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Capital Weekly (Augusta)
March 15, 2005
Reprinted with permission of the author. All rights reserved.
By Karlene Hale
AUGUSTA - In South Portland, a retired school administrator is kicked and stomped to death in a supermarket parking lot by a mentally ill man who is off his medications.
On an island off the coast of Maine, an elderly woman's skull is smashed with a rock when her daughter assaults her.
The daughter has stopped taking the medications that otherwise make her perfectly functional.
In any given community, the largest mental hospital is probably the county jail, where inmates who went off pills are doing time for a variety of crimes.
And every month an average of 75 patients at the Riverview Psychiatric Center in Augusta go in and out the doors there because failure to adhere to a medication regime has caused them to spiral downhill to a dangerous degree.
State Sen. John Nutting, D-Leeds, wants to put a stop to all this.
He has introduced a bill that would force severely mentally ill people to take their medications even if it takes a court order.
Maine is one of only eight states that has a patients' bill of rights so liberal that the mentally ill are allowed to decide if they want to take the pills that let them live normal lives.
"Maine should be taking better care of the mentally ill, similar to what's done in 42 other states," Nutting said Monday.
"We in Maine allow people to become sicker and sicker, so that eventually they face very long hospitalizations," he said.
His bill was the subject of a hearing last week that brought out hundreds of people, from psychiatrists to family members to law enforcement officials to advocates for the mentally ill.
Nutting said the vast majority of Maine's severely and chronically mentally ill take their medications.
"But there are between 50 and 100 mentally ill people who go in and out of hospitals constantly, over and over and over again - because they won't stay on their medications," Nutting said.
Under his bill, if a psychiatrist, family member, caregiver or crisis worker notices that a patient is off medications, the patient could be taken to court.
The patient would have a lawyer and other advocates present.
The caregivers could ask the court to mandate that the mentally ill person take medications for six months and stay in close touch with a psychiatrist.
If the patient failed to do so, he or she would be taken back to the hospital.
Nutting used figures from New York state to show how successful the program can be.
"In New York, 91 percent of those who were not taking medications began taking them, just because that law was on the books," the senator said.
He also said that arrests for petty and violent crimes among the mentally ill went down 78 percent and millions of dollars in hospital costs were freed up for community services.
Nutting said a percentage of the severely mentally ill have what are called "advanced directives," a list of behaviors that let family members or others know when it's time to take the person to the hospital.
But the problem is, the person often refuses to abide by the advanced directive once the time comes, he said.
"A doctor who testified at the hearing said it best," Nutting said. "He said, "'The organ of the body that needs to make the decision about medications - the brain - is the same organ that is affected by the mental illness.'"
Nutting's bill has the support of a number of groups, including the Maine Medical Association, the Maine Association of Psychiatrists, the Maine Nurse Practitioners Association, the Maine Chiefs of Police, the Maine Sheriffs Association, and Portland Police Chief Michael Chitwood.
But there are some opponents.
The Maine Disabilities Rights Center, which has sued the state under the Augusta Mental Health Institute Consent Decree, said the bill criminalizes the mentally ill.
"And it infringes on civil liberties," said Kim Moody, executive director of the rights center.
"How is this going to be enforced?" she asked. "It's very expensive to have monitors set up checking on people's medications. And does someone have a right to walk into a person's living place to see if they're taking medication?"
Moody said people often go off their medications because they don't have easy access to psychiatrists or because of transportation issues.
Most severely mentally ill people are covered by Medicaid, but there's not always adequate payment even with that program, Moody said, so cost becomes an issue.
And if a patient does hook up with a psychiatrist, it can be for 15 minutes every month or something equally as meaningless.
Moody said there is a group looking into forming a system of mental health courts in Maine, venues where only mental health issues would be heard.
The group is expected to have a report ready within a week. One of the members is Justice Nancy Mills who found the state in contempt for failing to abide by the AMHI consent decree. Mills put the old AMHI into receivership.
The Alliance for the Mentally Ill of Maine is remaining neutral on Nutting's bill, Director Carol Carothers said.
"We represent both families and consumers. This issue deeply divides us," she said.
The severely mentally ill go off medications for a variety of reasons - side effects, the belief that the drugs are blunting their personalities, or because their delusions convince them they are not ill.
The first work session for Nutting's bill was scheduled to be held on March 9.
Nutting said next year he wants to take on Maine's committal laws, which he and a great many others think are far too liberal.
In order for a person to be involuntarily sent to a mental hospital, he must be a danger to himself or others or unable to care for himself at the time that he talks with a psychiatrist or crisis worker.
The laws do not address any behavior that takes place right before or after the appointment with the professional.
There are no provisions for mentally ill people who refuse hospitalization as their lives go down the tubes and the person becomes sicker and sicker, but not violent or self-destructive.
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