Email | Print

The National Alliance for the Mentally Ill (NAMI) is a mental health advocacy organization that represents more than 200,000 families, consumers and providers across the country. NAMI-New York City Metro is the largest affiliate of this organization in New York State. As a group, we try hard to understand the different perspectives of consumers, family members and providers. So as a member of NAMI-NYC Metro, I am thrilled to have this opportunity to discuss the family perspective on outpatient civil commitment. I hope that this will help to build a bridge between family members and consumers so that we can both work together to fight for good mental hygiene laws in New York State.

Outpatient Civil Commitment is a legal mechanism that allows a judge to mandate outpatient treatment when an individual is discharged from a hospital. This program is limited to individuals who have been involuntarily hospitalized twice in the past 18 months due to noncompliance with treatment. This is an important detail: this program is only for the sickest individuals. Most people reading this column would never fall into this category - unless you have been a "danger to yourself and/or others" twice in the last 18 months just because you didn't follow treatment recommendations. The issue of using legal mechanisms to encourage compliance with treatment is, of course, controversial. It raises fundamental questions about how to divide the responsibility for mental illness between society and the individual consumer. NAMI-NYC Metro has supported some form of Outpatient Civil Commitment but we feel that the state must invest in much more services including housing, treatment for substance users, Assertive Community Treatment and other programs.

I do not believe that any mental health advocate will disagree with us that the system must provide more services but some consumers do not believe that any form of Outpatient Civil Commitment is necessary. Why does NAMI-NYC Metro support this concept? Here are two good reasons:

1. Outpatient Civil Commitment commits the system to the patient. We have all seen cases where an individual gets moved back and forth between providers like a hot potato. Each provider points to some minor way in which an individual does not fit their program and then refers them on. With Outpatient Civil Commitment, the hospital must provide a comprehensive discharge plan with providers that have accepted the responsibility to treat the consumer. This creates greater accountability.

2. Outpatient Civil Commitment minimizes coercion. It is clearly more coercive to keep a person in the hospital than to let them go into the community. Like it or not, doctors are more willing to let an individual out of the hospital if they know that there is some legal mechanism to encourage them to adhere to the treatment plan. So Outpatient Commitment provides treatment with the least restriction on an individual's freedom.

Some people think of Outpatient Commitment as an alternative to outpatient treatment without a legal mandate. But that is not the alternative. If an inpatient doctor is willing to discharge a patient without Outpatient Civil Commitment then he or she won't go through the difficult process of getting a court order. In reality, Outpatient Commitment is an alternative to continued hospitalization. This is not just a theory: the Bellevue Pilot Program demonstrated that Outpatient Civil Commitment decreases the length of subsequent hospital stays.

There are other reasons to consider supporting Outpatient Civil Commitment and there are other reasons to be cautious about it, too. I hope we can continue a respectful dialogue about this and other important issues.