Meds

Meds (iStockphoto / March 27, 2013)

Connecticut needs to help the tiny group of mentally ill people trapped in the revolving door of madness, homelessness, hospitalization and prison simply because they won't take their medication.

This state should join the 44 others that allow so-called outpatient commitment for those who can't fathom how ill they are and who may put themselves or others at risk.

Connecticut judges can commit people who pose an imminent danger to themselves or others. But judges should have another tool in the box for those people — no more than a few hundred in the state, if that — who need treatment to keep from descending into danger, but who refuse it.

Outpatient commitment has long been resisted in this state as a violation of civil liberties. But the alternative isn't working for the small population of people whose lives are a miserable cycle of repeat lock-ups. Hartford Probate Judge Robert K. Killian Jr. says he knows many of them by name because he's had to commit them so often to psychiatric facilities.

Once stabilized and back in the community, they soon lapse back into mental illness (often paranoid schizophrenia and bipolar disorder) because of noncompliance with treatment. A neurological condition makes some unaware that they're ill; others don't like the side effects of medication.

Other States' Laws

Kendra's Law. Kevin's Law. Nicola's Law. Gregory's Law. Laura's Law. Many outpatient commitment laws in other states bear the names of victims killed by people with a history of mental illness.

Connecticut has had its own cases — such as the homeless men who killed a Hartford shelter director and a Bristol priest.

It's important to note that a person being treated for mental illness is no more likely to kill than someone who has asthma. But those who are untreated are more likely to be violent, studies say.

Connecticut's lawmakers should look to New York's law, passed in 1999 after Kendra Webdale was pushed in front of a subway train. The law lets the court order medication, therapy, blood and urine testing if a mentally ill adult has a history of violence, hospitalization and/or noncompliance with treatment.

The law isn't perfect. Patients fall through cracks, and the program has suffered from underfunding. The New York legislature strengthened it after the Newtown shootings and two more subway deaths.

The law has been extensively studied, however, and mostly found to work. Nearly two-thirds of New York patients said that "being court-ordered into treatment has been a good thing for them," according to that state's Office of Mental Health. The odds of being arrested were two-thirds lower for those receiving court-ordered treatment in New York than for those who signed treatment voluntary agreements to take medication.

Resistance in Connecticut

Outpatient-commitment proposals have met with defeat over the years in Connecticut's General Assembly. This year, the idea didn't make through a task force on mental health reforms.

Critics say outpatient commitment means forced, and often humiliating, medication. Studies show, however, that the judge's order is usually enough to make most mentally ill patients cooperate.

It's hard to see, though, how outpatient commitment is any crueler than patients ending up on the street or back in a psychiatric hospital or prison.

Advocates for the mentally ill say the state has instead put its energies into encouraging clients to participate in their own treatment rather than forcing them to do so. Voluntary treatment is preferable, of course, but it simply hasn't worked for everyone, according to leading judges and psychiatric doctors in this state.

It's time to give courts another option, so that the small group of people who are in denial about their illness don't end up far worse off.