Any changes to the state law governing forced hospitalization for mental health emergencies must be accompanied by better funding of the outpatient treatment services that can help prevent people from getting to a crisis in the first place, speakers told a legislative panel Tuesday.
The House Human Services Committee held the hearing in Harrisburg amid calls for relaxing the part of the Mental Health Procedures Act used to involuntarily commit a person to a hospital for psychiatric care.
No legislation for modifying the law has been introduced in the House so far.
However, a Senate bill, introduced in April, would remove the current requirement that a person act on a threat to harm himself or others before officials could consider forced hospitalization, often called an involuntary commitment or -- in reference to a section of the mental-health law -- a 302 commitment.
That legislation, introduced by Sen. Patricia Vance, R-Cumberland County, instead would require that a person make a threat and that officials conclude that "the totality of circumstances supports a finding of danger" and need for a commitment.
Speakers at Tuesday's hearing demanded improved state funding of outpatient services, saying access to peer support, clinical care, case management and other help was seriously affected by a 10 percent budget cut during the 2012-13 fiscal year and had been eroding steadily even before that.
"Absent that, any changes in the Mental Health Procedures Act will have short-term and limited effects at best," said Lloyd Wertz, vice president for policy and program development at the Philadelphia-based advocacy group PMHCC.
Without access to care, he said after the hearing, people will deteriorate until they may need an involuntary commitment.
Improved funding and the need for additional inpatient and outpatient treatment services were issues raised in After Mayview, a recent Pittsburgh Post-Gazette series on mental-health services. The series was prompted by the approaching five-year anniversary of the closing of Mayview State Hospital, which treated seriously mentally ill residents of Allegheny, Beaver, Greene, Lawrence and Washington counties.
Carol Horowitz, Pittsburgh-based managing attorney with the Disability Rights Network of Pennsylvania, said budget cuts have tested the counties' commitment to serve the seriously ill without Mayview as part of the continuum of care. "Until that time," she said, "they were very successful in living without a state hospital."
Rep. Gene DiGirolamo, R-Bucks County, majority chairman of the Human Services Committee, supported calls for improved funding. "Maybe we need to start opening up some of these state hospitals again," he said. "I'm not sure. I mean, that's certainly something we can have a conversation about."
Mark Zacharia, assistant counsel for UPMC Corporate Services, and K.N. Roy Chengappa, professor of psychiatry at the University of Pittsburgh School of Medicine, said they supported changes that would speed emergency help to people in crisis. Currently, Mr. Zacharia said, "a patient's behavioral history or medical history is irrelevant" and a patient must "decompensate to the point of" harming himself or others before an involuntary commitment can be considered.
Though the incident did not come up at the hearing, UPMC's Western Psychiatric Institute and Clinic was the scene of a 2012 shooting by John Shick, who killed one employee and wounded others before being fatally shot by police. In the aftermath, District Attorney Stephen A. Zappala Jr. asked why Shick was not involuntarily committed before he had a chance to shoot anyone.
Other speakers said the state needs to better understand how the current law is used before making changes. They said the state lacks data on the number of involuntary commitments attempted each year and how use of the law varies from county to county.
Joe Smydo: email@example.com or 412-263-1548. First Published October 15, 2013 8:00 PM