We, who love people suffering from serious mental illness, psychosis, and anosognosia, would all like to think that our loved ones can make their own decisions in seeking treatment. However, it has become apparent to many of us who have watched our friends or family members struggle for years, that one facet of anosognosia is the inability to learn from experience. A person with anosognosia who refuses medication may commit crimes and go to jail, or he/she may behave in ways that cause them to lose jobs, homes, and connection to family and friends. However, a person with anosognosia is unable to realize that it is their behavior which results in these losses. They are much more likely to blame external delusionary forces. Because of the interactions among hallucinations, delusions, and anosognosia, our loved ones become trapped in an endless and punishing cycle. According to the Treatment Advocacy Center, at least one in five people experiencing homelessness and 16.7% of people incarcerated in Maryland and New York have a serious mental illness. (see Treatment Advocacy Center Research)
It has become clear to those of us with loved ones experiencing psychosis and anosognosia that rather than being humane, leaving the decision of whether or not to obtain treatment to our loved ones, leaves them floundering without a safety net and destined to repeat the cycle of homelessness, crisis, and incarceration over and over again. It also leaves our loved ones vulnerable to exploitation and at risk for harming others. Those of us who love them are often placed in danger ourselves and with no other choice but to sever ties.
For this reason, forty-eight US states have passed mandatory treatment laws and developed community based mandatory treatment programs. These programs require that participants comply with treatment while keeping them out of hospitals and jails. The mandatory treatment program in Maine is called the Progressive Treatment Program.
A progressive treatment program differs from mental health counseling and psychiatry in that the PTP is both comprehensive and mandatory. This means that it is court ordered. If your loved one refuses treatment, he/she may be hospitalized rather than released without assistance into the community. Treatment in a PTP is overseen by an intensive case manager, mental health group home, or by an assertiveness treatment program (ACT Team).
An ACT Team is also a comprehensive treatment program. However, ACT Team participation is voluntary while PTP program participation is court ordered. In both cases, comprehensive treatment includes psychiatric evaluation, medication management, counseling, intensive case management, crisis stabilization, and vocational support. ACT Team treatment also includes peer support and often, substance abuse treatment. Both programs assist the participant in navigating social systems, housing, and provide the benefit of a multidisciplinary team. There are nine ACT Teams in Maine, located in York, Cumberland, Androscoggin, Penobscot, and Kennebec Counties. (see the PTP Community Support link on The Brett Staples Website)
It is important to note that an individual cannot be assigned to a PTP program until he/she reaches 18 years of age. However, ACT Teams treat both juveniles and adults.
Until 2009, a person could only be court ordered into a PTP program if they were in a hospital or in a jail. In 2009, a statute was passed that enabled people suffering from a serious mental illness to be court ordered into a PTP program while they were living in the community. This was passed to reduce incarcerations and hospitalizations and to provide comprehensive treatment options to people suffering from psychosis and anosognosia. (see PTP laws link on BMSBDAC Website.)
To qualify for the progressive treatment program when not in the hospital, your loved one must have been previously hospitalized for mental health issues. Additionally, he/she must have a diagnosis of serious mental illness. There must be evidence from past behavior, that he/she would be unlikely to voluntarily follow a mental health treatment plan. A medical provider must attest that without following this plan, his/her mental health would likely deteriorate, and that there is reason to believe he/she would be likely to suffer physical/mental harm and/or would be likely to harm others.
Once an application for a PTP is filed with the district court and an attorney accepts the case, a court hearing is scheduled. Once the judge hears the case, treatment may be mandated for up to twelve months. At the end of the treatment time, a judge may order up to an additional twelve months of treatment. If at any time during the mandated treatment your loved one refuses treatment, he/she may be hospitalized.
Applying for a PTP for your loved one is not a simple process. It is important that you take time to comprehend the information in this and the preceding videos before moving forward. It is also important that you understand that for your loved one to be court ordered into a PTP, you may have to testify for the necessity of mandated care in your loved one’s court hearing. The person completing the application and the attorney acting to obtain the PTP order must be able to identify the ACT team, intensive case manager, or group home able and willing to oversee your loved one’s treatment while on the PTP. Your loved one would also have the right to obtain his/her own attorney to contest arguments for mandated treatment.
As you can see, there are many challenges in gaining your loved one’s admission into a PTP. At this point, you might wonder if it’s worth it.
To answer this question, it’s first important to remember that each episode of psychosis causes further brain damage that in many cases can not be reversed. It is also important to review studies of the effectiveness of PTP and similar programs. In studies of AOT programs (the name for PTP in other states), participating in AOT’s significantly reduced the subsequent number of inpatient hospitalizations, emergency room visits, homelessness, and incarcerations when compared to people with serious mental illnesses who did not participate in the programs. (see the link on PTP research on the Brett Staples Non-Profit website for specific study outcomes)
For many people suffering from serious mental illness and anosognosia, PTP’s have proven to be a life lifesaving option and a segue to independence.
For the detailed process of applying for a PTP order, see the Obtaining a PTP Order post.
