Inpatient and Outpatient Treatment

The presentation from Mark Heyrman: "Why the Legal Standard for Involuntary Commitment to Mental Hospitals Doesn't Matter" is worth an hour of your time to listen to a very short but comprehensive history of involuntary commitment laws in the United States since the 1950's. Mark Heyrman is Clinical Professor of Law at the University of Chicago Law School and his talk was recorded on November 6, 2007 as part of the Chicago's Best Ideas Series.

Unfortunately though, he limits his talk to inpatient involuntary commitment treatment in hospitals and the difficulties faced by hospitals, both state and private, due to cost of treatment for those with a severe mental illness, as well as the reduction in the availability of psychiatric hospital beds, which have decreased from 55,000 in 1952 to approximately 1,400 now (or a reduction of approximately 95% in all 50 states). He does not mention the positive effects that assisted outpatient treatment (AOT) laws, such as the outcomes from New York's Kendra's Law. And obviously, since it had not yet been released at the time of his talk, he did not refer to the outcomes from the Treatment Advocacy Center's report, "The Shortage of Public Hospital Beds for Mentally Ill Persons."

I do not agree with all of Prof. Heyman's solutions because he does not mention the effects of lack of insight or anosognosia for those who receive (or I should say do not request or accept) mental health services outside of a hospital. His suggestion that increased intensive services in the community alone will solve the problems that the reduction of beds available for those with a severe mental illness has caused does not address the difficulty of providing services to individuals who do not think they have an illness, due to lack of insight.

One of the most important experts on anosognosia, Dr. Xavior Amador, provides a method called LEAP (which stands for listen, empathize, agree, and partner) in his book, "I Am Not Sick, I Don't Need Help!" However, Dr. Amador has also stated and given me permission to post on my blog site that, "AOT is a vital tool that we need to help people who have anosognosia, or lack of insight, for mental illness."

Only a very small minority of people with a severe mental illness and lack of insight need this AOT "tool" that provides court-ordered assisted outpatient treatment, but they are often the very individuals whose lives are devastated when treatment isn't provided. Sensible treatment laws, like NY's Kendra's Law, and PA's proposed AOT law, SB 226, will ensure that those individuals are given the compassionate, timely treatment they deserve.