Despite a nationwide trend toward monitoring psychiatric patients and legislation in at least 20 states allowing judges to mandate care, mentally ill patients in Massachusetts cannot be forced to undergo therapy - or see their doctors or take their medication. It doesn't matter if they have gone through the court system or if their behavior may soon deteriorate without treatment.
But in the aftermath of two high-profile violent crimes connected to psychiatric patients, some state officials are renewing their call to close such gaps in care - urging, at the very least, medical checks on mental patients who have committed brutal crimes and been released later.Less than a week after the arrest of Steven B. Gordon, a convicted felon who said he raped three women after failing to take medication for manic depression, state Sen. William R. Keating continued his push for legislation that would let judges mandate psychiatric medication as part of parole.
And three days after the arrest of Russell Eugene Weston Jr., a paranoid schizophrenic accused of fatally shooting two guards in the Capitol, mental health specialists urged the state to consider outpatient civil commitments. These commitments are already in place in nearly half of all other states.
"There is no way, currently under the law, to continue supervising the mentally ill, no matter what kind of violent crime might have resulted in their being there in the first place," said Keating, a Sharon Democrat.
"For years in this state, we have had a problem with the dividing line between mental health and criminal justice."
It is a line that zigzags across the nation, each state drawing the boundary between individual rights and public safety in a different place.
In Arizona, sex offenders can be required to undergo counseling as one of their parole conditions, according to Ron Homberg, director of legal affairs for the National Alliance for the Mentally Ill. In Vermont, judges can order schizophrenics into outpatient civil commitment, he said.
In Massachusetts, psychiatric patients can be civilly committed - institutionalized and held for a period without a court hearing if they are determined to be a threat to themselves or others. But they cannot be kept under court supervision once released from an institution, according to Department of Mental Health spokesman John Widdison. Even sex offenders cannot be forced to accept treatment, he said.
"Once they're discharged, they're gone," he said.
Elected officials have urged several pieces of legislation in recent years. Not one has made its way into law.
The conditional-release bill, stalled in the Senate Ways and Means Committee for more than a year, would let judges order psychiatric suspects into care after they are released and dangle the threat of a return to the state hospital system if patients do not comply.
The lifetime-parole bill for sex offenders has a similar provision, allowing courts to send convicted rapists into counseling as part of the conditions of parole. It, too, has stalled. So has a proposal to create a "guilty but insane" conviction category, which essentially would allow juries to acknowledge a suspect's insanity and still send the suspect to prison for committing a serious crime.
"We have a very strong consumer lobby," said state Sen. Therese Murray, a Plymouth Democrat, referring to mental patients who do not believe they can be required to take medication.
Mental health advocates raise other objections to the stalled proposals. Steven Schwartz, director of the Center for Public Representation in Northampton, argued there is little documented evidence that tightened restrictions on psychiatric patients actually improve public safety or patients' lives.
"It is not just a civil liberties issue," said Schwartz. "The long and short of it is that it has not worked in a meaningful way in the states that have tried it, primarily because of the limitations in enforcement."
Dr. Paul Appelbaum, chairman of psychiatry at University of Massachusetts Medical School, said that in states where sufficient resources were devoted to monitoring psychiatric patients, the results can be positive.
Yet Appelbaum warned that even a network of guardians cannot predict whether a psychiatric patient will snap, as the Capitol Hill shooting and New Hampshire rape suspects allegedly did.
"Regardless of the system we set up, there will always be circumstances in which people are released and, in retrospect, questions are asked about why it was impossible to determine that they would commit a violent act," he said. "Which is why each time something like this happens, the question is asked: `Why couldn't we predict this? Why couldn't we prevent it?' "