The HIgh Cost of Forced Outpatient Care

I'm going to refer you to a long article in The Herald News,  Focus: Safety concerns prompt states to revisit involuntary commitment laws that address the mentally ill.  

Now I'd like to bring you to the end of the article where there is mention of the fact that President Obama has authorized $60 million to fund these programs.  If we divide that evenly between the states, it's about $1.2 million per state.  New York already has a program for involuntary outpatient commitment called Kendra's law.  The studies have shown that it has been successful in decreasing hospitalizations and incarceration.  The costs are calculated  per person "before" and "after" involuntary commitment, so the amount of money shelled out for each patient goes down when they've been put in the program.  What isn't reflected in the cost, is the overhead and infrastructure that New York State put in place to increase services.  I will point out to you that Kendra's law is mostly used in New York City, around Albany, and a few other hot spots, but not in the rest of the state.  And how much money has this successful program cost to implement in these populated parts of New York?  From the website of the NY Office of Mental Health:

Kendra's Law: Final Report on the Status of Assisted Outpatient Treatment
Resources to Provide Court-Ordered Services

The Governor's budget for Fiscal Year 2005-2006 provides more than $32 million for operation of services in support of Kendra's Law. This appropriation continues State support of case management and other services aimed at keeping recipients in a treatment program, including psychiatric medication as required. Since Kendra's Law went into effect, Governor Pataki has also acted to expand access to case management and other key community-based mental health services that would be needed by individuals receiving court-ordered treatment, as well as many other individuals with severe mental illness who have less intensive, but still substantial, service needs. The Governor's budget for Fiscal Year 2005-2006 also provides more than $125 million in ongoing funding for such services. This "Enhanced Community Services" funding has been used to both improve and expand the capacity of the existing community-based mental health system and to strengthen the cohesiveness and coordination of that system. More specifically, Enhanced Community Services were designed to steer the New York State mental health system toward a more person-centered, recovery-oriented service delivery approach, and were targeted for the following purposes:

• to expand case management, Assertive Community Treatment (ACT), and housing services to support community integration;
• to develop Single Points of Access (SPOA) to better manage service access and utilization; and
• to increase the availability of other services that enhance community participation and improve the engagement, quality of life, and satisfaction level of service recipients.

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 Many states have involuntary commitment laws. Few of them implement them, as the Herald News article highlights.  It costs too much.  $60 million is not going to do it for a country of 300 million people.  And while we do know that the program reduces hospitalizations and incarcerations in this vulnerable group of very ill, high users of emergency mental health services, what we also know is that the recipients don't like it; satisfaction rates are low (---that statistic doesn't make the news, presumably because no one cares?)

Finally, the article ends by pointing out that involuntary outpatient commitment is not about forcing medications.  This is a common saying of those who support it, but when legislation was proposed in Maryland, the legislation included an order for a specific class of medications and procedures to make changes or contest it.  If a judge tells you that you have to take a medication or you can be brought by the police to a hospital for evaluation, how is this not forced medication?