of Bucks County
Pennsylvania
Bucks County's Voice on Mental Illness
NAMI PA
Bucks County
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Bucks County's Voice on Mental Illness
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MENTAL HEALTH CRISIS Number 1-800-499-7455
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Bill mandates treatment for mentally illBy: JO CIAVAGLIA (Sun, Nov/18/2007)Bernadette Dyer can't stop the voices in her daughter's head, the same way she can't stop her sudden sojourns to God only knows where. Once she walked 50 miles from her Doylestown home guided only by the thoughts that her mom says tell her to go ... go ... go. A few weeks ago, she was missing for six days before she was found unconscious, kidneys failing in the Philadelphia Zoo parking lot. At least six times since October, Christine has wandered off, Dyer said. The last time was Monday, after she entered an intensive inpatient psychiatric program in Doylestown. Three days before that her family found her in Chester without shoes or a coat four days after she disappeared. But Dyer can only wait and worry. Christine is 44, an adult with control over her medical decisions, including how to treat — or not treat — her schizophrenia. Under state law, people cannot be forced into treatment until their mental condition deteriorates to the point a judge finds they pose a “clear and present danger” to themselves or others. That doesn't happen in more than 40 other states and the District of Columbia where courts can order people who are seriously mentally ill but consistently refuse treatment into outpatient programs. The state Senate Public Health and Welfare Committee last month held a hearing on a bill that would add assisted outpatient treatment to the state's civil commitment law. Bucks County Sen. Stewart Greenleaf, R-12, has proposed adding the mandatory treatment since 2002. Mental health advocates say the current commitment law has created a revolving door of brief, involuntary hospitalizations for patients who are unable or unwilling to follow recommended outpatient programs. “Would you let grandma with Alzheimer's wander around because she left the nursing home because she didn't want help?” said Debbie Moritz, executive director of the Bucks County chapter of the National Alliance for the Mentally Ill. “Sometimes people need to be in a safe place for themselves and society. Eating out of trash cans, living in the gutter is not a civil liberty.” Others, though, contend there is little evidence the court orders are effective, and the laws deflect attention from deeper problems plaguing the mental health system, such as a lack of funding for expanded treatment and support services. Patient advocates fear that law could be abused by applying it whenever a patient disagrees with a doctor's recommendations. A 2005 state law allows for psychiatric advanced directives specifying treatment preferences when a person's decision-making is impaired, patient advocates added. “I believe that the bill has grown out of a sincere desire to help people with mental illness,” said Joseph Rogers, president of the Mental Health Association of Southeastern Pennsylvania. “Unfortunately, if it became law, it would have the exact opposite effect.” LACK OF UNDERSTANDING Assisted outpatient treatment orders are not a new concept; Washington, D.C., and 42 states have them, and some have existed 20 years. Pennsylvania's bill is modeled after New York's “Kendra's Law,” one of the most recent and well-publicized laws adopted in 1999 following the death of Kendra Webdale, who was pushed onto subway tracks by a man with a long history of untreated schizophrenia. Since the law has been in place, New York has seen drops of 74 percent to 87 percent in previously non-compliant patients experiencing homelessness, arrest and incarceration, and psychiatric hospitalizations, said John Snook legislative and policy counsel for the Treatment Advocacy Center in Virginia. Roughly 750 New Yorkers a year are ordered to maintain psychiatric treatment under the state law, Snook said. In Pennsylvania, an estimated 500 people a year could be ordered into treatment, about eight in Bucks County, he added. Most of the opposition to assisted outpatient treatment is that it makes it easier to involuntarily commit someone to a psychiatric hospital, but that isn't the purpose, Snook said. What the law does is provide an extra layer of professional scrutiny designed to intervene before patients reach the crisis point. “We're trying to help people stay out of hospitals,” he said. The court orders would consider patient treatment wishes and nothing in the law allows involuntary medication, Snook said. If an adequate outpatient program opening is unavailable, the patient would be released after 72 hours, unless the clear-and-present-danger rule is met for involuntary commitment. A patient would have to meet all the law's criteria to be eligible for court-ordered treatment, including a previous history of mental health hospitalizations and non-compliance with recommended treatment, Snook said. The initial court order would last six months, but it could be extended for a year. Patients who refuse to follow their outpatient program could be held for up to 72 hours in a psychiatric center to determine if they meet the clear-and-present danger guidelines. If they don't, patients are released, Snook said. Assisted outpatient treatment laws address a brain disorder that medical research suggests is frequently experienced by people with schizophrenia and bipolar disorder. The neurological condition, called anosognosia, results from information processing difficulties and impairs the ability of people to recognize they have a mental problem. Newtown Township resident Jeanette Castello believes anosognosia is why her daughter was involuntarily hospitalized 15 times in 18 months. Her daughter, whom she didn't want identified, was diagnosed with schizophrenia her freshman year of college. Initially she reluctantly agreed to continue psychotropic medications, but after a year she stopped. Her mental health rapidly deteriorated. It took