Civil commitment an essential tool

Guest column published in the Portland Tribune, August 12, 2010

MY VIEW • Facts should guide mental health policy, by Aileen Kroll, legislative and policy counsel at the Treatment Advocacy Center.

“Millions in taxes buy nightmares for mentally ill”Jenny Westberg’s guest opinion on civil commitment (Aug. 5) – was long on passion but short on facts. Because the best opinions and policies are grounded in accurate information, the public and policy makers deserve more information.

CLAIM: Civil commitment does not prevent people with severe mental illness from being killed during encounters with law enforcement.

FACT: Law enforcement officers nationwide are today’s first responders to crisis involving mental illness. Too often, these encounters result in preventable tragedies such as the ones detailed in Peter Korn’s story, “Suicidal? Psychotic? Dangerous? Who should be committed?” (July 15). The law enforcement community knows this. That’s why the National Sheriffs’ Association, among others, supports progressive civil commitment standards.

In New York, where outpatient civil commitment has been in use since 2000, studies have consistently found that people with severe mental illness who are ordered by courts to stay in treatment experience fewer arrests. People who don’t come in conflict with law enforcement can’t be killed by law enforcement.

CLAIM: Commitment law is based on a federal standard.

FACT: The Supreme Court has established legal parameters to protect the civil rights of individuals who undergo involuntary commitment, but every state sets up its own civil commitment criteria. Oregon is no different. Civil commitment here, as elsewhere, is based on state law that establishes due process procedures for people who are too ill to voluntarily accept the treatment that would give them access to life-sustaining treatment.

An estimated 40 percent to 50 percent of all patients with bipolar disorder or schizophrenia have a neurological condition known as anosognosia – lack of insight into their own illness. People who can’t recognize they are ill don’t think they need treatment. Civil commitment exists to give them an alternative to the devastation of untreated symptoms.

CLAIM: Commitment is open-ended, and civil liberties are removed. “Every commitment is a potential life sentence.”

FACT: In Oregon, involuntary treatment is utilized only when voluntary treatment has failed and the person meets one of these standards: is a danger to self or to others; is unable to provide for basic personal needs and is not receiving care necessary for health/safety; or has chronic mental illness that has led to repeated hospitalizations. As soon as a patient is stabilized and no longer meets the criteria for commitment, the patient must be released.

On a more practical level, after decades of neglect and attack, Oregon’s mental hospitals have too few beds even for critically ill patients, much less to provide lifelong housing. In reality, the mentally ill in Oregon are far more likely to end up in jail or prison than in a hospital. The recently released study by the Treatment Advocacy Center and the National Sheriffs’ Association found there are three times more people with severe mental illness in Oregon jails than in its hospitals. The most likely “open-ended” scenario for many people with severe mental illness and their families is never getting treatment at all.

On one of Ms. Westberg’s points, we do heartily concur:

FACT: Outpatient care for mental illness is far less expensive than inpatient care. Fortunately, Oregon is one of 44 states that have outpatient commitment as an alternative to involuntary inpatient commitment. Court-ordered outpatient treatment (frequently referred to as assisted outpatient treatment or AOT) gives people a way to get treatment in the community either in lieu of hospitalization or as part of a discharge plan. It is compassionate, humane and it works, provably reducing arrests, incarcerations and homelessness while dramatically increasing medication compliance.

There is nothing softhearted or ethical about dooming people too sick to get help for themselves to living on the streets or in jail cells, to being victims or perpetrators of violence, and to being lost to themselves and society when they could be productive. There already is a “better way” for those with severe mental illness in Oregon. What remains is for well-informed public officials to put the law Oregonians have to work.