Call it freedom with strings attached for mental patients ordered into state detention.
Around the nation, including New York and Florida, it’s known as “assisted outpatient treatment.” Washington State lawmakers, led by a contingent from Pierce County, see it as part of the long-term cure for an ailing mental health system.
"I think it’s a pretty significant step forward," said Rep. Laurie Jinkins (D-Tacoma), prime sponsor of House Bill 1450, which would create the framework for assisted outpatient treatment. A companion bill in the Senate is sponsored by Sen. Jeannie Darneille (D-Tacoma).
Besieged by lawsuits and court rulings tied to a lack of state mental health beds, lawmakers are looking for ways to add treatment capacity and adjust involuntary commitment standards; but they’re also trying to save money and give patients the chance to recover in the community.
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Assisted outpatient treatment, according to its backers, provides a partial answer.
The bills in the Legislature are modeled on Kendra’s Law, a New York statute created in 1999 and named for a woman shoved into the path of an oncoming subway train by a man diagnosed with schizophrenia.
Backed by the National Alliance on Mental Illness (NAMI), the law was designed to address a perceived gap in the mental-health system: people needing treatment couldn’t get it until they reached the crisis stage.
The state bills follow the Kendra’s Law framework. They would allow mentally ill patients to live in the community rather than face involuntary commitment, as long as patients agree to follow court-ordered treatment guidelines, such as taking prescribed medications and attending therapy sessions.
Patients could be offered the option in several types of circumstances, but the bills generally target patients with histories of involuntary commitment as well as a history of noncompliance with treatment.
The policy is only half of the issue; lawmakers are also looking at the budgetary impacts, and eying data from New York’s experience.
Studies of the program showed reduced numbers of involuntary commitments, and significant cost reductions, according to Jinkins. She said she initially opposed the idea until she saw the outcomes.
“Within the first year that they implemented it, they actually started saving money on inpatient commitments,” she said.
At public hearings in the House and Senate on Jan. 28 and Feb. 3, testimony leaned in favor of the bill. Bob Winslow, president of the Pierce County chapter of NAMI, spoke at both hearings.
“We need to find a better way to provide treatment capacity for those who need it,” he said. “Assisted outpatient treatment provides capacity without beds. It won't eliminate the need for beds, but it can reduce the number of people requiring hospitalization.”
Mike DeFelice, a public defender who supervises King County’s civil commitment division, also spoke in favor of the concept.
“We support this idea,” he said. “We are very behind the idea of promoting outpatient treatment. We do have issues with way the bill is drafted.”
Those issues, also mentioned by civil liberties advocates, touch on the most sensitive aspect of assisted outpatient treatment: the involuntary element.
The bills don’t define the nature of the treatment, but it’s a given that courts would have the power to order patients into it; in theory, failure to comply with a court-ordered outpatient treatment would lead to involuntary inpatient treatment.
That compulsory part worries civil rights advocates, who raise constitutional concerns about the state’s authority to command people against their will when they haven’t necessarily broken the law.
“It’s still a deprivation of liberty,” said Shankar Narayan, legislative director of the Washington chapter of the American Civil Liberties Union.
Jinkins, mindful of the concerns raised by advocates and opponents, plans to roll out an amended version of the bill in the coming weeks.
A policy mandate won’t work without support services in place – especially housing availability for patients. That takes money – but it might lead to savings on state hospital beds, the most expensive option.
She makes no predictions, but sees cause for optimism.
“No one’s announcing that they hate the bill,” she said. “It’s always been a good idea – but now there’s evidence that it’s a really good idea.”