Editorial: Mental Health

Better treatment

Court-ordered outpatient treatment for the mentally ill is effective for the individual and less expensive for the state. But in Pennsylvania, it's rarely used.
That's because the state's outdated 1976 mental-health law requires ill people to be a "clear and present danger" to themselves or others before a judge can order them to get treatment.

By the time people with mental illness deteriorate to that point, outpatient services are often not appropriate. They usually end up hospitalized.

If such people receive community-based treatment before they deteriorate too far, the results are positive. But people with mental illness often don't recognize they need help, and won't agree to treatment voluntarily.

Forty-two states have some form of assisted outpatient treatment for the mentally ill. And a bill pending in the state Senate would bring Pennsylvania up to date in providing round-the-clock outpatient services. (The New Jersey Senate is also considering similar legislation).

Sponsored by Sen. Stewart Greenleaf (R., Montgomery, Bucks), SB 251 would allow judges to order outpatient mental-health treatment for people involuntarily for up to six months. It would apply only to patients who have been hospitalized at least twice within the previous three years, or have been involved in a serious violent incident within the past four years.

The new standard would be a "likelihood" of danger for receiving treatment involuntarily. The bill provides for a court hearing and legal representation for the mentally ill person.

New York state implemented such a law in 1999. Five years later, a report showed that individuals in the program experienced 77 percent fewer psychiatric hospitalizations, 87 percent fewer incidents of incarceration, and 74 percent less homelessness.

Greenleaf said he's mindful of Pennsylvania's history with the mentally ill, in which too many people were institutionalized and forgotten. "We're not going back to the bad old days," he said.

Rather, mental-health advocates say, the problem now is that too many people don't receive treatment before coming into contact with the criminal-justice system. About 20 percent of prison inmates suffer from mental-health issues. Those who do end up in prison tend to stay in prison longer than other inmates, costing the state more money and denying themselves effective treatment.

Supporters estimate that court-ordered outpatient treatment would benefit about 500 people in Pennsylvania annually. They say the service network is already in place to help such people in most counties.

Greenleaf said the legislation would not cost the state more money because Medicaid pays for these services. That aspect needs to be explored more thoroughly. While the state could very well save money with fewer prisoners and fewer state hospital commitments, some county human-service agencies might face greater demand for their services.

The state Senate should move ahead with this legislation, the goal of which is more effective patient care, fewer hospitalizations, and fewer incarcerations.