Editorial Support in NY Post
This document contains 2 editorials from the NY Post and a letter to the editor. The Post uses offensive and sensationalist headlines, but the points made in the editorials are valid.
The New York Post
May 3, 1999, Monday
All Editions; Pg. 034
DON’T LET DANGEROUS MANIACS ROAM FREE
For the second time this year, a mentally disturbed man has shoved an innocent New Yorker in front of an onrushing subway train. Unlike Kendra Webdale, who was killed when she was pushed by Andrew Goldstein in January, Edgar Rivera escaped with his life, though he has lost both legs. A homeless suspect, Julio Perez, is being held for psychiatric testing.
The madness that follows people like Perez into the subways is unfathomable. But that is no excuse for society not attempting to do something to control it and prevent future Kendra Webdales and Edgar Riveras.
State Sen. Frank Padavan (R-Queens) has been trying for more than a decade to do exactly that. A 1992 study of 36 subway-pushing incidents published in the Archives of General Psychiatry showed that the overwhelming majority are committed by people with psychotic symptoms.
For example:
*Reuben Harris, who pushed Song Sin to her death in 1995, suffered from paranoid schizophrenia, had a history of violent behavior and had been hospitalized 12 times.
*Jaheem Grayton had a history of severe mental illness when he pushed Naeeham Lee to her death while trying to steal her earrings in 1996.
Padavan’s bill would try to prevent such nightmares by pursuing what is known as “involuntary outpatient treatment” - AKA “outpatient commitment.”
Under this treatment regimen, which is in place in 39 states but not in New York, an individual would be required by court order to comply with a treatment program.
Mental-health professionals would monitor the patient’s compliance.
Failure to comply could result in inpatient commitment. After the fiasco surrounding Larry Hogue - the infamous Wild Man of 96th Street - Padavan did succeed in getting then-Gov. Cuomo and the Assembly Democrats to agree to a pilot project for outpatient treatment at Bellevue Hospital.
A study of that project revealed that the patients receiving outpatient treatment along with enhanced community services spent only six weeks in psychiatric hospitals, as opposed to 14 weeks for those who received only the enhanced services.
The Bellevue program expires on June 30 and Padavan is trying to get the Legislature to renew it. That’s good, but there must be more. Padavan wants the program expanded to the whole state, and Attorney General Eliot Spitzer is in agreement, calling the measure “Kendra’s Law.” Also, the Assembly is scheduled to vote tomorrow on Padavan’s “guilty, but mentally ill” bill. Such a verdict would allow a jury to incarcerate the likes of cannibal Richard Fentress, who could be sent to a state prison if psychiatrists eventually declared him sane, rather than be a candidate for simple release. The Assembly, however, has consistently blocked “guilty, but insane.”
Would any of these measures have stopped Julio Perez from attacking Edgar Rivera Wednesday night? There is no way of knowing. But it seems reasonably certain that adopting measures such as those proposed by Sen. Padavan would go a long way toward preventing future such incidents.
A PLAN FOR SAFER STREETS
New York Post (1/31/99)
Perhaps Kendra Webdale, the woman who was pushed in front of a subway train by a schizophrenic mental patient, did not die in vain. The tragedy sent a message to New Yorkers - and at least one ranking elected official has heard it.
Last week, Attorney General Eliot Spitzer proposed the “Involuntary Outpatient Treatment Act” - which, despite the menacing title, could temper New York’s now 30-year-old deinstitutionalization policy.
Once hailed by the mental-health profession as the guarantor of patients’ rights, deinstitutionalization was animated by the belief that those who suffer from mental illness should not be confined against their will. As a result, the mentally ill were turned out from institutions and allowed to live - often at great risk to themselves and others - without supervision or regular medication.
Many found themselves institutionalized anyway - that is, sent to prison for lack of a better way of keeping the occasionally violent off the streets. Spitzer’s proposal won’t turn around that policy, but it could ensure that medicine is administered to those who need it.
The legislation speaks to deinstitutionalization’s central failure: Patients often have difficulty maintaining a medication schedule. Until now, patients who did not want to take their medicine simply did not have to. No one was watching. No one could do anything about it.
.....
While the proposed change would allow patients to live as they wish, if the patient neglected medication, close family members, house mates or treatment providers could obtain a court order forcing him to adhere to the prescribed treatment.
