The MPS submitted comments on the proposed revisions to regulations for Involuntary Admission (IVA) based on MPS feedback about last year’s report from the Involuntary Commitment Stakeholders’ Workgroup, and further informed by current member concerns.   MPS supported changes to COMAR 10.21.01 that update the health care professionals who are authorized to complete a certificate but disagreed with the proposed definition of “danger” for purposes of emergency psychiatric evaluation and involuntary admission to a facility, which significantly narrows the ability to use involuntary commitment.  For example,

• It requires the patient to be “unable” to care for self, but few would meet this standard because it requires complete disability.
• It does not include significant destruction of property.
• “Reasonable fear of physical harm” can still be interpreted differently.
• Although there is similar risk with the existing regulation, the definitions could be mis-used.
• It requires overt acts.

The MPS supports the recommendation in the August 11, 2021  Involuntary Commitment Stakeholders’ Workgroup report to provide more information and training around the existing dangerousness standard, which readily accommodates a range of gray area situations involving serious risk to the individual or others. We also support the recommendation to gather more data about how the current system is working. To our knowledge the Stakeholder Workgroup’s recommendation to define dangerousness in regulations is the only action being taken at this time.

MPS went on to note that involuntary admissions are needed to keep patients safe when resources in the community are not available. These regulatory changes aim to address a problem that mainly stems from inadequate resources for people suffering acute mental health crises. Maryland needs more inpatient beds at both private and state hospitals. This deficiency can lead to individuals being inappropriately released from the emergency department when there is an ambiguous situation and no bed availability. We also need more specialized, high quality, community-based alternatives to hospitalization. This is the starting point for a comprehensive solution, in addition to training and gathering data.