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Involuntary treatment pursued for mentally ill in Maryland

The O'Malley administration proposed a law Wednesday that would force some mentally ill people onto medications to control their illness outside of hospitals.

Administration officials say their aim is to help the mentally ill live productive lives in their communities. But the approach, known as "outpatient civil commitment," has divided the mental health community.

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Some professionals, advocates and patients believe that requiring the mentally ill to take medication is necessary for those who don't realize they are sick and won't get help.

Others say it violates patients' civil rights.

The proposal, announced at a news conference Wednesday, follows months of study by the state health department.

Patients who refuse to take medication "end up in the criminal justice system or admitted to the hospital," said Dr. Gayle M. Jordan-Randolph, the state's deputy secretary of behavioral health. "We want to allow people to live in their communities, reduce their utilization of hospitals and their victimization."

The legislation is backed by some lawmakers and by advocacy groups such as the National Alliance on Mental Illness. Gov.-elect Larry Hogan did not respond to a request Wednesday for comment.

Jordan-Randolph said the state would introduce the requirement on a pilot basis to allow officials to assess its effectiveness.

It is not clear how much it would cost to enforce, Jordan-Randolph said. She described creating a program in which teams would assess not only the medical needs of patients, but their needs for housing and social services.

She said the health department would likely need to hire and train new staff, but predicted the state would probably save money in the long run by reducing police interactions and hospital visits.

She said the number of people who would need such a program would be small. She said the pilot would likely start with 100 people.

To force a patient into the program, the state would need a referral from a professional, review by an independent panel and court approval.

The patients would have to meet criteria such as having been involuntarily hospitalized twice in 48 months. There are circumstances now in which a court can order an individual to take medications as an inpatient, but not after discharge.

State Sen. Delores G. Kelley, a Baltimore County Democrat who supports the proposal, said during the news conference that Maryland is one of only five states without such a program.

Brian Stettin, policy director for the Treatment Advocacy Center, said an independent study of New York's program showed a reduction in hospitalizations and arrests. And one parent said she moved to Pennsylvania for such a program for her adult child.

Other parents said they were helpless as their adult children stopped taking their drugs and spiraled into psychosis that was ruinous to themselves, burdensome to the state and sometimes threatening to others.

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Susan Kneller has taken calls for a mental illness help line for 22 years.

"Many callers tell us their relatives have been hospitalized repeatedly but refuse to follow any recommended outpatient treatment, resulting in the psychiatric deterioration and hospitalization cycle starting all over again," Kneller said.

"These callers live the hell dealing with what is often horribly bizarre behaviors that cause dysfunction to whole families," she said. "We cannot offer them any solution since Maryland does not have an assisted outpatient treatment law."

Dan Martin, policy director of the Mental Health Association of Maryland, agreed that continuity of care is a challenge for some people. But he said it's better to work to get them into treatment and onto medications voluntarily.

The General Assembly rejected separate bills proposing the voluntary and involuntary approaches during the last legislative session.

Supporters of the voluntary approach released a report of their own Wednesday in which they said forcing a patient to take medications violates his or her civil rights, might divert money from voluntary programs, and can affect the poor and minorities disproportionately.

The Mental Health Association of Maryland, Maryland Disability Law Center and On Our Own of Maryland Inc. said there isn't enough evidence that involuntary programs reduce the use of the health and criminal justice systems or improve outcomes for the mental ill.

The groups said they prefer "assertive community treatment."

"Existing evidence supports the development of a voluntary program that identifies the high-risk population, provides ongoing outreach and engagement efforts, and delivers high-quality individualized services and supports," they said in the report.

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