A patient who did not comply with the court order could be held for 72 hours and given medication involuntarily. Nearly 40 states already have laws similar to the one Spitzer proposed. Experts who have worked with “outpatient commitment programs,” which is their kinder, gentler moniker, say that the approach benefits patients in multiple ways:
They keep more appointments with their psychiatrists, lead public lives without endangering themselves or others and, when necessary, incur shorter inpatient stays. The champions of deinstitutionalization will most likely find this a heartless violation of a patient’s free will.
Spitzer, however, has formulated the opposing argument well: “We must have compassion for the mentally ill. And part of compassion is knowing when people are just not competent to make their own decisions.” At last, New York has made common-sense progress in the way it deals with the mentally ill.
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ny post on 2/5/99.
Dear Editor:
Your editorial is mistaken in saying that outpatient commitment for individuals with mental illness is opposed by those who support deinstitutionalization. ("A Plan for Safer Streets", editorial, Jan. 31)
I support both and so do many others. Outpatient Commitment is not an alternative to deinstitutionalization, it is a way to ensure that those who are deinstitutionalized succeed. It does so by requiring them to take the medicines that can free them from the "bastille of their psychosis" and enable them to live free outside institutions, rather than imprisoned in them.
Sincerely yours,
DJ Jaffe
Coordinator
NY Treatment Advocacy Coalition
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NY POST
1/13/99
ALBANY FAILED KENDRA WEBDALE
By PAUL F. STAVIS
WHEN longtime mental patient Andrew Goldstein pushed Kendra Webdale to her death in the path of a subway car last week, it was more than a random tragedy. Four years ago, Ruben Harris pushed Soon Sin, a 63-year-old Korean grandmother, to her death via subway train - shortly after his release from Manhattan Psychiatric Center. And in the wake of that case, the state Office of Mental Health (OMH) did little to avoid the chance that it would happen again.
On his release from the center, Harris stopped taking his medication and began taking illicit drugs. The combination brought on severe psychosis, violent behavior - and Soon Sin’s death.
The Harris case brought a fast response from the then-new Pataki administration. The governor asked the state Commission on Quality of Care for the Mentally Disabled, a watchdog group where I served as chief counsel, to investigate and make recommendations. We did so; our prime recommendation was that the state Office of Mental Health strengthen efforts to keep certain patients on their psychiatric-treatment regimens and off illicit drugs after being discharged.
Specifically, the commission formally recommended reviving a little used law (on the books since 1919) called “conditional discharge.” This law allows a director of a psychiatric facility to put reasonable conditions on the early discharge of a patient, such as maintaining medication compliance, staying off illicit drugs and reporting for appropriate services periodically. Noncompliant patients could be taken back to their institutions for the remainder of their court-ordered commitment terms. Conditional discharge, being in the discretion of the director, requires no court hearings, lawyers or bureaucracy to implement. New Hampshire has been successfully using such a law.
Yet OMH rejected any use of this existing law. Instead, it supported a totally new one, the “involuntary outpatient commitment” law - one that seemed designed to fail. It requires multiple court orders to authorize treatment, and relies on courts, lawyers and police for its implementation. A recent independent study of the law found that not one patient in the program had been subjected to court-ordered, compelled medication-compliance, and that lawyers, judges and police all express confusion about their roles and responsibilities under the law.
The program does benefit other patients - the severely ill without a high-violence risk, who can be persuaded by benefits, like public housing and enhanced services, without the need to be compelled to take their medications.
Thus, OMH created this statute not as way to ensure appropriate treatment for people like Harris and Goldstein, but as a way to avoid treating them and to treat their gentler, more compliant cousins instead. Why? Real coercive treatments are neither easy nor pleasant; they are labor- and resource-intensive, and, since treatment of the hardest cases is most likely to fail, they open the bureaucrats and treating physicians up for criticism.
Gov. Pataki has a second chance to stem the tide of violence. He should order the Office of Mental Health to use the conditional-discharge law already on the books and to considerably simplify the new outpatient-commitment law while expanding it statewide. ---
Paul F. Stavis is now the director of the Law and Psychiatry Center at George Mason University School of Law. (Posted 2/1999)
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