Involuntary treatment for mental illness back before committee

Boston Statehouse

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BOSTON (SHNS) – Advocates for people with mental illness and those with disabilities lined up Monday afternoon to urge a legislative committee to once again reject legislation that would authorize court-ordered outpatient treatment programs for people with severe mental illness.

Massachusetts is one of three states that does not allow outpatient commitment, a civil court process sometimes referred to as assisted outpatient treatment (AOT) under which doctors, hospital officials and family members of an individual with a serious mental illness can petition a court to place the person in a treatment plan overseen by a mental health professional.

The concept has encountered opposition at the Joint Committee on Mental Health, Substance Use and Recovery in previous sessions — including from former mental health commissioner and current Secretary of Health and Human Services Marylou Sudders — but Rep. Mathew Muratore of Plymouth filed “reworked” legislation (H 2121) this session in hopes of making outpatient commitment a possibility in the Bay State for “at-risk individuals suffering from severe mental illness who have a history with treatment of 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 bounce between emergency rooms, jails and homeless shelters. But opponents said mental health care is not successful when it is forced upon people and argued the state should instead funnel more resources into voluntary, peer-based supports.

“Involuntary outpatient commitment, as also referred to earlier as assisted outpatient commitment, undermines the values of personal autonomy, liberty, dignity and choice that define what it means to live in the community,” Marlene Sallo, executive director of the Disability Law Center, told the committee Monday. “Involuntary outpatient commitment also creates yet another parallel to the correctional system where individuals with mental illness are forced into a cycle of being admitted, held, released, and then, with involuntary outpatient commitment, placed under probation in the community.”

Sean Donovan of the Wildflower Alliance, formerly the Western Mass Recovery Learning Community, told the committee that he was “locked up in a psych facility” after a suicide attempt at the age of 20 “via a false choice” — either sign himself in or be involuntarily committed by a doctor.

“That form of coercion had actually great effects: I didn’t stop thinking about suicide in the years after leaving that psych unit, but I learned to be quiet about my pain and struggle knowing it could lead to further suspensions of my liberty,” he said.

Supporters said Muratore’s bill contains language that takes away the possibility that someone who does not comply with a court order could be held in contempt of court.

“The last thing we’re trying to do here is establish a new basis to throw somebody in a cell. The only real legal effect of the court order is that it makes it a little bit easier to hold somebody for a short-term evaluation if it appears they’re not adhering to their treatment. If that evaluation finds they don’t meet inpatient criteria, the person is going to be released,” Brian Stettin, policy director at the Treatment Advocacy Center and a former New York assistant attorney general who helped write that state’s outpatient commitment law, said. “The point here is to convey to the person that the court is taking their outpatient treatment seriously. It is not to punish, coerce or bully somebody into submission and folks who are taking part in these programs do not perceive it that way in reality.”

Massachusetts has other procedures already in place to allow courts to order mental health treatment. A person can be involuntarily committed to a psychiatric facility if they are mentally ill, facing a likelihood of serious harm without being committed, and there is no appropriate, less restrictive setting available. So-called Rogers guardianship allows a Probate and Family Court judge to appoint a guardian to authorize “extraordinary medical treatment,” such as antipsychotic medication, for a person deemed unable to make informed decisions.

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

At that hearing, she rejected claims that outpatient commitment programs have saved money in other states and said mental health services required more funding for those who are seeking treatment, the News Service reported.

“I stepped down in 2003,” Sudders said in 2013. “In relative terms there was more money in the Department of Mental Health budget then than there is today. So I would suggest to you, if we pass this bill, if it became law — and I hope it does not — what exactly is it that we are committing people to? Wait lists? Boarding in emergency rooms?”

Sudders’ office did not provide an answer Monday to a News Service question about whether the secretary continues to oppose outpatient commitment and whether she or her office has shared testimony on the issue with the Joint Committee on Mental Health, Substance Use and Recovery as it considers Muratore’s bill this session.

Shawn Duhamel of CK Strategies, who advises the group AOT Now, said Muratore’s bill is redrafted from previous sessions to be a “narrowly-defined and workable AOT law.”

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

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