Floor Remarks: LD 1360

On April 7th, 2010, LD 1360 "An Act To Allow Law Enforcement and Family Members To Petition the District Court To Initiate Assisted Outpatient Treatment", came to the floor of the House of Representatives. Reprinted below are the comments I made on the record from the floor:

Madame Speaker and Ladies and Gentlemen of the House...

I speak today in opposition to the pending motion, with great respect for my colleagues on the Health and Human Services Committee that are on the current report in front of us.

LD 1360 is a bill which was extensively discussed in the Health and Human Services Committee and resulted in a divided report with two very different amendments which reflect two different approaches to a complex issue -- the best way to treat Maine citizens with a psychiatric disability in a community setting.

The subject at hand is the use of the Progressive Treatment Program or PTP which has been court-ordered outpatient treatment, typically under very close supervision, as a means of providing treatment and support for a person with a significant psychiatric disorder. This Progressive Treatment Program approach was originally enacted as a pilot several years ago with a sunset provision for July of this year.

Should we fail to act on this matter, the Progressive Treatment Program will be curtailed and a tool that has proved valuable to some individuals will no longer be available. Acting to maintain this out-patient treatment tool seems to be reasonable -- for it provides additional alternatives for individuals who are dealing with the impacts of a psychiatric disability.

Where the committee disagreed, and we split on a 9 to 5 vote, was regarding what approach to take. Committee Amendment B, which was the minority report that I supported, essentially leaves the existing program intact, extends the sunset provision until July 1, 2014, and calls for additional review and analysis of the effectiveness of the Progressive Treatment Program -- with a report due to the Committee in January of 2012.

Committee Amendment A describes a number of new elements in the Progressive Treatment Program, and expands both the mandatory nature of this out-patient treatment regime, the people who can order participation in the program, as well as the nature of that participation. In our debate today you have heard people speak about what they perceive as the advantages of these expansions of both mandatory participation and the people who can direct such participation. I will not comment extensively on the details of the approach because I did not support it. Frankly, I was not convinced in Committee or by the debate on the floor that the additional mandated elements would improve outcomes for the individuals or the community. While I think that a Progressive Treatment Program is another valuable tool in helping Maine citizens manage a psychiatric disability, I was concerned that the new elements have expanded the program in ways that could have unintended negative consequences. If you read the language and see the number of caveats, protections and limitations -- it becomes clear very quickly that we are on a slippery slope. I prefer to go slow on any mandated interventions that can deprive people of their freedom to choose.

All of us have encountered the impacts of psychiatric disability in our communities, perhaps in our own families. I am glad it no longer carries the stigma it once had, and that folks with a psychiatric disability are now able to be integrated into our communities and live productive and fulfilling lives. In my career as someone who encourages independent living for people with all types of disabilities -- physical, sensory, cognitive, or psychiatric -- I have worked closely with people who have made great strides in living as independently as possible. Providing the tools for that independence is the key to me. Community based service alternatives are essential -- but so is the freedom to choose the appropriate alternative. I am concerned that the majority report tips the delicate balance in the wrong direction on this matter of personal autonomy. Providing resources is essential, mandating the use of those resources … I am just not sure.

This discussion is a variation on a theme we often discuss in this Chamber and have for many, many years. How do we strike the balance between protecting the community and the individual, and giving individuals control, and the right to decide and even “the right to make the wrong decision?” There are some debates that come around over and over -- making helmets mandatory for all motorcycle riders -- there are always passionate voices and good arguments on both sides. Some of my colleagues would, no doubt, be happy to regulate a number of the behaviors that we know are “bad for us” like tobacco use. We always balance that in allowing for personal decision-making and autonomy. We must think long and hard when we tip that balance and take away people’s autonomy.

This body always struggles to find the balance -- and so we must here. This is another instance where we must find the “sweet spot” -- the point at which we encourage behaviors that are healthy and appropriate, without eliminating an individual’s autonomy. The sweet spot is hard to find on this issue -- because it is complex. How wide are our community norms? Where does behavior cross the line into being inappropriate? Who will be the keepers of those norms? Who decides? What is the basis for the decision? Should an ACT Team (Assertive Community Treatment Team) made up of a psychiatrist, a mental health nurse, licensed Master’s level clinicians, and counselors/case managers be the decision makers? Maybe the head of a psychiatric hospital? Or the Commissioner of Health and Human Services? Should it be a law enforcement officer who has information from a concerned family member? This proposal, even in its latest amended form introduces many more players and many more complexities into the mandating of treatments -- even in a community setting. It is not a responsibility I would personally welcome -- I know that. Do we really want to create this unwieldy system that can ultimately deprive an individual of his or her autonomy and decision-making?

I have not been convinced that a case has been made to expand the ways that a Progressive Treatment Program can be mandated -- without significant consequences for an individual living independently in the community. We need to maintain this tool, but we need to proceed with greater caution before we do anything that may take away the liberty or the autonomy of a person with a disability -- including a psychiatric disability -- no matter how good our motives may be. In this case, I am convinced that the motives behind the bill are well-intentioned. It is what is not intended, and the impact those unintended consequences may have on the lives of our fellow citizens -- that concerns me.

This vote will be a matter of conscience and one where we each weigh our values and our beliefs. I will continue to be voting against the majority report, Committee Amendment A as amended by the other body, and urge the more restrained approach taken by the minority of the HHS Committee in Committee Amendment B. I hope you will join me in rejecting the current motion, so we can have the opportunity to consider and pass Committee Amendment B and maintain this important tool for community based out-patient mental health services without unduly expanding its scope in a way that could undermine the autonomy of some of Maine’s vulnerable citizens.

Thank you, Madame Speaker.