NAMI Michigan

Introduction

 

House Bill 4809 proposes to “revise” the Mental Health Code’s definition of “persons requiring treatment.” However NAMI Michigan does not support this bill because it does not address the main problem with the current code’s definition of “involuntary treatment.” NAMI Michigan supports two different bills:

·        SB 199 (Brater) Criminal procedure; other; diversion from jail for certain individuals under certain circumstances; amend code of criminal procedure to allow. Amends 1927 PA 175 (MCL 760.1 - 777.69). 

·        SB 200 (Brater) Mental health; other; priority for providing mental health services to individuals diverted from jail; require under certain circumstances. Amends sec. 208 of 1974 PA 258 (MCL 330.1208).

These two bills “reform,” as opposed to “revise”, the Mental Health Code in order to increase early intervention for “persons requiring treatment.” This will increase recovery of those with mental illness and reduce harmful effects for individuals and society at large. In addition, these two Senate Bills take a positive step in the direction of aligning mental illness with other physical illnesses in the area of “involuntary treatment.”

 

This is a testimony prepared, but not yet presented, to express NAMI Michigan’s opposition to House Bill 4809.

 

Testimony

In order to maximize the potential for recovery, it is a widely known fact that we must work to facilitate treatment of individuals with mental illness at the earliest possible time. House Bill 4809 (H.B. 4809) does not go far enough in accomplishing this goal.

The 2004 Final Report from the Commission of Mental Health recognized the importance of early intervention and recovery. Goal #2 in the Final Report states: “…address the needs of those persons at the earliest time possible to reduce crisis situations.”[1] The report found that “people are frustrated at having to be in crisis before getting needed services.” Involuntary treatment is part of this frustrating process for individuals, friends, and family dealing with mental illness.  As the M.H.C reads now, before the state will order involuntary treatment an individual must be in “crisis.”[2] In order to provide the earliest intervention and therefore the best chance of recovery for individuals with mental illness the requirement of “crisis” must be removed from the code. 

Subsection (a) and (b) of proposed H.B. 4809 do just the opposite of removing “crisis” criteria and instead highlights and strengthens the commitment the criteria “crisis” requirements in the M.H.C. used to determine involuntary treatment.

Subsection (a) of the proposed bill seeks to make a technical change to the M.H.C. by consolidating subsections (a), (b), and (c) in order to call attention to the many different criteria under which a judge may prescribe involuntary treatment. Although the code currently lists subsections (a), (b), and (c), only look at section (a) is used when ordering involuntary treatment. In addition, subsection (a) is typically interpreted strictly to mean—an individual must be threatening homicide or suicide to be considered for involuntary treatment.[3]

Subsection (a) attempts to provide for early intervention, but its focus is misplaced. This proposed bill focuses on, and highlights, the conduct of an individual diagnosed with mental illness when in reality the question to be asked about involuntary treatment is does an individual have the capacity to make a decision about their treatment. It can be said that by consolidating subsection  (a), (b), and (c) H.B. 4809 clarifies the criteria by which to judge an individual’s capacity to make a decision. However, this bill is not what is going to increase early intervention because it still requires judges to find certain behavior or conduct before they can order involuntary treatment. This means that certain individuals who need involuntary treatment will not receive the early intervention they need because they don’t exhibit certain conduct. We must remember that in many cases we cannot tell by a person’s conduct whether or not they have the capacity to make a decision, and in the opposite, many times a person’s conduct does not mean that they do not have the capacity to make a decision.

If we want early intervention for those with mental illness we must redefine, not rearrange, the definition of “persons requiring treatment.” The new definition should be one that focuses on the capacity and not conduct of an individual to make a decision. The new definition must be flexible and allow for the early intervention and involuntary treatment of all those with mental illness regardless of conduct exhibited or not exhibited. The legislation should remove the current “crisis” criteria and replace it with language that defines a “person requiring treatment” as “an individual who has mental illness and lacks sufficient understanding or capacity to make or communicate informed decisions concerning his or her mental illness.”

Similar to subsection (a), subsection (b) highlights the “crisis” requirement of receiving involuntary treatment. The two determining factors of involuntary treatment in this section are an individual’s noncompliance with treatment that has led them to either (1) be placed in psychiatric hospital, jail, or prison twice in the last 48 months OR (2) has led them to commit one or more acts, attempts or threats of serious violent behavior in the last 48 months. Both of these behaviors signal that an individual is in “crisis” and thus should receive early intervention and involuntary treatment. However, this policy does not prevent crisis, instead it is reactionary. The Commission set a goal of increasing early intervention and reducing crisis, but a policy that reacts to crisis does not meet this goal.  H.B. 4809 not only fails the Commissions goal, but fails to reduce the frustration of those around Michigan who feel frustrated by the need for “crisis” in order to receive needed care.

In addition to reducing crisis and increasing early intervention, the Commission also identified that a key issue plaguing the mental health system was the “inappropriate use of the juvenile and criminal justice systems for people with mental illness and emotional disturbances.” Our jails are filled with those who did not receive timely treatment for their mental illness. H.B. 4809 does not address this issue. In fact it ignores this concern by requiring that those with mental illness must either be dangerous to society or have already been incarcerated.

Why put a band-aid on this issue when it can be fixed, especially since the band-aid will be more expensive? As the Fiscal Analysis of H.B. 4809 states, this bill will have fiscal implications for the state to the extent that the revised definition of “persons requiring treatment” will result in more persons being involuntary committed to state-operated health facilities. However, what the fiscal analysis does not take into consideration is the cost to the state prior to involuntary treatment. Of those who are mentally ill, and are not in jail, many are homeless and suffer from poverty in order to maintain eligibility for health care. If we do not redefine “persons requiring treatment” so that it is more encompassing and flexible the state will end up paying more in social services and incarceration because individuals will not recover and instead rely on the state or commit crimes against the public. To reduce costs we need a system that provides a structure for increasing early intervention, reducing crisis, and promoting recovery.

More importantly than reducing costs, the State of Michigan has a constitutional promise to uphold. We have an obligation to foster and support programs and services for the care, treatment, and rehabilitation of our citizens with serious mental illness. We know that programs that produce the best care, treatment, and rehabilitation are those that facilitate treatment of an individual at the earliest possible moment. H.B. 4809  does not facilitate this type of treatment, but rather it places barriers on access to this type of treatment by restricting access to  early intervention and treatment.