published Tuesday, April 5th, 2011

Tennessee bill divides advocates for mentally ill

by Emily Bregel

A bill proposed in the Tennessee General Assembly would allow courts to order outpatient treatment for people with severe mental illness, such as schizophrenia or bipolar disorder, who could be dangerous if not treated.

Tennessee advocates for the mentally ill are split about whether to support the legislation, billed as a crucial means of preventing tragedies.

The Tennessee chapter of the National Alliance for Mental Illness is neutral on the bill, which the Senate last week put off until April 6.

“It is too divisive for our membership,” said Roger Stewart, deputy director for the Tennessee chapter. “There is not a clear majority of people on one side or the other for us to take a stance on this bill.”


This bill authorizes a court to order a proposed mental health patient to receive assisted outpatient treatment upon finding that:

  • The person is at least 18 years old and has severe and persistent mental illness

  • Without treatment, the person is “reasonably likely” to pose a substantial risk of causing serious harm

  • The person is unlikely to comply with outpatient treatment voluntarily

  • Court-ordered compliance will help keep the person in treatment and reduce the risk of harm to the patient or community.

Source: Senate bill

Families of people with mental illness tend to favor the bill, which would allow a family member, hospital director or mental health care provider, or an adult who lives with the patient, to petition for an involuntary outpatient commitment.

The bill applies to people 18 and older. The court must find that the person has severe and persistent mental illness, is unlikely to comply with treatment voluntarily and is at a high risk of causing harm if not treated.

“When you see a loved one that’s spiraling downward, and you know something is not right, and yet they refuse to acknowledge there’s a problem, there really isn’t a legal solution to that,” Stewart said.

But some people with mental illness chafe at the idea of being forced to take medicine and worry about potential abuses, he said.

“These are extremely serious medications [for chronic mental illness],” Stewart said. “They have serious potential side effects. ... Somebody could be forced into consequences they don’t want for their life.”

Untreated mental illness has been cited as a cause for a number of fatal shootings. The most recent is Jared Lee Loughner, the man accused of wounding U.S. Rep. Gabrielle Giffords and killing six others, including a federal judge, in Tucson, Ariz.

Tennessee is one of six states that does not allow court-ordered outpatient treatment, according to the Treatment Advocacy Center, an Arlington, Va.-based nonprofit.

Tennessee’s bill (SB0608) was introduced by Sen. Doug Overbey, R-Maryville, in response to a 2007 shooting at a Knoxville Hooters restaurant.

The shooting suspect, David Rudd, had chronic mental illness and had not been violent in the past, his family told The Associated Press at the time.

But each time he was released from a mental health facility, Rudd would stop taking his medications and succumb to his illness. His family felt unable to get him the help he needed, the AP said.

“Studies show people with severe mental illness, while receiving treatment, are no more dangerous than everybody else,” said the Treatment Advocacy Center’s Brian Stettin, policy director and advocate expert on the state of Tennessee. “When you remove treatment from that picture, it changes.”

Stettin helped Overbey revise an earlier version of the bill.

Overbey said New York passed “Kendra’s Law” in 1999 after a person with mental illness who was off his medication pushed a woman to her death in front of a subway train.

“The whole idea is not punishment, but appropriate treatment,” Overbey said.

An early version of Overbey’s bill that required counties to develop assisted outpatient treatment programs was costly, Stettin said. This year’s version has no mandates and would cost the state much less, he added.

The bill is scheduled to be in subcommittees this week.

Dr. Larry Thompson, chief operations officer for Volunteer Behavioral Health in Chattanooga, worries about a section of the bill that would require a physician to certify that the patient has declined treatment and could be dangerous.

“I think getting a physician to certify what might happen in the future is kind of asking them to be a little more clairvoyant,” he said. “Most practitioners are going to be fairly reluctant to take that on.”

Thompson said having caseworkers persuade people with mentally illness to go into treatment voluntarily is more effective than involuntary outpatient commitment.

“Just showing up at the center kicking and screaming is probably not the best therapeutic approach,” he said.

about Emily Bregel...

Health care reporter Emily Bregel has worked at the Chattanooga Times Free Press since July 2006. She previously covered banking and wrote for the Life section. Emily, a native of Baltimore, Md., earned a bachelor’s degree in American Studies from Columbia University. She received a first-place award for feature writing from the East Tennessee Society of Professional Journalists’ Golden Press Card Contest for a 2009 article about a boy with a congenital heart defect. She ...

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ceeweed said...

Court ordered out-patient psychiatric treatment? How will the court assure compliance? Will the court provide transportation to and from these centers? Will patients be supervised taking their morning meds 7 days a week? Who will supervise medication compliance at bedtime? (A time when many psychotropic medicines are given)...What if a patient goes to a center and is found to need urgent in-patient treatment? How readily available will these in-patient beds be? What other out-patient mental health services are being cut to achieve the goals of these court ordered services?..... It seems there are more questions than answers...I am not taking a stand for or against this bill until these and other concerns are addressed.

April 5, 2011 at 8:52 a.m.
bpqd said...

My gut reaction is that this law will be somehow applied in a way to turn our jails into a cheap substitute for the mental health clinics Republicans don't want to pay for.

April 5, 2011 at 10:58 p.m.
AOTadvocate said...

"Thompson said having caseworkers persuade people with mentally illness to go into treatment voluntarily is more effective than involuntary outpatient commitment."

I sure would like to see the study that supports this statement made by Mr. Thompson.

Studies on Assisted Outpatient Treatment (Kendra's Law) have proved: 77 percent fewer experienced hospitalizations compared to before participation; 74 percent fewer experienced homelessness compared to before participation; 83 percent fewer experienced arrests compared to before participation; 88 percent fewer experienced incarceration compared to before participation.

Additionally, among surveyed participants in Kendra’s Law: 75 percent said AOT helped to gain control over their lives; 81 percent said it helped them to get well and stay well; 90 percent said it made them more likely to keep appointments and to take medication.


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