI board member Krista Erikson around 20 years ago, inspired by Amnesty International campaigns pressuring elected officials to intervene to stop human rights abuses. “Our thinking was by registering in advance if possible, then if there’s a threat that becomes real, we can actuate the Shield quickly,” Oaks recalled. Central to the program’s mutual aid approach is the registrants’ pledge to support others who might also be subjected to psychiatric force. He said that the program had also endeavored to create a network of individuals willing to provide safe havens to those fleeing the reach of civil commitment orders in their counties and states. While the ongoing logistics of maintaining such a network have proved challenging, one such successful effort in 2006 was documented in The Wall Street Journal.
When a Shield request comes in, typically an MFI volunteer will have a conversation with the requestor about their current circumstances. In some cases, the person is released before a Shield can be activated. If someone is currently incarcerated in a facility or facing civil commitment, the volunteer will discuss the possibility of retaliation or a worsening of their situation. “Several times I’ve seen folks decide not to ask for a campaign because they were concerned about retribution, or losing the few services they have,” Oaks said.
“I’m still worried about retaliation,” Russell said. “But I am going to try and hope for the best, and that with more attention, more people will say, ‘Hey, this is not right. Just locking people up, with a guardian-conservator that can tell that person to do whatever they want, is not very humane.’”
Another key consideration is privacy. The Shield’s design is inherently public, given that the action alerts connected are blasted out to thousands of people on the email list and are also put on the website, according to the program’s FAQ.
The Shield program has been historically unfunded and is run largely by a small all-volunteer group, so the capacity to respond has been an eternal challenge. Given these constraints, a disclaimer states that a Shield is not guaranteed to everyone who requests one, and likewise the scale of any campaign that is launched is up to the discretion of organizers. Oaks estimates that the program has activated anywhere from 30-50 Shields over the past years, and has launched 10 campaigns just in the last year.
Targets of these campaigns have varied, but often start with the doctors pushing the forced psychiatric interventions and moving to the higher-ups in administration. Jim Gottstein, an attorney who authored the book The Zyprexa Papers, directs the Law Project for Psychiatric Rights and has volunteered as Shield coordinator, told Mad in America that he views involuntary treatment as the “path of least resistance” for the system. “A lot of times it’s just not worth it to them to get all this grief, and they quit. That’s the basic idea of the Shield: to make it just not worth it.”
As in Russell’s case, campaigns have also targeted the guardian-conservators themselves and their organizations, as well as lawmakers at the local and state levels. “Typically, once the individual has some amount of people power, there are times that the opposition caves pretty quickly,” Oaks said, recalling Shield victories past and present. In July, Marcela Musgrove was freed from an involuntary psychiatric hold in South Carolina, hours after a Shield went up on her behalf. According to MFI’s website, Musgrove believes the program contributed to the outcome. And in May, Shield volunteers claimed a partial role in the release of William Mahler from psychiatric confinement in Massachusetts.
Mahler posted a glowing response in the comments section of his alert page, praising those who showed up to his Zoom hearing with “Free William Mahler” profile images. The supporters “helped sway the judge,” he wrote.
In Russell’s case, the system fought back. On June 21, Gottstein and MFI were slapped with a cease-and-desist letter from one of Mayo Clinic’s attorneys. The Shield alert had inadvertently included the personal cell phone numbers of two doctors behind Russell’s involuntary ECT orders. “As a result of your posting, they have received multiple harassing calls, including calls in the middle of the night,” wrote the attorney.
Gottstein fired off a response, writing that one of Russell’s shock doctors (named, incredibly, Dr. Schak), has “no trouble sleeping after having ordered torture be inflicted on Mr. Russell, and calls the lawyers in for having her sleep disturbed by people calling to ask her to stop it.” (MFI routinely reminds its Shield network to consider in all their communications that persons with a Shield are subject to retaliation.)
