Abuse of commitment laws

[David Baxter PhD]

Abuse of commitment laws
By Treatment Advocacy Center

The Treatment Advocacy Center advocates for strong treatment laws ? and protections. Our Model Law includes numerous overlapping protections to safeguard those under court-ordered treatment and to ensure that only those for whom it is appropriate are placed or remain in assisted treatment.

It should be extremely difficult to abuse such laws, and we are pleased when people trying to do so are caught and punished.

 

[David Baxter PhD]

Key aspects of the Model Law

The Model Law is more remarkable for what it is not than for what it is. It is not entirely revolutionary nor does it eradicate the basic constitutional protections provided by current treatment laws. There are familiar provisions for emergency treatment; a subsequent certification for a treatment hearing by an examining doctor; a more lengthy process to petition for the treatment of someone less sick; under different names, outpatient commitment and conditional discharge; periodic reviews and possible renewals of treatment orders; and a host of other mechanisms common to current laws for securing treatment for those overcome by mental illness.

A cursory examination may give the impression that the Model Law maintains the status quo when it is actually a compilation of the most effective provisions of existing state laws. Variations of virtually all of this proposal’s sections are the current law somewhere in the United States. In essence, we have combined each of the best available components into a statutory model better than any currently in effect.

Only in one area have we dared to be creative: the protection of the rights and well being of those placed in assisted treatment. There we put forth procedures more extensive and vigilant than those now in place anywhere in the nation.

Following is a description of some of the key aspects of the Model Law.

STANDARDS

In developing a system to place individuals in psychiatric care, the most crucial question is "when is such an intervention appropriate?" The answer is found in the legal standard that a person must meet in order for his or her placement in treatment to be allowed under the law. The Model Law sets out four alternative criteria that, if met, justify assisted treatment.

Chronically disabled: Only a few states have criteria designed to help people stuck in the "revolving door" of repeated hospitalizations, symptomatic behavior, and, for many, incarcerations. "Chronically disabled" allows consideration of possible harm to a person with symptomatic mental illness in light of past psychiatric history (which would include previous non-compliance with treatment), current likelihood of treatment compliance, and the risk of deterioration without treatment. This standard is thus tailored to assist those who are stuck in the revolving door.

Gravely disabled: A number of states have included "gravely disabled" as grounds for treatment placement. Most of these laws define this condition as when a person becomes so incapacitated by mental illness as to lose the ability to provide for his or her basic needs, with these normally delineated as food, clothing, shelter and, sometimes, medical care. The Model Law mimics the more progressive of the jurisdictions with gravely disabled criteria by explicitly including someone who is likely to suffer significant harm without treatment.

Incapable of making an informed medical decision: While not an independent ground for treatment placement, the "gravely disabled" and "chronically disabled" criteria each also require that the person is either unaware that he or she is ill or is otherwise incapable of making rational decisions concerning proposed treatment. Non-dangerous individuals who are capable of making informed medical decisions should not be placed in assisted treatment.

Danger to others: Every state allows for the court-ordered treatment of individuals who because of mental illness are a significant threat to the safety of other people. The Model Law incorporates a definition of "dangerous to others" similar to that of most states, but makes clear that presenting a threat to a person in one’s care, such as a child, or having caused intentional damage to the substantial property of another shall be evidence of dangerousness.

Danger to himself or herself: Similarly, every state allows for the assisted treatment of those who are demonstrated to be a danger to themselves, but the Model Law makes clear that a person’s past related behavior shall be considered when making the determination as to whether someone meets this treatment standard.

See the complete document here.