Clarifying Senate Bill 226

I recently received a comment to the previous blog on the complexities of mental illness which made me realize that many people probably do not understand exactly how Pennsylvania's proposed legislation, SB 226 would be enacted, who it would affect, and the period of time that it would be in place.

In order for someone to qualify for an assisted outpatient treatment (AOT) court order under SB 226, the person has to meet ALL of the numbered criteria to be eligible for the program. There is one area of either/or in the criteria – number (4), parts (i) and (ii). To be eligible, a person must meet all of the other criteria, but they only have to either have had the history of hospitalization (i), or the history of violent behavior (ii), not both.

For example, simply meeting (7) “likely to benefit from AOT” would not be enough for entry into the program. ALL of the other criteria would have to be found by a judge by clear and convincing evidence, as well.

(1) The patient is 18 years of age or older.
(2) The patient is suffering from a mental illness.
(3) The patient is unlikely to survive safely in the community without supervision, based on a clinical determination.
(4) The patient has a history of lack of compliance with treatment for mental illness that has:
(i) at least twice within the preceding 36 months been a significant factor in necessitating hospitalization, or receipt of services in a forensic or other mental health unit of a correctional facility, not including any period during which the person was hospitalized or imprisoned immediately preceding the filing of the petition; or
(ii) resulted in one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the preceding 48 months, not including any period in which the person was hospitalized or imprisoned immediately preceding the filing of the petition.
(5) The patient is, as a result of the patient's mental illness, unlikely to voluntarily participate in the recommended treatment pursuant to the treatment plan.
(6) In view of the patient's treatment history and current behavior, the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to pose a clear and present danger of harm to others or to himself as determined under section 301.
(7) It is likely that the patient will benefit from assisted outpatient treatment.

The initial court order would be for a period of six months, followed by a review. If it was determined necessary, this could be continued for an additional year.

The number of people in New York under Kendra's Law, which SB 226 is modeled after, is approximately 750 each year. Given the size of Pennsylvania in comparison, the number of people who might be in an assisted outpatient treatment order would be approximately 500 each year. If that is broken down into counties, that could mean about 8 people in each county.

The benefit behind a sustained period of time in treatment cannot be underestimated, as the outcomes from Kendra's Law show. The major goal of a bill such as SB 226 would be to enable the very small minority of people with a mental illness who meet the criteria and who often initially lack insight and end up homeless, hospitalized, or incarcerated to receive timely, sustained treatment and then for them to move forward in whatever direction they may choose.

Without this supportive bill, are we really providing the care and support that someone with an untreated mental illness deserves?