In June, the campaign pivoted to Catholic Charities of Southern Minnesota, which houses the guardian-conservator allowing the forced ECT at Mayo Clinic’s behest. “Why does a religious organization have legal rights over a man’s life and body in a supposedly secular state?” read one Shield alert by Gottstein. “We must fight to ultimately end this, and immediately get the Catholic Charities ‘guardian’ to stop the electroshock torture of David Russell!”
Psychiatric survivor and Shield volunteer Andrea Barnes told Mad in America that she was horrified to learn that Catholic Charities was heavily implicated in Russell’s case. “To find that out just felt like another spiritual betrayal by the church I was raised in.”
While the campaign has generally stuck to more traditional tactics of emailing and calling decision-makers, volunteers have also explored how to best use social media to raise awareness, mobilize action, and apply additional pressure. Shield volunteer Annie Singer uploads regular videos across TikTok and multiple platforms updating followers on the campaigns and providing education on the issues.
By July, the campaign’s spotlight had moved to Bishop Robert Barron, currently listed as ex-officio president of the Board of Catholic Charities of Southern Minnesota. Bishop Barron has a sizable social media following across all platforms, with 3 million followers on Facebook alone. A July 1 Shield update urged the network to comment on the clergyman’s posts and mention Russell’s case (using Catholicism’s social teachings as talking points if they wished), in hopes of getting his attention.
“A Sham Legal Process”
It’s challenging to determine precisely how many youth and adults experience involuntary psychiatric confinement in Canada and the U.S., the origin of the majority of Shield requests. As Rob Wipond writes in Your Consent is Not Required: The Rise in Psychiatric Detentions, Forced Treatment, and Abusive Guardianships: “Today, good statistics are hard to come by—federal, state, and provincial governments don’t gather them, don’t gather them in full, or don’t share them publicly. Nevertheless, everywhere decent statistics can be found, they show that Americans and Canadians are getting forcibly detained at per capita rates that have been rising steadily and dramatically since the 1990s.”
“The need is enormous,” Gottstein said. “There are literally millions of people in this country who are under forced psychiatry. So the need is, as a functional matter, infinite.”
What’s more, the official mechanisms created to safeguard the rights of people confined in psychiatric facilities are wholly inadequate to meet the demand. The Federal Protection and Advocacy for Individuals with Mental Illness (PAIMI) program has been “categorically abysmal” in “protecting and advocating for the rights of those that they have been federally funded by taxpayers to protect,” said Sarah Price Hancock, rehabilitation counselor and electrical injury researcher who contributes to the Life After ECT nonprofit and has advocated on behalf of Russell and others with a Shield.
“Every time I was in the hospital, they always had a little flier that said, ‘Know your Rights.’ But that number is so swamped. There are so many people needing help. They cannot help everyone,” Hancock said. “MindFreedom Shield’s grassroots effort to be the advocate when other advocates are not available is the only way we can ensure that people have someone willing to speak on their behalf.”
The poor quality of representation afforded to most people facing court-ordered psychiatric intervention is another reason the Shield exists, Gottstein said. “Public defenders often do really terrible representation of criminal defendants. But they at least know whose side they’re on … The lawyer, from what I can see, actively works against David. And that’s typical. It’s a sham legal process.”
Case in point: the court views Russell’s assertion that he is being harmed by neuroleptic drugs as arising from his “delusional concerns,” even though his opinion is supported by substantial evidence and his own lived experience. But his attorney has yet to argue for his client’s perspective on the matter. “In these [civil cases], the judges and the lawyers assigned to represent people think, ‘Well, if my client wasn’t crazy, they’d know this is good for them, and so they don’t present the evidence,” Gottstein observed, referring to the body of research showing that neuroleptic drugs can reduce individuals’ chance of recovery from 80 to just 5 percent, and shorten their lifespan by 20-25 years.
At the August 19 hearing, Russell pleaded for a new court-appointed attorney. “He will not respond to voicemails, emails, or communicate in any way,” he told the court. “He also refuses to give me any documents … and he has had absolutely zero contact with me for the vast majority of the matters he has ‘represented’ me on.” Russell’s request was again denied.
