Advocates Leaders Respond to the Globe's Spotlight

The Globe’s Spotlight report on the Massachusetts mental health system raises important issues, but the main solution offered – involuntary outpatient commitment – in our view is simplistic and dangerous to the rights of many people with mental health conditions, and would actually drive many people away from care.

Involuntary outpatient commitment is a blunt instrument for dealing with the situation of people refusing care. Unless it were enacted with great care and attention to the legal rights and legitimate preferences of the persons involved, and unless it were focused on the tiny minority of people who refuse medication and who pose substantial risk of harm, it runs a great risk of depriving many people of the fundamental liberty of making their own health care decisions.  In fact, a Duke University study noted that mandated treatment may serve as a barrier to care.

To enact mandated treatment with such proper care and attention would require a vast infrastructure – both legal and clinical – which does not currently exist, and which would be enormously expensive to build, requiring resources that would be more effectively spent on an array of community based, non-coercive services that include alternatives to traditional care.

To a great extent, the suffering of the families described in the Globe story reflects the dearth of non-coercive, recovery-based and family-oriented services currently available. Suffering alone at home, waiting until the situation meets the threshold of imminent dangerousness, only to be admitted to a short-term unit where clinicians have little to offer other than medications and no way of connecting the person or family to real resources in the community, represents a failure of our community system that we must vow to remedy.

Rather than implement a blunt and costly approach, which may hurt and alienate many in an attempt to address this limited but real risk, we call for a comprehensive conversation – ideally championed by the Governor in the spirit of the effort devoted to the opioid crisis – to bring together people with lived experience, families, providers, mental health advocates and funders, to find solutions that will promote safety, protect rights and effectively support the individuals and families who are suffering. Together, surely we can find a way.

Diane Gould

President and CEO