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NAMI Maryland (NAMI MD) believes that all people should have the right to make their own decisions about medical treatment. However, NAMI MD is aware that there are individuals with brain disorders such as schizophrenia and bipolar disorder who, at times, due to their illness, lack insight or good judgment about their need for medical treatment.

NAMI MD, therefore, believes that:

1. The availability of effective, comprehensive, community-based systems of care, including crisis services, for persons suffering from brain disorders will diminish the need for involuntary commitment and/or court-ordered treatment.

2. Involuntary inpatient and outpatient commitment and court-ordered treatment should be used as a last resort and only when it is believed to be in the best interests of the individual.

3. Methods for facilitating communications about treatment preferences among individuals with brain disorders, family members, and treatment providers should be adopted and promoted in Maryland.

4. Involuntary commitment and court-ordered treatment decisions must be made expeditiously and simultaneously in a single hearing so that individuals can receive treatment in a timely manner.

5. The role of courts should be limited to review to ensure that procedures used in making treatment decisions comply with individual rights and due-process requirements. The role of the court does not include making medical decisions.

6. Maryland should adopt broader, more flexible standards that would provide for involuntary commitment and/or court ordered treatment when an individual:

(a) is gravely disabled, which means that the person is substantially unable, except for reasons of indigence, to provide for any of his or her basic needs, such as food, clothing, shelter, health or safety; or

(b) is likely to substantially deteriorate if not provided with timely treatment; or

(c) lacks capacity, which means that, as a result of the brain disorder, the person is unable to fully understand or lacks judgment to make an informed decision about his or her need for treatment, care, or supervision.

7. Current interpretations of laws that require proof of dangerousness often produce unsatisfactory outcomes because individuals are allowed to deteriorate needlessly before involuntary commitment and/or court-ordered treatment can be instituted. When the "dangerousness standard" is used, it must be interpreted more broadly than "imminently" and/or "provably" dangerous.

8. Maryland laws should also allow for consideration of past history in making determinations about involuntary commitment and/or court-ordered treatment because past history is often a reliable way to anticipate the future course of illness.

9. An independent administrative and/or judicial review must be guaranteed in all involuntary commitment and/or court-ordered treatment determinations.

(a) Individuals must be afforded access to appropriate representation knowledgeable about brain disorders and provided opportunities to submit evidence in opposition to involuntary commitment and/or court-ordered treatment.

(b) Family members should be notified of the hearing and allowed representation and testimony.

10. Responsibility for determining court-ordered treatment should always be vested with medical professionals who must develop a plan for treatment in conjunction with the individual, family, and other interested parties.

11. The legal standard in Maryland to justify emergency commitments for an initial 24 to 72 hours should be "information and belief." For involuntary commitments beyond the initial period, the standard should be "clear and convincing evidence." Involuntary commitments and/or court-ordered treatment must be periodically subject to administrative or judicial review to ascertain whether circumstances justify the continuation of these orders.

12. Court-ordered outpatient treatment should be considered as a less restrictive, more beneficial, and less costly treatment alternative to involuntary inpatient treatment.

13. Efforts must be undertaken to better educate justice systems and law enforcement professionals about the relationship between brain disorders and the application of involuntary inpatient and outpatient commitment and court-ordered treatment.

14. Private and public health insurance and managed care plans must cover the costs of involuntary inpatient and outpatient commitment and/or court-ordered treatment.

Approved by the board on April 23, 1999

 

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