Involuntary outpatient treatment for mentally ill spurs new debate

Advocates say it's the best way to protect patients and the public. Opponents argue that it violates civil liberties.

By Amy Lynn Sorrel, AMNews staff. March 13, 2006.

Forty-two states have laws requiring involuntary outpatient treatment for severely mentally ill people, but a recent legislative fight in New Mexico and a case before the U.S. Supreme Court show that the issue is still divisive.

Even in states with such laws, their success is debated because the statutes have been passed without simultaneously providing the funds for mental health services. Critics say that not enough research has been done to test the laws' efficacy.

In February, New Mexico attempted to pass legislation to allow family members or doctors to seek court-ordered outpatient treatment, such as medication or therapy, for the mentally ill who refuse services. The measure, backed by Gov. Bill Richardson, was defeated in the Legislature after facing opposition from such groups as the American Civil Liberties Union of New Mexico.

Advocates say they are most concerned with getting treatment for the mentally ill to protect the public, as well as the patients, before violence occurs.

Doctors and advocates say the laws are aimed at a subpopulation of people with severe mental illness, such as schizophrenia or bipolar disorder, who require repeated hospitalization or treatment. Once such patients go off medication, they have difficulty recognizing that they are ill or that the medication will keep them stable.

"The core issue is how do you get someone into treatment when they don't know they are ill," a condition known as anosognosia, said Mary Zdanowicz, executive director for the Treatment Advocacy Center, Arlington, Va., which supports involuntary outpatient treatment laws.