weeks before she reached the point where she could be involuntarily committed. Less than two weeks after her second hospital release, she stopped her medications again. When Castello called the psychiatric hospital, she learned they couldn't get involved until her daughter's behavior reached the clear-and-present-danger level, she testified at the October Senate committee hearing. “You see the same symptoms when she stops her medication,” Castello said. “It's an ungodly way to handle this illness. With other illnesses you don't wait until the worst possible stage before you decide now we'll give you treatment.” After she was released from a state hospital in 2002, her daughter started following her treatment program, including medication. Today, the 30 year old has the illness under control. “She told me that the reason she stopped her medications all those times was because she didn't think she had an illness, and when she took the prescribed medications they didn't make her feel any better and that, instead, they just made her feel very tired,” Castello said. FORCE DOESN'T WORK Others in the mental health community say assisted outpatient treatment laws shift attention and limited mental health funding and resources away from developing and expanding support services that are effective in preventing an illness reoccurrence. “The idea is, if you have this, a lot of people will be entering into a system and it's not going to expand the things we think work better,” said Sue Walther, executive director of the Pennsylvania Mental Health Association, which opposed the proposed Greenleaf bill. Kendra's Law has been successful because New York lawmakers attached increased funding to improve and expand services when it passed, Walther said. The Pennsylvania bill doesn't include a budget appropriation. Patient advocates also fear the law would force people who are not exhibiting dangerous behavior into treatment, which usually means medications against their will. Many people experience bad side effects on psychotropic drugs, and finding the most effective medications and dosage combination is often a time-consuming process, which is why people stop taking them, mental health advocates say. Some health insurance plans don't cover specific brand medications, so patients are left with taking less effective drugs or paying hundreds of dollars out of pocket to fill prescriptions. “If you talk to people who were in forced treatment, they'll tell you it was not a pleasant experience,” Walther added. Activist Joseph Rogers, of the southeastern chapter of the Mental Health Association, said he is living proof forced treatment doesn't work. He has been diagnosed with bipolar disorder and has been involuntarily committed six times — twice with police involvement. Now he has a written psychiatric advanced directive that outlines his treatment preferences. “Force and coercion have been proved to drive people away from treatment,” Rogers testified before the Senate committee. “Particularly horrible is the use of physical force, coercion or intimidation in the administration of psychotropic medications.” A study from Bellevue Hospital in New York City found that what helped clients the most were intensive services regardless of whether they received them voluntarily or under court orders, he said. Also, a National Association of State Mental Health Program Directors survey of state mental health commissioners found that while many states have such laws, most use them rarely because of a lack of adequate community-based services necessary for implementing them, he testified. Meanwhile, Bernadette Dyer waits for a call from her daughter, a family member or the police. She finds herself increasingly haunted by feelings of guilt. Is there something more she could have done? Dyer hopes her daughter will be found soon, but knows one day she might not. “Each time it gets worse. I don't want to see her die in the street,” she said. “She gets some kind of comfort from the voices when she walks. She has no fear. I try to ask her, what goes through her mind. She says she doesn't know. It's the illness. It's a horrible illness.” Greenleaf's district includes Upper Southampton, Warminster, Warrington and 14 municipalities in Montgomery County.
WHAT IS CLEAR AND PRESENT DANGEROUS BEHAVIOR It may include actual or attempted substantial self-injury, attempted or inflicted serious bodily harm to another, acting in a manner that indicates that you may not be able to take care of yourself without assistance, or attempting suicide or showing high risk of suicide. The behavior must be observed and it must have occurred within the 30 days prior. HOW THE STATE'S INVOLUNTARY COMMITMENT LAW WORKS An individual who files a petition must truthfully describe in writing the behavior that they witnessed in the past 30 days that supports their belief that an individual is a clear and present danger to herself/himself or others. The petitioner may be asked to attend a hearing to testify about the information that they gave about the individual's behavior. Reports that someone is at risk because of mental illness go to the county mental health delegate. If the delegate determines the behavior meets the act's criteria, a warrant is issued. This authorizes a representative of the county mental health administrator or the police to take someone for psychiatric examination. An involuntary commitment period cannot exceed 120 hours. There is a provision in the law that allows an extension of involuntary treatment (inpatient or outpatient) up to 20 days. The extension is determined on the basis of a hearing with a mental health review officer, an official of the Court of Common Pleas, who can order extended care. CRITERIA PATIENTS MUST MEET TO BE CONSIDERED FOR ASSISTED OUTPATIENT TREATMENT UNDER PENNSYLVANIA SENATE BILL 226
Source: Pennsylvania Mental Health Procedures Act of 1976, Senate Bill 226 Jo Ciavaglia can be reached at 215 949-4181 or jciavaglia@phillyBurbs.com.
Article's URL: http://www.phillyburbs.com/pb-dyn/news/111-11182007-1442905.html | ||||||||||||||||||
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