Involuntary Outpatient Commitment

Research demonstrates that access to a comprehensive array of well-funded community mental health services can prevent crisis, minimize negative outcomes, and promote recovery for people with mental health conditions. These are goals we all share, and they are achievable.

Unfortunately, some approaches to mental health reform rely principally on force and coercion, too often undermining opportunities for meaningful engagement with people with mental health conditions. MAMH joins advocates, providers, and people with lived experience across the Commonwealth in opposing efforts to impose involuntary outpatient commitment in Massachusetts.

Involuntary outpatient commitment is a process through which courts can order individuals with mental health conditions living in the community to participate in treatment interventions they do not want. Bills currently filed in the Massachusetts Legislature (H.1694/S.980) would allow judges to approve service plans developed by providers that direct people to take psychiatric drugs, attend therapy, and participate in other interventions against their will. Consequences of failing to follow or comply with the treatment plan include involuntary hospitalization.

Studies do not show that involuntary outpatient commitment improves mental health outcomes, reduces homelessness, or results in more people receiving care. Learn more about H.1694/S.980 and why we oppose these bills:

• Fact Sheet
• Policy Paper
• Summary of Research Based on Other States' Experiences
• MAMH Legislative Testimony
• Summary of Advocates Testimony

Effective strategies to engage people with mental health conditions

• This year, Massachusetts launched its Roadmap for Behavioral Health Care, which for the first time offers people with mental health conditions a broad range of same-day behavioral health treatment, including walk-in support and extended hours, along with a Help Line to connect individuals and their families with services. The Roadmap provides culturally and linguistically responsive interventions for individuals who are in crisis, require urgent care, or need longer term services.
• Non-clinical options, including peer respites, peer supports embedded in more traditional services, peer-led Recovery Learning Communities, Living Room programs, and peer recovery coaches (for people with substance use conditions). For more information about why many people with mental health experiences advocate for these alternatives, read The Wildflower Alliance's op-ed here.
• Supportive housing, which combines access to permanent, safe housing with voluntary services and supports, and which has a proven track record of success and savings. Some supportive housing models, like Safe Havens, are designed to serve hard-to-reach individuals who are chronically unhoused and often have disabling mental health and substance use conditions.

Involuntary outpatient commitment is bad public policy

• Studies of outpatient commitment do not show that it improves mental health outcomes, results in more people receiving more care, or reduces homelessness.
• Multiple studies do show that whatever benefits may come from outpatient commitment laws derive not from its coercive nature, but from the expansion of those services and supports that may be established at the same time.
• BIPOC communities are disproportionately subjected to involuntary treatment orders, exacerbating their negative experiences in an already discriminatory metal health system.
• People who live with mental health and substance use conditions and with disabilities widely oppose outpatient commitment as it threatens autonomy, dignity, and liberty and is not consistent with fundamental precepts of disability rights and recovery movements.
• Involuntary outpatient care will divert money, resources, and precious workforce from the roll out of the urgent care, outpatient, and crisis resolution services of the Roadmap for Behavioral Health Care and from implementation of the mental health omnibus law, Chapter 177 of the Acts of 2022. The funds that will be necessary to administer a court-based IOC system would be better used to meet the well-acknowledged need for a broad range of voluntary services, including access to housing, medical care, behavioral health services and supports, food assistance, and transportation.

To read testimony submitted by our Coalition partners to the Joint Committee on the Judiciary, click here.

For more information, contact: Jennifer Honig, MAMH Co-Director of Public Policy & Government Relations at jenniferhonig@mamh.org

Coercive practices are so widely used that they seem to be unavoidable, but I suggest turning our thinking and action the other way around. Let us assume that each case of using nonconsensual measures is a sign of systemic failure, and that our common goal is to liberate global mental healthcare from coercive practices. We should search, with concerted efforts, for creative ways to replace substitute decision making with support according to an individual’s will and preferences.