Testimony on SB 428 –An act concerning assisted outpatient treatment for certain persons with psychiatric disabilities

Public Safety

March 10, 2020

Submitted by: Dr. Christine Limone, PhD, LCSW

Members of the Public Safety and Security Committee: My name is Dr. Christine Limone.  I am a licensed clinical social worker, a social work educator, and hold a doctorate in social work from Fordham University. I am here today to express my opposition to SB 428 on behalf of the Connecticut chapter of the National Association of Social Workers, representing over 2,400 social workers across the state.

I worked as a clinical social worker at a DMHAS funded community based psychiatric rehabilitation program for fourteen years. I have also done extensive research on New York State’s Involuntary Outpatient commitment law “Kendra’s Law”.  From my own first hand practice experience, I can tell you how heartbreaking it is to watch someone you work with and care about, slip into psychiatric distress because they failed to take their medication. However, this medication centric proposed solution is an inadequate response to the problem and reflects a myopic understanding of mental well-being.  I make this assertion based on both my own practice wisdom as well as on empirical research.

Primary reliance on psychotropic drugs does not guarantee psychiatric stability.  A holistic, comprehensive approach to wellness that includes does medication and a good psychiatrist, but also includes evidenced based practice models such as supervised housing with supports, Assertive Case Management, psycho-social services, employment opportunities, is the formula that keeps people stable and functioning. When speaking of community based services for persons with mental illness in 2000, The US Surgeon General said,  “the need for coercion should be significantly reduced when adequate services are readily available”  If the goal of SB 428 is to reduce an individual’s “propensity for violence”, the solution lies in securing funding for a robust, comprehensive, responsive recovery – oriented community based system of care, not in coerced treatment.

To illustrate this point – Kendra’s Law was enacted in New York in 1999.  According to New York State’s Mental Hygiene’s Medical Review board’s own critical incident review of the incident that led this statute “In the Matter of David Dix”, the mental health consumer in question, wasn’t refusing or resisting treatment, he was simply incapable of medication self administration. The longest period of time he had in the community of psychiatric stability was two years prior when he was a resident in a supervised housing program.  At the time of the incident, he was actually seeking services and was on a waiting list for supervised housing, but was living in an “independent apartment” in the meantime. Without the proper wrap around supports he decompensated.  He was a victim of a broken, inadequate community system.  A 2009 study of Kendra’s law that was conducted by a team of researchers from Duke University was inconclusive in their findings as to the effectiveness of Kendra’s Law – this supports earlier studies from other states that conclude that coercive treatment is no more effective than adequate, accessible voluntary community services.

Language is Section 1 of SB 428 states that agents of the supervising agency should, “attempt to develop a rapport with the participant and earn their trust” in order to facilitate compliance with treatment plans.  I can tell you as a licensed clinician and researcher, nothing jeopardizes the trust and therapeutic alliance between and individual and their social worker like coerced treatment. One evidenced based intervention that DOES promote rapport and trust between these parties is Motivational Interviewing. Every DHMAS funded community- based provider from psychiatrist of record to the paraprofessional who works second shift in a housing program should be trained in Motivational Interviewing techniques to gain an individual’s endorsement of their treatment plan. This is consistent with a recovery oriented system of care that DMHAS promotes as well as the NASW Code of Ethics.

In closing The National Association of Social Workers opposes SB 428.  It inadequately addresses the problem.  Making sure that a comprehensive community-based system of care that protects individual’s dignity and self determination while preserving the therapeutic relationship between client and provider is the better solution.  Thank you.

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