Categories: ASD and DD, Adult-focused
By Margaret Walsh, M.A., BCBA
[This column was published in the West Springfield Republican on June 22, 2022.]
Some adults living with an intellectual disability (ID) such as autism are also diagnosed with a mental illness and take anti-psychotic medications to treat their mental illness. Those who are unable to make their own “informed choices” deserve the support of a person looking out for their well-being.
When an individual with ID is deemed incapacitated or incompetent, a judge in the Probate and Family Court appoints a guardian to help them make decisions about their life. In Massachusetts, individuals who have been found incompetent by a court and take anti-psychotic medications are appointed a person who serves as their Rogers guardian. This legal process is meant to ensure that people who need this kind of oversight receive care that is safe, appropriate, and effective.
For a guardian to have Rogers authority, they must be appointed by a judge and undergo an annual review of that appointment by the court. To determine if someone needs a Rogers guardian, the court must decide that he or she is incompetent and unable to provide informed consent. The court must also determine if the person would choose to take anti-psychotic medications if he or she were competent. To make this decision, the court considers what the person’s prognosis would be without these medications, as well as any potential side effects of the medications. The court also considers the person’s treatment history before they took anti-psychotics, their religious beliefs, and how these medications might impact relationships with their families and other important stakeholders in their lives.
The individual in question has certain rights. These include the right to know if a petition has been filed, the right to attend the guardianship hearing, and the right to be represented by a lawyer. If the person cannot afford a lawyer, one can be appointed for them. The individual is allowed to object to the appointment of a guardian and may contest the guardian chosen by the court.
If a guardian is given Rogers authority, the court will appoint a person called a Rogers Monitor. The Rogers Monitor can be the appointed guardian, or some other person the court appoints.
Once appointed, the Rogers Monitor is responsible for overseeing the individual’s care by making sure that he or she receives a thorough evaluation and has a clear psychiatric diagnosis and assessment, and that alternative treatments are considered. Specifically, the monitor must ensure that the individual is taking the exact anti-psychotic medication in the dosage range ordered by the court. If the person starts taking a different anti-psychotic, the court must be petitioned again for approval for the new medication.
Most importantly, the Rodgers Monitor will make regular visits to see the person they are serving. These visits give the monitor an opportunity to establish a relationship with the individual, get a firsthand account of how the medications are impacting their life, and observe any side effects.
The Rodger’s Monitor will also meet with the individual’s guardian and any professionals or staff members that work with the person, review medical records, and attend meetings with psychiatric providers. Each year, the Rogers Monitor must compile a report to present to the court. The court then decides if the treatment plan for the individual will be extended, needs to be amended, or should be terminated because it is no longer needed.
In Massachusetts, a Rogers Monitor is a vital part of providing effective treatment for many people with ID who also have a mental illness. Individuals who cannot make informed decisions and require anti-psychotic medications to treat their mental illness deserve to have additional safeguards in place in order to live a healthy life. These safeguards ensure that the treatment they rely on is not dangerous, improves their outcomes, and enhances their quality of life.
Margaret Walsh, M.A., BCBA, is the Director of Clinical Services for the May Center for Adults Services in Western Massachusetts. She can be contacted in West Springfield at 413-734-0300 (ext. 262) or at email@example.com.
May Institute is a nonprofit organization that is a national leader in the field of applied behavior analysis, serving individuals with autism spectrum disorder and other developmental disabilities, brain injury and neurobehavioral disorders, and other special needs. Founded more than 65 years ago, we provide a wide range of exceptional educational and rehabilitative services across the lifespan. For more information, call 800.778.7601 or visit www.mayinstitute.org.