BOSTON – When Ashoke and Vinita Rampuria’s son returned home after taking a year off to complete his classes, he didn’t seem like himself.
“He was unable to perform tasks. He was lying on the couch,” said Ashoke Rampuria, a resident of Acton, Massachusetts. “He took a few jobs, but couldn’t hold them.”
In 2011, her son was diagnosed with what Rampuria described as a serious mental illness. He soon began cycling back and forth to health facilities, appearing to have his illness under control, then falling back once released. In 2021, the couple said their son used a new drug and was able to work for three months, but did not continue taking the drug.
Throughout, Rampuria said he and his wife lacked a crucial tool – the power of a judge to order their now 36-year-old son, currently in a psychiatric hospital in Lynn, Massachusetts, from outpatient care. mandatory.
Massachusetts, along with Connecticut and Maryland, are the only states that do not give this authority to the courts.
“It’s a revolving door. They will send him to the hospital for a while and then they will release him and if he doesn’t take his medicine he will come back,” Rampuria said. “If our son could go on treatment continuously for a year, he would achieve what he wants to achieve, to have a job and live independently.”
A bill before Massachusetts lawmakers would allow family members and mental health professionals to ask the courts to order outpatient mental health care for adults with persistent mental illness and a significant history serious bodily harm to themselves or others.
The court would be allowed to order an individualized treatment plan, including a monthly assessment by a mental health professional to see if the person should remain in court-ordered community treatment, according to the bill’s author, the Democratic State Senator Cindy Friedman. The bill is still in the very early stages of its journey through the Legislative Assembly.
Friedman said the legislation was based in part on what she called the “black robe” effect — the idea that a judge-ordered treatment plan is more likely to be followed by the patient. She also dismissed criticism that mental health care should only be given to those who seek it.
“You don’t solve the problem of lack of treatment by denying people who need treatment, treatment,” she said. “This is a very specific subset of people who don’t know how sick they are.”
Friedman said there can be potentially tragic consequences when the state lets the seriously mentally ill fall through the cracks. She pointed to the 2018 stabbing death of a medical student at a public library in Winchester, Massachusetts, by a man who was diagnosed with schizophrenia in high school and later hospitalized multiple times due to his mental illness.
He was found not guilty by reason of insanity in 2021.
Other states have also tackled the problem, in part due to concerns about homeless people with mental illness.
California Governor Gavin Newsom, a Democrat, last year signed legislation to create new “care courts” aimed at forcing people with mental health issues off the streets and into treatment. In Oregon, some lawmakers have pushed to expand the ability to force people into mental health care.
In New York, Democratic Mayor Eric Adams announced in November that he wanted the city’s police and doctors to more aggressively remove people with severe mental illness from the streets and subways, and put them on a treatment.
In Connecticut, Republican State Representative John Piscopo proposed a bill this year that would have allowed probate courts to order people with psychiatric disorders or substance abuse to submit to an involuntary medical evaluation and to assisted outpatient treatment. The bill did not receive enough support.
“It’s a very, very small population that would need this and I don’t understand the opposition from defenders,” Piscopo said.
According to Lisa Dailey, executive director of the Treatment Advocacy Center, a national nonprofit organization working to break down barriers to treatment for people with mental illness.
“You want someone to stay stable long enough to realize they’re doing better with treatment and going on their own,” she said. “Research shows it takes six months to stabilize on medication and no one stays that long in a hospital.”
But critics say forcing anyone into mental health care can backfire. They say the mentally ill already face a range of risks.
According to Sera Davidow, director of the Wildflower Alliance, a nonprofit that opposes mandatory outpatient care, there are other voluntary strategies, from peer counseling to creating spaces where people can talk about their difficulties.
“People who want resources can’t get them, and people who don’t necessarily want them are forced,” she said. “Both are harmful.”
Eliot Olson, a Connecticut resident who also opposes mandatory care, said as a high school student he suffered from depression and was given an ultimatum to accept mandatory outpatient care or quit school.
“I didn’t want to be there. Everyone else I was with didn’t want to be there. There was just a huge lack of understanding and empathy,” said Olson, 30, who works for the organization nonprofit PeerPride, which focuses in part on addressing homelessness in the transgender community.
Olson said he had been in the program for about six months when the school recommended he be institutionalized. His mother refused, he said.
“I was not going to participate in something in which I had no choice,” he said.
In Boston, a voluntary treatment program aims to help people with serious mental illness, who have an ongoing criminal case or who are on probation. Launched in 2020, the Boston Outpatient Assisted Treatment initiative has served 165 people, 33 of whom have successfully completed the program.
Massachusetts Governor Maura Healey, a Democrat, said she welcomes the ongoing debate over access to mental health care.
“It’s really important that people have access to the mental health care they need and also that we balance individual rights in the process,” Healey said.
Associated Press reporter Susan Haigh in Hartford, Connecticut, contributed to this report.
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