Senate Bill 226 changes the Mental Health Procedures Act—perhaps for the better.
May is Older Americans Month, Vocabulary Month and Asparagus Month. Much as I like elderly people, words like floccinaucinihilipilification and smelly vegetables, May is also Mental Health Month, and thus I’m charged with saying something serious.
It’s the kind of obligation that makes me wish my beat were ducklings, so I could write about the fact that May is National Duckling Month.
Which it is, believe it or not.
There’s a lot happening in mental health these days, and in particular I’d like to urge everyone to sit down with a nice cup of coffee (or tea, or Paxil), and do a search of The New York Times archives for articles by Benedict Carey on the subject of psychiatry and the pharmaceutical industry.
Or do a Google search using the words “Zyprexa scandal.”
Either or both will help you understand what I believe are the two most important issues in mental health today: prescribing psychotropics for children, and pharmaceutical-industry influence.
If I could, I’d write about just these two things for the rest of the year.
But given that the largest mass shooting in U.S. history occurred last month, it’s hard to ignore the issues that have come to the fore in the wake of that tragedy.
One such issue—and this is perhaps the third thing I’d write about all the time if I could—is how to get people treatment even when they don’t believe they need it. And how to do so without infringing on people’s rights—the rights of the sick person, and the rights of the caregiver.
Since I started writing this column eight years ago, I’ve been flooded with requests for help from readers trying to get treatment for sick relatives or friends who are too psychotic and delusional to know they need it. These people are almost always turned away from hospitals because they don’t seem to present a clear and present danger—Pennsylvania’s current standard for involuntary treatment.
Now when caregivers ask me for help with an urgent situation, I tell them the truth: There’s nothing you can do. You’ll have to wait until it gets so bad, it’s life or death.
Activist Jeanette Costello knows this well.
In one year Costello’s daughter was in and out of hospitals 15 times. “Each time she stopped her medications,” Costello says, “I waited the days or weeks that it took to see her reach the level of clear and present danger to herself or others currently required by our current Mental Health Procedures Act. She had a total lack of insight for her need for the medications that would help her.
“Each time I tried to find help for her, I was only allowed to relate to the emergency room staff what dangerous behavior had occurred within the last 30 days. If what I stated wasn’t considered dangerous enough, we’d need to go back home and wait a little longer.”
Costello spent those required waiting periods in a state of fear and hypervigilance. Her daughter would hear voices that told her to leave the house, so she’d wander away in the middle of the night.
Costello could get a case manager to visit only every two weeks. Meanwhile, Costello was living in crisis every minute of the day. It was exhausting and destructive.
Costello’s daughter is better now, but those frantic days took a toll. So Costello is fighting (with her daughter’s support) for Pennsylvania Senate Bill 226, which would compel some people with severe, disabling mental illness to receive outpatient assisted treatment. It isn’t forced hospitalization, but it is forced treatment.
Costello says she isn’t trying to infringe on anyone’s rights.
“The bill is important because it would change the frighteningly long period of time it can take to meet the stringent dangerousness criteria that currently exists,” she says. “It also allows for a history of someone’s hospitalizations to be considered, instead of just 30 days, which means that someone in my daughter’s situation would be spared the Russian roulette-type of waiting to receive treatment while hoping that nothing too serious or irreversible occurs.”
No one wants to go back to the days when involuntary hospitalization meant months or years of spurious and damaging treatment.
But when there are more mentally ill people in prisons than in hospitals, you know there’s a problem that calls for serious measures.
Is Senate Bill 226 one of those measures?
Mental health journalist Philip Dawdy, who writes the blog FuriousSeasons, isn’t sure. He worries about how effective such legislation would be.
“I also worry that these laws don’t do a good job of protecting the rights of patients who are innocent of a crime yet have their rights to their own bodies taken away by society,” he says. “A real key for a law like this is what provisions are built in so that the patient has appropriate representation in court and can switch medications and dosages should a medication prove injurious or doesn’t work.”
Dawdy makes a good point. So though I’d like to make a grand, sweeping statement for Mental Health Month, I can say only this for now: Senate Bill 226 raises some interesting issues.
Or I could make a grand, sweeping statement for National Duckling Month, one free of complexity and nuance: Duckies are cute!
I think that’s something we can all agree on.
Just the Facts
>> To read Senate Bill 226 go here and type in the bill number in the upper right corner.
>> Last week The New York Times’ Benedict Carey reported that an increase in payments from pharmaceutical companies to doctors has coincided with an increase in antipsychotic drug prescriptions for children. “There’s an irony that psychiatrists ask patients to have insights into themselves, but we don’t connect the wires about how money is affecting our profession and putting our patients at risk,” wrote Carey.
>> In a year-long search for the funniest joke, British psychologist Richard Wiseman and his team from the University of Hertfordshire found that the duck is the world’s funniest animal. “If you’re going to tell a joke involving an animal, make it a duck,” said Wiseman.
