People with Mental Illness and Comprehensive Community-Based Treatment

The Judiciary Committee of Connecticut’s General Assembly has once again rightly rejected a law that proposed a repressive way of dealing with people with very serious mental illnesses who are not receiving the treatment and support services they need.

Although most states have such “outpatient commitment” laws, most states also do not enforce these laws because of the costs of providing the services. Connecticut already has conservatorship laws that allow the courts to appoint a conservator for someone incapable of managing their own affairs, with the legal protections for the person who is being conserved.

Connecticut also has an inpatient commitment statute that allows someone to be hospitalized who is “gravely disabled.” There is no issue about Connecticut having enough laws regarding the treatment of people with serious mental illnesses. There is a fundamental issue regarding the lack of effective outreach and engagement services to help the individual not involved in treatment deal with their own health issues.

There is no other illness for which we would presume that we should use legal force to make someone take medications. In fact, about 50 percent of people who are prescribed heart medications do not take them or take them erratically, but no one would even think we would use the intervention of the court and health care “police” to make them do so. The same applies to people with diabetes and many other chronic health conditions. Not taking care of one’s blood pressure, heart conditions, diabetes and many other disorders could result in someone causing a car crash that would injure others, erratic behavior and self harm. However, it would be unthinkable to do the following that this bill outlined:

“A conservator of the person appointed pursuant to subsection (b) of this section may request that state or local police or a licensed or certified ambulance service assist in transporting the patient to a designated location for purpose of administering the medication.”

The National Institute of Mental Health conducted an in-depth study on psychiatric medications in 2005 and found that 75 percent of people with serious mental illnesses on medications go off their meds because they don’t work or because of disturbing side-effects. It requires patient, and often trial and error approaches, to find a medication regimen that is effective with fewer side-effects for someone with a serious mental illness (as it does for other people with complex health care conditions).

Studies comparing outpatient commitment with services to those in which the same services are available without forced treatment find little difference in outcome.

Nationally, and in Connecticut, initiatives such as Housing First, in which people who are homeless, mentally ill and may also have substance abuse disorders, are linked with decent housing with no requirement for services. These individuals DO engage in services and treatment and have a high success rate in maintaining housing and stabilizing their health.

The same approaches are now being piloted nationally and in Connecticut with people with serious mental illnesses and with others with complex health care conditions: Engage individuals in a manner they find acceptable, work with them to help manage their serious health issues and address their social and support issues in order to improve their quality of life and well-being.

The issue is not forced outpatient treatment, but rather outreach, engagement and nontraditional services that do not give up on people.

This, of course, requires that the state fund these services, some of which could be Medicaid reimbursable, as well as adequately fund the need for health education and medication evaluation that complex health care issues require. Involuntary outpatient commitment will not do away with the lack of supported housing and underfunded services in the current mental health system, and it is not a substitute for the necessary resources for effective treatment.

In an op-ed piece that was submitted earlier to The Mirror, the Treatment Advocacy Center ended its statement about forced outpatient treatment with the following:

“A more constructive use of such advocacy energies would be to focus on ways to help this neglected population while making the most effective and efficient use of scarce resources.”

We agree. Let’s work together on an effective and efficient and humane mental health system that focuses on engagement and the range of services and housing needed. This is the approach that works.