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Metro

Push renewed for forced mental treatment

Massachusetts is one of only five states that have not approved a law requiring certain people with severe mental illnesses to take prescribed medications or face involuntary hospitalization, according to a study by a prominent advocacy group.

The Virginia-based Treatment Advocacy Center maintains that the absence of such a law — an issue to be taken up on Beacon Hill Tuesday — contributes to homelessness, violence, and a state prison system where nearly a quarter of the men and more than half of the women are considered mental health cases.

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Backers say the need for such a law was illustrated dramatically this summer, when Edwin Alemany was accused of abducting and murdering 24-year-old Amy Lord, a Web designer living in South Boston.

Alemany, 28, has been ruled competent to stand trial for allegedly murdering Lord and attacking two other women. But he was repeatedly hospitalized for a variety of serious mental health problems, including hallucinations, and had vowed to discontinue taking anti-psychotic and antidepressant medications prescribed for him while in the custody of the state Department of Youth Services, the Globe found.

“He came out with a huge pack of medicine, and he said, ‘I’m not taking these anymore,’ ” said one of Alemany’s brothers-in-law.

The four other states that have not approved the use of court orders to make mental health outpatients take their medications are Maryland, New Mexico, Tennessee, and Connecticut.

Last December, Adam Lanza, a 20-year-old Connecticut man who allegedly had emotional problems, murdered 26 people, including 20 children, at the Sandy Hook Elementary School.

‘The problem often comes when someone with a history gets on the medications and things start going well and they feel they don’t need to take them anymore.’

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The Advocacy Center, a nonprofit group, maintains that without such a law, many people with serious mental health problems are not getting the care they need.

The group timed the release of its report on mental health care in Massachusetts with a Tuesday hearing on state legislation that would allow clinicians to petition the courts for an order requiring a person with a documented history of severe mental illness to take medications designed to reduce the risk they might pose to themselves and others.

“The problem often comes when someone with a history gets on the medications and things start going well and they feel they don’t need to take them anymore,” said State Representative Kay Khan, a psychiatric nurse and Democrat from Newton who has repeatedly filed a bill requiring such treatment. “That’s where the trouble can start, with the whole cycle repeating itself.”

Khan and other supporters of an assisted outpatient treatment law in Massachusetts point to models of success in New York and North Carolina, where, studies show, the laws have reduced cases of violence among persons living in communities with serious mental health problems.

New York’s Kendra’s law, named for Kendra Webdale, a young woman killed in 1999 after being pushed in front of a subway train by a person with untreated schizophrenia, is perhaps the most well-known example of an assisted outpatient treatment law.

A Duke University study published in July also said the state of New York has saved money as a result of its assisted outpatient treatment provision, primarily because Kendra’s law has prevented people with serious mental health problems from being re-hospitalized.

Under Kendra’s law, people under outpatient treatment orders may be arrested and involuntarily hospitalized if they fail to comply with their treatment plans.

Those opposed to the Massachusetts proposal say assisted outpatient treatment laws are not a panacea for what often seems like an epidemic of mass shootings committed by people with serious mental health problems.

The 2011 mass shooting in Tucson, in which US Representative Gabrielle Giffords was severely wounded, and the 2012 mass murder at a movie theater in Aurora, Colo., occurred in states with assisted outpatient treatment laws.

Much of the opposition to Khan’s bill has come from people with severe mental illnesses and their supporters who fear the loss of civil liberties. They argue that patients should have the right to refuse to take anti-psychotic medications, which can have unpleasant side effects.

“We don’t want to be in a place where peoples’ rights are impacted,” said Lynda Cutrell, former president of the Massachusetts chapter of the National Alliance on Mental Illness. “I have heard from many people who are afraid that this is going to involve something that is forced.”

On the other hand, Cutrell said, “we do absolutely know that we need change.”

She added that the organization is reviewing Khan’s bill with an eye toward taking a position on the legislation at a later date.

Anna Chinappi, spokeswoman for the state Department of Mental Health, said the state also has reservations about Khan’s bill, for the same reason.

“Any change in the mental health system that deprives people of their civil liberties based on disabilities requires thoughtful and careful consideration and further study,” Chinappi said.

Marylou Sudders, a former commissioner of the state’s Department of Mental Health who has opposed passage of an assisted outpatient treatment law for a decade, argues that it’s not necessary since judges already have the power to order outpatient treatment of people with severe mental health problems through the appointment of what is called a Rogers guardian.

But supporters of an assisted outpatient treatment law counter that Rogers guardianships are seldom used and can involved drawn-out hearings in the state’s probate courts.

Sudders said she also opposes adoption of an assisted outpatient treatment law because the state’s diminishing mental health budget won’t support one.

“We do not have the services and programs in place to serve individuals in outpatient treatment,” Sudders said. “You have to have the services in place. Then, if the services don’t work, we can have this conversation.”

Since 2001, state leaders have reduced the state mental health care budget by nearly $100 million, or more than 12 percent, according to the Massachusetts Budget and Policy Center, a nonprofit, nonpartisan group that adjusted the figures for inflation.

Kathryn Cohen, the legislative and policy counsel at the Advocacy Center, said it’s impossible to say whether an assisted outpatient treatment law in Massachusetts would have prevented Lord’s death, but she said there is little doubt the law would have applied to Alemany, requiring him to take prescribed medications and participate in a community treatment plan. “With a history of untreated mental illness, re-hospitalization, and violence, Alemany certainly would have qualified for [assisted outpatient treatment] in many states,” Cohen said.

Michael Rezendes can be reached at Michael.rezendes@ globe.com. Follow him on Twitter @RezGlobe.
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