I'd like to discuss the present law and possible needed
 changes. . . . I'm hoping to talk about holes I see with the present
law which are serving a significant segment of the mentally ill very poorly .
. .

I don't believe there are many issues that have come before this committee
that are more important nor affect such a large segment of the mentally ill

     NAMI-TAC shows NAMI and it's members are serious about remedying this
wrong and wanting to get laws changed to open up the standards by which loved
ones can commit their own mentally ill who need treatment but who are too sick
to have the capacity to recognize it . .  ( read NAMI-TAC statement of purpose
) -- then elaborate -- also Arizona, Missouri have new laws . . . The
Legislative Committee of the Illinois AMI is seriously looking into changes to
broaden the involuntary treatment law. Other states are looking at possible
changes to their voluntary treatment laws.
  *  *   *   *   *   *   *   *   *   *   *   *   *   *   *   *
Let me start with a little history as I understand it . . . .

The situation with families committing a loved one 25+ years ago.
My understanding is that prior to the last 30 years, families had the
practical ability in many states to intervene to help a mentally ill loved one
be involuntarily committed and treated. In  those states "loved ones" who
wanted to get their mentally ill family member into treatment could so with
comparative ease. There were indeed some rare cases where families either
committing a loved one without good cause or the ill were left in a hospital
far longer than was warranted. And many institutions undoubtedly lacked
thorough screening procedures to ensure that those "candidates" for
hospitalization and treatment unquestionably needed it.

The treatment was often only marginally effective and major side effects. were
prevalent. . .. . Many of the early medications had serious side effects
and/or kept patients in a doped up, zombie like condition -- partially because
that was all that was available and partially because it made patients easier
to deal with.

Right of families to easily commit was replaced by "right to refuse?
Thus the climate was ripe for change and major efforts to remedy the
injustices that had been imposed on a sizable segment of the mentally ill in
to many states. State by state, the ACLU and mental health bar engineered &
succeeded in getting legislatures to pass laws which took away the traditional
ability  of families to commit their seriously mentally ill loved ones who
needed treatment and substituted the right of the patient "not to be treated"
unless they were a danger to themselves or gravely disabled.

           THE UNINTENDED HARMFUL CONSEQUENCES

Did the new waive of laws regarding involuntary treatment of the mentally ill
go too far? Those with vested interests aren't talking much about the
unintended harmful consequences of the present inadequate law and delivery
system . . . . The passing of present laws to preserve the "rights" of a
mentally ill person "lacking capacity" to understand that they have a serious
mental illness have helped produce "unintended harmful consequences" causing
them unwarranted suffering. Civil libertarians would like to ignore these, but
here are some of those "unintended consequences". . . . . . . . .

 1. Violence both by the some of the untreated mentally ill and to them. The
               incidences of violence would not be nearly as prevalent among
the
               mentally ill if the law weren't obstructing path to getting
them treated.
 

 2. Several 1000's of needless suicides annually by untreated mentally ill.
 

 3. Homelessness for a conservatively estimated 125,000 mentally ill -- a
great many of whom, if treated, would not otherwise be homeless.
 

 4. Needless incarceration of 10's of thousands of the untreated mentally ill
      who we have been shamelessly jailed rather than treated . . .
 

 5. Unnecessarily causing the untreated mentally ill persons to remain
locked in their illness and unable to realize their life's full potential.
 

           6. The present law has been a major detriment to the relief of the
frustration       and agony experienced daily by hundreds of thousands of
family         members who have been unable to get their mentally ill loved
ones to        treatment. . . . The 27-10 Statute simply contains no standard
to allow        commitment for those who are not dangerous but are severly
mentally ill       & lack insight regarding their illness.

Each of these above consequences of our failing to make treatment for all of
the seriously mentally ill a priority is a tragedy in and of itself. But
collectively these consequences involve a magnitude of harm & misery which
should evoke loud and persistent demands by civil libertarians and the media

that those problems be eliminated. Instead, many turn their heads and pretend
that these problems don't exist.

Committing and treating most mental ill persons today is likely to far less
invasive than committing a person during the 50's, 60's, 70's, and 80's . . .
There are three factors at work today which make the climate for allowing an
expanded "involuntary treatment" law to be much less invasive for the mentally
ill person . . . . .

 1. The new breed of anti psychotic medications are much more effective and
almost free of side effects.
 
 2. In Colorado we're working on improving the procedures already in  place to
         insure that those who are recommended for involuntary confinement and
treatment are definitely gravely
          mentally ill and truly in need of treatment.
 
 3. Where confinement and hospitalization are warranted, the stays for the
nonviolent are relatively short and
          the law provides for careful periodic review so continued
incarceration wouldn't happen for a highly improved
          patient.

 4. There have been several success stories regarding states which have
carried on outpatient programs. Their
          efforts have worked well because those jurisdictions have laws with
teeth providing that patient may remain
          in the community at large as long as they are taking their
medications regularly.

 6. The type of patient which would be a candidate involuntarily commitment
and treatment under a "lacking
          capacity" much more likely to be nonviolent and not gravely disabled
and is a superior candidate, once
          stabilized, for outpatient treatment! . . . .

