Wednesday, 12 August 2020

Outpatient Forced Commitment: An Update on ‘Forced Treatment’ in Massachusetts

Massachusetts is one of the last states (alongside our neighbors in Connecticut) to not have a formal ‘outpatient commitment’ law (often referred to as ‘AOT’ or Assisted Outpatient Treatment in the media). These laws can be extremely far reaching in how they applied.

For example, a person can be ‘sentenced’ to this kind of forced treatment when they get in legal trouble or simply because others feel they’ve been hospitalized too frequently. As a part of this kind of forced treatment, they can be required to do anything from taking particular psychiatric drugs to attending therapy and/or day programs to living in a particular area and so on. And, when they fail to comply, that can be grounds for them to immediately be picked up and incarcerated in a hospital (even if they are doing well overall in the community and simply based on the theory that something might go wrong for them because they are not complying with the order).

Overall, Massachusetts has resisted Outpatient Forced Commitment laws in spite of ongoing pushes from legislators like Senator Ken Donnelly and Representative Kay Khan along with the national Treatment Advocacy Center. However, in the last year, proponents of this kind of forced treatment were successful in pushing through a $250,000 pilot program. The pilot program is currently underway at Eliot Human Services based in Lexington.  This pilot is dangerous even if Eliot finds a 'nicer' and more 'progressive' way of implementing it (which could, more than anything, lead to a dangerous blending of force and choice-oriented approaches that ultimately only serves to distort the concept of 'person-centered' and 'self-determination').

This pilot program is extremely problematic for a number of reasons including:

  • It’s a slippery slope: Although the door is not fully open to widespread Outpatient Forced Commitment in the state, this pilot is like a ‘foot in the door.’ The longer it is allowed to continue, the more likely it becomes that this sort of forced treatment will shift into a full Outpatient Forced Commitment law.
  • Eliot is employing people in peer roles in this program: Peer-to-peer support is absolutely inconsistent with the use of force. Employing someone working in a peer role as a primary team member of a program built around the concept of Outpatient Forced Commitment is an abuse of the peer role. Some are even calling for the individual working in that peer role to have to give up their certification as a ‘Peer Specialist’ because this represents a violation of the Certified Peer Specialist Code of Ethics. To allow this to continue will do a great deal of damage, including to the integrity of the peer role itself.
  • Eliot is using Pat Deegan’s Commonground as a part of this program: Commonground is a computer program that supports informed choice and full participation for people when they are meeting with their psychiatrists. It is based on the concept of person-centered and person-driven care and the wisdom that comes from living your own life and knowing what is right for you. It is dishonest and disingenuous to employ this tool in an environment that is based on the concept of Outpatient Forced Commitment. It was also put in place as a component of this program without the knowledge of Pat Deegan (who herself was once diagnosed with schizophrenia and has gone on to build a full life, including the development of this program).

This program must be stopped. Unfortunately, the Senate Ways & Means Committee just earmarked $250,000 for the pilot program to continue. However, before the budget becomes final, the Senate and House must form a joint council to review the differences in their budget recommendations and come up with a joint plan to submit to the Governor.

TAKE ACTION: You can help stop this effort by contacting own Senators and Reps (wheredoivotema.com) along with leadership of the Ways & Means Committee today. Consider saying something like, “Forced Outpatient Commitment (also known as AOT) is harmful. It has been proven ineffective and a waste of resources by a number of studies (for details: ncmhr.org/downloads/NCMHR-Fact-Sheet-on-Involuntary-Outpatient-Commitment-4.3.14.pdf). Please oppose the earmark for the continuation of the AOT Pilot in Massachusetts.”

To find the contact information for members of the Ways & Means: malegislature.gov/Committees/Joint/J39



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