In a 2005 paper, Gottstein wrote that the “involuntary mental illness system operates largely illegally.” What he means is that in the US, involuntary commitment proceedings routinely flaunt the procedural, due process rights enshrined in the Fourteenth Amendment. Further, the process frequently defies the “least restrictive alternative” principle enshrined in the 1999 Olmstead Decision and iterated through case law going back to the early 1970s.
“If rights were being honored, no more than 10% of the people who are psychiatrically incarcerated would actually meet the criteria,” Gottstein said. “No one could be drugged or electroshocked against their will because the state has to prove it’s in their best interest, and that there’s no less intrusive alternative—neither of which is true. And so all of these cases are legally insufficient. The lawyer’s role is really to check the box that the person had a lawyer.”
Both Mahler and Gottstein believe that the efforts of a sympathetic attorney, Tamara Barney, contributed to the positive outcome for Mahler. “Unlike most lawyers in these cases, starkly demonstrated by the ones before William’s, Tamara Barney did a terrific job putting up a defense,” Gottstein wrote. “This was unusual enough for the judge to remark about the quality of the hearing.” After his release, Mahler wrote, “I’ve known Tamara for more than a decade and she’s always won. In fact, no one had won before.”
Barney shared a comment with Mad in America via email that centered the work of her client and his advocates: “William’s victory was a testament to his own strength and the support of the MindFreedom Shield program … It is our clients who deserve the lion’s share of credit for their victories, as they endure tremendous challenges while hospitalized. As attorneys, we judge ourselves not by the court’s decisions, but by our clients’ trust and the knowledge that we did everything possible to fight for their autonomy and freedom.”
Systemic Disregard for Domestic Legal Guidance and international Law
The Shield cases involving forced ECT tend to get the most attention, according to Gottstein. This is likely because of the procedure’s particularly invasive and dangerous nature. ECT proponents have tried to sell the idea to the public and medical professionals that it is “safe and effective.” In a stark contrast, international human rights bodies call it an “irreversible intervention” that can be understood as a form of torture, especially when it is being forced upon people amid distressing conditions of indefinite confinement, as is the case for Russell.
Guidance issued by the United Nations and World Health Organization in 2023 states that “coercive practices in mental health care violate the right to be protected from torture or cruel, inhumane and degrading treatment, which is a non-derogable right.” The UN Special Rapporteur on torture wrote in 2020 that supposedly benevolent purposes such as medical necessity do not “vindicate” coercive or discriminatory practices. The international human rights bodies say that there is an “immediate international obligation to end these practices.”
The UN/WHO guidance goes on to say, “ECT without consent violates the right to physical and mental integrity and may constitute torture and ill-treatment. People being offered ECT should also be made aware of all its risks and potential short- and long-term harmful effects, such as memory loss and brain damage.”
While Russell is well aware of the risks, and is experiencing the damage in real time, he cannot opt out.
At his August 19 hearing, he addressed the court, stating that the ECT was harming him physically and mentally. “I also have difficulty remembering vast portions of my life and especially the last half decade,” he read. “Finally, there is significant irreversible physical damage as well that is documented in the medical record. But I’m sure the documentation says that ECT helped and you already agree, the damage done is worth it, and that further damage and even death would be worth it too.”
Advocates are particularly concerned that the ECT has continued even after it was discovered in June that Russell had a blood clot in his arm. Price Hancock called this decision “so beyond reprehensible,” saying it proves that his treating psychiatrists have “no understanding of the physiological consequences of electrical injury.”
When someone receives ECT, their bodily blood flow increases anywhere from 300-400%, she explained. “Here we have a patient who has a blood clot in their arm and they’re going to instantaneously spike the blood flow in the body to three to four times normal. What happens if that blood clot dislodges? Pulmonary embolisms are fatal.”
For Barnes, the Shield volunteer, Russell’s experience reminds her of stories she’d been told about her maternal grandfather who was committed to a state hospital. While receiving ECT there, he suffered a cerebral hemorrhage and died on the table—an experience which has left lasting generational wounds on the entire family. “People do die [from ECT],” she said.
