Additional Recommendation – Involuntary Outpatient Commitment<= /title> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"place" downloadurl=3D"http://www.5iantlavalamp.com/"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"State"/>  <style>  </style>  </head> <body lang=3DEN-US style=3D'tab-interval:.5in'> <div class=3DSection1> <o:p> </o:p> Recommendation – Involuntary Outpatient Commitment<o:p></o:p> <o:p> </o:p> The Task Force was directed by Governor Codey on November 16, 2004 at its organization meeting to study and make recommendations concerning Involuntary Outpatient Commitment generally and Senate Bill 1640 specific= ally. While the Task Force unanimously does not support S1640, a majority does support the concept of<= /p> involuntary outpatient commitment. The Task Force recommended and supports<o:p></o:p> Governor Codey’s FY 2006 budget proposal of $1.5 m= illion to provide specialized<o:p></o:p> case management in a least restrictive setti= ng for those persons identified as difficult<o:p></o:p> to engage and/or treatment resistant, but wh= o do not meet the terms for involuntary<o:p></o:p> inpatient commitment. The purpose of this program is to ensure that the appropriate services are available for individuals committed on an outpatient basis. Involuntary Outpatient Commitment (“IOC”), sometimes known as Assisted Outpatient Treatment, is a means by which a court may enter an order requiring a person with serious mental illness to submit to treatment. This co= erced treatment differs from the commitment system in current <st1:State w:st=3D"on"><s= t1:place w:st=3D"on">New Jersey</st1:place></st1:State> law in that it “commits” a person to outpatient rather than inpatient care. IOC has generated a great = deal of interest in <st1:State w:st=3D"on"><st1:place w:st=3D"on">New Jersey</st= 1:place></st1:State> in recent years. This interest derives in part from tragic cases in which persons with severe mental illness who were not adequately engaged in trea= tment caused serious, sometimes fatal, injuries to themselves or others; have fallen p= rey to physical violence or theft; and/or often live in sub-standard and sometimes inhuma= ne conditions as a result of their uncontrolled mental illness. The interest also derives= in part from a perception that our current system, in which coercion is available only wh= en a person is symptomatic enough to require inpatient care, fails to protect or facilit= ate recovery for a group of seriously mentally ill persons whose treatment resistance is, in= part, a manifestation of their illness. Those opposing IOC express concerns that coercion may not be necessary if suffici= ent community services are made available. There were addi= tional concerns that IOC may even be counterproductive if the provision of treatmen= t were to become associated with adversarial processes. Concerns were also raised that = IOC could be misused to apply coercion in situations where it is not warranted. The issues raised by those advocating and opposing IOC are serious and difficul= t. The Task Force devoted several meetings to considering these concerns. Experts in fa= vor and opposed to IOC presented compelling and thoughtful arguments. Many organizations and individuals provided interesting and helpful mater= ials to aid in the Task Force’s deliberations. Members of the Task Force recognized the complexity of the argument. In the end, although the members of the Task Force were u= nable to reach consensus on the current need for IOC in <st1:State w:st=3D"on"><st1:pl= ace w:st=3D"on">New Jersey</st1:place></st1:State>, the Task Force reached str= ong unanimity on one important principle. That principle is that no move to= IOC should take place in New <st1:place w:st=3D"on">Jersey</st1:place> unless and until adequate, appropriate servi= ces are available in the community for all who voluntarily seek them. As other states have recognized (<st1:State w:st=3D"on"><st1:place w:st=3D"on">New York</st1:pla= ce></st1:State>, for example) it is unwise and unjust to implement IOC if the commun= ity infrastructure is not adequate to meet the treatment needs of people with serious men= tal illness. The Task Force unanimously agreed that making culturally competent services, based on evidence-based and promising treatments directed to achieving wellnes= s and recovery will increase the percentage of people with serious mental illness engag= ed in treatment. The availability of appropriate services will at least greatly reduce the = need for IOC. The Task Force’s primary principle on IOC, then, is