Those of us who work in psychiatric hospitals know that persons with serious mental illnesses such as schizophrenia are frequently readmitted to the hospital because they don't continue in treatment after discharge. These readmissions are often the result of behaviors — driven by paranoia or hallucinations — that put them or others in danger. There is very sound science to show that these symptoms are effectively and safely treated with appropriately prescribed antipsychotic medications. Uninterrupted outpatient treatment could prevent many if not most of these readmissions.
The commentary by Laura Cain, Linda Raines and Mike Finkle ("Forced treatment is not a panacea," Jan. 8) implies that a study cited by Dr. Thomas Insel of the National Institute of Mental Health supports their proposition that antipsychotic medication "is causing permanent disability for some individuals with serious mental illness." Neither Dr. Insel nor the actual study cited by Dr. Insel made any such claim. What the study actually showed was that some younger persons, in the first episode of their illness, may do better on low doses of medication, which is not a new finding at all. But it also showed that only 17 percent of the individuals in the entire study were able to be completely off medication during the last two years of a seven-year study. Again, not a new finding. We know that medication is an indispensable component of the treatment of psychosis in nearly all cases.
The proposal for outpatient civil commitment by the Maryland Department of Health and Mental Hygiene is designed to prevent a small number of particularly vulnerable persons with serious mental illnesses from dropping out of treatment and out of sight until they are in crisis. It will provide a means by which a treating provider can request that such a person be evaluated if he or she drops out of sight — hopefully before the development of dangerous symptoms. The goal is to encourage people to stick with outpatient treatment so that they are able to live safely, make progress in their recovery from illness and avoid crisis situations that often lead to emergency room visits and hospitalizations or arrests.
We clinicians need additional tools to help us stop the vicious cycle of crisis readmissions and improve the quality of life and response to treatment of these vulnerable citizens. Outpatient civil commitment is one such tool. Its time has come.
Drs. John Boronow and Robert Roca, Towson
The writers are, respectively, medical director of adult services and vice president of medical affairs for the Sheppard Pratt Health System.