We feel compelled to respond to the Maryland Disability Law Center’s commentary on Aug. 7 regarding The Daily Record’s July 31 editorial, “Sharfstein’s report card.” It is important to directly address MDLC’s assertions about the Department of Health and Mental Hygiene’s decision to develop a proposal to implement Outpatient Civil Commitment (OCC) in Maryland.
We all agree that Maryland must expand access to an array of proven voluntary community services to help individuals with mental illness live well in the community — from early detection and intervention to supports like supported employment, case management, assertive community treatment and crisis services. Over the past few years, DHMH has paid important attention to these and other issues affecting individuals with mental illness and their families, including improved patient care and reduction of health care costs and health disparities. Our counterparts elsewhere in the nation look to Maryland’s innovations in these areas.
At the same time, the National Alliance on Mental Illness Maryland also recognizes that a small subset of individuals with serious mental illness cannot benefit from voluntary community services because they lack insight about their need for medical treatment. For those individuals, OCC provides a less restrictive treatment alternative to hospitalization and maintains an individual’s health and safety in the community. We believe that DHMH’s decision to propose an OCC program in Maryland is the correct decision.
MDLC would have you believe that the process undertaken by Secretary Sharfstein ignored the law passed during the 2014 legislative session directing DHMH to convene a stakeholder workgroup to examine outpatient services, including OCC, and to develop a program proposal. This is flatly untrue. Del. Peter Hammen and Sen. Thomas Middleton, chairmen of the committees that approved the legislation in question, have both said that the department is following the law.
In addition, MDLC fails to mention that in 2013, DHMH launched an extensive process to explore and make recommendations to improve the continuity of care for individuals with serious mental illnesses. DHMH convened the Continuity of Care Advisory Panel and encouraged extensive stakeholder input over many months, providing multiple opportunities for “open dialogue” and to share “contrasting opinions.” The panel found that “there is evidence of the effectiveness of a well-designed outpatient civil commitment program and recommends moving forward to define such a program in Maryland.”
We are baffled by MDLC’s assertion that DHMH was less than open and transparent by proposing OCC implementation in its final proposal, considering the amount of stakeholder input in the latest workgroup process. MDLC also omits the fact that this final proposal, which will be presented to the legislature for review, will also include a plan to increase access to voluntary outpatient services.
MDLC also alleges that OCC has a myriad of underlying problems. We respectfully disagree.
First, OCC provides those unable to recognize their own treatment needs with a viable option while remaining in the community. Without this alternative, this small subset of people with severe mental illness will continue to revolve in and out of emergency rooms, jails and prisons or suffer other outcomes of non-treatment: homelessness, criminalization, victimization, suicide or violence. This does not benefit the individual, his or her family or community, or Maryland taxpayers.
Second, MDLC asserts that the implementation of OCC in New York led to a decline in availability of voluntary services. MDLC failed to share the rest of the study’s findings. In fact, the cited study found that any detriment to voluntary patients in New York was temporary, as counties built capacity to service OCC patients, and that “following the initial ramp-up … intensive community services increased for [both OCC patients and others] alike.” DHMH has diligently sought guidance from several states to craft a program that will not disrupt the availability of voluntary services and will work best for Maryland.
Third, MDLC seems to allege that the state will be taking control of all involuntary commitments. The draft OCC proposal does bring program control under DHMH, but only for Outpatient Civil Commitment. Filing a petition for involuntary in-patient services will remain the same. Whenever there is a need to balance between civil liberties and health and safety concerns, a careful and consistent process is critical. We are pleased with DHMH’s plan to centralize the petition process for OCC. This will help promote consistency of application, diminish regional discrepancies and assist the department in collecting data to assess the program going forward.
Lastly, we were stunned by MDLC’s claim that OCC has been “disproportionately used against” economically disadvantaged minorities concentrated in urban areas. Putting aside whether OCC can be used “against” anyone, the aforementioned New York study found “no evidence that [New York’s program] is disproportionately selecting African-Americans for court orders, nor … evidence of a disproportionate effect on other minority populations.”
Thankfully, our next governor and the General Assembly will have the opportunity to establish a well-researched, cost-effective OCC program that has been designed with extensive stakeholder input. Finally, the small subset of the most seriously ill who currently do not understand their need for treatment will be able to receive effective services in their communities and will break the seemingly endless cycle of crisis, expensive inpatient services, discharge and cycling down into the “freedom” of yet another crisis.
Farinholt is executive director and Honke is policy and advocacy director for National Alliance on Mental Illness Maryland.