Treatment Advocacy Center Staff Testify on Expanding the Use of Mandatory Outpatient Treatment in Virginia
By Treatment Advocacy Center News
Treatment Advocacy Center’s Director of Advocacy Lisa Dailey and Consultant Eric Smith testified today, December 8, 2020, before the Virginia Senate Joint Subcommittee to Study Mental Health Services in the 21st Century: Involuntary Commitment/Emergency Services Workgroup. Dailey and Smith offered testimony in support of the draft legislation that improves Virginia’s mandatory outpatient treatment law (MOT) to make it more usable for implementers and to work better for those enrolled.
Below is the full text of Smith’s opening statements to the Committee:
Thank you, Delegate Hope, for having me here as a guest today. I am honored and thankful to have this opportunity for discussion with you, and the others in this meeting today. I am so thankful, not just to be here at this event, but here, alive, because of mandatory outpatient treatment (or MOT), also known as assisted outpatient treatment (or AOT). Let’s talk about that, and together we can explore the importance of MOT as a program, and the laws on which it is based.
My name is Eric Smith, and I am 37 years of age. I am speaking to you from Texas, but not intending to speak as a Texan who knows what is best for the people of Virginia. Rather, I’m speaking as someone of the severe mental illness population who knows firsthand that MOT saved my life, and does so for others who share similarities with me as part of the diagnosed population.
I have been diagnosed with schizoaffective disorder by psychiatrists who have seen me at my worst, and bipolar disorder by psychiatrists who have not seen me at my worst. I functioned well enough for many years, and much time went by with no suggestion for hospitalization or mandatory treatment. I nor any of my doctors over the years understood the full seriousness of my illness until my mid-20s, when I was hospitalized for the first time as a result of mental illness.
I was discharged from the hospital for the third and final time near the beginning of 2012, at which point I entered into San Antonio’s groundbreaking mandated outpatient treatment program for the third and final time.
MOT requirements of me were simple: Take my meds as prescribed, and show up to my mandatory outpatient treatment hearings. It was one hearing per week to start with, and eventually moved on to one hearing per month, until I was deemed ready to graduate out of mandatory treatment.
The purpose and goals of the hearings were to evaluate my mental health, and the professionals on my treatment team would get to judge that for themselves at these hearings. Each hearing acted like a gatekeeper between myself and society, confirming that I still no longer required hospitalization, helping decide whether or not I could move to less frequent court hearings, and preparing me for reintegration back into society without need for further mandatory involvement.
The time between my second and third hospitalizations was a matter of several weeks, as my psych meds abruptly stopped working for me during a MOT order. Being that I was on a MOT order at this time while I was decompensating, it was relatively easy for the judge and psychiatrist overseeing my order to get me the inpatient care and stabilization I needed. Without MOT at that juncture, it is easy to see how I could have been sent to an ER or hospital to manage my decompensated state of dangerous and problematic symptoms.
Medical experts tell me that one of the typical things that happens in an ER when someone like me shows up is that we are given Haldol or something similar to try to quickly reduce problems of psychosis. That medicine and others like it do not have a history of working for me, so that would have been a waste of time, energy, money, and other resources spent by me, spent by a hospital, spent by first responders, and spent by society trying to remedy my situation with things that have already been identified as not working. An MOT treatment team was already familiar with what hadn’t worked for me, so we didn’t have to start as square one.
One thing I’d like to address today is the value of making an order six months to begin with, rather than a shorter period of time such as 90 days. It makes total sense to do this. Swartz et al. (1999) shows, and I am quoting here: “…individuals whose outpatient commitment order lasted six months or fewer, regardless of the intensity of services received, were as likely as those who received no outpatient commitment to return to the hospital, have multiple hospitalizations, and to have longer length of stays.”
My first mandatory outpatient treatment order nearly went for a full year, and the length of that order is something that was appropriate and necessary for me at that time, and is also appropriate and necessary for many others in circumstances similar to my own. My third and final MOT order was also originally set for a year, but I was doing so well that the judge, doctor, and rest of my treatment team decided that after a few months it was no longer necessary for me to be on any sort of mandatory outpatient treatment order, and they terminated the order early. In short, 90 days or less is unlikely to be enough time for a mandatory outpatient treatment order to result in desirable outcomes for most, but it very well could be for a few outliers.
For a variety of reasons, it makes far more logistical sense to set an order at six months, and then allow discretion of judges and doctors to determine whether an order is no longer necessary at 90 days or at some other point. This way, there won’t be time unnecessarily spent on labor to extend orders beyond 90 days, especially since data shows 90 days is not likely to be enough time to accomplish stated goals for the population served by MOT.
