Involuntary commitment of the mentally ill

By Matthew Gregory
Special to the Saipan Tribune

Thank you for the opportunity to present comments on House Bill No. 15-121, entitled “To create an Assisted Outpatient Treatment program for persons with mental illness, and to protect both persons with mental illness and the community from the effects of mental illness, and for other purposes.”

There is an urgent need for this legislation.

Current Commonwealth law allows for involuntary commitment of persons only if they are mentally ill and a danger to self or others, or are gravely disabled. The gravely disabled category is rarely used, as it applies to persons who cannot “use the elements of life which are essential to health or safety, including food, clothing, or shelter, even if provided to them by others” (3 CMC § 2501 [n]. Its use, therefore, is restricted to those who are profoundly retarded or cannot feed and clothe themselves without assistance due to some other mental disability.

The involuntary civil commitment provision for those who are mentally ill and a danger to self or others requires that the danger to self or others be exhibited by overt acts or threats which occur no more than 24 hours prior to the application for commitment. These narrow requirements preclude the Commonwealth from removing persons from the streets who are known to be psychotic and in need of medication prior to their committing some act or threat which could be quite extreme, including severing of body parts and even murder (both of these have happened). The law is so narrow it actually prevents persons from receiving badly needed assistance until it is, perhaps, too late.

It is frequently the nature of mental illness that persons are either unable or unwilling to keep track of their medications or other treatment. Without the medications, their illnesses are soon out of control. Currently, CHC pursues aggressive treatment where possible by seeking out the persons and bringing medications to them. However, if they can’t be found, or refuse the medication or other treatment, nothing can be done until they have done something that makes them eligible for involuntary commitment. This creates a revolving door situation where patients enter CHC under involuntary commitment, receive treatment until they are capable of being released, go back into the community, fall off their medications, commit some act which makes them eligible for commitment, are then brought back to CHC, and the process begins again.

This Assisted Outpatient Treatment Bill would remove current impediments to the care and treatment of these individuals by allowing the courts to order preventive treatment before some drastic act occurs. Most of these individuals are non-psychotic, non-violent, and capable of taking care of themselves to some degree if they are taking the medications available to and prescribed for them by CHC psychiatrists. The Act would enable mental health care providers to track these individuals and, if they refuse their medications, bring them to CHC for at least 72 hours in order to get them back on their treatment and medication regimen. If they can’t be found, the Act authorizes the Department of Public Safety to find and bring them to CHC upon request by mental health care providers.

The Act further authorizes social workers at CHC to assist these individuals in obtaining employment, education, housing, etc., in an attempt to make them as self-sufficient as possible and help them achieve a lifestyle appropriate to their needs and which offers positive incentives not to slip back into the throes of their illness. This should stop the revolving door, be beneficial to the health of the mentally ill, and ensure the public safety.

Some twenty-seven states now have assisted outpatient treatment statues, and they are quickly being recognized as essential tools for the care and treatment of the mentally ill in the place of discarded procedures for massive institutionalization. The State of Hawaii was successfully sued for allowing untreated psychotic individuals to wander the streets and is currently under a Federal court order to provide exactly the type of services contemplated by this bill.

Superior Court Associate Judge Kenneth L. Govendo, who presides over mental health commitment hearings, is a strong supporter of assisted outpatient legislation, and has been pushing for an Act like this for the last couple of years.