Saturday, December 13, 2014

Tennessee, Listen Up: We need AOT!

This morning I received this message and editorial from Michael Biasotti, my friend and fellow advocate in New York. Thanks, Michael. You are absolutely right!  I hope Tennessee is listening.
Hi Karen,

Here is a link to a great editorial in the Baltimore Sun. It's message is also what Tennessee needs to hear.
Too often families of people with serious mental disorders feel they have little choice but to stand by and watch helplessly as their loved ones' condition deteriorates. Many mentally ill people do not realize they are sick and resist seeing a doctor or taking medications. As a result their conditions can worsen to the point where they pose a danger to themselves or others, lose their jobs, end up on the streets or run afoul of the law. Yet short of having an adult relative involuntarily committed to a mental institution, which is extremely difficult under current Maryland law and is not a long-term solution, there are few other options for families seeking to get loved ones the help they need.

That's why a state health department proposal, announced this week, to allow courts to order some mentally ill people into outpatient civil commitment programs if they don't take their medications as prescribed could help hundreds of Maryland families care for relatives. whose condition falls short of the standard required for involuntary commitment to a hospital. Under the proposal, judges could force patients to accept treatment and counseling on an outpatient basis, take their prescription medications and comply with their doctor's instructions under court supervision.

That's in line with policies adopted by 45 other states and the District of Columbia, which have approved outpatient civil commitment programs for mentally ill patients who don't require immediate hospitalization but who are still unable to manage their symptoms in way that doesn't disrupt their own lives or those of people around them. Maryland is playing catch-up to well established practices elsewhere that are intended to protect mentally ill people from a downward spiral into psychosis that is ruinous to themselves, burdensome to the state and sometimes threatening to others.

Some advocates, however, have criticized the idea of forcing mentally ill people into treatment on the grounds that it violates their civil liberties. Certainly there would have to be adequate safeguards against abuse: Under Maryland's proposal, officials would be required to get a referral from a mental health professional before any action could be taken, and the process would also require a finding by an independent review panel and court approval. Moreover, only patients who had been involuntarily committed to a hospital at least twice within 48 months could be subjected to an outpatient civil commitment order.

The advocates' concern for the civil liberties of mentally ill people is commendable, and it's perfectly understandable that they would prefer pursuing voluntary strategies to get people into treatment. But the health department's proposal wouldn't prevent them from doing that; on the contrary, it is aimed at patients for whom voluntary treatment strategies already have failed and whose conditions render them incapable of making rational decisions in such matters.

Studies elsewhere have shown that outpatient civil commitment can reduce the number of involuntary hospitalizations by interrupting the vicious cycle of psychotic breakdowns, bizarre behavior and arrests that can keep victims bouncing in and out of the health care and criminal justice systems for years. Just as important, it offers a way for families to help stabilize a mentally ill loved one without going through the lengthy and often frustrating process of trying to get a judge to issue an involuntary commitment order for someone who isn't showing unmistakable symptoms that would make them a danger to themselves or others.

There should be some middle ground between the extremes of confinement to a hospital and letting someone simply spin out of control. Legislation to implement an outpatient civil commitment program in Maryland will be taken up when the General Assembly convenes next year. This is a complex issue that requires sustained and careful scrutiny if it is to be effective, but we hope lawmakers will find a way to act on it that guards the civil liberties of people suffering from mental illness while at the same time giving families and health officials more options to get victims the help they need.

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