 
 NOTE: States should be using "outpatient treatment" more. But there needs to
be the will to provide for effective case management and a law in place
enabling with the teeth to induce patients to stay on their meds such as  that
reported in the State of Arizona and Dane County, WI . . Studies have shown
that successful outpatient treatment lowers the need for hospitalization, and
hence, lowers overall treatment costs to the governmental entities.

*   *   *   *   *   *   *   *   *   *   *  *   *  *   *

Do the involuntary treatment laws in Colorado and other states violate the
right of the "due process" of patients who are held in confinement, but not
treated?
Doesn't it seem strange that Colorado's 27-10 statute and subsequent court
cases and those of other states provides a path for being able to confine a
mentally ill person, but once confined, offers no requirement for treating
that person. Shouldn't the law also require that when a person is confined for
mentally illness that the state then provides a way to treat the cause of the
problem was the basis for their confinement?? Isn't confining someone without
"due process" a violation of their "civil rights"?

The degree of invasiveness by the law and the delivery system is key as to
whether and how much protection should be afforded patients with mental
illness under the law and in the manner and extent of their being committed

and treated . . .  If mental patients are incurring much less invasiveness in
being committed and treated today than in the past, then there is less need to
protect them by granting them freedom to refuse treatment which may benefit
them greatly . . . . For instance if several drugs were available today which
were 99% effective and side effect free, and could be administered effectively
on an outpatient basis, we wouldn't need to worry as much about whether or not
we should legally force them to be treated. While the state of the art in
treating the mentally ill is not at that level yet, that day may not be all
that far off.

*  *  *  *  *  *

Do opponents of broadening involuntary treatment standards have a plan to
improve the occurrences of harm to the ill?  As an alternative to broadening
the involuntary treatment standards, we have presented a course of action
which I believe will go a long way toward fixing things for many of the
mentally ill who are now not being treated. Some who have expressed
reservations about these proposals for various reasons. . . As people engaged
in occupational endeavors aimed at improving the plight and health of the
mentally ill, I assume that your larger avocation is to reach out and improve
the lives of a wider segment of the mentally ill. So what is your plan to
bring that -- you who don't think broadening the standards for involuntary
treatment is the answer???

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *
 

Colorado laws and other don't permit Doctor's automatic right to treat with
MEDS
Going a full step further, current laws ( with case law ) of many states
including Colorado law provide that committed individuals had the right to
refuse treatment unless the hospital physicians went to court and could prove
that the patient needed treatment under a fairly elaborate set of
"dangerousness standards. Then wouldn't it follow that physicians should be
going to court for permission to treat the physical diseases of the seriously
mentally ill?  But the law doesn't question the Dr.'s motives and ability to
treat physical disease for those who are mentally ill . . . . . Under review,
physicians should be free to do what they're trained to do without a judge
looking over their shoulder  deciding whether it is needed. Judges simply
aren't better trained and better equipped to decide whether a medication
treatment is adequate or not? And courts usually bring in experts from both
sides which has the effect of confusing the issue of whether to medicate or
not..

Shouldn't the wellness of those "lacking mental capacity to know they are ill"
be a primary interest which overrides the interest of affording a person his
"freedom of choice" not to be treated -- when the person's mind isn't
functioning well enough to make a "truly free choice"?
*  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *
 

Let's review Jane's history (typical). Her condition isn't bad enough for
courts . .
Jane's mental condition is horribly confused and psychotic and her life very
miserable, e.g. she's been raped, can't hold a job, function well, etc. I've
been told by attorneys that I would not be able to prove severe enough
problems for my daughter ( My God, how horrible does it have to be? ) for the
courts to involuntarily commit her. Families from almost every state all over
the country report similar ( and far worse ) problems and frustrations because
the standards for commitment in the states are similarly restrictive . . . .

Isn't it a compassionate society that steps in to help those in need who don't
have the ability to help themselves???  What I think is a prudent policy for
my daughter, I also think would be appropriate to apply to me. Because of
watching Jane's illness develop and now finding her on a plateau and at a dead
end, locked in the horrible disease of Schizophrenia, unable to fully
appreciate her life or reach anywhere near her life's full potential  -- I
have no reservations about wanting to be able to commit her for a treatment
program. And I would want her to do the same for me . . . . We're able to step
in and act for the elderly we love, but not for the mentally ill we love who
need our help. Why not?

Shouldn't we apply same logic to help the mentally ill as we do for those with
Alzheimer's?  It's a mystery as to why we don't apply the same social thinking
and policy as well as the same laws for our seriously mentally ill as for our
impaired aged loved ones who are afflicted with Alzheimer's. Most Alzheimer's
afflicted aren't dangerous and many also would not fit gravely disabled
standard any more than the mentally ill who we allow to refuse treatment --
those who "lack capacity" to know they are ill are so similar to the
Alzheimer's patients who also "lack capacity".

