Disability rights groups worry about an Ohio bill to expand involuntary psychiatric commitment
COLUMBUS, Ohio (WCMH) – State lawmakers are considering a bill to make it easier to involuntarily hospitalize people with mental illness – and disability rights advocates are seriously concerned.
For months, the Ohio House Behavioral Health Committee has mulled over legislation that would expand the reasons someone can be civilly committed to inpatient psychiatric care against their will. The bipartisan legislation, which its sponsors claim would result in fewer mentally ill people being jailed and better health outcomes for them, would add Ohio to the growing list of states that have expanded ways to involuntarily hospitalize people.
While the bill is supported by health care providers, judges, and law enforcement, disability rights organizations are worried the legislation will not help the people it’s purported to benefit – and may in fact seriously harm their chances of recovery or long-term stabilization. Involuntary hospitalization does not address housing insecurity, food insecurity, job insecurity and the other factors that contribute to mental health issues, advocates say, and in many cases can put people at further risk of poverty and homelessness.
“It’s just a cycle that continues and perpetuates, and people just don’t get out of it,” said Lewis Bossing, senior staff attorney for the Bazelon Center for Mental Health Law.
To initiate civil commitment in most cases, a qualified person – including most law enforcement, physicians, licensed mental health workers and public health officials – must file a petition for emergency hospitalization, a process commonly referred to as “pink-slipping.” Under current law, to be immediately hospitalized without consent, a person must present a “substantial risk” of physical harm to themselves or others, must be unable to care for their basic physical needs due to mental illness, or must post a “grave and imminent risk” to the substantial rights of themselves or others that would be remediated through mental health treatment.
House Bill 249 would add a category of people who could be involuntarily hospitalized. To qualify under the “psychiatric deterioration” standard, a person must meet all of the following:
- Their judgment is impaired by a lack of understanding of having an illness or a need for treatment, or both
- They have refused treatment or are not following a prescribed treatment
- They have been diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, delusional disorder, or major depressive disorder
- They are “reasonably expected to suffer mental deterioration” if not treated and, because of that, would fall into another category outlined in existing law
Its sponsors, Rep. Brett Hillyer (R-Uhrichsville) and former Democratic Rep. Tavia Galonski, said adding a “psychiatric deterioration” standard allows the legal and health systems to initiate care before a person harms themselves or others – and in some cases, ends up with a criminal charge.
“Intervention can reduce an individual’s risk of societal consequences, like arrest, incarceration, homelessness or job loss,” Galonski, who resigned in January after being named the Summit County Clerk of Courts, testified last September.
The sentiment was repeated in proponent testimony by judges, police officers, and the Ohio Psychiatric Physicians Association. Several acknowledged that 21 states have some form of “psychiatric deterioration standard” and argued that early intervention leads to shorter hospital stays.
Summit County Judge Elinore Marsh Stormer wrote in testimony submitted on behalf of the Ohio Judicial Conference that HB249 enables providers to care for people “who refuse or cannot access treatment.” She emphasized that emergency hospitalization often does not lead to full civil commitment, and said in Summit County, less than a third of people who are pink-slipped end up making it before a judge in a civil commitment hearing.
“The other 70% receive appropriate treatment and are released,” her testimony reads.
But emergency hospitalization can be harmful in and of itself, Bossing said. People can be held for several days, and in that time may lose their jobs, be unable to provide for their family or their relationships may suffer. And often, Bossing said, forced hospitalization means little more than forced psychiatric medication and release. People are discharged into the same community that lacks adequate support services to keep them stable, he said.
“There’s no evidence to indicate that just because there is a court order requiring treatment that that treatment is going to be more effective than voluntary engagement of a person,” Bossing said.
Available research on involuntary hospitalization supports Bossing’s assertion. The scientific literature indicates that forced hospitalization does not improve people’s long-term mental health, and some studies show people are worse off.
A 2019 systematic review published in the Journal of Nervous and Mental Disease found multiple studies showed involuntarily hospitalized people are significantly more likely to be readmitted, have higher rates of suicide and are viewed more negatively by hospital staff than voluntarily admitted patients. A 2008 review of more than 40 studies published in the European Archives of Psychiatry and Clinical Neuroscience found similar results.
Disability Rights Ohio agrees with Bossing. While it doesn’t formally oppose HB249, the organization said in written testimony that the legislature should instead focus on funding community-based services and prioritizing voluntary access to care.
“People’s rights should not be jeopardized simply because they have a diagnosis, are experiencing symptoms, or because the community lacks the availability of adequate services and supports to meet their needs,” Disability Rights Ohio’s testimony read.
The new category of person subject to civil commitment is further problematic, Bossing said, because it requires the person initiating involuntary hospitalization to make a judgment call about how someone may act in the future. While proponents, including a police sergeant and crisis intervention coordinator, testified that the new law’s criteria act as sufficient guardrails for unnecessary hospitalization, Bossing said it’s an inherently subjective call that is often unreliable.
People who have had negative experiences with mental health care have "very rational" reasons for avoiding treatment, including psychiatric medications, Bossing said. Particularly during a housing crisis, and at a time when states like California have expanded involuntary commitment laws to target rising homelessness, Bossing worries that the people will use homelessness as a proxy for whether someone can care for themselves. But it’s often not that simple, he said.
“For many people, the alternative to living on the streets is living in a shelter, or in some sort of hospital – both of which are often crowded, chaotic, unsafe, unclean conditions where people often feel victimized or otherwise subjected to kinds of abuse,” Bossing said. “If it were me, I would pick living in a tent on the street versus being in a shelter.”
Both Disability Rights Ohio’s testimony and Bossing emphasized that people need mental health treatment – and Bossing acknowledged that in some serious cases, emergency hospitalization may be necessary. But the Bazelon Center, Disability Rights Ohio and other advocacy organizations argue that the state should promote – and properly fund – the least restrictive care for people and prioritize autonomy in health care decisions.
“One of the biggest barriers to recovery remains the lack of access to community mental health services, a result of historic underfunding of these systems,” Disability Rights Ohio’s testimony, submitted for Tuesday’s hearing, read. “Forcing people into institutionalization does not solve this problem.”
HB249 was scheduled for a committee vote on Tuesday, but before hearing testimony on the bill, House Behavioral Health Committee Chair Gail Pavliga (R-Portage County) announced the vote had been tabled.