More study of young adults, mental health urged; issue of involuntary outpatient commitment debated
HARTFORD, Conn. — A Connecticut task force charged with reviewing behavioral health services for young adults has recommended more study on whether the state should authorize involuntary treatment in the community for people with mental illness.
Created by the General Assembly following the 2012 mass shooting at Sandy Hook Elementary School in Newtown, the panel has been meeting since August 2013 and presented its final recommendations to lawmakers last week. Panel members say the group tried to reach consensus on whether to recommend the legislature adopt a system of involuntary outpatient commitment.
"The task force struggled to arrive at definite conclusions about recommendations in a number of specific areas," said Dr. Daniel Connor, the group's co-chairman. "Thus, the recommendations should be considered our best attempt at consensus, given the magnitude and complexity of the task."
While it's unclear whether the parents of Adam Lanza, the 20-year-old gunman responsible for the Sandy Hook killings, sought to have him involuntarily committed, there have been cases in Connecticut where families have struggled to help young adult children who refuse to take psychotropic medications or seek other treatment.
Friends say Margaret Rohner, the 45-year-old Deep River woman who police say was killed the day after Christmas by her 23-year-old schizophrenic son, struggled to persuade him to take his medication in the weeks before her death.
According to the Virginia-based Treatment Advocacy Center, Connecticut is one of five states that do not allow involuntary treatment in the community, also known as involuntary outpatient commitment or assisted outpatient treatment. Supporters say that without forced treatment, people with mental illness are more likely to get the care they need before they become so ill they require hospitalization. But some opponents claim there's evidence that involuntary outpatient commitment improves public safety.
Outpatient treatment could include residential services, psychotherapy, medication, outpatient counseling, day treatment services and case management.
Tim Marshall, a clinical manager who helps oversee mental health and substance abuse services provided by the Department of Children and Families, was the agency's representative on the Task Force to Study the Provision of Behavioral Health Services for Young Adults.
He said the panel heard from frustrated parents who could not persuade their young adult children to get services or take their medications, as well as a large number of young adults with mental illness who said they should be allowed to make decisions about their own lives.
"It's a very complicated issue," he said. "And the moment you come down on one side or the other, you're going to have a whole group of advocates saying you were wrong."
He said it will be up to the legislature to decide whether to create a new task force when lawmakers return in January.
Under Connecticut's existing civil commitment law, individuals cannot be involuntarily committed to a hospital or psychiatric facility unless they have psychiatric disabilities and are found to be a danger to themselves or others, or are gravely disabled, such as facing possible harm because they can't provide for their own basic human needs and they refuse hospitalization.
Commissioner Patricia Rehmer of Connecticut's Department of Mental Health and Addiction Services said her agency is looking at alternative ways of helping young adults, besides involuntary outpatient commitment. For example, one alternative — a peer mentoring program — is in the early stages but she hopes will support the agency's hypothesis that actively engaging with young adult clients is more effective than involuntary commitment in the long run.
She said outpatient civil commitment might not even be an option for some young adults because of the strict criteria that sometimes accompany commitments. States with such laws often require that the person have a history of violence, arrests and noncompliance. A young adult, she said, might not have such a history.
Meanwhile, Rehmer's agency is seeking federal grants to extend many of its existing services for severely mentally ill young adults, such as case management and vocational programs, to those with less severe mental illness. It's part of an effort to help clients early, before their condition worsens. The funding also would help provide such services to people with private insurance, which typically does not cover the cost. Government-funded Medicaid usually does.
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