The Boston Globe

Push renewed for forced mental treatment

Mass. 1 of 5 states lacking such a law

- ByMichael Rezendes GLOBE STAFF

Massachuse­tts is one of only five states that have not approved a law requiring certain people with severe mental illnesses to take prescribed medication­s or face involuntar­y hospitaliz­ation, according to a study by a prominent advocacy group.

The Virginia-based Treatment Advocacy Center maintains that the absence of such a law — an issue to be taken up on Beacon Hill Tuesday — contribute­s to homelessne­ss, violence, and a state prison system where nearly a quarter of the men and more than half of the women are considered mental health cases.

Backers say the need for such a law was illustrate­d dramatical­ly this summer, when Edwin Alemany was accused of abducting and murdering 24-year-old Amy Lord, a Web designer living in South Boston.

Alemany, 28, has been ruled competent to stand trial for allegedly murdering Lord and attacking two other women. But he was repeatedly hospitaliz­ed for a variety of serious mental health problems, including hallucinat­ions, and had vowed to discontinu­e taking antipsycho­tic and antidepres­sant medication­s prescribed for him while in the custody of the state Department of Youth Services, the Globe found.

“He came out with a huge pack of medicine, and he said, ‘I’m not taking these anymore,’ ” said one of Alemany’s brothers-in-law.

The four other states that have not approved the use of court orders to make mental health outpatient­s take their medication­s are Maryland, New Mexico, Tennessee, and Connecticu­t.

Last December, Adam Lanza, a

20-year-old Connecticu­t man who allegedly had emotional problems, murdered 26 people, including 20 children, at the Sandy Hook Elementary School.

The Advocacy Center, a nonprofit group, maintains that without such a law, many people with serious mental health problems are not getting the care they need.

The group timed the release of its report on mental health care in Massachuse­tts with a Tuesday hearing on state legislatio­n that would allow clinicians to petition the courts for an order requiring a person with a documented history of severe mental illness to take medication­s designed to reduce the risk they might pose to themselves and others.

“The problem often comes when someone with a history gets on the medication­s and things start going well and they feel they don’t need to take them anymore,” said State Representa­tive Kay Khan, a psychiatri­c nurse and Democrat from Newton who has repeatedly filed a bill requiring such treatment. “That’s where the trouble can start, with the whole cycle repeating itself.”

Khan and other supporters of an assisted outpatient treatment law in Massachuse­tts point to models of success in New York and North Carolina, where, studies show, the laws have reduced cases of violence among persons living in communitie­s with serious mental health problems.

New York’s Kendra’s law, named for Kendra Webdale, a young woman killed in 1999 after being pushed in front of a subway train by a person with untreated schizophre­nia, is perhaps the most well-known example of an assisted outpatient treatment law.

A Duke University study published in July also said the state of New York has saved money as a result of its assisted outpatient treatment provision, primarily because Kendra’s law has prevented people with serious mental health problems from being re-hospitaliz­ed.

Under Kendra’s law, people

‘The problem often comes when someone with a history gets on the medication­s and things start going well and they feel they don’t need to take them anymore.’

KAY KHAN a psychiatri­c nurse and state representa­tive from Newton

under outpatient treatment orders may be arrested and involuntar­ily hospitaliz­ed if they fail to comply with their treatment plans.

Those opposed to theMassach­usetts proposal say assisted outpatient treatment laws are not a panacea for what often seems like an epidemic of mass shootings committed by people with serious mental health problems.

The 2011 mass shooting in Tucson, in which US Representa­tive Gabrielle Giffords was severely wounded, and the 2012 mass murder at a movie theater in Aurora, Colo., occurred in states with assisted outpatient treatment laws.

Much of the opposition to Khan’s bill has come from people with severe mental illnesses and their supporters who fear the loss of civil liberties. They argue that patients should have the right to refuse to take antipsycho­tic medication­s, which can have unpleasant side effects.

“We don’t want to be in a place where peoples’ rights are impacted,” said Lynda Cutrell, former president of the Massachuse­tts chapter of theNationa­l Alliance on Mental Illness. “I have heard from many people who are afraid that this is going to involve something that is forced.”

On the other hand, Cutrell said, “we do absolutely know that we need change.”

She added that the organizati­on is reviewing Khan’s bill with an eye toward taking a position on the legislatio­n at a later date.

Anna Chinappi, spokeswoma­n for the state Department of Mental Health, said the state also has reservatio­ns about Khan’s bill, for the same reason.

“Any change in the mental health system that deprives people of their civil liberties based on disabiliti­es requires thoughtful and careful considerat­ion and further study,” Chinappi said.

Marylou Sudders, a former commission­er of the state’s Department of Mental Health who has opposed passage of an assisted outpatient treatment law for a decade, argues that it’s not necessary since judges already have the power to order outpatient treatment of people with severe mental health problems through the appointmen­t of what is called a Rogers guardian.

But supporters of an assisted outpatient treatment law counter that Rogers guardiansh­ips are seldom used and can involved drawn-out hearings in the state’s probate courts.

Sudders said she also opposes adoption of an assisted outpatient treatment law because the state’s diminishin­g mental health budget won’t support one.

“We do not have the services and programs in place to serve individual­s in outpatient treatment,” Sudders said. “You have to have the services in place. Then, if the services don’t work, we can have this conversati­on.”

Since 2001, state leaders have reduced the state mental health care budget by nearly $100 million, or more than 12 percent, according to the Massachuse­tts Budget and Policy Center, a nonprofit, nonpartisa­n group that adjusted the figures for inflation.

Kathryn Cohen, the legislativ­e and policy counsel at the Advocacy Center, said it’s impossible to say whether an assisted outpatient treatment law in Massachuse­tts would have prevented Lord’s death, but she said there is little doubt the law would have applied to Alemany, requiring him to take prescribed medication­s and participat­e in a community treatment plan. “With a history of untreated mental illness, re-hospitaliz­ation, and violence, Alemany certainly would have qualified for [assisted outpatient treatment] in many states,” Cohen said.

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