Every year, 2,000 Massachusetts residents experience episodes of psychosis, some of which are lost in personal realities and end up homeless or incarcerated, and they now have access to a more precise and diverse range of antipsychotic medications than when they were first introduced. 70 years agoMany psychiatrists say there is no excuse for failing to treat a delusional patient when he or she says “no.” Treatment is incompleteCritics worry that giving psychiatrists more power will lead to abuse, citing the days of shock treatments and lobotomies that kept patients at the mercy of doctors.
Currently, in Massachusetts, it typically takes more than a month to force a patient to take medication, with a few exceptions. a finding of legal incompetence; and Judge’s orders.
of Proposed legislation It lists certain circumstances in which psychiatrists can prescribe medication to patients without a court order or a finding of incompetence, including when there are signs of significant impairment in functioning, when there is a risk of harm to self or others, or when the patient’s condition is not expected to improve or worsen in the future. Three days. Supporters say the bill simply clarifies existing law and gives providers more clarity. Instructions on how to treat patients who are unable to recognize their own need for medication.
“In these cases, you really want to get that person into treatment as quickly as possible,” said state Sen. John Bellis, chairman of the Joint Committee on Mental Health, Substance Use and Recovery. “The longer it takes to get treatment, the worse the outcome is often.”
Disability advocates and some lawyers say the bill does more than just ensure the status quo: It significantly expands what current law allows, leaving service providers open to violations. Patients’ constitutional rights.
“If this bill becomes law, our clients will be forced to take medication without judicial oversight or legal representation,” said Robert McGovern, spokesman for the Public Council Services Committee.
And even for people with delusions, forcibly medicating them can be counterproductive, says Danielle Fisher, vice president of the National Mental Health Recovery Coalition: It destroys trust, creates trauma and worsens the chances of recovery.
“Recovery requires people to address their living situations,” Fisher said.
The bill, currently before the Senate Ways and Means Committee, is one of several being considered to address Massachusetts’ mental health crisis.
Separate invoices It seeks to establish court supervision to ensure that people with serious and persistent illnesses receiving outpatient psychiatric treatment can continue their care. Nick Craciun’s mother, Balboni Craciun, sees it as another important tool for families who are powerless to help relatives who cannot recognize their own illnesses.
Nick Craciun began showing signs of serious mental illness in 2013, around age 11, according to his mother. Over time, his behavior became more erratic and his delusions became increasingly bizarre, his parents said. He was diagnosed with bipolar disorder with psychotic features and was hospitalized twice, in 2022 and 2023.
His hospitalizations were short-lived, and he always refused medication. In late 2023, Nick began a spiritual journey to a mosque in Boston. His father said he seemed to be doing better, and showed glimpses of his old humor, warmth, and kindness. However, Nick’s delusions returned, and he asked to be released from the hospital.
Laurentiu Craciun brought Nick to his Cambridge home on Dec. 27, 2023. Nick didn’t want to sleep alone, so his father brought a mattress into the living room so he could be closer to him. Then, Laurentiu said, Nick started hitting his father for no reason.
The assault continued outside, where Laurentiu was punched in the head and bitten on the back while trying to restrain her son. Police charged Nick with kidnapping and assault with a dangerous weapon, according to court records.
Nick was examined at Bridgewater State Hospital, a Department of Corrections mental health facility where his parents hoped he would be given antipsychotic medication, but in March a judge found him fit to stand trial and he was transferred to the Middlesex House of Correction. A place for him to stay.
“In my heart, I’m devastated,” Laurentiu said. “I still think he’s OK.”
Nick Craciun and his lawyers did not respond to interview requests. “I don’t think I have a mental illness,” Nick said at a recent competency hearing.
He also faces burglary and theft charges in Barnstable Superior Court and Lawrence District Court.
If a legally incompetent patient refuses medication, they can petition a judge to determine what kind of treatment the patient would have wanted if their capacity was not impaired. A judge can consider factors such as the diagnosis, the patient’s wishes, prognosis, family needs and possible side effects and decide whether to allow forced medication through something called a Rogers order.
State law allows patients to administer medication. Psychiatrists will not treat patients without their consent or a judge’s order if there is an imminent risk of violence or self-harm, or if the psychiatrist believes the patient is likely to suffer “immediate, significant and irreversible deterioration.”
Supporters of the bill say vagueness in current law discourages doctors from challenging it, and they also argue that obtaining a Rogers order takes too long. study The Bridgewater study found that an average of 41 days passed between petition and administration of medication, but judges approved about 82 percent of the requests. The study also found reduced rates of self-harm and violent incidents among patients who received Rogers-ordered medication.
“These patients are not just psychopaths,” Dr. Jiram Biswas, the study’s author and president-elect of the Massachusetts Psychiatric Society, said of Bridgewater’s patients. Patients who refuse to take their medication are restrained and forcibly medicated. She says it is inhumane for patients to go untreated when they are unaware of their illness. Research has shown that both bipolar disorder and schizophrenia can be progressive, another reason why treatment should begin promptly.
“This is a medical illness, and we’re exacerbating it,” she said, “so our patients are constantly cycling between homelessness, incarceration and long-term institutional care.”
Opponents of the bill worry that by expanding the definition of “immediate, significant and irreversible deterioration,” a wider range of mentally ill people could be forcibly medicated without a judge’s discretion.
“Any bill that infringes on people’s rights to this extent is cause for serious concern,” said Tatum Pritchard, litigation director for the Disability Law Center, a Boston-based legal advocacy group. “There are so few guardrails in place that I can’t imagine this bill will be used with care.”
Amid the complex issues surrounding mental health treatment, families like Craciun’s just want their loved ones a path back to health.
Father and son shared a love for the Boston Celtics, even as the son struggled. As the Celtics made another run for the championship, Laurentiu had to tell his son the results of the game, who spent most of his time in solitary confinement. He explained that the prison curfew meant he wasn’t able to watch the final minutes.
“This is the hardest time of my life,” his father said. “Being in solitary confinement with a mental illness is very difficult.”
Jason Laughlin can be reached at [email protected] Follow Jasmine Lean.