The MOT hearings I was in partially focused on if I was taking my medication as prescribed. If I was taking meds as prescribed but decompensating, the treatment team could keep an eye on that and weigh options if and when I was falling away from sanity.
At the hearings, the Judge (Judge Kazen) would ask “Eric, are you taking your meds as prescribed?” …and I’d say yes. I have clear memories of sitting there wondering how he or anyone else could possibly know if that is true, but they would know! If any of you have ever seen someone diagnosed with SMI not on meds, or on meds that aren’t working, you understand it can be pretty apparent when someone is not sane. So when I was asked by a judge during my hearings whether or not I was taking my meds, looking back, it was probably more about if I was appearing to be sane to him and the rest of my treatment team than whether I said yes or no.
Also important to note, I never felt an urge to lie to the judge or the rest of my treatment team, because I knew they were there to help me, and I knew this was not a criminal court trying to levy the power of a criminal justice gavel to treat my illness. These were civil proceedings, guided by evidence-based compassion and an understanding that the criminal justice system cannot fix matters of illness, nor is it designed to do so.
The symbiotic relationship between the judge, doctor, social worker, and the rest of the MOT treatment team completely changed my view of managing mental illness. The non-criminal proceedings and caring treatment team cognitively and behaviorally taught me to take ownership of my treatment, to the point that mandatory involvement was no longer necessary. My desire to voluntarily adhere to treatment became a driving force in my life, benefitting me with an opportunity to pursue my goals and dreams, and benefitting society with me no longer draining resources from police, FBI, Secret Service, hospital emergency rooms, psych hospitals, and that list goes on but you get the idea.
On a related note, and with certainty, mandatory outpatient treatment is not an opinion, it is a paradigm supported by a growing body of literature and stories like mine. The value of MOT is not just about preventing one person from harming another, it is also about freeing the diagnosed population from being held hostage by their own minds. When I was in the abyss of my illness, I was a victim of my mind’s torment every single day.
For people who are swayed by money as a bottom line rather than by moral arguments of right and wrong, MOT is about spending tax dollars and funding on something that works instead of a bottomless pit of money unnecessarily wasted on repeat trips to an ER, repeat police calls, and endless hours of police transportation for those diagnosed with SMI to jail, where we know mental illness is not meaningfully addressed. Jailing people with SMI is the wrong thing to do, it doesn’t work, and it is a waste of money.
I, along with others of the SMI population must acquiesce power to professionals who have the training, experience, and understanding on our behalf that I and others like me are often incapable of understanding our illness. We must receive mandatory treatment in the face of anosognosia (a condition often accompanying SMI that prevents people like me from understanding our illness and the likely consequences of refusing treatment). Anosognosia is real, and I have experienced it. It is terrifying to think nothing is wrong while all of my family, friends, medical professionals, mental health professionals, and everyone else who interacts with me can clearly see something is wrong with me while I am simultaneously convinced I am totally sane and healthy.
Disability rights groups, civil rights groups, and others who fight against having strong MOT programs and better access to psychiatric beds are fighting for my right as an individual diagnosed with serious mental illness to be a victim of the demons that own every part of who I was before a psych bed and a strong MOT program saved my life.
Without mandatory outpatient treatment, I would at best be living under a bridge somewhere, consumed by mental illness, but perhaps more likely than that, I would probably be dead. The treatment team enabled me to regain my health and start a new life…a better life once thought distant fantasy by me.
MOT took me from a path of delusion and danger to becoming an accomplished, habitual honors student who is now diligently preparing as a graduate student to help other people as I have been helped. That gets done by strengthening MOT laws and policies where they exist, creating them where they do not exist, and making sure treatment teams are staffed with people who understand mandatory outpatient treatment is how our society can best address some of the toughest issues stemming from SMI, without criminalizing mental illness and those who are diagnosed as such.
Mandatory outpatient treatment helped me finally experience and fall in love with reality, which is a tall order for anyone to achieve in 90 days or less, so the importance of changing the initial order to six months cannot be overstated.
I reflect on it like this: I was diagnosed with bipolar disorder and schizoaffective disorder. I dropped out of high school and got a GED. I failed out of college in my second semester. I became addicted to various drugs, both prescribed and illicit. I was committed to a mental hospital. Then, mandatory outpatient treatment comes along as a safety net, and despite being a high school dropout once hooked on drugs and diagnosed with SMI, I beat all of those odds stacked against me because MOT was there for me. Without MOT, we know what that trajectory looks like, and it is a downward spiral that wouldn’t have stopped until it put me six feet under.
With your support today, MOT will save the lives of others, and also better serve the people of Virginia.
Thank you.
Watch their testimony, here.
For more information on Assisted Outpatient Treatment, visit our website, here.