I've told my family that they have my advanced permission that  1) if I were
to become mentally incapacitated from mental illness Alzheimer's Disease, etc.
and  2) if I was unable to make wise treatment decisions for myself, and  3)
if there was reasonably good treatment available for my mental or physical
illness, that they should disregard my expressed wishes at that time and
commit me to the treatment. I have told them that this would be the right and
compassionate thing to do for me and to please disregard any anger or ill
feelings that I might have because I was not in my right mind.
*   *   *   *   *   *   *   *   *   *   *   *   *

And shouldn't our laws apply the same standards to our mentally impaired
adults as to our minor kids? Why society refuse to allow our children between
10 and 18 ( most of whom whom have better mental judgment about their
illnesses than the very chronic mentally ill ) -- the right to make their own
treatment decisions for both their physical and mental diseases but allow that
right for seriously mentally impaired adults who, in many cases have less
capacity to make good judgments for themselves. The logic of this
contradiction escapes me! An existing residue of the stigma of mental illness
must be the explanation! A 12 year old youth has a greater "mental capacity"
to make wise treatment decisions for himself than does my schizophrenic
daughter who continues to refuse medications . . .  .
 

Where's the consistency in the laws which protect the 12 year old from his or
her mental inadequacy by placing treatment and other decisions in the hands of
his parents, while failing to protect the equally mentally impaired adult who
lack "mental capacity" to make good treatment choices for themselves. This
silly policy simply places the untreated mentally ill person at unnecessary
high risk of harm because of the misguided effort to upholding his "right to
refuse" treatment at all costs. And what high costs!

*  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *

Why not a broader standard -- providing ever so thorough screening &
evaluation? The current law increases the odds that that segment of the
mentally ill -- who would otherwise qualify to be involuntarily committed
under a "lack of capacity" standard -- will be much more subject to harmful
consequences than the general public . .  Studies have shown that if they go
untreated there is a greater likelihood that they will be much more subject to
homelessness, suicide, violence, and continued degradation. This scenario
could be reduced if the law were changed to provide for their involuntary
commitment containing that a clause mandating that a solid screening and
evaluation process be in place. . . .  That would enable more of the mentally
ill who truly needed and now are not being treated to be brought into the
system and get relief from their horrible affliction.    >>>> ( per Flory and
Friedrich )

* *  *  *  *  *  *  *  *  *  *  *  *  *  *  *

It's not uncommon for devastated families, at wits end, to wish their ill
loved ones would have an aborted suicide attempt in order to get the family
member involuntarily committed to treatment. . . . Right now the law seems to
sanction commitment and treatment so that a mentally ill person can get
mentally well enough to gain the capacity to make good decisions about how to
handle a serious physical  affliction -- yet the same law fails to provide
that loved ones may commit their
non dangerous mentally ill to treatment so that they could gain the capacity
to make wise decisions about treatment for their serious mental disease. Go
figure!
 

                     WHICH INTEREST(S) DESERVE PRIORITY?

Shouldn't the vital interests of children and/or other dependent family
members to have their mother or other family head of household in a healthy
mental state take priority as to whether the courts allow involuntary
treatment admittance?
 

The welfare of children and other dependent relatives of the mentally ill is
likely to suffer when they are seriously neglected -- whether the cause is
mental retardation, drug & alcohol abuse, or mental illness. But in too many
states it is occurring when mental illness "hits home" because state laws, the
mental health delivery system and the welfare beaurocracies turn their heads.
 

Why is preserving someone's civil rights today given more importance under our
present laws than consideration for those who must depend on the mentally ill
person for their very survival. Mentally ill mothers, for instance, in a grave

state of paranoia, have not infrequently refused to give their children
prescribed medications and have neglected their feeding, care, and health
needs.
 

It is a crime in every state of the union for parents to seriously neglect
their children. So why haven't we made it mandatory to treat the mentally ill
parent with diminished mental of capacity who obviously would not neglect them
once the treatment outcome was successful. That would give both the mentally
ill parent and the children a better chance at life.
 

                        QUESTION for CONSUMERS?

1. Do you feel that you have made a wise decisions to continue taking meds?

2. Do you believe that there is a fairly large segment of the mentally ill who
" lack the insight" to know that they are ill?

3. Would you have wanted to be involuntarily committed if you had continued to
"lack insight" as to your illness?

4. Since you feel treatment has been beneficial for your illness, would you
not want treatment for others so impaired they lack the capacity to know they
are ill?

5. If you had a mother or father with serious Alzheimers disease, would you
advocate that he or she be accorded the right not to be hospitalized and
treated --  and left to their own devices?

6. Wouldn't it be a more compassionate society which, under it's laws, would
allow loved ones the ability ( with proper safeguards ) to step in and make
the right decisions on behalf of their mentally ill family member who doesn't
have the capacity to make that decision for himself?
 
7. How do you feel about involuntarily admitting and treating those who are
ill and have young children at home who are dependent on, say a mother, for
their welfare and survival? Is the parent's right to refuse treatment take
priority of the needs and rights of the chilrden to have a parent who is as
mentally healthy as society can help them be?