Bill would defog requirements for compelling psychiatric help

Mental health advocates are cautiously optimistic about a proposed law that would clarify who can be ordered to get outpatient psychiatric help.

Marya Grambs, executive director of Mental Health America of Hawaii, said the measure is designed to help those who are "unable to take care of themselves," adding, "Someone who is psychotic and who may have hallucinations that command them to do things, these are people who don’t understand they’re sick."

Under Senate Bill 310 any "interested party" — from a relative to a case manager — would be able to file a petition with Family Court alleging a person meets the criteria for treatment.

It also is clearer about who would be targeted. The court must find that the person meets all of these conditions:

» Has a mental illness.

» Likely has an inability to "live safely in the community."

» Has a history of inpatient mental health treatment or of presenting a danger to themselves or others.

» Has a history of "lack of adherence" to beneficial treatment.

The bill, destined for a House-Senate conference committee as early as this week, also no longer refers to "involuntary outpatient treatment," using instead the phrase "assisted community treatment."

Hawaii’s involuntary outpatient law has been used just once in the last 13 years, a fact advocates blame on a lack of clarity about how to push people to comply with treatment orders.

The new measure would allow law enforcement or other authorized parties to transport those who fail to comply with treatment orders to a mental health program in hopes of getting them to comply.

If the person continues to refuse treatment — and if he does not pose a harm to himself or others —he will be released.

But advocates are hoping that putting mentally ill through the process will nudge at least a large number of them to agree to stick to treatment.

More than a dozen mental health groups and relatives of those with untreated mental illnesss have testified in support of SB 310, saying it would allay concerns about vague language in the current law.

The old definition of those eligible for involuntary outpatient did not include the "lack of adherence" requirement or the provision that they are unlikely to "live safely" in the community.

Louis Erteschik, executive director of the Hawaii Disability Rights Center, said people undergoing assisted community treatment would also not be required to take medication.

Earlier versions of the bill did appear to allow "forced medication" provisions under certain scenarios, something Erteschik staunchly opposed because of possible constitutional concerns.

People who are committed to a hospital for being a danger to themselves or others can be forced to take medication with a court order.

Erteschik said that whileoutpatient treatment billhas received wide support in Hawaii’s mental health circles, he is lukewarm about the measure and not sure whether it will make a difference.

"To me, as long as it didn’t trample on civil liberties, I’m not against it," he said.

But others, including the state Office of the Public Defender, are concerned that even the current version of the bill would impinge on individual rights.

"Some of our clients who suffer from mental illness, disorder or defect elect not to avail themselves to mental health treatment," the office said. "This measure will make it easier for the state to ‘sweep’ the streets for mentally ill people to order into court-supervised treatment. We believe every individual has the right to be left alone, even at their own peril."

At least 41 states have involuntary community treatment statutes, according to Mark Mitchell, mental health branch administrator at the state Department of Public Safety. The proposed changes to Hawaii’s law would bring it in line with what other states use, he said.

Mitchell added he strongly supports the bill as a way to "avoid unnecessary criminalization of mentally ill individuals who are in need of treatment rather than incarceration."

The state Health Department, meanwhile, has said while it supports the intent of the bill, it’s concerned about how the law will be implemented.

In written testimony, DOH Director Loretta Fuddy told lawmakers recently she’ll need time to come up with procedures needed to meet the requirements of the law.