Pilot Program for Outpatient Civil Commitment – Update

The Baltimore City Outpatient Civil Commitment Pilot Program now includes patients who have been in the hospital on a voluntary basis.  As you may know, Maryland is one of a few states that do not have outpatient civil commitment –also called Assisted Outpatient Treatment (AOT), mandated outpatient treatment, or community treatment orders.  For the past two years, Behavioral Health System Baltimore (BHSB) has had a grant for a pilot program for outpatient civil commitment in Baltimore City.  To be admitted to the program, a person must be a resident of Baltimore City and must have been retained on the inpatient unit at a civil commitment hearing at least twice in a 12-month period.  The program accepts both voluntary and involuntary participants, and most of their clients have been voluntary.

What’s interesting about this program is that it does not mandate people to treatment or medications.  It puts them in a program where they have a peer support counselor who engages with them and helps them navigate medical and psychiatric services, benefits, and transportation to appointments.  Patients are eligible for the program even if they are already engaged with treatment, and some clients are receiving ACT services, so non-compliance is not a requirement.  The services must be initiated by the inpatient unit, and even the voluntary services go through a judge’s order (the same ALJs who go to the hospital for commitment hearings).  If the patient comes out and refuses to meet with the peer specialist, the order has no “teeth.”  They don’t drag the patient to the ER or back to the inpatient unit, or to jail.  It’s basically a gentle way to try to get very sick people to engage with services, to help them negotiate both the psychiatric and medical aspects of care and benefits, and to help them get to appointments.  They are happy to take on homeless patients.  The term Outpatient Civil Commitment is a bit of a misnomer.

Just recently, the program’s eligibility criteria have changed to include Baltimore City residents who have had two admissions within the past 12 months, regardless of whether those admissions were voluntary or involuntary.  The patient must live in Baltimore City; the admissions do not need to be in the city.  The request for service must be initiated by the inpatient unit and a judge’s approval is still needed.  If the admissions were voluntary, then the patient must agree to the services, they cannot be put on the involuntary track.  Please share this information with anyone who treats patients who might benefit from this service as they are actively trying to increase the number of people in the program.  Click here for information about the program.  You can also contact Behavioral Health System Baltimore (BHSB) at ClinicalServices2@ BHSBaltimore.org or (410) 735-8574 for more information.

Dinah Miller, M.D.

[See related article in Clinical Psychiatry News.]