Mental Health Advocates Urge Protest Against Forced Treatment Addition to Medicare Bill

An array of national mental health and disability advocacy groups joined together today, urging people to contact their senators in protest of a section of a bill rushed through the House of Representatives by voice vote yesterday. Section 224 of HR4302, up for a vote in the Senate on Monday, would subject people in crisis to forced treatment. “In its rush to fix a problem with Medicare, the House passed a bill including a highly controversial program, involuntary outpatient commitment, with no debate and no roll call vote,” said Raymond Bridge, public policy director of the National Coalition for Mental Health Recovery, “And it seems that the Senate may pass a version of the House bill including this troublesome provision on Monday.” “This legislation would eliminate initiatives that use evidence-based, voluntary, peer-run services and family supports to help people diagnosed with serious mental illnesses to recover,” said Daniel Fisher, M.D., Ph.D. “It would bring America back to the dark ages before de-institutionalization, when people with mental health conditions languished in institutions, sometimes for life.”

Of further interest:
List of phone numbers for DC offices of U.S. Senators
Research on Outpatient Commitment (Psychrights)
Compulsory community and involuntary outpatient treatment for people with severe mental disorders (Cochrane Review)

Compulsory community and involuntary outpatient treatment for people with severe mental disorders

Kisely SR, Campbell LA, Preston NJ

Published Online: October 17, 2012

The evidence found in this review suggests that compulsory community treatment may not be an effective alternative to standard care.

We examined the effectiveness of compulsory community treatment for people with severe mental illness through a systematic reviewof all relevant randomised controlled clinical trials. Only two relevant trials were found and these provided little evidence of efficacy on any outcomes such as health service use, social functioning, mental state, quality of life or satisfaction with care. No data were available for cost and unclear presentation of data made it impossible to assess the effect on mental state and most aspects of satisfaction with care. In terms of numbers needed to treat, it would take 85 outpatient commitment orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest.

Press Release From National Coalition for Mental Health Recovery:

For Immediate Release

Mental Health Advocates Decry Forced Treatment Provision in “Doc Fix” Bill

WASHINGTON (3/28/14) – The bill rushed through the House of Representatives by voice vote yesterday to patch Medicare regulations includes a highly controversial provision that has nothing to do with Medicare, and that would subject people in crisis to forced treatment. Studies have shown that such force causes trauma and drives people away from treatment, mental health advocates warned.

“In its rush to fix a problem with Medicare, the House passed a bill including a highly controversial program, involuntary outpatient commitment, with no debate and no roll call vote,” said Raymond Bridge, public policy director of the National Coalition for Mental Health Recovery (NCMHR), a coalition of 32 statewide organizations and others representing individuals with mental illnesses. “And it seems that the Senate may pass a version of the House bill including this troublesome provision on Monday,”Bridge added.

The 123-page Protecting Access to Medicare Act of 2014, H.R. 4302, includes a four-year, $60 million grant program (Sec. 224) to expand involuntary outpatient commitment (IOC) – also called Assisted Outpatient Treatment (AOT) – in states that have laws authorizing IOC. The laws allow courts to mandate someone with a serious mental illness to follow a specific treatment plan, usually requiring medication. The facts show that involuntary outpatient commitment is not effective, involves high costs with minimal returns, is not likely to reduce violence, and that there are more effective alternatives.

Assisted Outpatient Treatment  is central to the controversial Helping Families in Mental Health Crisis Act (H.R. 3717), proposed by Rep. Tim Murphy in December 2013.

“This legislation would eliminate initiatives that use evidence-based, voluntary, peer-run services and family supports to help people diagnosed with serious mental illnesses to recover,” said Daniel Fisher, M.D., Ph.D., a psychiatrist and an NCMHR founder. “It would bring America back to the dark ages before de-institutionalization, when people with mental health conditions languished in institutions, sometimes for life.”

The provisions of H.R. 3717 would exchange low-cost, community-based services with good outcomes for high-cost yet ineffective interventions, according to the NCMHR; the National Disability Rights Network (NDRN), the non-profit membership organization for the federally mandated Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP) for individuals with disabilities; and the National Council on Independent Living (NCIL), which advances independent living and the rights of people with disabilities through consumer-driven advocacy.

