States Consider Forced Treatment at Intersection of Homelessness and Mental Health Tragedies

California and Oregon look to reform forced treatment in the face of mental health issues leading to homelessness and higher mortality rates.

According to an article from the Kaiser Family Foundation, several public tragedies have given state lawmakers pause to consider a shift in strategy when dealing with individuals with severe mental illness. As covered previously on the blog Maryland lags behind 47 states and the District of Columbia on providing some form of court-ordered outpatient treatment. The legislation stalled once again in the 2023 legislative session; meanwhile, some states already have programs looking to go further.

From the article:

People with schizophrenia, for example, have died of hypothermia on the city’s streets. One resident gave birth in a snowstorm to a stillborn infant. Methamphetamine, cheaper and more potent than it used to be, is creating a heightened risk of overdose and psychosis.

According to the article, a third of homeless individuals suffer from severe mental illness and are more susceptible to experiencing the misfortune described above. These tragedies arise at the intersection of untreated mental health needs, exploding costs, and catastrophic shortages in affordable housing. This is to say nothing of all the mechanisms out of the individuals’ control that compounded their dire situation to the point of homelessness. The evolving question here considers whether a forced bed, treatment, and meals is a more humane approach than allowing individuals to languish in the streets, often leading to premature and preventable death. The article highlights why mental health care and emergency response shifted so drastically in the direction of voluntary care.

Half a century ago, California policymakers shuttered state psychiatric institutions, denouncing them as inhumane. Involuntary commitment was de-emphasized, and state laws ensured that it was used only as a last resort. The thinking was that the patient should have autonomy and participate in their care.

During the 2023 legislative session, 62 of the 75 submissions of written testimony supported some form of mandated treatment with the common justification that the individuals requiring this type of care suffer from a kind of illness where voluntary admission is often impossible. Policy approaches in other states take the form of mandated treatment ordered by a court judge, an expansion of eligibility requirements for a conservatorship and psychiatric hold, and reconsidering the “danger standard” when weighing whether someone is a danger to themselves or someone else. While Maryland is not currently seeing the number of homeless tragedies of other states, the need for mental health services and housing is a pressure point across every jurisdiction in the state.