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Lawmakers consider mental health bills

Four bills under consideration in the 2014 Maryland General Assembly could help those who have severe mental illness.

“We think some of these laws will give some families the ability to treat people and give them back their lives and health,” said Stephanie Rosen, executive director of the Montgomery County chapter of the National Alliance for Mental Illness.

Rosen provided a rundown of four important bills this session:

SB67/HB606: Dangerousness Standard

This bill would clarify Maryland’s law on emergency psychiatric and inpatient commitment by changing standards for involuntary hospitalizations and emergency evaluations.

According to Rosen, current law allows physicians or health workers to “involuntarily commit” someone only if the person presents a danger to the life or safety to [the patient] or to others. “Currently, there is no definition of that requirement,” she said.

The new bill would have a definition and would make it easier to involuntarily hospitalize people if there’s a reasonable expectation that they would hurt themselves or others if not hospitalized.

A similar change would affect standards on how health officials give emergency evaluations to people with mental disorders.

SB262/HB273: Mental Health and Substance Abuse Safety Net Act

This bill would provide help moderate- to high-risk offenders with a history of mental illness and substance abuse, before and after release. It would require that a plan for incorporating behavioral health services in all public schools be delivered to the legislature by Oct. 1.

It also would provide health services — including behavioral health services for Baltimore city and Caroline County — and early intervention services statewide for substance abuse and mental health.

Rosen said the bill would head off potential crises earlier.

SB831/HB767: Assisted Outpatient Treatment

This bill would let courts order outpatient treatment for people with serious or disabling mental illness and who struggle to adhere to voluntary mental health treatment, Rosen said. Maryland is one of five states whose courts can’t order outpatient treatment for people with severe and disabling mental illnesses who can’t follow voluntary prescribed treatment, she said.

The bill is specifically for people who don’t recognize their mental illness and wouldn’t seek treatment, she said.

“We do not want to force people to be treated, but for this small subset, lack of treatment is resulting in hospitalizations and imprisonment and great cost to community,” she said.

SB620/HB592: Medication-over-objection

This bill would help people with mental illness move toward recovery by allowing the forced administration of medication in certain conditions.

Currently, someone considered dangerous enough to be admitted to a hospital must be actively dangerous in a hospital to receive forced medication.

“We don’t want it to be easy [to force someone to receive medication]. There should be a panel, host of requirements ... but when necessary, I think there should be an option for treatment,” Rosen said.


Amid a spate of unusual and violent killings in Montgomery County last month, authorities are investigating what they say is a common thread: mental illness.

• In Germantown, two women were accused of stabbing two young children to death in an attempted exorcism.

• In Gaithersburg, police said, a man stabbed a 7-Eleven clerk to death less than a week later.

• Police said an off-duty sergeant shot his adult son to death as the son was stabbing his mother to death.

The two women and the 7-Eleven defendant were transferred to a psychiatric hospital in Jessup for mental evaluation and treatment.

The slayings prompted Montgomery County State’s Attorney John J. McCarthy to highlight local law enforcement’s role in dealing with and caring for the mentally ill. He talked about the lack of funding for treatment and the need for more resources and funding.

“The larger issue for us in the community is: How do we deal with people who have persistent mental health issues and intersect with the criminal justice system?” McCarthy said in a press conference last month.

He said it’s an “open secret” that jails are one of the largest providers of mental health care and treatment nationwide.

Statistics show a growing problem.

According to data from the county prosecutor’s office, the number of “intakes” — people who were arrested — at the Montgomery County correctional facilities decreased from 9,256 in 2010 to 7,879 in 2013.

But the number of people who needed mental health screenings increased from 2,161 in 2010 to 2,222 in 2013.

The 2,222 are 28 percent of the jail’s population. Of those, 926 had to be taken to the jail’s 34-bed crisis intervention housing unit, where the detention center houses the most seriously mentally ill.

Law enforcement officials said they can’t explain the rise.

Of the 2,161 inmates in 2010 who had mental health screenings, 653 needed to be transported to a critical intervention housing unit, according to the state’s attorney’s office.

“Of all the issues faced by adult corrections, mental illness is by far the most challenging and difficult,” said Arthur Wallenstein, chief of the county’s Department of Correction and Rehabilitation.

On Tuesday at the county jail’s critical intervention unit in Boyds, therapist Laurie Mombay said that as many as 10 to 12 of the 34 inmates at the unit at any one time were chronic offenders. They might cycle through the jail multiple times a year on low-risk offenses, like trespassing or disorderly conduct charges.

