Outpatient Commitment Would Harm Patients in Need

Several days after the shooting at the school in Newtown, Conn., the Boston Globe published an editorial supporting outpatient commitment. Outpatient commitment means that although a person has been discharged to the community, they remain under close observation. If a friend, family member, or provider reports they are not complying with their treatment plan, they can be rehospitalized without a further hearing.

Several years ago the Globe published an op ed article by then DMH commissioner Mary Lou Sudder critiquing outpatient commitment. This editorial is the first time the Globe has supported out[patient commitment. Massachusetts is one of only a few states without such a law. However, Massachusettes does already have a guardianship to force people to take medication in the community, called a Rogers Guardianship. (ironically it is the result of the Rogers versus Okin decision, which said the state could not forceably medication persons in the community.)

This is the letter that the Boston Globe published:

Outpatient commitment would harm patients in need

As a practicing psychiatrist, member of the White Commission on Mental Health and a person who recovered from schizophrenia, I believe that a state policy shift to allow outpatient commitment, as advocated by the Globe, is wrong (“Response to Newtown killings demands gun laws — and more,” Editorial, Dec. 20). It is based on the false premise that persons with mental illness are more prone to violence than the general population.

Furthermore, trust is the cornerstone of the therapeutic alliance, and outpatient commitment destroys trust. Involuntary treatment is traumatic and frightens people away from treatment. Outpatient commitment is also a gross violation of human rights.

The best means to assist in recovery is not more laws, but increased access to voluntary, community-based, peer-delivered services such as peer-run respites and recovery learning communities.

Another approach is to improve the capacity of all community members to help each other. The National Empowerment Center has helped develop such a public health approach to emotional distress, called emotional CPR.

DANIEL B. FISHER

Executive director
National Empowerment Center

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.