EDITORIAL
Fla. needs OK to order medication - 
Mentally ill people can get in trouble without medicine

Drugs can be effective in managing mental illness, but are useless if not taken.

Too many people in Florida with severe mental illnesses are ending up in trouble, in danger and often in jail - sometimes for serious crimes - because they do not take the medications that would allow them to live peaceful lives in the community.

It's time that Florida adopts legislation already in place in 41 states allowing "assisted outpatient treatment," or court-ordered medication, in plainer language.

Civil liberty concerns are very important in this matter. The law must be carefully crafted so as not to violate the rights of people with mental illnesses just because they choose not to take their medication. Their behavior must pose a real problem, and the court-ordered program must have a reasonable chance of working.

That means there must be enough treatment resources in place to handle additional patients. That's a huge problem, as anyone knows who has followed the crisis in mental health care in Southwest Florida in recent years.

But Florida has seen the devastating, sometimes deadly consequences to families, law enforcement officers, the public and patients when the severely mentally ill don't take the medications they need.

Florida's basic law for dealing with people with mental illness who become problems, the Baker Act, was written 30 years ago. That was before the development of drugs that allow so many people who would once have been locked up in mental hospitals to live in the community, as outpatients.

In a Baker Act procedure, the essential issue is whether a person should be institutionalized or not, and the court cannot intervene until mentally ill people become a danger to themselves or others. If institutionalization cannot be justified, the person must be set free, often to get into difficulty again.

Some research indicates almost half of people with severe mental illnesses such as schizophrenia and bipolar disorder also have a biological condition, anasognosia, which results in a lack of awareness of their illness.

Mary Lou Weddle, president of the Lee County chapter of the National Association for the Mentally Ill, who endorses assisted outpatient treatment, says, "A lot of people are too ill to know they need to take their medication."

The courts need another option, a way of pressing people to take their drugs.

The proposed reform allows a judge under certain circumstances to intervene before people's conduct gets to the point of danger and before they have gotten themselves jailed. The judge would be able to order people to take the drugs that have been prescribed for them and force them into treatment programs.

Advocates of such programs say that once people are ordered - not physically forced - to take medication and are required to participate in support programs, most come to realize the need for taking their medicine.

Those who ultimately cannot be persuaded to take their medications cannot be further detained unless they meet the old Baker Act standards for involuntary commitment.

Jan Eustis, chief executive officer at Ruth Cooper Center, Lee County's chief mental health facility, says, "This is a tricky issue. We need to look carefully at what's happened in other states."

This new law would, after all, allow people to be detained for medical treatment against their will. To qualify for court-ordered treatment, a person must have a history of refusing to take medication, and the court must be reasonably sure that continued refusal eventually will result in dangerous behavior, even if it isn't imminent.

Legislation implementing this reform got lost in the hectic shuffle in this year's Legislature. The issue will come up again. At that time we should urge our lawmakers to adopt the measure, and to raise whatever money is needed to pay for it. Very possibly, the reform could save money in the long run by preventing people from getting into real trouble.

That is one reason the idea has the support of Florida sheriffs and other law enforcement officials, whose jails to some extent have become mental illness holding centers.

Court-ordered medication can help get mentally ill people the treatment they need before they become dangerous and break the law. This is good for them, their families and the general public.

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