Maine law lays out four criteria for determining whether a person poses enough “likelihood of serious harm” for a court to mandate inpatient psychiatric treatment.
The first three – harm to oneself, harm to others, or an inability to avoid risk or protect oneself from harm – are based on recent or current behavior. The fourth is more forward looking: If a person’s treatment history, current behavior and impaired ability to make an informed decision create “a reasonable likelihood” that the condition will deteriorate further and harm will result, a judge can order involuntary commitment.
But there’s a catch. The fourth benchmark – in effect, seeing trouble ahead and averting it – applies only in cases where a court-ordered commitment has already occurred and the person has been released from treatment subject to the conditions of a “progressive treatment plan,” known in the mental health community as a PTP.
The bill before the Judiciary Committee would eliminate that caveat, enabling providers and family members to petition the court for involuntary commitment in cases where no PTP exists. In other words, it would ask the court to compel inpatient treatment based not only on what’s already happened but on what those close to a person in crisis strongly believe will happen unless that person is placed in a secure therapeutic setting.
The change has the strong support of mental health providers. They include Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services, Maine, a statewide consortium of 35 agencies that provide mental health and substance abuse treatment services.
In an interview, Shaughnessy said she understands the fears civil rights advocates have about returning to the days when someone could be locked inside a psychiatric ward for reasons – sexual identity, for example, or religious belief – that have nothing to do with their mental health or a risk of harm. As she told the committee, the deinstitutionalization movement of the late 20th century changed that – the number of psychiatric inpatients in this country fell from a high of some 550,000 in the 1950s to about 30,000 in the 1990s.
But these days, Shaughnessy said, too many people in desperate need of help are ending up on the streets or in jail rather than in a secure treatment facility, where medication and therapy can help bring more stability to their lives.
“It’s a balance,” she said. “And I think we’ve tipped the scales just a little bit too far to an inhumane place where people are allowed to have their life all the way up to where they get shot by the police or arrested and sent to jail. And what they’re put through in that situation is so much worse (than involuntary commitment).”