NDRN, NCMHR, and NCIL note that the bill does not represent the mainstream of national thought, practice and research.

“This legislation will have a devastating impact on persons with psychiatric disabilities by stripping SAMHSA [Substance Abuse and Mental Health Services Administration] support for consumer involvement in their recovery,” said Mark Perriello, president and CEO of the American Association of People with Disabilities. “Americans with psychiatric disabilities are our friends, co-workers, neighbors, and sisters and brothers. This legislation tramples their civil rights, and must not move forward as currently written.”

“Force and coercion drive people away from treatment,” said Jean Campbell, Ph.D., one of the nation’s leading mental health researchers. “In 1989, 47% of Californians with mental illnesses who participated in a consumer research project reported that they avoided treatment for fear of involuntary treatment; that increased to 55% for those who had been committed in the past.”

Enlarging the capacity for inpatient commitment “could violate Olmstead v. L.C. (1999), the Supreme Court decision, because it would increase ‘unjustified segregation of persons with disabilities [which] constitutes discrimination in violation of Title II of the Americans with Disabilities Act,’ ” said Kelly Buckland, executive director of NCIL.

Rep. Murphy’s bill is based on a false connection between mental illness and violence, the advocates say. “Study after study shows that no such connection exists. In fact, individuals with mental illnesses are actually 11 times more likely to be victims of violence than the general public,” Dr. Fisher said.

“Rep. Murphy’s bill would eviscerate the rights and privacy protections enshrined in the federally mandated Protection and Advocacy (P&A) System, which is the largest provider of legal advocacy services to people with disabilities in the United States,” said NDRN executive director Curt Decker.

“We all agree that incarceration and homelessness are not the outcomes people diagnosed with serious mental illnesses want or deserve,” Dr. Fisher added. “We urge Congressional leaders to engage in a meaningful dialogue with our mental health communities to learn about our creative innovations that truly support the health and safety of people with mental illnesses and of all Americans.”

Contact:
Dr. Daniel Fisher, [email protected], 877-246-9058, cell: 617-504-0832 (press only)

Raymond Bridge, 703-883-7710, [email protected]

More Information From NCMHR:

Repeated studies have shown no evidence that mandating outpatient treatment through a court order is effective; to the limited extent that court-ordered outpatient treatment has shown improved outcomes, these outcomes appear to result from the intensive services that have been made available to participants rather than from the existence of a court order mandating treatment.[1]
Two systematic reviews have been done of studies concerning involuntary outpatient commitment. Both reached the same conclusion: there is no evidence that mandating outpatient treatment is more effective than providing such treatment on a voluntary basis.[2] RAND Health found that there was clear evidence that “alternative community-based mental health treatments can produce good outcomes for people with severe mental illness.”[3]
Common sense, cost concerns, and concerns about forced treatment undermining client-provider relationships and driving individuals away from services dictate that we engage people and offer voluntary treatment before restricting their freedom with coercive interventions.[4]

[1] See Dr. Michael Rowe, Alternatives to Outpatient Commitment, 41 J. Amer. Acad. of Psychiatry and the Law 332 (Sept. 1, 2013), http://www.jaapl.org/content/41/3/332.full.pdf+html (describing the studies).
[2] M. Susan Ridgely, Randy Borum and John Petrila, RAND Health, The Effectiveness of Involuntary Outpatient Treatment (2001), http://www.rand.org/content/dam/rand/pubs/monograph_reports/2007/MR1340.pdf; Steve R. Kisely, Leslie Anne Campbell, and Neil J. Preston, Compulsory community and involuntary outpatient treatment for people with severe mental disorders, Cochrane Database of Systematic Reviews (Feb. 2012).
[3] Ridgely et al., supra note 2.
[4] No Good Evidence for Outpatient Commitment, Courant (Feb. 5, 2014), http://www.courant.com/news/opinion/letters/hcrs-18599–20140204,0,1263487.story.