New state law seeks to improve mental health treatment

A new state law enacted last month is aimed at ensuring that people with untreated mental illnesses get the help they need, with the additional hope that it will reduce the burden on emergency rooms, jails and prisons.

Senate Bill 43, which passed the Ohio Legislature unanimously, grants probate judges the power to order outpatient treatment for those with a documented history of harming themselves or others. It also empowers families of such people to initiate the process necessary to order that treatment.

The law, signed by Gov. John Kasich in June, was co-sponsored by state Sen. David Burke of Marion and Charleta Tavares of Columbus.

“I’ve always been passionate about mental health issues,” Burke said. “It was a bill we’ve been working on for a while. A lot of it resonates when we have these shootings in places like Aurora, Colorado, or Chardon, and folks say, ‘Weren’t there any signs that was going to happen?’ When you do the research, sure enough, parents sought help for their kids and couldn’t get it, and the children end up hurting other people.”

Burke said the law reaffirms an existing law that gives probate judges the power to order outpatient treatment, gives more rights to the accused, requires high evidentiary standards and criminalizes its misuse.

Jane James, executive director of Stark County office of the National Alliance on Mental Illness, said her organization strongly supports the change. One in four Americans, James said, has some issue with a mental illness.

“NAMI, in general, is in favor of any form of assisted outpatient treatment because it’s a less-restrictive option than ‘pink-slipping,’ or mandating hospital for someone to be civilly committed,” she said. “It’s difficult to get a person pink-slipped; but this is another option that will make it a little more accessible because it allows family members to initiate the process rather than the person getting arrested, going to jail and getting civilly committed.”

James said 1 to 2 percent of people with mental illness are so severely ill, they don’t realize they have an affliction.

“They don’t understand that what they’re feeling and thinking is the result of some sort of holistic hallucination,” she said. “They don’t seek treatment and typically are in and out of criminal justice systems or homeless. They are the ones we hear about.”

IN-BETWEEN OPTION

Carole Vesely, a crisis counselor at Canton’s Crisis Intervention and Recovery Center for 25 years, said the new law offers an “in-between” option, and is the result of a well-thought-out process.

“Right now, we have two choices. I’m a health officer at the Crisis Center, which means I can ‘pink-slip’ a person, or they can voluntarily choose treatment,” she said.

“The group we were missing are those who fall in between that. There are individuals who need treatment but who have issues following up, though they don’t meet necessary standards for involuntary treatment. Having the option of another system overseeing their getting treatment is (good).”

James said most counties didn’t utilize the previous law because probate judges felt the verbiage wasn’t clear enough. Under the new law, if a person complies with the court order, the case against them can be expunged after 90 days.

“Because the new bill is more specific and clear, it’s had a lot of support throughout the state,” she said.

OPPOSITION

Jack Cameron, executive director of the Ohio Empowerment Coalition, a Columbus-based patient advocacy group, said the new law not only violates people’s civil rights, it’s a “quick-fix” attempt that will alienate those already wary of treatment.

Cameron, a Canton resident, was director of Canton Friendship Center from 1986 to 2000.

“Our biggest objections are around the loss of a person’s civil rights,” he said. “When people are forced to take medication that can have significant, long-term side effects, it becomes a civil-rights issue. It’s not that we don’t think people can’t be encouraged to get treatment, but the idea of being forced to take medicine that can make a person sick or worse, is bad strategy.”

“Because of historical civil infractions with people with mental illness, you can almost say the pendulum swung a little too far,” James said. “We’ve lost sight that if someone’s ill from a brain disorder, they don’t have the cognitive ability to make decisions. They need someone to do that for them. ... We understand it’s a sensitive issue. We feel there’s room for common sense and to still maintain room for people’s rights.”

Burke said the law requires compelling evidence, either from police and/or medical records, that proves beyond “the shadow of a doubt” that the person in question is at risk to harm to themselves or others.

“The accused has the right to a public defender if they so choose,” he said. “This isn’t about a person being guilty or innocent. It’s about getting them treatment. It’s really preventative. ”

Cameron further argues that the new law doesn’t provide any new money, unlike “Kendra’s Law,” a similar measure passed in New York.

“New York put great deal of money on the table to prioritize treatment for folks who need help in an urgent way,” he said, “In Ohio, there’s no new money attached to the bill, so while judges may order treatment options, in many cases, services won’t be available. There are long waiting lists in smaller counties especially.”

“I don’t disagree,” Burke said. “We have a mental health system that has been openly described as fragmented and broken. I would like to see more a managed-care environment. People with mental illness live 25 years less than those who are not ill because they don’t think about their diabetes or their blood pressure. We’re trying to address that and have a managed care approach. I think you’ll see that in the future.”

QUICK AND EASY FIX?

Cameron said that in most cases, the people the law will most impact have ongoing problems, and he has concerns about its potential abuse it in the form of coercion by family members.

Cameron said his group supports the public mental health system moving away from the medical model of the “doctor knows best.”

“The best way to reach people is to make a connection with them,” he said. “Many are disengaged from their families and community.”

Cameron said that rather than limiting treatment to such billable services as counseling, housing and medication, there also should be peer support.

MORE AWARENESS

Stark County Probate Judge Dixie Park said the new law should help families become more aware of the services available in their communities. Park said that of the 1,600 guardianship cases her court oversees, 588 involve people with some mental illness issue.

“It’s always helpful to families when they have the option to help a loved one with their mental health issues,” she said. “I think our community has a lot services available. It would be great if people could become more aware of them. “

Each week, Park oversees confidential hearings at Heartland Behavioral Health in Massillon involving people who are alleged to be mentally ill and require hospitalization.

“We’ve had an increase of individuals who had been committed for inpatient treatment,” she said, noting that 371 cases were filed with her court in 2012 compared to 298 cases in 2013.

Park said the option for mandated care has existed for some time but few families have taken advantage of it. She said she has been working with the Mental Health and Recovery Services Board of Stark County to help develop a protocol in applying the new law.

Park said that in terms of ongoing mental-health care, the challenge is in making sure there’s ongoing support, case management and treatment.

“Once they have the diagnosis, it just can’t stop there,” she said. “The earlier it’s attended to, the greater the likelihood they can get back to life.”

She urges those experiencing a life-changing event to consider counseling to avoid more serious issues down the road.

‘GUN BILL IN DISGUISE’

Cameron calls the new law “a gun bill in disguise.”

“The legislators took the cowardly way out to see this as a solution to the gun-violence problem,” he said. “I think it was the wrong way to go. It achieves a short-term goal. You can’t restrict them forever. I just don’t think it’ll work.”

Vesely doesn’t see the connection.

Neither does Burke.

“... I don’t know how there’s a link. It prevents tragedies that may involve a gun, but normal people don’t go to the mall and start shooting. The person is the cause, they just used the gun. It’s probably a public safety (bill) more than a gun bill.

“At the end of the day, the goal is we look at these tragedies, and we ask why is that somebody didn’t know? Dig a little deeper and we find someone did know. If somebody gets treatment, it can stop these incidents. It also ensures that people get help while protecting their rights. I would consider that a victory.”

Repository staff reporter Shane Hoover contributed to this story.

Reach Charita at 330-580-8313.

On Twitter: @cgoshayREP

For more info

NAMI Ohio offers a guide: “Understanding Ohio’s Court Ordered Outpatient Treatment Law.” To download it, visit www.namiohio.org