In the wake of several serious crimes committed by people with severe mental health challenges in recent years, some advocates have pushed for more use of Progressive Treatment Program, a court-ordered program for individuals who pose a threat to public safety.

Advocates cited cases such as Robert Card, who was responsible for the mass shooting in Lewiston last October, and Justin Butterfield, who was found not criminally responsible by reason of insanity in the killing of his brother in 2022 at their home in Poland.

Here are questions and answers based on the state statute to better understand its scope and an overview of what is being asserted.

What is a Progressive Treatment Program?

It is a court-ordered treatment plan a person must legally abide by. The district court is the only authority that can admit a person to a PTP plan, though there are several types of people who can submit a court application to have a person placed on such a plan. A court can reject or approve the application.

Who qualifies for a PTP plan?

A person qualifies if they suffer from a severe and persistent mental illness, poses a likelihood of serious harm, has a suitable individualized treatment plan and is unlikely to follow that treatment plan voluntarily, according to state statute. Licensed and qualified community providers must be available to support the treatment plan.

In order to have a PTP plan in place, the applicant must prove that it will help protect a patient from interruptions in treatment, relapses or deterioration of mental health and enable the patient to survive more safely in the community without posing a likelihood of serious harm, according to the statute.

Who is considered a patient?

There is some dispute between state officials and advocates of the law about the way the definition of a patient should be interpreted.

The statute states that a patient means “a person under observation, care or treatment in a psychiatric hospital or residential care facility pursuant to this subchapter, a person receiving services from an assertive community treatment team, a person receiving intensive mental health management services from the department or a person being evaluated for emergency admission … in a hospital emergency department.”

John Nutting, PTP advocate and former legislator who helped get updated PTP legislation passed around 2010, defines a patient more broadly, stating that even someone who has been seen in an emergency room recently is still considered a patient who can be the subject of a PTP application.

At the time the updated statute was making its way through the Legislature a decade and a half ago, legislators were told that the definition of a patient was broader than how the department is interpreting it, Nutting said.

Who can submit an application for a person to be placed on a PTP plan?

They include the superintendent or chief administrative officer of a psychiatric hospital, the commissioner, the director of an assertive community treatment team, a medical practitioner, a law enforcement officer or the legal guardian of the patient who would be subjected to the treatment.

PTP advocates and officials at the Department of Health and Human Services have been at odds as to who can submit an application. The department uses the strict definition in the legislation to define who a provider is. Nutting uses a more broad definition, stating that even an intensive case manager at a jail or prison is considered a provider who can submit an application for an incarcerated individual. It’s an assertion the department denies.

What is required to submit an application?

A court application for a plan must include a certificate from the medical provider treating the patient, providing “facts and opinions necessary to support the application,” according to the statute.

Those provider opinions must be based on one or more recent medical exams or personal treatment of the patient and be their observations, along with the patient’s medical history and other factors, according to statute. The application must include a proposed treatment plan and identify one or more licensed and qualified providers in the community willing to support such a plan.

Who oversees a plan of care?

If a judge places a patient on a plan it is effective for one year, according to the statute. A plan can be supervised by an assertive community treatment team or other outpatient facility that have the restrictions or conditions reasonable and necessary to comply with the plan.

If a patient does not comply with the order, they may be admitted to a psychiatric hospital, according to state statute. It can be extended for up to one year or a judge can dissolve or modify it before then. If treatment plan goals are achieved, a judge can suspend or end the court order.

However, advocates against PTP plans state that a patient who refuses to comply with the plan is only ordered to a psychiatric hospital if there is one available at that time and if a hospital is willing to take the patient. If not, there are essentially no consequences.