Involuntary remedy for psychological sickness again earlier than committee

BOSTON – Lawyers for people with mental illness and people with disabilities lined up Monday afternoon to urge a legislative committee to again reject laws that would allow court-ordered outpatient treatment programs for people with severe mental illness.

Massachusetts is one of three states that prohibit outpatient treatment, a civil court process sometimes known as assisted outpatient care (AOT) that sees doctors, hospital officials, and family members of a person with severe mental illness petition a court for placement can put the person on a treatment plan that is supervised by a psychiatrist.

The concept has met opposition in previous meetings of the Joint Committee on Mental Health, Substance Use and Recreation – including former Mental Health Commissioner and current Secretary of State for Health and Human Services Marylou Sudders – but Plymouth MP Mathew Muratore submitted one “Revised” legislation (H 2121) this session in hopes of making Bay State outpatient services an option for “those at risk with severe mental illness who have a history of treatment for non-compliance”, he said .

Proponents of the measure said it would be an improvement on the current system where people with severe mental illness can often hop back and forth between emergency rooms, prisons and shelters for the homeless. Opponents, however, said mental health care is unsuccessful when imposed on people, arguing that the state should instead pour more resources into voluntary, peer-based support.

“Involuntary outpatient engagement, formerly referred to as assisted outpatient engagement, undermines the values ​​of personal autonomy, freedom, dignity and choice that define what it means to live in community,” said Marlene Sallo, executive director of the Disability Law Center the committee announced on Monday. “The involuntary outpatient obligation also represents a further parallel to the penitentiary system, in which people with mental illness are placed on probation in a cycle of admission, detention, release and then, with an involuntary outpatient obligation, in the community.”

Sean Donovan of the Wildflower Alliance, formerly the Western Mass Recovery Learning Community, told the committee that after attempting suicide at the age of 20, he was “locked up in a mental health facility” by “wrong decision” – either registering himself or by one Doctor involuntarily committed.

“This form of coercion actually had a big impact: I haven’t stopped thinking about suicide in the years after leaving psychiatry, but I learned to be quiet about my pain and struggles because I knew it would lead to further waivers of mine Freedom could lead. ”He said.

Proponents said Muratore’s bill contained language that eliminated the possibility that someone who fails to comply with a court order could be detained in disregard of the court.

“The last thing we’re trying to do here is create a new base to put someone in a cell. The only real legal effect of the court order is that it becomes a little easier to hold someone for short-term assessment if they are found to be disregarding their treatment. If that assessment indicates that they do not meet the criteria for inpatient treatment, the individual will be released, ”said Brian Stettin, Policy Director at the Treatment Advocacy Center and former New York Assistant Attorney General who helped draft this state’s Outpatient Obligation Act has contributed. “The point here is to convey to the person that the court takes their outpatient treatment seriously. It’s not about punishing, coercing or bullying someone into submission, and the people who participate in these programs don’t really see it that way. “

Massachusetts has already put in place other procedures that allow courts to order mental health treatment. A person can be involuntarily admitted to a mental health facility if they are mentally ill without the threat of serious harm and there is no suitable, less restrictive environment. The Rogers Guardianship enables a probate and family judge to appoint a guardian to approve “extraordinary medical treatment” such as antipsychotic medication for an individual deemed incapable of making informed decisions.

The state’s Rogers guardianship laws were one of the reasons why Sudders, who served as the state’s mental health commissioner from 1996 to 2003, spoke out against similar outpatient obligation laws at a 2013 hearing on Beacon Hill.

At that hearing, she denied claims that outpatient commitment programs in other states had saved money and said mental health services need more funding for those seeking treatment, the intelligence service reported.

“I resigned in 2003,” said Sudders in 2013. “In relation to that, there was more money in the budget of the Ministry of Mental Health at the time than there is now. So I would suggest to you that if we pass this law, when it becomes law – and I hope it doesn’t – what exactly are we going to oblige the people to do? Waiting lists? Boarding in emergency rooms? “

Sudders’ office on Monday did not respond to a question from the intelligence service as to whether the secretary continues to oppose the ambulatory obligation and whether she or her office has given what it considers testimony to the Joint Committee on Mental Health, Substance Use and Recovery on the issue has Muratores bill for this meeting.

Shawn Duhamel of CK Strategies, who advises the AOT Now group, said Muratore’s bill had been reformulated from previous sessions to be “a tightly defined and workable AOT law”.

“The aim is to create an AOT law that only serves the seriously ill with a history of treatment violations, hospitalization and / or incarceration, while ensuring due process and respect for individual rights,” he said.

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