Vermont bill would change involuntary treatment laws

By Rivkela Brodsky
July 1st, 2014

A bill sitting on Vermont Gov. Peter Shumlin’s desk will change the state’s involuntary treatment and medication laws for psychiatric care.

The state currently requires two separate court hearings on involuntary commitment to a psychiatric hospital and later, on involuntary medication, a process that state officials and hospital administrators say was taking too long. A new bill that saw bipartisan support among lawmakers in the latest legislative session would allow the hearings to take place at the same time and sets something of a timeline to treatment in a hospital.

Other changes include that an “interested party” can request an emergency psychiatric exam and file an application for treatment with an accompanying certification by a licensed physician. Interested party includes “guardian, spouse, parent, adult child, a responsible adult friend or person who has the individual in his or her charge or care. It also means a mental health professional, a law enforcement officer, a licensed physician or head of hospital,” according to the bill.

“Law enforcement needs some tools to help them,” says Rep. Thomas Koch (R-Barre Town), referring to the list of individuals on the interested party list.

Koch says part of the drive for changes to the state’s law came from hospitals dealing with backed up emergency rooms, “which we eventually realized was an immoral way to treat people,” he says. “Some of them are occupying beds that other people could probably use. Some people have been waiting for treatment and have been violent to staff and other people.”

There have been some recent cases of violence toward hospital staff in Vermont by a patient waiting for mental health care in an emergency room.

Paul Dupre, Vermont’s mental health commissioner told New England Psychologist in November that the delay in care puts hospitals at risk of losing Centers of Medicare & Medicaid Services certification because CMS requires that patients be receiving active care. At the time, he said the process for involuntary treatment and involuntary medication takes an average of 45 days, and often, it’s closer to 60 days before being completed. At the time, Vermont’s governor had said he wanted to see the law change.

Koch says changes will cut two to four weeks off the process and strikes a good balance between public safety and the rights of the individual. “I think what we were doing in allowing people to refuse treatment because their illness was telling them to refuse treatment and letting them linger for weeks or months was inhumane,” he says. “I think this was the right thing to do.”

Rep. Vicki Strong (R- Orleans-Caledonia) was one of a handful of lawmakers in the House that voted against the legislation. “To me it’s very alarming and I believe a huge step backward in personal liberty. I take that personal sovereignty very seriously. I feel this is giving the state, the government, more power in our lives to interfere and do something against our will,” she says.

She was concerned with how many people were included as an “interested party” and that the bill did not look at other options besides medication.

“So instead of focusing on what can we do besides stepping up what they called ‘expediting the process,’ they are not examining other programs and other opportunities. In their minds, expediting the process to get medicated more quickly is solving the problem whereas I felt like it’s going to make that problem worse because in the end people knowing they could be involuntarily medicated against their will avoid even getting help or it’ll just in the end make people get medicated quicker instead of getting help in other ways,” says Strong.

“Our minds are our last bit of freedom and liberty that we have… I feel like that is a huge violation of human rights and of humane treatment.”


Other aspects of the law

Those admitted or held at a hospital for treatment shall be given the opportunity to communicate with others including visits by peer or other support person designated by the person and the presence of that support person at all treatment team meetings.

The person admitted shall be given the use of a telephone, e-mail and the Internet.

The person admitted will be asked for names of persons s/he want notified and informed of his or her hospitalization and status. The head of the hospital shall see that such personnel are notified and how the patient may be contacted and visited and how to obtain information concerning the patient.

Once admitted, the hospital has 24 hours for a psychiatrist to examine a person dealing with mental health issues or the person needs to be released. If examined and the patient needs treatment, the hospital can hold the patient for another 72 hours before needing to release him or her unless the patient has been voluntarily admitted to the hospital or an application for involuntary treatment has been filed.

A court hearing must take place within ten days of an application for involuntary treatment being filed or 20 days if a psychiatric exam is ordered.

A hearing on involuntary medication must take place in seven days of the application being filed unless the decision is made at the treatment hearing.

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