Wednesday, 23 September 2020

Forced Outpatient Treatment



The public hearing on forced outpatient commitment

has been scheduled as follows:


Tuesday, October 22nd at 9am


@ the State House in Boston, room A-1




About Forced Outpatient Commitment: Forced outpatient commitment can be referred to by many different names. Some people call it ‘Assisted Outpatient Treatment’ (AOT) or ‘Involuntary Outpatient Commitment.’ In some states where it exists, it has been named after a person (e.g, ‘Kendra’s Law’ in New York State). In the United Kingdom, they are referred to as Community Treatment Orders (CTOs). Regardless of what it is called, Massachusetts is one of only six states remaining that do not have any outpatient commitment laws currently on the books. (Connecticut, Maryland, Nevada, New Mexico and Tennessee make up the other five.)

Representative Kay Khan of Newton, Massachusetts has filed a petition to have a bill passed to bring outpatient commitment to our state. You can view the full bill here: malegislature.gov/Bills/188/House/H1792.

Based on established legislative process, a public hearing must be held in order for a bill to be evaluated and have the potential to pass. This is our one and only opportunity to be heard in a public forum by the legislature on whether or not we believe that outpatient commitment should become legal in Massachusetts. If this is something you disagree with, please remember that it is much harder to get rid of a law than it is to stop something from becoming a law in the first place.

What Forced Outpatient Commitment Could Mean for People with Psychiatric Diagnoses in Massachusetts: Outpatient commitment laws vary from state-to-state in terms of what they allow and how they are enforced. However, essentially, an outpatient commitment law would mean the following: If you are found to be at risk for not following treatment recommendations and if (by not following those recommendations) you are believed to be a likely risk for hurting yourself, hurting other people, or going in and out of the hospital, then a petition for an outpatient commitment order could be made. If successful and you are placed on an outpatient commitment order, you could be required to do any number of things related to recommended treatment. At least in some states, these have included (not a complete list!): Taking your prescribed medication; Electroshock Therapy (ECT); Attending all therapy and psychiatry appointments; Attending day programs, vocational programs and/or drug and alcohol treatment programs or groups; Submitting to regular drug testing; Living in a residential program.


If you fail to comply with treatment requirements on your outpatient commitment order, you can be immediately picked up and taken to the hospital whether or not you appear to be doing well overall.



Arguments for and Against Outpatient Commitment Laws: Proponents of outpatient commitment laws suggest that these sorts of measures could prevent more tragedies like those that have occurred in Arizona, Colorado and Connecticut in the last few years. The strongest voices in favor of outpatient commitment can be found from groups like the Treatment Advocacy Center (www.treatmentadvocacycenter.org). However, there are also many groups speaking out against outpatient commitment laws.


For example, in July of this year, the Council on Recovery and Empowerment (CORE - an advisory council to the Massachusetts Department of Mental Health) released a position paper stating they are opposed to the current bill. Meanwhile, Harvey Rosenthal (Executive Director of the New York Association for Psychosocial Rehabilitation Services [NYAPRS]) has been travelling well beyond his own state to present a variety of arguments against outpatient commitment laws. Meanwhile, in one of the largest studies of its kind, a group based in the United Kingdom released findings that suggested that outpatient commitment does not work as anticipated.


Some of the main points of these groups include:

  • Outpatient commitment fails to achieve one of its primary goals: reducing re-hospitalization rates (UK Study)
  • In one of the states where outpatient commitment is most frequently used (New York), a three-year study conducted by Bellevue hospital found no statistical difference between outcomes for people who were provided with enhanced voluntary services and people placed on court orders (NYAPRS)
  • Outpatient commitment disregards basic civil liberties (CORE)
  • Outpatient commitment can undermine the recovery process by creating an atmosphere of mistrust and adding additional trauma to someone’s life (CORE)
  • Massachusetts already has measures in place to address situations where people are deemed unable to make their own decisions such as the Rogers Order and Guardianships (CORE)
  • Outpatient commitment laws are applied with bias. For example, in New York, it was found that people of color were almost five times as likely to be put on an outpatient commitment order. (NYAPRS)
  • It adds tremendous cost to the state. For example, it required 32 million in New York in 2000. (NYAPRS)
  • Research suggesting that outpatient commitment works often completely disregard the positive impact of simultaneous expansion and/or improvements of voluntary supports in the same area. (NYAPRS)
  • Suggesting that these laws are needed due to recent acts of violence only serves to perpetuate the MYTH that people with psychiatric diagnoses are more commonly violent than the average citizen (NYAPRS)
  • In a review of several of the recent incidences of violence, it was found that the people who committed them either wouldn’t have qualified for outpatient commitment or were already engaged in voluntary treatment that was failing them (NYAPRS)

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