Act 382: A New Mental Health Law

Source: Quince Creative 275 images / Pixabay

Louisiana’s new Act 382 was created to make it easier to detain a person with severe mental illness, requiring, in many cases, that they be psychiatrically assessed and receive treatment.

Before the New Law

In the past, people with severe mental illness could not be detained against their will unless they were in danger of hurting themselves or others, or were gravely disabled. This new law is necessary to prevent the severely mentally ill from descending into a world of hallucinations, delusions, and other cruel symptoms they may not even know they have. Some persons become homeless due to severe mental illness and may remain so for months or years. (In my case, it was years.) In addition, many people who are not ill enough to be legally detained for evaluation and treatment are still in grave danger of drug overdose or committing suicide. It is hoped that Act 382 will reduce tragic deaths while providing a pathway to diagnosis, treatment, and recovery.

Louisiana’s new law recognizes that a person with severe mental illness may need treatment based on the deteriorative nature of the illness itself, not just their behavior. It is noted that half of people with schizophrenia and bipolar disorder likely will not seek help. Today, many families in Louisiana will no longer have to wait for a loved one to become violent to have them evaluated by a doctor. Now the big question is: Will this new law will be put into practice or will it be largely ignored?

Discontinuation of Treatment After Release

Many families are struggling and feel helpless as they watch loved ones slowly spiral into delusions, hallucinations, and paranoia. Commonly, a patient becomes ill enough to be hospitalized, spends a few days or weeks in a hospital, and sees improvement. However, following his or her release, there is often a quick discontinuation of their treatment or medication. Many patients think they have been cured and no longer need the medication. Others complain of side effects. (These complaints should be taken seriously and addressed with changes in the treatment plan, changes in diet, switching to a new medication, or adding a medication to help with side effects.) Sometimes, asking an individual to patiently wait for side effects to diminish or for a medication to work is asking too much, and the person refuses to cooperate.

Following discontinuation of a medication, there is often a period of slow and gradual mental decline as the blood level of medication slowly reduces and finally reaches zero after a few weeks.

This period following discontinuation of the drug is a crucial time. In rare cases, the patient will be capable of managing their mental health without medication or treatment. However, much more often, symptoms will return, sometimes worse than they were originally. Some patients will exhibit an acute psychosis following discontinuation of the medication, as I did.

Persons cycling in and out of the hospital have the highest chances of becoming disabled. Every time they discontinue and then restart antipsychotic medications, the medication may be less effective or ineffective.

My Experience

In 2007, following release from my first hospitalization, I quickly discontinued my medication due to extremely severe side effects. My extrapyramidal side effects (muscle stiffness, restlessness), weight gain, sedation, and anhedonia (inability to experience pleasure) were nearly unbearable. I felt my doctor had been dishonest with me about the antipsychotic, and I imagined that all antipsychotic medications would be the same or worse.

However, two weeks after I discontinued my antipsychotic medication, my parents, whom I lived with, saw my symptoms coming back slowly. I became more paranoid, restless, confused, and childlike. But, because I was not yet technically in danger of hurting myself or others, they could do nothing.

Parents like mine, with loved ones who have discontinued treatment and are spiraling downward, often call the foundation I work for to ask for me to share my own experience. I always tell them to watch their loved one closely and to not be afraid to call 988 (before the launch of the new national helpline, it would have been 911)¹. If and when their loved one gets bad enough to meet the standard for involuntary commitment, I encourage them to take the opportunity to try to convince that individual to stay in treatment to begin a new life, while at the same time looking into becoming their legal guardian, to become able keep them in treatment.

Long-acting injectables are sometimes an option. A guardian can mandate that the patient receive injections to keep them from experiencing psychosis again. A situation in which the patient willfully consents to an injection, seeing it as freeing—and so will not have to remember to take the pills—may be ideal.

I’m grateful that my parents called 911 on that day in April 2007 when I had become acutely psychotic after going off my medication. That hospitalization convinced me to be patient through several medication trials until I found the right one, and during that time, I did exactly what the doctor recommended. I see that hospitalization as one of the biggest milestones in my life.

Now we will see whether Louisiana will in fact implement the guidelines outlined in Act 382. And if they do, whether other states will follow.

There has been extensive criticism about the general inability to detain persons for psychiatric evaluation. While it is important to fight for personal independence, it is hoped that mandating that individuals receive treatment will result in long-term future benefits. It is also hoped that once these individuals recover, they will be grateful for their treatment. Being captive to a world filled with hallucinations, delusions, paranoia, and homelessness is not freedom. It is imprisonment. Treatment can set people free.