NAMI MERCER TESTIMONY in SUPPORT OF S2760

Submitted on September 26, 2005

by Jerry Lindauer, L.C.S.W.

Executive Director, NAMI Mercer

Many of our members have experienced the pain of watching helplessly while their loved one refuses treatment and becomes increasingly psychotic, only to be told by mental health professionals that nothing can be done. This circumstance is simply unacceptable. While S2760 does not solve this problem, it does offer an important and necessary additional resource for individuals in this situation. Therefore, NAMI Mercer supports passage of S2760 allowing involuntary commitment to outpatient treatment in New Jersey.

Insight in chronic mental illness is usually gained slowly. Ideally, it occurs progressively through collaborative treatment and steady supports. However, there are a small group of individuals who are so cognitively disabled by a mental illness that they persistently deny having a mental illness and repeatedly refuse treatment. These individuals disproportionately become homeless, incarcerated, exploited or harmed. Their suffering and the suffering of their family is enormous and sometimes avoidable.

While New Jersey has provision for civil commitment of these individuals to a psychiatric hospital, New Jersey is one of only 8 states that lack any provision for commitment to outpatient treatment. Commitment to outpatient treatment can provide additional opportunity for necessary and successful treatment in a less restrictive setting than inpatient care.

S2760 provides an important and necessary tool to provide treatment to people whose illness has shown a history of recurring deterioration and risk of harm. It allows a mental health professional to actively intervene, even if the ill person unwilling, so that a traumatic course does not recur again and again. It also provides a critical clarification of the standard currently used for civil commitment. This clarification should clear some of the unnecessary roadblocks to earlier intervention that now exist.

NAMI Mercer supports S2760 as written. We also recommend two improvements.

• First, clarify the procedures for changing treatment level from outpatient to inpatient, to give responsibility to screening centers, not outpatient providers; and require judicial review for this change of status.
• Second, require presumptive involvement of a family member in treatment planning connected to involuntary treatment, unless specifically refused by the patient.

We also agree that S2760 must be accompanied by provision of adequate community services for these individuals at risk, so that targeted interventions to engage the person’s cooperation with care are available before outpatient commitment is invoked, and so that quality outpatient care that meets the person where they are, is provided after Involuntary Outpatient Treatment is invoked. We believe that the intent of this bill is not to substitute coercion for engagement and cooperation, but to add another means to leverage cooperation. The new mental health budget takes an important step in this direction by expanding psychiatric emergency services, and by budgeting a million and a half dollars for specialized case management services to implement new involuntary outpatient treatment services.

To ensure effective implementation of Involuntary Outpatient Treatment, the Department of Human Services should set up a review committee including the Department, mental health providers, family members and consumers, representing the variety of positions in favor of and opposed to the bill. This need not be included in legislation, but should be understood. The goal of Involuntary Outpatient Treatment is to prevent individuals with mental illness being left to deteriorate to the point of harm to themselves and their community, without every effort being made to avoid or interrupt this suffering. Recommendations made by the review group intended to achieve this goal, while also protecting the rights and autonomy of people with mental illness, should be given the highest priority in the Department.