Price Hancock and other ECT researchers have also pointed out the utter lack of standardization in how ECT devices are used across various treatment settings. She said that ECT providers often simply mimic the medical traditions of their mentors, leading to wild variations in the dosing of powerful electrical current through human brains. In Price Hancock’s view, these practices amount to “unregulated human experimentation.”
“That’s a war crime and it’s never been viewed that way, because let’s be honest, we’re dealing with humans who have psychiatric diagnoses,” she said.
In June, the California Supreme Court’s decision in Himes v. Somatics LLC marked a watershed moment for advocates who have fought for decades for ECT device manufacturer accountability. Somatics LLC “did not dispute” that its device can cause brain damage and permanent memory loss, or that it failed to warn doctors of these risks. Further, the company did not dispute that the plaintiff, Michelle Himes, had been brain-injured. Somatics’ defense rested upon what is called the “learned intermediary doctrine,” which posits that device makers have a duty to warn physicians, but not patients directly, about potential risks. The defendant claimed that it should be shielded from liability, due to the testimony of Himes’ physician that he would have still prescribed ECT, even if the manufacturer had warned him more strongly of the risks involved.
The California Supreme Court rejected these arguments, and held instead that “the patient’s role in deciding his or her own course of treatment does not disappear in the context of the learned intermediary doctrine” and that “the learned intermediary doctrine does not allow health care professionals to substitute their judgment for that of their patients.”
The Himes decision “clarifies a gap in the law that the pharmaceutical industry has exploited for decades,” said plaintiff’s attorneys Wisner Baum in a statement. Senior partner Bijan Esfandiari, who argued the Himes case, stated: “As a result of the California Supreme Court’s Himes decision, moving forward, pharmaceutical and device manufacturers who fail to warn of risks associated with their products can no longer avoid liability by misusing the learned intermediary doctrine. Today’s decision in Himes is not only a victory for consumers injured by defective pharmaceuticals and medical devices but is a victory for anyone who champions patient autonomy.”
Price Hancock said that family members, attorneys, psychiatrists, and other stakeholders with the authority to make or enforce medical decisions are largely unaware of this new legal precedent. “I think it’s critical that we update not only the psychiatrists, and also that we update the judges, because they are the ones making these choices,” she said.
She also suggested that those using psychiatric advanced directives (PADs), legal documents stating a person’s mental healthcare preferences, should consider revising their PADs to reflect the Himes decision, which she hopes may prompt legal and medical professionals to take them more seriously than has historically been the case.
“We’re Not Going to Forget About Them”
In eternal need of volunteers and funding, the Shield program is the David to the medico-legal system’s Goliath, trying to support the people it can, when it can, through the wins and losses. “They’re counting on people not caring,” Barnes said. Although little tangible impact has been seen in Russell’s case to date, she noted: “MindFreedom was able to show that we were there in numbers. We’re not going to let David Russell be forgotten about. That’s an important part of the Shield—just reminding people that we’re not going to forget about them.”
Russell shared his reaction to the August 19 review hearing with Mad in America via email: “I’m thankful it didn’t go worse, but it despairs me to know the situation I’m in. Despite my testimony about the attorney, guardian/conservator, and ECT’s damage to me, my ability to file complaints was completely ignored and dismissed. I knew from the beginning that’s how it would go, though.”
He remains “scared shitless” about his future, and wants to “regain control” of his life and not to be “constantly under a threat of extremely high doses of antipsychotics.”
“That’s really the most that I dare hope for,” he wrote.
Russell also continues to hope that his case and others like it can “help make the system better.” He doesn’t deny that sometimes “somebody needs help…for mental health reasons,” adding “I just don’t agree with the way it’s done. It seems to be more of a lock the door and throw away the key type of thing.”
Until providers and the courts abide by the latest medical and legal guidance, Price Hancock said, “We need the MindFreedom Shield to have someone in our corner when we are told that it doesn’t matter what we want, that someone else can make a choice about our bodies that we will have to live with for the rest of our lives.”
“It’s the patient, not the doctor or the judge, that has to live in the individual’s body for the rest of their life.”