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Maine passes
assisted outpatient treatment law
(July
2006 Issue)
By Phyllis Hanlon
Following the lead of several other states, Maine passed an assisted
outpatient treatment (AOT) law, known as a "progressive treatment
plan" in May, according to Sen. John M. Nutting (D-District 17,
Androscoggin County). Data from 12 other states that revealed a
marked reduction in re-hospitalization, acts of violence and incarceration
influenced the legislature's decision.
Nutting says that the law garnered backing from several groups
including nurse practitioners, the sheriff's department, the Maine
Psychiatric Association, Maine Medical Association and hundreds
of parents. "We built a broad cross-section of support for the bill,"
he says.
Maine's law says that the court can order a mentally ill person
to take his medication or undergo psychiatric treatment. This treatment
could take place on an inpatient basis if necessary. The law would
be invoked only for those individuals who have a history of violence
when not taking their medication, those who have a history of non-compliance
or those who have demonstrated improvement while on medication.
As currently written, the law can be enforced for only a six month
time frame.
Implementation will begin slowly with approximately 75 individuals
under the first phase, according to Nutting. "It will be limited
to those hospitalized many times with a history of violence and
no self care and a history of doing well on a treatment plan," he
says. The Department of Health and Human Services (DHHS) is working
closely with hospitals, ACT teams and the court system to implement
the bill on Oct. 1, 2006.
Nutting adds that DHHS will report annually to the legislature
on the progress of the plan.
Mary T. Zdanowicz, J.D., executive director of the Treatment Advocacy
Center in Washington, D.C., characterizes Maine's law as a "pilot
program" whose limitations reflect the state's desire to proceed
with caution. "This approach will allay the fears of those who opposed
the bill," she says. Studies indicate that AOTs improve the continuum
of mental health care, according to Zdanowicz. She says that adherence
to medication and treatment plans are increased, while tragic consequences,
such as homelessness, victimization, suicide risk and violence are
reduced. "This is a good engagement tool to decrease consequences,"
she says.
Zdanowicz emphasizes that only a small percentage of individuals
ever need an AOT. "There is a fear that this [law] will become the
default, that everyone will have to have a court order," she says.
"Maine's limited approach will demonstrate that this is a small
measure for a small group that can make a big difference."
Most of the 50 states have passed some version of a court-assisted
commitment law. According to Zdanowicz, Massachusetts has no official
AOT, but rather invokes the "Rogers Order," which gives the court
the right to order an individual unable to make decisions to take
medication. The law applies to both inpatient and outpatient settings.
Michael Schwarzchild, Ph.D., director of professional affairs for
the Connecticut Psychological Association, indicates that his state
has a modified AOT law. "I testified about it in my first legislative
outing for the Connecticut Psychological Association, about a decade
ago. Basically, we won the right - which everyone already has, in
a sense - to have a patient transported to a general hospital emergency
room for psychiatric evaluation. That's the extent of our involuntary
commitment law, at least as it pertains to psychologists," he says.
New Hampshire, Vermont, and Rhode Island also have AOT laws in
their states.
Regardless of the nuances in the legislation, states that have
AOT laws will achieve positive results only when the law is actually
implemented. In her experience, Zdanowicz has found that many healthcare
professionals are unaware of the existence of these laws.
According to Zdanowicz, opponents to AOTs cite infringement of
civil liberties and the individual's right to make choices as major
challenges. She explains that these programs are typically used
for people whose compromised brain functioning because of mental
illness prevents rational decision-making. She adds that in many
cases, opposition stems from an emotional source often based on
the wording of the law.
One of the most convincing arguments for implementation of AOT
legislation comes from patients themselves. "New data has been collected
in the last couple of years. There is now evidence from participants
who are the best judges. The majority say their lives have improved
significantly," says Zdanowicz.
Nutting believes that both physical and mental health deserve equal
treatment. "If parents deny treatment for their child who has diabetes,
the state can step in and force treatment. Mental illness is not
different than biological illness and should be treated."
Zdanowicz says, "People are literally dying with their 'rights
on.' The things that happen when they are not on treatment are horrific.
AOT legislation saves lives. There is ample empirical evidence to
support policy decisions that cover the entire mental health spectrum."
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