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Should people with severe mental health needs get court-ordered treatment? State Senate to decide

Maryland Health Secretary Dr. Laura Herrera Scott. Photo by Bryan P. Sears.

Maryland’s Senate is set to vote on a bill that could impose court-ordered mental health treatments for people whose significant mental health needs lead to frequent hospitalizations or interactions with law enforcement.

House Bill 576 would create so-called “Assisted Outpatient Treatment” processes across the state in which a circuit court can order a specified mental health treatment regimen for someone with severe and persistent mental health needs — potentially without their consent.

The bill, from the Maryland Department of Health, received near unanimous support from the House of Delegates, and it’s now up to the Senate to determine whether those who do not comply with suggested mental health treatment should face a judge.

Maryland is one of three states without an assisted outpatient treatment law, along with Connecticut and Massachusetts.

The preamble to the legislation says that a “small but persistent subset of individuals with severe mental illness struggle to engage voluntarily in treatment necessary to live safely in the community.” Those individuals tend to experience homelessness, hospitalizations and repeated incarceration, according to the bill.

Under the bill, the director of specific mental health programs or any adult with a legitimate interest in the welfare of a person with persistent severe mental health needs can petition a circuit court for assisted outpatient treatment.

After a petition is filed, a “care coordination team” would create a treatment plan for the individual with mental health needs and the individual has an opportunity to voluntarily agree to the plan. If the individual does not agree to the treatment plan, then the issue would go to a circuit court hearing.

The legislation has support from people who have watched loved ones struggle to keep up with, or are unwilling to comply with, medications and treatments meant to improve their mental health conditions.

That includes Eric Luedtke, Gov. Wes Moore’s (D) chief legislative officer. In February, he testified in favor of HB 576.

“My brother has schizoaffective disorder,” Luedtke told the House Health and Government Committee. “I did my best. I’ve done my best. I don’t know where he is right now. I haven’t seen him in a year. He’s homeless. He’s been in and out of emergency rooms. In and out of interactions with police.”

“The constant cycle that our family members face is torture,” Luedtke continued. “Those of us who deal with it will tell you that you live with an enormous sense of guilt at having failed your loved ones. But the truth is we need more tools to help people and this is one of those tools.”

At the same hearing, Department of Health Secretary Laura Herrera Scott said that while assisted outpatient treatment can result in court ordered treatment, the legislation also affords “individuals the opportunity to engage in mental health treatment on a voluntary basis.”

“A court hearing would only be scheduled if an individual has not agreed to participate in treatment,” she said.

Another supporter of the legislation is Debra Bennett, who recently wrote an op-ed in the Baltimore Sun about her late son, who passed away after numerous hospitalizations due to his mental health needs.

She believes that an assisted outpatient program would have helped her son keep up with suggested treatment for his mental health.

“My prayer is that this does pass,” Bennett told Maryland Matters. “While it is too late for my son…it (assisted outpatient therapy) can save the life of someone else.”

However, some mental health and disability advocates worry that the process could further traumatize those who are already struggling, lead to distrust in hospital settings, and create medical debt for those patients.

Courtney Bergan, an Equal Justice Works Fellow with Disability Rights Maryland, opposes the bill and argues that “there’s usually a good reason” some people do not keep up with their mental health treatments.

Such reasons include side effects of prescribed drugs for their conditions, inaccessible costs of medications, housing instability, and flack of transportation to receive treatment.

“I believe the risks outweigh the benefits,” Bergan said.

‘Outer bounds’

When the Senate Finance Committee discussed HB 576 Tuesday, Sen. Clarence K. Lam (D-Howard and Anne Arundel) proposed an amendment to the bill to place some barriers on which medical treatments could be used in an assisted outpatient treatment program and when.

“It doesn’t seem like there are any outer bounds,” he said, referring to the breadth of potential court-ordered treatment options, such as electroconvulsive therapy.

According to the American Psychiatric Association, electroconvulsive therapy (ECT) is “highly effective for the relief of major depression,” and has been used in treatments for bipolar disorder and schizophrenia, but Lam wanted to prohibit ECT from being ordered on an involuntary basis.

He also wanted to place limits on how certain drugs were used in an assisted outpatient treatment, to “make sure you can’t, let’s say, compel someone to take birth control because you think they have a mental illness and they shouldn’t be procreating.”

Sen. Pamela Beidle (D-Anne Arundel), chair of the Finance Committee said that while she agreed the legislation could have some guardrails, she thought Lam’s amendment went “overboard.” She also noted that the Maryland Department of Health was “not fond of this amendment.”

After some discussion, Lam withdrew his amendment. The Senate Finance committee passed the bill with 10 members voting in favor, but Lam abstaining from the vote.

The full Senate will likely vote on the measure in the coming days as the General Assembly works through hundreds of bills in the final days of its session.


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Should people with severe mental health needs get court-ordered treatment? State Senate to decide