Improved care for the mentally ill outlined

Gov.'s panel proposes ways to close gaps in care

January 21, 2014|By Meredith Cohn, The Baltimore Sun

A panel convened by Gov. Martin O'Malley after the 2012 shootings at Sandy Hook Elementary in Newtown, Conn., has made more than two dozen recommendations to bolster care for the mentally ill in Maryland.

The report by the Continuity of Care Advisory Panel looked at deficiencies in the behavioral health system that led to breaks in care for those with schizophrenia, bipolar disorder, major depression and other conditions. Those interruptions — for economic, social, legal or clinical reasons — can, on rare occasions, lead to dangerous situations, according to the state Department of Health and Mental Hygiene.

Among the more controversial of the panel's recommendations was one to develop a proposal that addresses "outpatient civil commitment" — or forcing mentally ill people to stay in therapy or on medications because of the risk they may hurt themselves or others.

Currently, only the courts can force such action as a condition of release from the system. Maryland is one of five states with no general law, though some doctors and advocates for the families of the mentally ill have historically supported it.

Bills on the subject are expected to be introduced this legislative session. The O'Malley administration has not yet taken a position on this subject or any others in the report from the panel, which was led by Dr. Gayle Jordan-Randolph, a deputy state secretary for behavioral health and disabilities, and included members of the psychiatric and corrections communities.

"We appreciate the work the advisory committee did, and we'll be reviewing the recommendations," said Dr. Joshua Sharfstein, state health secretary.

Specifically, the recommendation on outpatient civil commitment calls for a proposal that "respects civil liberties of individuals to be served" and addresses the potential for racial bias. It calls for exploration of federal financial contributions.

The report included an addendum about the history of such programs and concluded that there is "moderately strong evidence about the effectiveness of [outpatient civil commitment] for persons with severe mental illness in reducing admissions to psychiatric hospitals and in engaging recipients in community-based services. However, on the basis of current evidence, there is only weak support for the idea that [outpatient civil commitment] reduces criminal justice involvements or saves states money."

The level of support for law in the community also is not clear, but NAMI Maryland, which advocates for the mentally ill, supports the outpatient civil commitment recommendation.

"The recommendations of the panel, when implemented will benefit individuals living with mental illness as well as families and communities that are impacted when individuals do not have access to necessary services" said Kate Farinholt, the group's executive director, in a statement. "In particular, NAMI Maryland supports the panel's conclusion that Assisted Outpatient Treatment is effective and should be a tool available to use in limited circumstances for the benefit and safety of the individual and the community."

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