Laws that delay psychiatric treatment: A closer look at Rogers Guardianship laws in Massachusetts

Sarah Earp, MD

Brigham and Women’s Hospital
Laws that delay psychiatric treatment: A closer look at Rogers Guardianship laws in Massachusetts

Scientific Abstract

Background: Current laws in the state of Massachusetts may contribute to prolonged treatment delays, which put patients and caretakers at increased risk of adverse clinical events. The process for involuntary treatment for patients in inpatient forensic psychiatric settings involves an initial 20-day evaluation to determine commitment (MGL 123 §15B) with up to a 14-day waiting period for placement on the court docket (MGL 123 §7C), for a total of 34 days to allow for a judge to evaluate necessity of involuntary treatment (MGL 123 §8B or §16B; Rogers Guardianship) in a Section 8B hearing (8B).

Methods: We recorded the role of treatment delays on the occurrence of adverse clinical events (including patient-on-patient violence, patient-on-staff violence, suicidal ideation, emergency treatment, milieu disruptions, and medical events) in 158 male patients at Bridgewater State Hospital (BSH; a forensic psychiatric hospital) with 8B hearings between 2015-2016. Number of events in the time between admission and 8B were counted by two independent raters within the allotted time period and compared to number of events after 8B was granted.

Results: Of the 293 total 8B petitions analyzed in our study, only two (~0.007%) were not upheld by a judge. We expect further analysis to show that the number of adverse clinical events will decrease after the 8B is granted when patients are analyzed cumulatively. We expect a t-test to show fewer adverse events after the 8B is allowed when compared to the pre-8B period. Likewise, we anticipate that treatment delays longer than the 34-day evaluation time will be associated with a higher number of adverse clinical events when these groups are directly compared.

Conclusions: We predict that the analysis will show an overall decrease in adverse events after the 8B is granted. During these long delays, mentally ill patients are often symptomatic and subject to adverse events, many of which could have been reduced if 8B delays were shortened or absent. Thus, we advocate that the adversarial judicial process, as it currently stands, exposes patients to a greater number of adverse events with minimal benefit.

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research Areas

Authors

Sarah Earp, MD, Jhilam Biswas, MD