The massive bill could make involuntary medication easier

Each year, 2,000 Massachusetts residents experience the onset of a psychotic disorder. Some miss the private realities that lead to homelessness or prison. Antipsychotics are more precise and more diverse than when they were first introduced seventy years ago. Failure to treat when a delusional patient says no is vulnerable, many psychiatrists say. However, critics fear that the treatments are imperfect and the expanded power of psychiatrists invites abuse. They cite an era of shock therapy and lobotomies that put patients at the mercy of their doctors.

Now, the involuntary treatment of a patient in Massachusetts takes more than a month and with some exceptions requires one determination of legal incompetence and then a judge’s order.

The proposed legislation lays out specific circumstances in which psychiatrists may treat a patient without a court order or finding of incapacity, including when there are signs of significantly impaired functioning, risk of harm to self or others, and an expectation that the patient’s condition the person will not improve or worsen in the future Three days. Supporters say the bill simply clarifies existing law, giving providers more clarity guidelines on how to treat patients who cannot recognize their need for medication.

I find myself in these cases erring on the side of wanting to get that person into treatment as soon as we can, said state Sen. John Velis, chairman of the Joint Committee on Mental Health, Substance Use and Recovery. The longer it takes to treat them, in many cases the worse the results.

Disability advocates and some defense attorneys argue that the legislation does much more than affirm the status quo. It greatly expands what the current law allows, they said, increasing the likelihood that providers will run afoul constitutional rights of patients.

If it becomes law, it will allow our clients to be forcibly medicated without judicial oversight or legal representation, said Robert McGovern, spokesman for the Public Counsel Services Committee.

Additionally, forced medication is counterproductive, even for those with delusions, said Daniel Fisher, vice president of the National Mental Health Recovery Coalition. It destroys trust, creates trauma and worsens the chances of recovery.

Recovery requires engaging people in their own life circumstances, Fisher said.

The legislation, now with the Senate Ways and Means Committee, is one of several bills under consideration to address a mental health crisis in Massachusetts.

Separate bills aim to establish judicial supervision of seriously and persistently ill people receiving outpatient psychiatric care, to ensure they continue treatment. Balboni Craciun, Nick Craciun’s mother, sees this as another important tool for vulnerable families to help a relative unable to recognize their illness.

Nick Craciun began showing signs of serious mental illness in 2013 when he was about 11 years old, his mother said. Over time, his behavior became more erratic, his delusions increasingly bizarre, his parents said. He was diagnosed with bipolar disorder with psychotic features and committed to hospital care twice in 2022 and 2023.

Both stays were short and he always refused medication. In late 2023, Nick began a spiritual journey that led him to a Boston mosque. He seemed better, his father said, and showed flashes of his old humor, warmth and kindness. But Nicks delusions returned and he was asked to leave.

On December 27, 2023, Laurentiu Craciun brought Nick to his home in Cambridge. Nick didn’t want to sleep alone, so his dad brought his mattress into the living room to be close. Nick then hit his father without provocation, Laurentiu said.

The attack continued outside, where Laurentiu was hit in the head and bitten on the back as he tried to restrain his son. Police charged Nick with kidnapping and assault with a dangerous weapon, according to court records.

Nick went to Bridgewater State Hospital, a Department of Corrections mental health facility, for evaluation. Nicks’ parents hoped he could receive antipsychotic medication there, but a judge in March ruled that Nick was competent to stand trial. He was transferred to the Middlesex House of Correction, where he stands.

Inside I am destroyed, said Laurentiu. Even now, he thinks it’s fine.

Nick Craciun and his attorneys did not respond to requests for interviews. At a recent competency hearing, Nick said, I believe I have no mental illness.

He also faces breaking and entering and theft charges in Barnstable Superior Court and Lawrence County Circuit Court.

If a legally incompetent patient refuses medication, a judge may be asked to determine what treatment the patient would want if his judgment were not impaired. The judge considers factors including diagnosis, patient wishes, prognosis, family needs and possible side effects, and then may decide to allow involuntary medication through what is called a Rogers Order.

State law allows the patient to be treated without the consent or order of a judge if there is an immediate risk of violence or self-harm, or a psychiatrist determines that the patient may suffer immediate, substantial, and irreversible deterioration.

Supporters of the bills say ambiguities in existing laws discourage practitioners from even trying. They also argue that obtaining a Rogers Order takes too long. A Bridgewater study found that an average of 41 days passed from petition to treatment, although judges approved about 82 percent of requests. The study also found that patients’ rates of self-harm and violent incidents dropped after being treated under a Rogers order.

The author of the study, Dr. Jhilam Biswas, president-elect of the Massachusetts Psychiatric Society, described the patients at Bridgewater who refuse medication placed in restrictions and forcibly drugged. It is inhumane, she said, to leave patients oblivious to their untreated illness. Studies suggest that both bipolar disorder and schizophrenia can be degenerative, another reason to start treatment quickly.

Her medical condition and was allowing her to get angry, she said. This is causing our patients to … live in this constant revolving door of homelessness and incarceration and institutionalized long-term care.

Opponents worry that the legislation would expose a wider swath of mental health care patients to involuntary medication without the help of judges by broadening the definition of immediate, substantial and irreversible deterioration.

Any bill that would erode so much of people’s rights should be a serious concern, said Tatum Pritchard, director of litigation for the Disability Law Center, a Boston-based advocacy organization. This is not a tool that we would expect to be used sparingly, with so few handrails up.

Amid the complicated questions surrounding mental illness treatment, families like the Craciuns simply want a path back to health for their loved ones.

Father and son shared a love for the Boston Celtics even through their youth struggles. As the Celtics headed for another championship, Laurentius had to tell his son, who spends most of his time in solitary confinement, the results of the games. The prison schedule, he explained, did not allow him to see the last minutes.

These are the most difficult years of my life, said the father. Being mentally ill and being in a cell is very difficult.

Jason Laughlin can be reached at Follow him @jasmlaughlin.

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