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Treatment Advocacy Center

TREATMENT ADVOCACY CENTER PUBLISHES
ASSISTED TREATMENT MODEL LAW

ARLINGTON, VA – The Treatment Advocacy Center (Center) will introduce its progressive Model Law for Assisted Treatment on June 17^th, at the annual NAMI convention being held in San Diego, as part of its commitment to reduce, and ultimately reverse, rates of homelessness, incarceration, suicide and violence among Americans with untreated severe mental illnesses.

A compilation of the most effective provisions of existing state treatment laws, the Model Law is designed to be the legal framework for the provision of care for individuals who, due to the symptoms of untreated severe mental illness, become either dangerous or in need of treatment and incapable of making rational medical decisions. It will be disseminated to policymakers, academicians, psychiatric professionals, lawyers, and families around the country in an effort to bring antiquated state laws up-to-date with current scientific knowledge on the nature of severe mental illness and advancements in treatment.

"Treatment voluntarily embraced is always preferable," said Treatment Advocacy Center Executive Director Mary Zdanowicz. "It must be remembered, however, that severe mental illnesses are biologically based diseases that attack the brain and cause many sufferers to lose the ability to self-assess and make rational decisions about their need for treatment. When an individual becomes dangerous or is in need of treatment and unable to make informed medical decisions, it is humane to intercede with assisted treatment to protect their lives and well-being and that of society."

At least 50% of the 4 million Americans diagnosed with either schizophrenia or manic-depression, the two severest forms of mental illness, lack insight into their disorder. They do not realize they are sick and in need of treatment because their brain disease has affected the frontal-lobe function that is necessary for complete self-awareness. They do not recognize that the symptoms of their illness - hallucinations, delusions, paranoia, and withdrawal - are, in fact, symptoms. Since these individuals do not believe they are sick, they refuse to take their medication, and often deteriorate, which is perfectly acceptable in the eyes of the law.

"In addition to the landmark win in New York last year with the enactment of Kendra’s Law, states from coast to coast are re-evaluating the way the mentally ill receive care," said Zdanowicz. "The Model Law for Assisted Treatment will be an especially important tool for state legislators as they look for ways to help combat the tragic and preventable consequences of non-treatment that are plaguing their communities," said Zdanowicz.

The predictable consequences of non-treatment are as clear as they are dire:

• At least one in three homeless individuals, or some 150,000 people, suffer from untreated severe mental illness; 28 percent of them forage for some of their food in garbage cans.
• Approximately 16 percent of jail and prison inmates, or nearly 300,000 people, are severely mentally ill; many of them arrested for minor crimes. In fact, a person with untreated mental illness is at least five times more likely to be found behind bars than receiving treatment in a public psychiatric hospital.
• Suicide is increased 10 to 15 times in individuals with untreated severe mental illness.
• Individuals with untreated mental illness are almost 3 times more likely to be a victim of a violent crime; women are 2 to 3 times more likely to be raped.
• While individuals with untreated severe mental illness represent less than one percent of the total population they commit almost 1,000 annual homicides in the United States, or between four and five percent of the total murders.
• Moreover, studies suggest that delaying treatment results in permanent clinical harm, including increased treatment resistance, worsening severity of symptoms, increased hospitalizations and delayed remission of symptoms.

"Our Model Law promotes assisted treatment of severe mental illness at every turn for those who need it, while zealously guarding the rights of those who receive it," said Zdanowicz. "In fact, the protection of the rights and well-being of those placed in assistant treatment was of paramount importance when drafting the Model Law. We included provisions that are far more extensive and vigilant than those now in place anywhere else in the nation."

The Model Law sets out four alternative criteria that, if met, justify assisted treatment. Two of the four (i.e., chronically disabled and gravely disabled), also require a finding that the person is unable to make a rational decision about treatment. The four criteria include:

• Chronically disabled, which allows consideration of possible harm to a person with symptomatic mental illness in light of past psychiatric history, likelihood of treatment compliance and risk of deterioration without treatment;
• Gravely disabled, which applies when an individual is unable to provide for basic necessities but also includes, as in the more progressive jurisdictions with gravely disabled criteria, someone who is likely to suffer significant harm without treatment;
• Danger to others, which incorporates a definition of "dangerous to others" similar to that of most states, but makes clear that presenting a threat to a person in one’s care, such as a child, or having caused intentional damage to the substantial property of another shall be evidence of dangerousness; and
• Danger to himself or herself, which makes clear that a person’s past related behavior shall be considered when making the determination as to whether someone meets this treatment standard.

There are now 41 states with laws allowing for the use of some form of assisted outpatient treatment to substantially improve the lives of those suffering from severe mental illness. While numerous scientific studies have proven that assisted outpatient treatment is effective in ensuring treatment compliance, many states fail to utilize what is at their disposal. Instead, they choose to tolerate the revolving-door syndrome of hospital admissions, readmissions, abandonment to the streets and incarceration that usually engulfs those not receiving treatment. Restrictive standards based on dangerousness alone and lack of protocols for non-compliance are the most common reasons for not using existing assisted outpatient treatment laws. The Center’s Model Law addresses both of these issues.

Many of the provisions of existing state assisted treatment laws make little sense. They delay needed treatment, are inefficient from both judicial and clinical perspectives, or are concepts from other areas of law ill tailored to assisted treatment proceedings.

The Center’s Model Law, which includes both inpatient and outpatient assisted treatment provision recommendations, adopts procedures from various states that promote both clinical and judicial efficiency, including combined commitment and treatment proceedings; single standard for inpatient and outpatient care; psychiatric treatment boards; mandatory treatment plans; family rights; and consumer rights.

Established in 1998, the Center works to eliminate barriers to treatment caused by outdated laws. In drafting a Model Law that would meet these goals and withstand constitutional challenge, Zdanowicz explained that the organization solicited advice and assistance from individuals who are diagnosed with severe mental illnesses, their families, and medical and legal professionals. She further stated that the Model Law is consistent with the seminal United State Supreme Court decision, O’Connor v. Donaldson, 422 U.S. 563 (1974) which Judge David L. Bazelon explained held that "persons institutionalized solely because they are in need of treatment are deprived of their constitutional right to liberty if they are denied treatment while confined."

"It is madness to turn our heads while individuals with untreated mental illness commit suicide, slowly die on a park bench from malnutrition or freezing temperatures, shoot someone or push a passerby into the path of an oncoming subway train," said Zdanowicz. "Mandatory treatment for those too ill to recognize their need for treatment is a much more humane intervention than what we have now: mandatory non-treatment.

"The legal standard should be need for treatment, not dangerousness alone," said Zdanowicz. "Society has an obligation to save people from degradation, not just death."

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The Treatment Advocacy Center (www.treatmentadvocacycenter.org) is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. TAC promotes laws, policies, and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

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