that the developmen= t of an adequate system of community care is an absolute precondition for the ado= ption of IOC. As for the underlying question – the current need for the adoption of IOC – the Task Force membership split. The majority voted to recommend the adoption of IOC consistent with four principles (detailed below): the = need for adequate community services; the adoption of a unitary standard for court-ordered care (other states, including <st1:State w:st=3D"on"><st1:place w:st=3D"on">Wisconsin</st1:place></st1:State> which = has operated with a unitary standard for the past 10 years, have been successful with this model); the adoption of a least restrictive alternative rule; and a commitment to independent evaluation of the implementa= tion of IOC. A minority, including George Brice, Jr., voted to reject IOC. The minority believed that IOC represents an extreme measure incompatible with the au= tonomy rights of people with serious mental illness, particularly in light of the c= urrent shortcomings of the community treatment system in <st1:State w:st=3D"on"><st1:place = w:st=3D"on">New Jersey</st1:place></st1:State>, and expressed concern that the risks of a= buse of IOC significantly outweigh any positive effects it could produce. <o:p> </o:p> The principles adopted by the majority of the Task Force are set out below. 1. No program of involuntary outpatient commitment should be created unless and<o= :p></o:p> until the availability of appropriate commun= ity treatment reaches a safe and<o:p></o:p> adequate level. Satisfaction of this conditi= on precedent will help respond to<o:p></o:p> concerns that IOC will:<o:p></o:p> *create “designed to fail” commitments, in which a person violates IOC orders due to inability to access appropriate services; *create a “queue jumping” problem in which IOC becomes, perversely, the only route to services that would be accepted voluntarily, if availa= ble; and *be constructed on the erroneous assumption that failures to engage in services= are not always or usually the result of consumer disinterest &= #8211; it is, on the contrary, clear that most people who are not engaged in treatment are not well-s= erved by current community treatment systems. 2. The “dangerousness” standard for <st1:State w:st=3D"on"><st1:place = w:st=3D"on">New Jersey</st1:place></st1:State>’s inpatient commitment should be<o:p= ></o:p> clarified to permit the recognition of danger arising in the reasonably foreseeable<o:p></o:p> future, and this same standard should be app= lied to IOC. This clarification will:<o:p></o:p> *corrects a concern in the inpatient commitment standard that has given rise to impet= us for IOC; and *create a unitary standard that will limit the chance for abuse of coercive treatme= nt orders, thereby protecting the constitutional rights of people with severe mental illness from the overly-broad use of orders of coerced treatme= nt. 3. The commitment standard applied to inpatient and outpatient commitment<o:p></o:= p> should be accompanied by a “least restrictive alternative” principle. This “least<o:p></o:p><= /p> restrictive alternative” principle wil= l:<o:p></o:p> *allow a separation of the assessment of the order for involuntary treatment to be= separated from the determination of what treatment is = most appropriate in a given case – inpatient or outpatient; *permit orders for mandated treatment in appropriate cases without mandating unnecessary hospitalizations; and *permit amendments of order, e.g., from inpatient to outpatient treatment without a new commitment hearing. 4. The effects of IOC should be evaluated by a qualified independent researcher<o:= p></o:p> two years after the effective date of the ch= ange, and again five years after the<o:p></o:p> effective date. The independent report shoul= d be submitted to the Governor and the<o:p></o:p> Legislature. The reports should assess:<o:p>= </o:p> *the effect of the clarification of the standard for involuntary treatment to determine the extent to which it is applied by screening centers, co= urts, and other evaluators; *the effect of IOC on people with severe mental illness, the rate and geographic= distribution of IOC orders, the response of people und= er order to IOC, and the extent to which the use of IOC affects the rates of institutiona= lization and incarceration; and *the effectiveness of IOC in facilitating the provision of appropriate services = to people under IOC orders, and the effect<o:p></o:p> <o:p> </o:p> </div> </body> </html>

