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Capital Weekly (Augusta)

March 28, 2005

Reprinted with permission. All rights reserved.


EDITORIAL
Mandatory medication law is needed

Mandatory medication law is needed

Sen. John Nutting of Leeds has introduced a bill that deserves the backing of the Legislature and the people of Maine.

His bill is bold, incisive - and sensitive - for it pits the rights of the mentally ill against the safety of family members, co-workers, and community members who live within range of the severely mentally ill with violent tendencies.

Nutting's proposal would allow the courts to force a small segment of the mentally ill to take their medications or face going back to the hospital, where the drugs would be automatically administered.

Maine is one of only eight states that does not have a mandatory medication law for persons with mental illness who also have a history of violence or self-destruction when they go off medication.

Nutting's bill addresses a very small slice of the mentally ill population in Maine, somewhere between 50 and 100 people, who repeatedly go off medications, then spiral downward until they wind up in the hospital. This happens over and over and over again, according to testimony from doctors and other caregivers who showed up for the public hearing on LD 151 a few weeks ago.

Right now the bill has been turned over to an impartial 15-member committee of legislators, family members, doctors and others who will study the language and make sure the proposed legislation allows for full due process.

The bill is expected to go back to the Health and Human Services Committee by May 1.

Nutting's bill is not aimed at highly functional people who take antidepressants, for example, and decide to go off them. They do not pose a threat to public safety or to other people.

But there is a segment of the mentally ill population that has a history of violence when not on medication, a history of going off medication, and for whom it has been shown that irrational or dangerous behavior disappears when the person is put back on drugs.

Under Nutting's bill, a person in that category could be forced under court order to stay on medication for six months and remain in close touch with a psychiatrist. If the person still refused to take the necessary drugs, he or she could be taken back to the hospital.

Due process would be assured during the court proceeding by having an attorney or an advocate present for the mentally ill person. And a judge might very well rule that the mentally ill person can remain off drugs if carefully monitored.

The need for Nutting's bill is obvious. Homeless shelters are repositories for the mentally ill, some of whom are dangerous, especially when drinking or on drugs. Horrific crimes have been committed in Maine by severely mentally ill people who were off medications and hallucinating. Mentally ill people are arrested every day for petty and serious crimes, arrests that could be avoided if a medication regime were adhered to.

In New York state, when a mandatory medication law was passed, violent crimes committed by the mentally ill went way down, arrests of the mentally ill went down, and 91 percent of those who were not taking medication began taking it just because that law was on the books.

The law in New York, by the way, is called Kendra's Law and is named for a young woman who was pushed in front of a subway car by a mentally ill man who was off his medications and hearing voices.

The question of patients' rights comes up at a time like this, as well it should. Advocates for the mentally ill say that patients, no matter how sick, have a right to go without medication. We disagree with that argument. A person's right extends only as far as the safety of another person. When a mentally ill person with a history of violence goes off medication, that becomes a societal issue, not a personal choice.

Advocates for the mentally ill do make some good points. They note that transportation to medical appointments is a problem because most severely mentally ill people don't have cars. There's also the problem of finding a psychiatrist who will spend more than 15 minutes with a patient and monitor that patient closely.

And it's true that community services are not what they should be. In our rush to empty out mental hospitals in the 1970s and beyond, we simply could not keep pace with community needs for the mentally ill. The result for some has been a revolving door of hospitalizations, release into a stressful world, and readmittance to the hospital.

If we had mandatory medication laws for the most dangerous segment of the mentally ill population, millions of dollars could be freed up from hospital care and transferred to community services.

Maine was once a leader in mental health care, with one of the first mental hospitals in the country. But over the years our system became frayed around the edges and gradually broke down, for lack of money and lack of will.

And somewhere along the way, the rights of patients became more important than the rights and safety of society, to the point that the patients and their advocates are calling the shots.

This has to end. And Nutting's bill would help do that.

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