When a family member or dear friend shows symptoms of intense mental illnesses such as bipolar disorder or schizophrenia, the immediate focus normally lies in treatment. In Maryland, there are two avenues which one can take.
If the mentally ill person is cooperative and/or agrees treatment is necessary, then they will be admitted to a psychiatric or general hospital voluntarily, the treatment is administered, and if all goes well, the patient will go on to lead a relatively secure life.
If said person is uncooperative and/or denies their disorder, then the process to a longer, safe life is far messier…
In Maryland, the only option for a family or supportive community to get their loved one/ neighbor treatment is through an emergency evaluation, in which one must petition to a court office for involuntary treatment. The judge can only grant the petition if “the court finds probable cause to believe that the emergency evaluee has shown the symptoms of a mental disorder and that the individual presents a danger to the life or safety of the individual or others.”
The specific criteria for involuntary admission to a psychiatric hospital are when the person meets all of the following:
- Has a mental disorder
- Needs inpatient care or treatment
- Presents a danger to the life or safety of the person or others
- Is unable or unwilling to be admitted voluntarily
- There is no available less restrictive form of intervention that is consistent with their welfare and safety
According to NAMI (National Alliance on Mental Illness) Maryland, average stay in a private psychiatric hospital is about nine days. If the patient who was initially admitted involuntarily still requires treatment, then another emergency evaluation can be called; this process continues until the patient is allowed to leave the facility.
Compared to other states, this policy is very lenient, offering more agency to the patient. According to the Treatment Advocacy Center, involuntary treatment is more difficult to be administered in Maryland than in any other state. In their comprehensive study of each state’s involuntary aid given to the homeless, they ranked Maryland dead last, with a score of 18 out of 100. Maryland is one of just three states which does not have an outpatient commitment law, a policy which would help support those with anosognosia after leaving the hospital.
The main issue with this procedure is that once a patient is properly medicated, it is possible that the mental illness is only temporarily masked. If the patient goes off their treatment, as is often the case when the patient suffers from anosognosia, then the effects will return, and the patient will still pose a threat themself, as was initially proven by court.
Advocacy groups in favor of involuntary commitment (Treatment Advocacy Center) and others which fight for the agency of the involuntarily committed patients both have some agreeable principle. While a civil commitment program is the only way for anosognosic patients to receive treatment, there are a range of issues which might arise from involuntarily committing someone to psychiatric care, such as strict timelines which restrict the patient’s ability to achieve proper representation in court, and, in cases of a vastly expanded civil commitment program, the possibility of those who pose very little threat to those around them or themselves being arrested and forced into treatment—stemming in some cases from incomprehensive criteria as to what qualifies as a “threat.”
These issues should be properly addressed in every iteration of legislation, though there is always the possibility of diverging circumstances. Civil commitment is by nature a display of the State’s authority, and if the criteria is not specific enough, there is a real threat to people’s agency. However, the threat that those with mental health pose to themself must be addressed, and those who suffer from anosognosia will receive no treatment with a restricted civil commitment program, such as the current one in Maryland.
In fact, in 2021, the Maryland Annual report from the Commission to study Mental and Behavioral Health in Maryland gave a detailed account on the need to “ develop a clear and unambiguous standard for determining when individuals in crisis pose a danger to themselves and others” for the purpose of involuntary treatment. The recent focus has been on reducing unwarranted civil commitment, now it is time to focus on getting more consistent treatment to those in need.