MIME-Version: 1.0 Content-Location: file:///C:/A360AE23/task_force_recommendations_IOC.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Additional Recommendation – Involuntary Outpatient Commitment<= /title> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"place" downloadurl=3D"http://www.5iantlavalamp.com/"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"State"/>  <style>  </style>  </head> <body lang=3DEN-US style=3D'tab-interval:.5in'> <div class=3DSection1> <o:p> </o:p> Recommendation – Involuntary Outpatient Commitment<o:p></o:p> <o:p> </o:p> The Task Force was directed by Governor Codey on November 16, 2004 at its organization meeting to study and make recommendations concerning Involuntary Outpatient Commitment generally and Senate Bill 1640 specific= ally. While the Task Force unanimously does not support S1640, a majority does support the concept of<= /p> involuntary outpatient commitment. The Task Force recommended and supports<o:p></o:p> Governor Codey’s FY 2006 budget proposal of $1.5 m= illion to provide specialized<o:p></o:p> case management in a least restrictive setti= ng for those persons identified as difficult<o:p></o:p> to engage and/or treatment resistant, but wh= o do not meet the terms for involuntary<o:p></o:p> inpatient commitment. The purpose of this program is to ensure that the appropriate services are available for individuals committed on an outpatient basis. Involuntary Outpatient Commitment (“IOC”), sometimes known as Assisted Outpatient Treatment, is a means by which a court may enter an order requiring a person with serious mental illness to submit to treatment. This co= erced treatment differs from the commitment system in current <st1:State w:st=3D"on"><s= t1:place w:st=3D"on">New Jersey</st1:place></st1:State> law in that it “commits” a person to outpatient rather than inpatient care. IOC has generated a great = deal of interest in <st1:State w:st=3D"on"><st1:place w:st=3D"on">New Jersey</st= 1:place></st1:State> in recent years. This interest derives in part from tragic cases in which persons with severe mental illness who were not adequately engaged in trea= tment caused serious, sometimes fatal, injuries to themselves or others; have fallen p= rey to physical violence or theft; and/or often live in sub-standard and sometimes inhuma= ne conditions as a result of their uncontrolled mental illness. The interest also derives= in part from a perception that our current system, in which coercion is available only wh= en a person is symptomatic enough to require inpatient care, fails to protect or facilit= ate recovery for a group of seriously mentally ill persons whose treatment resistance is, in= part, a manifestation of their illness. Those opposing IOC express concerns that coercion may not be necessary if suffici= ent community services are made available. There were addi= tional concerns that IOC may even be counterproductive if the provision of treatmen= t were to become associated with adversarial processes. Concerns were also raised that = IOC could be misused to apply coercion in situations where it is not warranted. The issues raised by those advocating and opposing IOC are serious and difficul= t. The Task Force devoted several meetings to considering these concerns. Experts in fa= vor and opposed to IOC presented compelling and thoughtful arguments. Many organizations and individuals provided interesting and helpful mater= ials to aid in the Task Force’s deliberations. Members of the Task Force recognized the complexity of the argument. In the end, although the members of the Task Force were u= nable to reach consensus on the current need for IOC in <st1:State w:st=3D"on"><st1:pl= ace w:st=3D"on">New Jersey</st1:place></st1:State>, the Task Force reached str= ong unanimity on one important principle. That principle is that no move to= IOC should take place in New <st1:place w:st=3D"on">Jersey</st1:place> unless and until adequate, appropriate servi= ces are available in the community for all who voluntarily seek them. As other states have recognized (<st1:State w:st=3D"on"><st1:place w:st=3D"on">New York</st1:pla= ce></st1:State>, for example) it is unwise and unjust to implement IOC if the commun= ity infrastructure is not adequate to meet the treatment needs of people with serious men= tal illness. The Task Force unanimously agreed that making culturally competent services, based on evidence-based and promising treatments directed to achieving wellnes= s and recovery will increase the percentage of people with serious mental illness engag= ed in treatment. The availability of appropriate services will at least greatly reduce