“It’s difficult to intervene in a way that helps people get better,” she said, citing the demands of the system, the number of inmates the unit treats, and how critically ill they often are when they arrive.

Historically, in the U.S., those with debilitating mental illness were held in institutions, including psychiatric hospitals. Decades ago, for example, Saint Elizabeths Hospital in Washington, D.C., held thousands of patients. Today, it holds just a few hundred.

According to Dr. Alan Newman, a psychiatrist with Georgetown University, in the past, institutionalization was “too easy.”

Now, people can only be hospitalized against their will if they are “an immediate danger” to themselves or others, he said.

“The flip side means that many people who are severely mentally ill, untreated and homeless, cannot be forced to get treatment because they do not meet this narrow definition of dangerous,” he said.

“Some of those patients will eventually commit an offense that they wouldn’t have if they had gotten treatment,” he said. Conversely, those who committed violent acts when untreated often are not a threat to the community once they’ve received the care they need, he said.

Advocates for those with mental illness say that when Congress passed legislation emphasizing de-institutionalization in 1963, the goal was community-based treatment centers. That goal never substantially materialized, Wallenstein said.

“Unfortunately we only hear about mental illness when there’s an egregious act of violence,” said Dr. Raymond Crowel, the county’s Chief of Behavioral Health and Crisis Services.

“We shouldn’t be waiting until someone breaks the law before they begin to get treatment,” he said. “There’s a conflict in the way the system is structured.”

The county spends about $34 million — including federal and state dollars — on mental health services, he said.

“We don’t have all the resources for someone coming out of jail with mental illness,” he said.

“We have to be able to recognize [symptoms] and treat them earlier. ... If someone comes in for a second time, we have to be able to catch that and intervene before things become violent,” he said.

Programs like pre-jail diversion (which the county already uses) and longer hospital stays could help, he said. Government agencies also should look at stabilizing a person’s life through resources for education, housing and vocation, he said.

Mental health courts — in which treatment teams, prosecutors, public defenders work together to keep people out of jail — also could help, he said.

People who previously might have been in the more paternalistic health care institutions of generations past are out on their own, without the protection of a safety net.

“If they are refusing treatment and not considered an ‘imminent danger,’ they are allowed to sort of rot away with their rights on,” Newman said.

That has put some living with mental illness in a precarious position, advocates say. Many people who come into contact with police wouldn’t be in the criminal justice system if they had the help they needed sooner.

“Mental illness includes a lot of different disorders,” said Stephanie Rosen, executive director for the Montgomery County chapter of the National Alliance for Mental Illness.

Mental illness encompasses everything from mood disorders to phobias, or panic disorders, along with conditions like eating disorders, or schizophrenia, she said. The vast majority of people with mental illness are nonviolent, living successful lives, she said.

According to the National Institute of Mental Health, about 25 percent of the adult U.S. population will experience symptoms of mental illness in a one-year period.

Mental health advocates say that sometimes the only way a person can get the care they need is by being arrested and taken to a correctional facility.

Law enforcement and mental health professionals also find themselves in a bind, Rosen said, when a person with mental illness may be arrested, but can’t be sent to the hospital, because the person doesn’t think he or she is sick.

One case Rosen was familiar with was a man suffering from schizophrenia who routinely visits a 7-Eleven even after being told not to.

“He constantly comes back to the same 7-Eleven,” she said. “The same officer is constantly having to pick up the same individual — there are zero laws, and no other options than arresting him.”

Police say they have seen a jump in calls for service dealing with individuals who may be mentally ill.

McCarthy said mental health has become a significant factor in how criminal cases are handled. That includes services for defendants while their cases are investigated and prosecuted, putting new pressures on jails and police officers.

“The biggest challenge we face in this county is dealing with people with delusional disorders,” said Officer Scott Davis, Montgomery County Police’s Crisis Intervention Team coordinator. “They’re not ill enough to involuntarily petition, but if we let [the situation] lay the way they are, it causes non-stop calls for service.”

He and his fellow officers have had to respond to calls at one house in Bethesda 50 times over the last few months, because of constant calls by the person living there, who Davis said has a mental disorder.

According to Davis, county police responded to 5,256 calls for service related to mental illness in 2013 — up from 4,449 in 2009. That number from 2013 accounts for about 20 percent of the 235,000 calls police made that year. Local law enforcement officials say the influx has strained their resources.

“Corrections never asked to be a mental health provider and now we find more seriously and persistently mentally ill persons in our custody than ever before,” Wallenstein said, calling the issue a “crisis.”