Bill would force mentally ill to take their meds
Tuesday, June 21, 2005 - Bangor Daily News
AUGUSTA - The mental health community is divided over a proposed new law that would require some people with mental illness to take prescribed psychiatric medications or face involuntary admission to a state hospital.
The initiative, known as "community commitment," had all-but-unanimous bipartisan support in both the House and Senate during the recently adjourned legislative session, but has been held over for reconsideration because it would draw about $600,000 over the next two years from the state's bare-bones General Fund.
Lawmakers on the budget committee may approve the fiscal note when they reconvene in special session at the end of this month. If not, the bill will be reintroduced in the regular fall session.
The Maine chapter of the National Alliance for the Mentally Ill, a leading organization that advocates for patients' rights, has refused to take a position on the community commitment bill for fear of splintering its membership. A NAMI spokeswoman said last week that while some providers and family members see the measure as a way to keep people healthy and productive, others find it coercive and an infringement of personal rights.
In its final amended form, L.D. 151, An Act to Improve the Delivery of Maine's Mental Health Services, would set up a one-year, Augusta-based pilot project to treat a maximum of 50 people. It would trigger a court review of patients with multiple psychiatric hospitalizations and repeated outpatient noncompliance with their medication orders. When those patients are discharged from Riverview Psychiatric Center in Augusta - one of Maine's two public psychiatric hospitals - they could be ordered by a court to participate in an "assertive community treatment" process, or ACT.
ACT provides intensive outpatient support and monitoring with a team of mental health professionals. While there are already a number of ACT teams working with recently discharged patients in Maine communities, they don't have the authority to require medication compliance and often simply stop seeing patients who drop off their radar or become noncompliant, hostile or uncontrolled.
The pending law would create a new ACT team dedicated to serving community commitment clients. If team members determined that a client has stopped taking medications as ordered and is showing even mild symptoms, the team would be empowered to have the client readmitted to the hospital against his will. Once restabilized, the client could once again be discharged to community commitment and the ACT program. The law would limit the initial commitment period to four months and subsequent discharges to more than one year.
The measure also would fund temporary housing for those assigned to the program.
The bill's sponsor, Sen. John Nutting, D-Leeds, said Monday that family members, frantic to protect the well-being of their loved ones, have been a primary driver of the proposal. Other pressures include the societal costs of having people with poorly controlled mental illness living in Maine communities, as well as the cost of repeated hospitalization or incarceration of those who become dangerous. The measure has the support of a broad coalition of health care groups and law enforcement officials.
According to Nutting, 42 other states have community commitment provisions. In New York, he said, the average length of stay in psychiatric hospitals has decreased from 50 days to 15 days, and there has been a 78 percent decrease in the number of inmates in the state's prisons and jails who have a diagnosed mental illness.
In New Hampshire, Nutting said, the average length of time a psychiatric patient stays compliant with medications after discharge has risen from 31/2 months to 11 months since the state enacted an outpatient commitment process.
Nutting's bill has engendered strong opposition from Maine's Disability Rights Center. Public Policy Director Helen Bailey said last week that people with mental illness have the same rights as those with other illnesses.
There are good reasons why people may choose not to take their medications, she said, and the right to do so should be protected. Some drugs cause intolerable side effects, and some should not be taken, for example, if a woman is pregnant. Some people have no transportation or other complicating factors and are unable to get their medications, she added.
Accepting that ACT teams should sometimes be more aggressive in maintaining therapeutic relationships with difficult clients, Bailey said it's appropriate to beef up their accountability without "putting the onus on the people with mental illness."
The debate over LD 151 has focused on a few "anecdotal situations," Bailey said, but the real problem is the overall quality of care being provided in the community mental health system.
At the Bangor Area Homeless Shelter, Executive Director Dennis Marble said he supports the idea of community commitment, while acknowledging that its coercive aspect is a problem. Many of his clients regularly cycle through the mental health system, Marble noted - they get hospitalized to get their medications straightened out, are discharged for follow-up services in the community, function well for a time and then gradually get worse. When they reach the point where they are a danger to themselves or others, they get recommitted to the hospital, or are imprisoned.
With each cycle, Marble said, people with mental illness take longer to restabilize. They also suffer "cumulative consequences to their overall health," he said, including worsening chronic conditions such as heart disease or diabetes, loss of nutritional health and injuries due to loss of judgment.
Marble said he "gets comfortable" with the idea of community commitment when he focuses on the notion of community - both as a source of caring intervention and as a system with limited financial resources. Unmanaged mental illness costs the state a lot of money, he noted - dollars that could be better spent providing health care to a broad range of Mainers.
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