the = need for IOC. The Task Force’s primary principle on IOC, then, is that the developmen= t of an adequate system of community care is an absolute precondition for the ado= ption of IOC. As for the underlying question – the current need for the adoption of IOC – the Task Force membership split. The majority voted to recommend the adoption of IOC consistent with four principles (detailed below): the = need for adequate community services; the adoption of a unitary standard for court-ordered care (other states, including <st1:State w:st=3D"on"><st1:place w:st=3D"on">Wisconsin</st1:place></st1:State> which = has operated with a unitary standard for the past 10 years, have been successful with this model); the adoption of a least restrictive alternative rule; and a commitment to independent evaluation of the implementa= tion of IOC. A minority, including George Brice, Jr., voted to reject IOC. The minority believed that IOC represents an extreme measure incompatible with the au= tonomy rights of people with serious mental illness, particularly in light of the c= urrent shortcomings of the community treatment system in <st1:State w:st=3D"on"><st1:place = w:st=3D"on">New Jersey</st1:place></st1:State>, and expressed concern that the risks of a= buse of IOC significantly outweigh any positive effects it could produce. <o:p> </o:p> The principles adopted by the majority of the Task Force are set out below. 1. No program of involuntary outpatient commitment should be created unless and<o= :p></o:p> until the availability of appropriate commun= ity treatment reaches a safe and<o:p></o:p> adequate level. Satisfaction of this conditi= on precedent will help respond to<o:p></o:p> concerns that IOC will:<o:p></o:p> *create “designed to fail” commitments, in which a person violates IOC orders due to inability to access appropriate services; *create a “queue jumping” problem in which IOC becomes, perversely, the only route to services that would be accepted voluntarily, if availa= ble; and *be constructed on the erroneous assumption that failures to engage in services= are not always or usually the result of consumer disinterest &= #8211; it is, on the contrary, clear that most people who are not engaged in treatment are not well-s= erved by current community treatment systems. 2. The “dangerousness” standard for <st1:State w:st=3D"on"><st1:place = w:st=3D"on">New Jersey</st1:place></st1:State>’s inpatient commitment should be<o:p= ></o:p> clarified to permit the recognition of danger arising in the reasonably foreseeable<o:p></o:p> future, and this same standard should be app= lied to IOC. This clarification will:<o:p></o:p> *corrects a concern in the inpatient commitment standard that has given rise to impet= us for IOC; and *create a unitary standard that will limit the chance for abuse of coercive treatme= nt orders, thereby protecting the constitutional rights of people with severe mental illness from the overly-broad use of orders of coerced treatme= nt. 3. The commitment standard applied to inpatient and outpatient commitment<o:p></o:= p> should be accompanied by a “least restrictive alternative” principle. This “least<o:p></o:p><= /p> restrictive alternative” principle wil= l:<o:p></o:p> *allow a separation of the assessment of the order for involuntary treatment to be= separated from the determination of what treatment is = most appropriate in a given case – inpatient or outpatient; *permit orders for mandated treatment in appropriate cases without mandating unnecessary hospitalizations; and *permit amendments of order, e.g., from inpatient to outpatient treatment without a new commitment hearing. 4. The effects of IOC should be evaluated by a qualified independent researcher<o:= p></o:p> two years after the effective date of the ch= ange, and again five years after the<o:p></o:p> effective date. The independent report shoul= d be submitted to the Governor and the<o:p></o:p> Legislature. The reports should assess:<o:p>= </o:p> *the effect of the clarification of the standard for involuntary treatment to determine the extent to which it is applied by screening centers, co= urts, and other evaluators; *the effect of IOC on people with severe mental illness, the rate and geographic= distribution of IOC orders, the response of people und= er order to IOC, and the extent to which the use of IOC affects the rates of institutiona= lization and incarceration; and *the effectiveness of IOC in facilitating the provision of appropriate services = to people under IOC orders, and the effect<o:p></o:p> <o:p> </o:p> </div> </body> </html>