Committing someone to a psychiatric hospital may appear to be an easy decision and a straightforward procedure. But in reality, it's often a tough call, followed by a series of steps that can get hung up -- and end in tragedy.
The bottom line: Until shown to be a danger to self or others, a person can't be committed. And some psychiatrists and family members say it's just too difficult to get someone involuntarily hospitalized in Maryland.
Denise Cherry said her husband's physicians had refused to admit him. She partially blamed them for Baron Michael Cherry's being charged with the fatal shooting of a police officer.
Dr. Larry Alessi, director of the Harford-Belair Community Mental Health Center where Cherry was a patient, said he could not comment on the case without permission from him.
Dr. Peter Coleman, director of the North Baltimore Center, another community mental health facility, described the state's commitment criteria: "It's almost to the point they have to say in front of a physician, 'Yes, I do intend to kill someone, or kill myself.' "
There are several ways in which one may be committed.
Both a physician and another health professional -- at minimum a psychologist with a doctorate -- must agree on the need. The person must have a mental disorder and be a danger to self or others.
But many times the patient is unwilling to see a doctor. A judge can be asked to grant an emergency petition for involuntary evaluation at a hospital. Several families who have dealt with the process said that late at night, court clerks may decide not to call a judge, or the judge may not grant the order.
Another possibility is getting a health professional or peace officer to see the patient, and based on their opinion, take him to a hospital for examination without judicial review. But then two health professionals must see the patient and decide whether to commit.
Outside forces also come to bear. Managed care plans may be reluctant to pay for expensive inpatient treatment. Also, for years, the national trend has been to move the mentally ill from institutions to the community, where advocates and most patients believe they get better care, experts say.
But against that backdrop, hospitalization may seem to represent failure.
"We're overly committed to the idea of keeping people out of the hospital no matter what," said Dr. Agnes Hatfield, a retired VTC University of Maryland professor and founding member of the National Alliance for the Mentally Ill.
Last fiscal year, about 1,650 people were involuntarily committed to psychiatric hospitals in Maryland. Dr. Stuart Silver, director of the state's Mental Hygiene Administration, said it was easier to gain commitment in Maryland than in some other states.
Studies have shown that overall, people with mental illnesses are less dangerous than the general population. But every day, psychiatrists face commitment decisions. Complicating matters is the varying time frame in which patients who have stopped taking medicine will relapse.
"It's real tough," said Dr. Jack Vaeth, attending psychiatrist at Sheppard and Enoch Pratt Hospital. "What we end up weighing on the scale is, at what point do we intervene and protect society? At what point can I be assured that this patient is probably safe?"
Pub Date: 5/09/97
