“‘Commitment’ is just a word, but for many of us that word has a powerful and intimate association. It’s a word that comes with an experience and a weight of the history of treatment of this disease [mental illness].” With that opening statement, Pete Feigal began a forum held on Friday, Jan. 21, sponsored by Hennepin County NAMI. The purpose was to introduce a new bill that was sponsored by Rep. Mindy Greiling and Sen. Don Betzold. As Sen. Betzold succinctly put it, “the system is geared for waiting until a patient hits rock bottom.” The question, how to best deliver services before individuals and their families endure a crisis?
In 1997, a Supreme Court Task Force drafted an amendment known as the early intervention commitment process. His amendment addressed two major concerns: Firstly, for persons with predictable patterns of deterioration, the amendment permitted hospitalization for the purpose of intercepting that deterioration; Secondly, the amendment also permitted hospitalization for persons who’s disturbed behavior or faulty perceptions significantly interfere with their ability to care for themselves but who would have chosen treatment if competent.
The law is not well known and has scarcely had a chance to be implemented. There is a reluctance to use this under the assumption that will expand the number of court proceedings and drive up commitment costs. (as discussed in an article written by Patricia M. Siebert, 12/19/99, MN Disability Law Center, to Rep. Greiling and Sen. Betzold).
Here are the questions: Before creating yet another law, why not concentrate on funding for voluntary commitment? Why not work for expanded health coverage? Current health coverage only supports hospitalization of a week to 10 days. Why not address the Diagnostic Related Grouping which Medical Assistance relies on to determine fee for service (a catch-22 situation, causing a decrease in services)? What of the 75 percent commitment rate filed by hospitals which has caused a situation for persons needing care, in whixh they must endure the stress and humiliation of commitment? Where is individual autonomy and freedom? Lastly, can one truly have quality care if it involves coercion?
This is an emotional issue for everyone involved—persons with mental illness, family members, and professionals. As Pete Feigal said in his opening statement, “this disease is not just a disease of an individual but of families.” There is also an urgent need to do something positive. Pete Feigal put it succinctly: “the freedom to suffer is no freedom.” (Look to page 5 of this issue for a reprint of the text of Fiegal’s opening comments.)
Representative Greiling shared with the audience her journey with her son, through the process of diagnosis and obtaining services. Greiling—like too many others—tells of having no choice but to arrest her son in order to obtain the help he needed. Others at the forum also expressed their concerns that too many are in jail due to intervention that is too late. Too often, crisis also puts the person with a mental illness at risk of violence. One father spoke of the need to have law officers armed with nonlethal weapons for such interventions.
One psychologist added another perspective. It disturbed him that hitting rock bottom is only true for those who refuse treatment. Where is access? Is there some way of mandating access within 24 hours, through such methods as accreditation?
Many at the forum repeated that it is routine for persons with mental illness and their families to face a system that is, as one mother put it, “set up to serve the bureaucracy not the client.” Add to that a system that intimidates and it is no wonder people stop trying to seek help.
Studies have not shown that early intervention commitment works. However, studies have proven that when more services are provided to individuals, these additional services works. Therefore we must ask ourselves: What can most realistically be accomplished in order to provide more service? At what point does this become intrusive? There are no easy answers. What I do know is that Rep. Greiling has acted out of her own experience to better a situation. I believe that Sen. Betzold has also acted out of his own experience as a lawyer involved in commitment cases for 20 years, and also wants to better this situation. Pete Feigal is blessed with the gift of being able to create a space and time where all voices can be heard. He is also blessed with the gift of setting a tone where we all can work towards a common good.
Linda Larson is a disability advocate and mom of an adult child with an eating disorder