Commentary on Current Events

Thoughts, Ideas, and Comments of Bob Cardwell, from Indianapolis, IN.

Friday, January 14, 2005

Indiana's Mental Health Commitment Law

Indiana's Outpatient Commitment Law

Prior to helping to form the PAIR Mental Health Diversion Program, I helped to develop, lobbied, and helped implement an updated version of the commitment law to cover outpatient commitments. This was about ten years ago, 1994 or so, and was accomplished with the help of Mike Grubbs, Attorney at Law.

I was the keeper of the records on about 600 persons that Midtown MHC had on outpatient commitment. I was also part of the Forensic Team which tried to encourage patients' compliance with treatment as an outpatient. Until the early 90's my team was able to enforce compliance with a judge's order and a compliance hearing. If the patient did not comply with the order he was found in contempt. The Indiana Supreme Court overturned this procedure with the TT decision.

Under the new ruling, a treating facility could only enforce compliance of the commitment by bringing the patient back into the hospital as an inpatient. This presented several problems. One was that the treating facilities did not have law enforcement officers which could go out into the community and the other was that these individuals were frequently "sub-acute" and did not require inpatient treatment. When the centers would call on law enforcement to pick these individuals up and transport them to the hospital, they often refused.

This was clearly a problem to the community as these patients were at times dangerous and it was a problem to the patients. Often a patient would face severe criminal charges for acting out symptoms of their mental illness.

One case I know of is a good example. I will call the patient, Dee. Dee had been non-compliant with his treatment. He had decompensated to the point of suffering and being suicidal. Instead of going to the hospital which held his commitment, he went to a private psychiatric hospital as he had Medicaid. He was examined and it was determined that he was in need of emergency psychiatric care. While a room was being prepared for him, he was told to wait in the waiting room. While waiting the "voices" continued to bother him. He started wandering the halls and went into the employee lounge. He picked up a walkman style radio and put the headphones on. Psychiatric patients often do this to drown out the "voices". Well, the employee who owned the walkman called the police and Dee was promptly arrested.

Dee had a 20 year history of being in and out of mental institutions. He also had a history of many criminal arrests stemming from him acting out the symptoms of his illness. Dee went to jail, was tried in court and found guilty. In addition to being found guilty of theft, he was charged with being a habitual criminal and was given an additional 30 year sentence without possibility of parole. For all practical purposes, he will spend the rest of his life in prison for being mentally ill.

Many of us in the mental health field and the criminal-justice system were well aware of the problems with the mentally ill in the justice system. One area to change was the law and the other was being more pro-active in treatment delivery. I helped with the law and met with many representatives of the legislature. It was passed.

This change in the outpatient law led to the present law and the development of the sub-acute units' part in caring for the mentally ill in the community. Read the present law here.
The other discussions about being more pro-active in our care of the mentally ill in the justice system led to the development of the PAIR Diversion Program and the implementation of the new mental health diversion law. Read it here.

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