NY Times on Involuntary Treatment

April 6, 1999

 Weighing Mental Patients’ Treatment

By SERGE SCHMEMANN

The case of a schizophrenic man accused of pushing a woman to her death under a subway train in January has generated new interest in proposals authorizing involuntary treatment for mental patients in New York.

 The measures include one initiated by Attorney General Eliot L.  Spitzer, who took office immediately after the Jan. 3 incident in which Andrew Goldstein, 29, is said to have shoved Kendra Webdale off a subway platform.

 Spitzer’s proposal would enable relatives and doctors to compel the mentally ill to receive treatment and medication. As state laws stand now, involuntary treatment is largely limited to patients who are considered a threat to themselves or others.

 Yesterday in State Supreme Court in Manhattan, Goldstein was found competent to stand trial on a charge of second-degree murder.

 Elizabeth A. Connelly, an Assembly member from Staten Island, has introduced a bill to extend and expand a five-year-old pilot program at Bellevue Hospital Center for involuntary outpatient treatment. The State Legislature is not likely to embrace changes in the system fully during this session, lawmakers say. But there is support for extending the Bellevue program.

 The effort to change state laws is strongly supported by many mental patients’ families, who now are powerless to initiate treatment for relatives too ill to recognize they need it. The proposals are fiercely opposed by a small but vocal number who see any enforced treatment as a violation of fundamental civil rights and a regression to the thinking that fostered the insane asylums of the past.

 Advocates of the new measures invoke images of people like Goldstein, who drifted from treatment to treatment until that day in the subway. In the parlance of mental treatment, Goldstein was noncompliant: He did not stay on his medication.

 The supporters include an unlikely combination of psychiatrists who believe in the efficacy of new medications, and law-and-order conservatives who want to get the mentally ill off the streets. Their group also points to the large number of people with mental disorders among prison inmates and the homeless, arguing that many of them might be safer if they were compelled to take medication.

 “In the past 10 years, it’s been firmly established that mental disease is a neurobiological condition,” said Carla Jacobs, a director of the National Alliance for the Mentally Ill, the largest group advocating involuntary commitment. “So we have to start looking at mental illness like any other disorder. If I have a high fever, people would take me to the hospital and give me medication until I could continue or discontinue it on my own. But we don’t do that in mental illness. We put a special shroud on the ill, we treat them like lepers, and we cloak inaction with false ideas of human rights.”

 ….

 The Spitzer bill has received strong support from groups like the Treatment Advocacy Center, many of whose members, like Mrs. Jacobs, have mentally ill relatives.

 “The bottom line is you have to have a provision to treat people before they exhibit some behavior that gets them in jail or prison, but the history of these kinds of bills is that they get watered down and eviscerated by civil libertarians,” said E. Fuller Torrey, a psychiatrist and chairman of the Treatment Advocacy Center, whose sister suffers from schizophrenia.

 Dr. Torrey said he sympathized with the fears of mental patients. Many of the older anti-psychotic drugs had serious and occasionally devastating side effects, and newer drugs cost “horrendous amounts of money.” But he said that opponents of mandated medication exaggerated the frequency of side effects, and that they overlooked the benefits of compelling patients to take medication that could improve their lives.

 In Washington, D.C., which has a law on involuntary outpatient commitment, a case that would prompt him to seek legal help typically involved a man who had been hospitalized about 20 times and had repeated troubles with the law, he said.

 “I would bring in his mother, his sister; they would testify to the things he did, and the judge would almost invariably grant an order,” he said. “He would turn to the fellow and say, ‘You must come back for your injection. If you don’t, we have the legal right to send the police after you.’ What we found was that we almost never had to.”

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TREATMENT  ADVOCACY  CENTER STATEMENT

By Executive Director, Mary T. Zdanowicz, Esq.

