Some in Pennsylvania see commitment laws for people with mental illnesses as outdated

From the York Daily Record:

Twice a week -- on Tuesdays and Fridays -- Victor Neubaum goes to the psychiatric wing of York Hospital to be the arbiter of who stays and who leaves.

In a small conference room, doctors and loved ones explain why a person needs to remain in the hospital against his or her will. A lawyer representing the committed, nearly always a public defender, asks questions, picking away at the arguments to extend the client's stay.

Then Neubaum, who serves as the mental health review officer for the county, rules if the person can still legally be committed.

In making his decision, Neubaum must use what he says is an outdated and imperfect law, the Mental Health Procedures Act of 1976.

Under that law, a person must be an immediate danger to himself or others in order to be committed.

At a hearing, Neubaum might hear a doctor say he thinks a person is suicidal. The attorney for the committed will likely ask why the doctor thinks that. Does the person have a specific plan to kill himself? Could he carry it out?

If the doctor answers no, Neubaum likely cannot

Attorney Victor Neubaum displays books that he uses to understand mental illness and make decisions about whether people can be involuntarily committed. He s been serving as the mental health review officer for more than a decade and thinks the Mental Health Procedures Act of 1976 needs to be updated. (Daily Record/Sunday News -- Paul Kuehnel)extend the person's commitment, even if he believes the person has not fully recovered.
He's presided over these hearings for more than a decade. Sometimes, he said, people in need of help are lost over the narrow edge of the law.

And a lack of housing -- in and of itself -- is not a factor, Neubaum said.

"Mere homelessness is not a reason to commit somebody," he said.

And yet, mental health specialists say, a stable home or place to stay is essential to a mentally ill person's recovery.
It's not against the law to be crazy or act irrationally, said Steve Warren, who directs mental health services for York and Adams counties.

"We have a system that certainly offers the consumer the opportunity to make those choices -- and also gives them the opportunity to make poor choices -- and we have consumers that have done that," Warren said. "We have consumers that have chosen to be homeless."

The county supports these people the best it can, he said, with case managers who try to find people homes.

Added Bev Mackereth, York County's human services director, "There's a point where it's just not up to us."

Some people say the law needs to be changed. Dr. Stephen Rydesky Jr. of Carroll Township (pictured) is one.

He watched his daughter, Stephanie, grow sicker over time because she wouldn't take medicine for her mental illness. Her behavior became so strange that he added extra locks to his bedroom door.

The dentist had his daughter taken to a hospital for an evaluation before Christmas, but she was released soon after.

Two weeks later, police said, Stephanie Rydesky burned down their home in a suicide attempt.

She is receiving treatment at Torrance State Hospital and is doing much better, her father said.

Stephen Rydesky questions why he had to endure a tragedy when he says his daughter showed signs of being in danger.

"You just wonder why in God's name?" he asked.

The people who helped him fill out the mental health warrant "knew I put extra locks on," he said. "They knew I was afraid of her, and they still would release her."

People who work with families feel the frustration, too.

When families bring a loved one to the Crisis

Stephen Rydesky recalls the day his 32-year-old daughter, Stephanie, allegedly started a fire that burned his house to the ground. (Daily Record/Sunday News -- Kate Penn)Intervention unit at York Hospital, they often expect counselors to force their loved ones to take medication or go into a hospital, crisis manager Jennifer Richard said.
It gets especially hard for a family that has seen someone suffer a setback before, Richard said, because they know it will likely get worse until a person can be committed.

The person is deteriorating, "they're not taking their meds but they haven't done anything that's committable," Richard said. "If they're not doing anything dangerous, and they're on some level functioning, they can't be committed. That's the law.

"And that's where some people fall through the cracks."

Officials who work in the mental health system say people can be released from the hospital at any time if they respond to treatment.

Doctors will recommend that the patient work with a case manager from the York-Adams Mental Health/Mental Retardation program, see a psychiatrist at Edgar Square on a regular basis and work on getting more stable housing, program administrator Steve Warren said.

People with mental illness have the same right as other health patients whether to follow through on those recommendations.

It's the same as if a person broke an ankle, Warren said. The doctors fix it and give directions for rehabilitation "and you walk out and say, 'Screw that,' and 'I'm going home, the heck with it.' "

The law provides for treatment in the least restrictive manner, and it is designed to give people with mental illness the freedoms that everyone else has, he said.

Mental illness is treatable, Warren said. The more options and supports offered to the consumer, the better chance that person has.

The law can never cover everybody or every situation, Mackereth said.

People with mental illness often struggle to find housing because there isn't enough. Some wind up living on the streets -- especially if they've been in prison.

But just as people with alcoholism, mental retardation, senility or drug dependency must also be diagnosed with mental illness in order to be committed, the same applies to people who are homeless, Neubaum said.

Neubaum said he sees an area of the law that could change. The state's law hasn't been updated since 1976, and it doesn't deal with the advances made in psychiatry, he said.

He'd like to see a provision made so that people who have a reckless disregard for their own safety or the safety of others be committed for treatment.

For example, a man with a history of suicide attempts tells others that he's going to take his life. But under the current law, unless he takes action on that threat, he wouldn't qualify for an involuntary commitment, Neubaum said.

"We shouldn't have to wait for something bad to happen," he said.