Rights and Legal Issues - Involuntary Commitment

Letter to Court Examiners concerning Riverview Psychiatric Center's Progressive Treatment Program

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January 11, 2007

Dear Court Examiner:

As you are probably aware, Maine’s new Progressive Treatment Program (PTP) is underway for eligible patients from Riverview Psychiatric Center. This is a program that is similar to what is called outpatient commitment in other states. Because you are on the list of examiners who periodically perform commitment evaluations for the District Court in Augusta, I wanted to make you more aware of the program and of resources available to you to learn more about the program.

To have a person admitted from RPC to the Progressive Treatment Program, the hospital has to show the court by clear and convincing evidence that

1. The respondent is 21 years old or older;
2. The respondent is currently involuntarily committed to Riverview Psychiatric Center;
3. The respondent suffers from a severe and persistent mental illness;
4. Based on the respondent’s (i) current behavior; (ii) treatment history; and (iii) history of positive responses to treatment during hospitalization, relapse and deterioration of mental health following discharge, and inability to make informed decisions regarding treatment, the respondent is in need of progressive treatment in order to prevent interruptions in treatment, relapse, and deterioration of mental health, and in order to survive safely in a community setting in the reasonably foreseeable future without posing a likelihood of serious harm under 34 B M.R.S.A. § 3801(4)(D); and
5. An assertive community treatment team is available to provide treatment and care for the respondent.

You can find the basic statutory program description at 34 B M.R.S.A. § 3873. Briefly, PTP provides for intensive community services for six months or until the client within that time either is no longer in need of services or is involuntarily recommitted to the hospital.

Several of the terms used in assessing appropriateness for PTP are defined specifically at 34 B M.R.S.A. § 3801. Those defined terms include:

• Severe and Persistent Mental Illness
• Inability to Make an Informed Decision
• Likelihood of Serious Harm (for purposes of this program)
• Assertive Community Treatment

Here are the links to these two parts of the involuntary commitment statute:

http://www.mainelegislature.org/legis/statutes/34-B/title34-Bsec3873.html

http://www.mainelegislature.org/legis/statutes/34-B/title34-Bsec3801.html

Persons admitted to the Progressive Treatment Program from RPC will be served by the RPC assertive community treatment (ACT) team. This is an ACT team of hospital employees providing services to clients living in the community. The team members represent the disciplines that are required by the PTP statute, MaineCare regulations, and the ACT team fidelity model. The team is currently headed by Program Service Director Bruce Samuels and Team Manager Kathryn Murray. This ACT team has an 8:1 client to staff ratio and also serves forensic patients from RPC who are on community release.

To seek admission of a current RPC patient to the PTP program, the hospital files a court application that is very similar in format to the application filed for involuntary hospitalization. The court process, as the PTP statute explains, is then like the process used for involuntary hospitalizations, except that the evidence must support the five requirements set out above. In addition, the court must include in its order requirements that the patient be returned to the hospital if he or she fails to participate in treatment and requires hospitalization under a best interest and likelihood of future harm standard.

If you are selected as an examiner, either the court will let you know if any of the week’s hearings includes the need for a PTP assessment, or you can check the legal section of the patient’s chart to see which kind of petition has been filed. If you have questions about the services that the ACT team will be offering, the unit staff can put you in touch with the ACT team Program Service Director, who can provide you with any additional information pertaining to treatment services being proposed if that would help you in making your assessment.

We hope shortly to have additional materials up on the RPC website concerning this program, but, in the meantime, if you have questions, please feel free to contact me.

Sincerely,

Brian A. Daskivich, Ph.D.
Deputy Superintendent of Program Services
Riverview Psychiatric Center