Law eases intervention in mental health cases

Treatment: While many advocates cheer the new Maryland measure, critics argue that it could infringe on the rights of patients.

October 26, 2003|By Jackie Powder | Jackie Powder,SUN STAFF

When the delusions take over, he threatens to burn down the house. He quotes the Bible and says that God is telling him to hurt his family. His wife tries to take him to the hospital, but he refuses and drives off in a psychotic rage - and she waits.

State standards that govern treatment of the mentally ill have hampered Sheila Fitch's desperate efforts to get help for her husband, who suffers from bipolar disorder. A judge once told her that his threats against the family weren't sufficient to warrant a trip to a hospital.

Another time, the police responded to Fitch's call for help, but her husband was calm when they arrived at the home, and they couldn't legally take him to the hospital.

"They said, `Yes, he's very ill, he obviously needs treatment, but he's sitting here quietly now, so there's nothing we can do,'" says Fitch, 52, a psychiatric nurse at Springfield Hospital Center in Sykesville. Although he is stable much of the time, Fitch's husband has been hospitalized seven times in 23 years, five times on emergency petitions.

Mental health advocates hope that a new Maryland law that relaxes the standards for involuntary emergency psychiatric evaluations will make it easier for families and others to obtain the proper treatment before a crisis becomes a tragedy.

The aim of the legislation, which went into effect Oct. 1, is to get a mentally ill person assessed, stabilized and treated as soon as possible, to avoid relapses and long-term hospitalizations, according to members of the Maryland chapter of the National Alliance for the Mentally Ill, which organized the effort to change the law.

'Get better faster'

"The intention is to allow earlier treatment, allow better lives and perhaps even save some lives," says Dr. Jeffrey S. Janofsky, associate professor of psychiatry and director of the psychiatry and law program at the Johns Hopkins School of Medicine, who supported the law.

"If you intervene early with patients who are ill, they can get better faster," he said.

Maryland has joined 41 other states that have enacted similar changes to emergency evaluation laws, according to the Treatment Advocacy Center in Virginia, which works with states to update treatment laws. "Maryland is moving in the direction that most states have gone," said Rosanna Esposito, a staff attorney with the Virginia center.

But critics worry that facilitating emergency evaluations can infringe on the rights of the mentally ill and lead to irreversible repercussions in their lives.

"The consequences of a commitment order are so extreme that a relaxation of standards is of great concern," says Tammy Seltzer, staff attorney with the Bazelon Center for Mental Health Law, a Washington-based legal advocacy group for the mentally ill.

"The consequences can include losing your job, losing your housing, losing your children," Seltzer says. "And that doesn't even take into account the stigma of being labeled as someone who had to be involuntarily hospitalized."

Seltzer calls the nationwide trend of lowering the bar for emergency evaluations a "red herring" that masks a more serious problem- "a severe lack of accessible and effective community mental health services and support."

Under the old Maryland law, a mentally ill person had to present an "imminent danger to himself or others" to be taken for an evaluation involuntarily. The new law removes the word "imminent," a change intended to make it easier for petitioners - typically families, health care providers and police - to get help before it's too late, mental health advocates say.

"I see what families go through trying to get their loved ones to the hospital," says Fitch.

The most recent high-profile case that involved emergency evaluation occurred in August last year. Two Prince George's sheriff's deputies were fatally shot after they arrived at a home to serve emergency petition papers on James Logan. The parents of the 23-year-old man, who has been charged with killing the deputies at point-blank range, had previously tried twice, unsuccessfully, to get him to a hospital on an emergency evaluation petition.

"There are other stories you don't hear about that affect many people, most of them suicides," says Lynn Albizo, a Howard County attorney who was instrumental in drafting the new law.

Another significant change to the Maryland law permits police officers to consider information pertinent to the mentally ill person's state of mind in making a decision on the petition. That may include the family's account of the person's behavior shortly before police arrived or mental health records. Previously, law enforcement authorities had to observe the dangerous behavior to seek a petition.

Frustrated because frequently their hands were tied, police sometimes advised family members to go before a judge to petition for an emergency evaluation. But the petitioner had to meet the "imminent danger" standard.

Danger signs

Under the old law, the judge might have told the family to return when the person became "really sick," Janofsky says.

Now, more passive signs of mental illness, such as not eating, self-neglect and isolation, are considered dangers. If a person refuses to eat, two weeks might pass before the condition becomes life-threatening, health officials says.

"We don't want to paint a picture that everyone with mental illness is a threat," says Barbara Bellack, executive director of the Maryland chapter of the National Alliance for the Mentally Ill. "We hope that the law will be applied to a very small segment with mental illness who need treatment but deny they need treatment."

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