Friday, February 07, 2014

Outpatient Civil Commitment: Coming to Maryland Soon?

Today's blog post is over on Clinical Psychiatry News.  See Dinah's article summarizing a lecture on outpatient commitment, guns, and more, by Duke sociologist Jeff Swanson: Here.

As mentioned, Delegate Murphy in Maryland has proposed a bill legislating Outpatient Civil Commitment here in Maryland.  The text of the HB 767 is here.  In it's current form, the bill is not likely to pass.  Please remember, before you comment, this bill was written by a legislator, it is not coming from psychiatrists. 

On another note, there is another editorial by Dinah on Psychology Today's website about defining mental illness.  It's not much different than the piece on Clinical Psychiatry News a few weeks ago, and with this, the topic of the Who Are the Mentally Ill? survey is now done.  


Anonymous said...

What are legislators doing talking about anosognosia which they clearly know nothing about? How do they propose to distinguish anosognosia from people who simply don't want treatment or don't want to risk the side effects. Answer - they can't.

For example, I'm sure a few people have noticed that I'm not a fan of forced treatment. Is my failure to see forced treatment as a helpful option for me, a sign of anosognosia? Do the antipsychotics I take work on everything except beliefs about forced treatment?

Blaming anosognosia is a way to forcibly treat anyone who doesn't agree with the psychiatrist's treatment plan. That is scary, scary stuff.

Hope it fails.


Dinah said...

P-K: I totally agree with you when I see legislators writing nonsense about anosognosia.

But I don't believe this legislation could apply to you -- you are willingly in treatment. I don't believe there will be psychiatrists taking patients to court for not agreeing to treatment plans or refusing specific medications. It's not about nuance (or it shouldn't be), it's really about people who refuse all treatment and end up getting hospitalized over and over again, especially those who are dangerous and violent when they get sick. But you are right, as this law is written, pretty much anyone who can get a psychiatrist to back them up can force a specific treatment plan on someone. It assumes lots of shrink time in court on short notice, and I can't imagine the judiciary will fly with this. Don't lose sleep about this particular law, it won't pass.

CatLover said...

In my state, many people were put under involuntary commitment orders when they were voluntary patients, because otherwise the state hospitals refused to treat them for lack of room. Now there are no state hospitals except for one, but it was only a few years ago I was threatened with commitment when I was in voluntary treatment, then the psychiatrist backpedaled and said that he had people voluntarily agree to be involuntarily committed. The ombudsman said that hadn't been true for years, so have to wonder about this doctor's ideas. I wonder if he ever warned people about the legal consequences? I doubt it. I had good insurance but it didn't cover treatment at the state hospital where I didn't want to go, and the state hospital would have taken all my assets for their abusive "treatment." (I was in there once, and it was abusive as hell, which most hospitals were not at that time. I was being hospitalized over and over again at the time, but i took my drugs as prescribed, and it was those drugs causing the behavior problems so the whole thing really makes me angry still. I'm a classic Robert Whitaker book example for treatment making me worse. Again, most of my doctors have been very nice but some were abusive, on purpose (arrogant SOB) or in most cases inadvertently.

I feel outpatient commitments just make it easier to stick people in the database. Maybe times have really changed, but my scare was only 8 years ago or so.

Dinah said...

catlover --what state? I'm sorry if I've asked before.

Dr. Swanson was clear that the improvements (meaning fewer hospital days, fewer incarcerations) may have been because AOT doesn't just obligate the patient to services, it obligates the services to the patient-- including services like case management and housing. Housing is really good. So someone can be a "voluntary" patient, but if they can't get the medicines they need or have no where to live but on the street, they may have repeated hospitalizations. Then AOT may not be just about control, but also about getting people things they need. So the only thing I can think of is that the doctor may have wanted you to be involuntary so that the state would be obligated to provide you with services. Obviously, I don't know your situation.

I think it would be better to provide services to those who want and need them on a voluntary basis.

CatLover said...

No, I had a good income (for a mental patient) and stable housing, and in fact was married (and still am, to the same person). My husband was appalled. The ombudsman wasn't happy either. I did have serious problems, but I always complied with treatment, which the drugs were making me much worse. I also exercised and used a light box, saw a therapist, etc. When I was in the state hospital, the psychiatrist who saw me was appalled that I was there and wrote multiple pages in my chart about why I should never be committed. He said that it was necessary to write all that because many psychiatrists were much too quick to commit, and my resources at home were a lot better than any state hospital would offer.

Dinah said...

Catlover, so I guess we're left with the fact that you weren't mandated to outpatient services, it was just an idea that got raised as a theoretical and was appropriately dropped. Please don't refer to yourself as "a mental patient.' I'm absolutely certain there is so much more to you than that. Perhaps a cat loving wife who is a very articulate blog participant who happens to have a psychiatric disorder? I'm guessing there's more to you as well.