Virginia reviews involuntary commitment standard

Virginia's House of Delegates subcommittee has begun their review of the standard used for involuntary commitments for individuals with a mental illness who do not voluntarily seek treatment. VA's commitment law currently requires an imminent danger to self or others and the proposed legislation, House Bill 559, would change that to ‘There is a substantial likelihood that, as a result of that mental illness, a person will, in the near future, cause serious physical harm to himself or others as evidenced by recent behavior causing, attempting or threatening such harm, or any other relevant information,’”

Just as in Pennsylvania, where our clear and present danger criteria and inability to include a history of prior hospitalizations when determining the need for treatment, Virginia's overly strict criteria often stands in the way of timely treatment that can help prevent the type of dangerous situations that both of our states' laws now require before someone is provided treatment.

In an article from Virginia's The Daily Progress, Mental health bill vetted by panel: Proposal would ease involuntary commitment standard, by Bob Gibson, January 12, 2008, Alex R. Gulotta, executive director of the Charlottesville-based Legal Aid Justice Center, stated “If we had the time and money, we would create more services at the front end” and prevent people from getting worse and needing involuntary commitments."

Providing more services alone does not identify what is at the core of the problem for those with a severe mental illness and a lack of insight (a.k.a. anosognosia) to seek treatment. If someone does not realize that they need support because they are experiencing the symptoms of a mental illness that could be helped with treatment, they will not ask for treatment, either before they are "getting worse" or when they are in dire need of immediate help, whether or not services are available.

In my own situation and from the many families I have spoken with, services were available for their family member: club houses, day programs, group therapy during hospitalizations and mental health professionals were also available: psychiatrists, therapists, and case managers. The only thing missing was a law that would require the person in need of help for the symptoms of their illness to accept the prescribed treatment from the mental health professionals who had evaluated their needs for medication, therapy, and services.

Laws such as PA's proposed Senate Bill 226 are court-ordered assisted outpatient treatment (AOT) laws that provide the services and treatments that an individual with a severe mental illness may need for an initial period of just 6 months, followed by a review and, if required, an additional year. The law would also require the designated provider to be responsible for providing the support and follow-up of services the individual may need. This type of timely, consistent support has been proven to be effective, as the outcomes from NY's Kendra's Law show so clearly.

Hopefully, over time, the results of effective AOT laws will lead other states around the country to use that model so that individuals with a severe mental illness and lack of insight to seek support on their own will have the benefit of timely, compassionate treatment.