From the December 31, 2005 Williamsport Sun-Gazette:

Mental health review officers ensure fair treatment for patients for 30 years


As the county’s chief public defender in the early 1970s, John Felix worked as an advocate for mental health patients facing a system that made it a little too easy” for the mentally ill, or in some cases, the perfectly sane, to be sent to mental hospitals with minimal evaluation.

But when a law went into effect in 1976 requiring the state to prove that a person whose sanity was in question must pose a danger to himself or others in order to be involuntarily committed, Felix no longer found himself advocating for the mentally ill but, rather, deciding their fate.

Felix and George Orwig, both private practice attorneys in the city, were appointed by the county president judge to begin a new branch of the county’s criminal justice system.

The two became mental health review officers, or administrative law judges, conducting hearings on petitions for involuntary commitments, otherwise known as civil commitments.

Thirty years later, Felix and Orwig are the longest mental health review officers in the state.

Before the law took effect, Felix said that the process was very informal, citing some cases where a spouse had his or her partner committed just so that they could “get on with their life.”

The psychiatrist would only speak with the patient for all of about five to ten minutes before the hearing, and there was no assurance that a patient’s status would be checked on a regular basis, he said.

“There wasn’t any real safeguards for the patient there,” Felix said.

Under the 1976 law, everyone who faces involuntarily commitment is entitled to a hearing. Testimony is given by he person who filed the petition and a psychiatrist, Felix said.

The patient is entitled to representation by counsel — a public defender acts on behalf of the patient nine times out of 10, Felix said.

As soon as the act went into affect, Felix said he and Orwig ad several hearings over the first few months with patients who had just been “sitting” in mental hospitals.

“We discovered, sometimes, then we had a hearing, the hospital just said ‘We have no reason why he’s here, he’s just here,’”  Felix said. “Now they need specific treatment plans or plans to discharge them back to the community.”

Above and beyond that, petitioners can not just speculate at a person may be a danger themselves or others, but must prove that within the past days the patient has shown or she is a danger.

‘When we start the hearing, ways advise the patient that not a question of whether or not the person might benefit from the treatment, but that they must pose a danger to themselves or others,” he said. Ten to 15 percent of cases are dismissed, Felix said. Of those found to be dangerous, the majority are found dangerous to themselves.

“Indirect danger is that you are not able to fulfill your daily living needs,” he said. “You’re taking medication or you’re walking around Market Street without shoes on in the winter.” If the review officer decides that the evidence for holding a patient is “clear and convincing,” under law, the individual must be sent to the setting that is the “least restrictive and most appropriate,” Felix said.

Sometimes they determine outpatient treatment is sufficient. If inpatient treatment is best, review officers can order the person to receive up to 20 lays of treatment, usually at Divine Providence, Felix said.

If after 20 days, the hospital decides the individual needs further care, another hearing can be held and the review officer can order 90 more days of treatment, with the permission of a county judge. But since Divine Providence doesn’t keep patients more than 30 days, another treatment facility must take the patient, Felix said.

In the past, Felix said he sent patients to the Danville State Hospital, but that is no longer an option since the hospital has closed. Now he uses Mercy Special Needs Hospital in Nanticoke.

Another hearing is held if he 90-day treatment is found be insufficient, and the review officer can order up to 180 more days of care.

If an individual disagrees with the review officer’s ruling, he may file an appeal. Felix said only about a dozen of the roughly 3,000 cases he has heard resulted in an appeal.

Review officers also hold hearings at the State Correctional Institution at Muncy and the County Prison. Felix said he averages at least 50 hearings a year at Muncy alone.

One of the problems with mental health prison inmates is that prisons are not equipped provide more than “very basic” mental health treatment, Felix said.

“The state prison is first and foremost a prison,” he said. “Sometimes they (prison guards, administrators, etc.) write the person up and form criminal charges. There is no understanding that this person might just be mentally ill.”

With the closing of state mental institutions over the past 10 years, Felix said one of the more difficult parts of his job is finding suitable places for involuntary commitments.

“The patient is entitled to a setting that is the least restrictive and the most appropriate. What options do I have?” he said. “Even the state hospitals are very crowded right now.”

But for Felix, the main concern for mental health patients is where to place them once they are discharged.

“There is more and more need for people to go into a supervised setting. That, for many people, is what is really necessary to aid their transition back to completely independent living,” he said. “They need to be afforded care and treatment for their benefit and the benefit of the community.”

Felix said he is disappointed about the recent community protest over a proposed group home on Guinter Avenue that would serve as a supervised setting for transitional mental health patients.

“I’m surprised in our community, in Northcentral Pennsylvania. Twenty or 30 years ago I would have said there was more the stigma, but now, hopefully people are made aware of the fact that mental disability is an illness and it is treatable,” he said.

“People that should know better don’t appear to grasp the fact that these people can live in a community and be productive citizens.”