3300  NORTH  FAIRFAX  DRIVE  *  SUITE  220  *  ARLINGTON,  VIRGINIA

22201  *  703.294-6001

FOR IMMEDIATE RELEASE                           CONTACT:        Valerie Rheinstein

April 5, 1999

212.366.0527 - NY tie-line

703.294.6008 - direct dial

NEW YORK MUST PASS “KENDRA’S LAW” TO PREVENT FUTURE EPISODES OF VIOLENCE

BY INDIVIDUALS WITH UNTREATED SEVERE MENTAL ILLNESSES

ARLINGTON, VA - Kendra Webdale should not have lost her life under a New York City subway train, and Andrew Goldstein, her attacker, should not have been allowed to remain in the community without proper treatment and monitoring of his brain disease.  The horrific incident that occurred in January at the 23rd Street and Broadway subway station tragically reflects the deadly pattern of what happens when schizophrenia and manic-depressive illness - the two severest forms of mental illness - are allowed to progress untreated.

Mr. Goldstein was hospitalized on six separate occasions in 1998 for his schizophrenia, and was released from his last hospital stay only three weeks before his deadly encounter with Ms. Webdale.  Upon each hospital release there was no means of guaranteeing he would continue taking his medications, which would have ensured that his mental stability did not deteriorate following his discharge to the community.

New York must swiftly pass “Kendra’s Law,” announced in February by Attorney General Eliot Spitzer, to reverse this deadly trend and improve the quality of life for all New Yorkers.  “Kendra’s Law” would prevent individuals like Mr. Goldstein from spinning endlessly through the revolving door of hospital admissions and readmissions, only to be abandoned to the streets with no follow-up care.

One of the most effective means of ensuring that those who have serious brain disorders remain in treatment is the use of outpatient commitment (OPC).  At least 39 states now use some form of assisted treatment to substantially improve the lives of those suffering from severe mental illness and enhance the communities in which they live.  “Kendra’s Law,” would make OPC available statewide for those individuals with severe psychiatric disorders.

Long-term OPC has shown repeatedly to be more effective in improving outcomes for severely mentally ill individuals than routine outpatient care.  For example, among patients who had been outpatient committed in Arizona, 71 percent voluntarily maintained treatment contacts six months after their court orders expired compared to almost none of the patients who had not been put on outpatient commitment.  A study in Iowa showed that 80 percent of patients in outpatient commitment complied with their treatment programs.  After their outpatient commitment term expired, some three-quarters of that group remained in treatment on a voluntary basis.

A recent study of New York’s Bellevue Hospital OPC pilot program revealed that individuals who received court ordered treatment in addition to enhanced community services spent 57 percent less time in psychiatric hospitals than individuals who received only enhanced services.  During the 11 months of the study, individuals who had both court ordered treatment and enhanced services spent only six weeks in the hospital, compared to 14 weeks for those who did not receive court orders.

Nearly half of those individuals who have schizophrenia or manic-depressive illness, the two severest forms of psychiatric illness, have no awareness of their disease.  They do not recognize that the symptoms of their illness - hallucinations, delusions, paranoia and withdrawal - are, in fact, symptoms.  These individuals consistently refuse to take medication because they do not believe they are sick, and commonly will only take it under some form of assisted treatment.

Mandatory treatment for those too ill to recognize their need for treatment is a much more humane intervention than what we have now: mandatory non-treatment.  The legal standard for assisted treatment should be the need for medical care, not dangerousness.  Society has an obligation to save people from degradation, not just death.

This does not mean that we will have to reopen all the psychiatric hospitals that have closed as a result of deinstitutionalization.  Most individuals with severe mental illnesses who have experienced severe deterioration in rational thought can live in the community.  But, their living in the community should be conditioned on continued medication compliance.  OPC, conditional hospital releases, and conservatorships must be widely used to ensure that discharged patients continue to take their medication. 

Mr. Goldstein should not be sitting in a jail cell today awaiting trial, and possibly facing a life behind bars.  Ms. Webdale, a young woman with a promising future, should be fulfilling her dreams and ambitions.  Both of these individuals should be living their lives to fullest in a system that protects and balances the rights of all its citizens.  “Kendra’s Law” would help prevent such tragedies in the future and give every New Yorker the chance of living a safe and productive life.

The Treatment Advocacy Center (Center) is a nonprofit organization dedicated to eliminating legal and clinical barriers to timely and humane treatment for millions of Americans with severe brain disorders who are not receiving appropriate medical care.  The Center is working on the national, state, and local levels to educate civic, legal, criminal justice, and legislative communities on the benefits of assisted treatment in an effort to decrease homelessness, jailings, suicide, violence and other devastating consequences caused by lack of treatment.

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