In April, Maine enhanced its existing Progressive Treatment Plan, which authorized two public hospitals – Dorothea Dix Psychiatric Center in Bangor and Riverview Psychiatry Center in Augusta – to ask the courts for a commitment order of community-based treatment for six months with services provided by the Assertive Community Treatment program.
Some of the provisions in the new law include expanding the criteria for involuntary commitment, extending the treatment timeframe from six to 12 months and allowing licensed physicians, registered physician’s assistants, certified psychiatric clinical nurse specialists, nurse practitioners and licensed clinical psychologists to sign involuntary commitment papers. Maine’s assisted outpatient treatment (AOT) law takes effect July 1 when the current Progressive Treatment Plan expires.
Sen. Peter Mills (R-Corvine), one of the authors of the bill, says the AOT law also expands the numbers of agencies permitted to invoke this mandatory outpatient treatment for community-dwelling individuals with mental illness.
Several studies have found assisted outpatient treatment offers a number of benefits: fewer hospital admissions; reduced homelessness, arrests, violence and victimization; improved treatment compliance and a decrease in substance abuse problems.
Kristina M. Ragosta, Esq., legislative and policy counsel for the Treatment Advocacy Center, reiterates the importance of implementing assisted outpatient treatment laws. “First and foremost, these types of laws are not punitive. They are designed to help those individuals whose illness renders them incapable of understanding that they are sick and therefore do not volunteer for necessary services. For this subset of the most mentally ill, no amount of money spent on services will ever be enough to engage them in treatment,” she says. “This is a gap that existed in the law in Maine, as far as consumers accessing community services and is another tool to try and get people help before they end up in more restrictive, more expensive hospital or jail settings.”
Ragosta reassures those concerned about civil rights violations that such privileges are not restricted by AOT laws, because “the illness and their consequent symptoms, not the treatment, restricts civil liberties.” She points out that some of the AOT laws across the country are more than 20 years old and have never been overturned by the U.S. Supreme Court. “In addition, various provisions of assisted outpatient treatment laws were tested and found constitutional by state courts throughout the country,” she says. “For instance, Kendra’s Law in New York has been upheld through a series of challenges over the past 10 years.”
Ragosta adds, “Assisted outpatient treatment minimizes the need for incarceration, restraints and involuntary inpatient commitment, allowing individuals to retain more of their civil liberties. It is neither civil nor right to leave people psychotic when so many who have been spared that fate later say they wish someone had stepped in to save them and restore their ability to reason again.”
Forty-four states now have AOT laws on the books. In New England, only two states remain without such legislation. John Mehm, president of the Connecticut Psychological Association, reports that Connecticut has never adopted involuntary outpatient commitment or AOT laws. Massachusetts follows the Rogers Order, which gives the court the right to order an individual, whether inpatient or outpatient and unable to make decisions, to take medication.
The National Alliance on Mental Illness in Maine (NAMI-Maine) took no position on this legislation, according to Executive Director Carol Carothers, LCPC, LADC.