Pa. moves to loosen requirements for court-ordered outpatient mental health treatment

What if a family member were so mentally ill that he or she refused treatment?

Pennsylvania has a good mental health care system, but not for people who are seriously ill, said John Snook, executive director of the Treatment Advocacy Center.

“They’re too sick to understand that they need care, they think the CIA really is after them,” he said.

“Unfortunately, the standards that Pennsylvania uses to provide those folks care are really outdated, they’re from the late ’70s, and what that meant on the ground is that families were told, ‘Your loved one can’t get care unless they pose a clear and present danger.’ And that’s a terrible way to try to provide medical care,” he said.

The Treatment Advocacy Center pushed to change this standard in Pennsylvania, and a bill doing just that is now on the desk of Gov. Tom Wolf.

The new standard would make court-ordered outpatient treatment — called assisted outpatient treatment — possible for people who meet a new list of requirements. They include a history of refusing treatment for a mental illness when that lack of treatment leads to violence.

Annette Hanson, an assistant professor of psychiatry at the University of Maryland and at the Johns Hopkins University School of Medicine, knows patients the bill is meant to help.

“I’m a forensic psychiatrist, so I work in a maximum-security prison, and I work in a forensic hospital doing court-ordered evaluations,” she said. “So I see the bad outcomes. I see the cases where a family member may have been assaulted or even killed by a mentally ill loved one.”

Hanson, who also co-authored “Committed,” a book about involuntary psychiatric treatments, said she has concerns about the lower standard for involuntary treatment in Pennsylvania. She fears that it could be interpreted to include people who, for example, cut themselves, but do not show signs of psychosis.

After studying these laws across the country, Hanson said they work best when combined with a serious investment in providing more mental health care to the people who need it.

For example, Kendra’s Law passed in New York almost two decades ago, after a man with a mental illness shoved a young woman in front of a subway train. New York also spent millions on its outpatient treatment program, which is why it worked, according to Hanson and other researchers. The vast majority of states have passed assisted outpatient treatment bills, but the details can vary greatly from state to state.

So Hanson asks, why doesn’t Pennsylvania just expand mental health care access?

“It would be a lot easier if we would be willing to invest the resources upfront to put these systems in place without necessarily passing a law that would take away somebody’s civil liberties,” she said. “But how many people are going to go into the ballot booth … and vote in favor of raising their taxes for a person with serious mental illness?

“That’s a hard sell because these people don’t have a strong advocacy group when it comes to voting,” Hanson said.

Disability Rights Pennsylvania, the Pennsylvania Mental Health Consumers’ Association, the Mental Health Association in Pennsylvania, and the Pennsylvania chapter of the National Alliance on Mental Illness all opposed the bill, and have asked Wolf to veto it.

Jennifer Wolff, policy specialist at Mental Health Partnerships, agreed with Hanson’s concerns about the overly broad terms for who could be ordered into outpatient treatment. She also pointed out that any “serious violent behavior” or “threats of, or attempts at, serious physical harm to others” in the past 48 months could be considered. She questioned why that time frame was used to measure whether someone has changed.

But this may all be a bit of a moot point now. No lawmakers voted against the bill in the Pennsylvania House or Senate.