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Maine may pass
mandatory treatment bill
(August/September
2005 Issue)
By Catherine Robertson Souter
Maine is currently one of only eight states nationwide that does
not have a mandatory treatment bill. That may be about to change.
Introduced by Sen. John Nutting (D-Androscoggin), Maine's mandatory
treatment bill was passed by both the House and the Senate in June
by a wide margin. As of early July, however, the state's Appropriations
Committee had tabled the bill because of its $1.3 million price
tag (more than half of which would come from federal funding). According
to a report by the Courier Publications, the committee tabled all
bills that required new funding.
"We will be coming back into session in the fall to look at those
bills that have not been funded as of yet," says Nutting. "We will
be watching revenues and in the fall will be meeting for a tax session."
First introduced in January of this year, the bill has an implementation
date of July 1, 2006. That date was moved from its original date
of Jan. 1.
"We wanted to give the Department of Health and Human Services
more time to educate people on this new statute," says Nutting.
The bill won approval by the state's Health and Human Services
Committee in June after being fine-tuned by a 10-person committee
made up of mental health professionals, consumer advocates and legislators.
Changes were made to make the bill less coercive and more respectful
of patients' rights, says Brenda Harvey, deputy commissioner for
Integrated Services at Maine's Department of Health and Human Services.
"We objected to the original bill," she explains, "because it was
too coercive and for some people simply giving them medications
would be only part of the package necessary [for mental health care]."
The process of re-writing the bill included taking a closer look
at the programs currently being offered at the community level,
she adds. The new bill also includes a "sunset," a built-in time
frame for when the legislation would have to be reevaluated, in
this case, four years.
"One of the challenges is finding the balance between assuring
the community and families that people can access treatment without
having to fall apart, if you will," says Harvey "and protecting
the community and protecting the individual's civil rights. There
are no clear-cut answers to any of those issues."
Although mandatory treatment bills are on the books in most U.S.
states, (but not in New England's Maine, Massachusetts or Connecticut),
they are not necessarily enforced. They can be difficult and expensive
to enforce, especially when budgets are already so tight for many
mental health programs and questions about ethicality arise.
Detractors of Maine's new bill have asked where the money for this
program will come from in light of slashed funding elsewhere. They
question where people will be sent for mandatory care when existing
programs do not have the funding to do the necessary outreach. They
believe that legislators should focus more on helping people do
their jobs…or enforcing them to do them in some cases.
The Disability Rights Center of Maine, a non-profit protection
and advocacy agency for people with disabilities, has taken a stand
against this legislation. Consumers' rights can too easily be abused
and studies have not shown these types of laws to be effective,
they say.
"We are violently opposed to this law for a number of reasons,"
says Helen Bailey, Esq., public policy director for the DRC. "If
you look at the report out of New York [on a similar law], some
of the individuals subjected to outpatient commitment do not meet
the criteria. There is some serious potential for abuse."
In addition, she explains, the state has cut community services
for the mentally ill and is now going to mandate that certain people
must receive services. In many cases, she says, services to some
consumers have been discontinued because of lack of funding. A client
may be too far from a city center or the cost to the consumer of
medication or therapy is too high.
"There are some who say that outpatient commitment is good because
it forces providers to treat individuals whom they otherwise wouldn't,"
adds Bailey.
The Maine Psychological Association cannot fully stand behind the
bill either, according to MePA president Kendra Bryant, Ph.D.
"We did not support the original draft version of the involuntary
outpatient bill," she says. "In its amended form, the bill has a
large price tag. Given the currently strained fiscal climate and
competing budgetary interests before the Appropriations Committee,
we do not support funding the involuntary outpatient bill at this
time."
All of these arguments have been heard, says Nutting, and still
legislators voted to pass the bill. It passed by a vote of 32 to
3 in the Senate and 132 to 14 in the House.
"Maine crossed the coercion bridge a long time ago with the passage
of the involuntary commitment and state guardianship," he explains
when asked about the possibility of the abuse of patients' rights.
"Most people who would come under this statute would already be
under those laws and would have no rights at all. A consumer who
would come under this would have more rights than they would otherwise,
more freedoms. They would stay in their communities."
The law would affect between 50 and 80 people in Maine, he adds.
Only those consumers who have been treated and have demonstrated
both that they fare better with treatment and that they could be
a danger to others without treatment would fall under this statute.
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