Lessons from Kendra's Law Tampa (Florida) Tribune 03 15 03 on Baker Act reform by Alexander Sasha Bardey

In Florida in 2002, one individual alone accounted for 41 Baker Act examinations at an approximate cost of $81,000 - not including court costs, law enforcement resources, or long-term treatment.

Five years ago, New York and Florida had similarly senseless laws regarding people with severe mental illnesses that made them too sick to make rational treatment decisions. Until they became dangerous, we left them to fend for themselves, resulting in suicide, homelessness, incarcerations, deadly encounters with law enforcement, and violence. And we prohibited court-ordered outpatient treatment, forcing courts to either commit people to an inpatient facility or leave them untreated.

Today, Florida's Baker Act is still based on archaic science, ignoring not only advances in understanding brain diseases, but also overwhelming evidence on the benefits of assisted treatment, or involuntary commitment. As evidenced by the recent deadly encounter that Alan Houseman had with Tampa police in Hyde Park (Metro, March 10), just one of such tragedies, the current law isn't working.

New York revised its law in 1999. Florida legislators take up reform this session. I urge them not to make the mistakes New York made. Further delay - by instituting a pilot project, believing misleading budget numbers, misunderstanding the population reform will serve, or decrying changes as unconstitutional - is both absurd and deadly.

Pilot programs and studies at best delay implementation of important reform and at worst contribute to senseless tragedies.

After a decade-long reform effort, New York's legislature authorized a pilot program, hesitating to expand the law statewide - until Andrew Goldstein, a man with untreated schizophrenia, pushed Kendra Webdale to her death in front of a subway train.

Tragedy sadly influenced legislators where statistics and scientific data had not, and "Kendra's Law" was passed statewide. Its successes are impressive: of those placed in six months of assisted outpatient treatment through December 3, 2002, 77 percent fewer were hospitalized, 85 percent fewer experienced homelessness, 83 percent fewer were arrested, and 85 percent fewer were incarcerated.

And protections in both Kendra's Law and Baker Act reform shield civil liberties so those who are free from psychosis can enjoy a meaningful exercise of their rights.

Assisted outpatient treatment works. A Duke University study showed that for individuals with a history of multiple hospital admissions combined with arrest and/or violence in the prior year, long-term assisted outpatient treatment reduced the risk of arrest by 74%, hospitalization by up to 74%, victimization by 50%, and risk of violence by up to 50%.

New York's pilot program and a study ordered by the legislature were ineffective at indicating the true potential of reform - they were effective only in delaying help to those who needed it.

If you aren't moved by lives being saved, consider the potential cost savings in times of great economic paucity.

Assisted outpatient treatment makes existing services more cost effective by improving treatment compliance. Recidivism is expensive. In the two years before Andrew Goldstein committed murder, he received 199 days of inpatient and emergency services, on 15 occasions, in six hospitals. Four clinics provided outpatient services. In 1998 alone, Goldstein's mental health and residential care cost taxpayers $95,075.

In Florida in 2002, one individual alone accounted for 41 Baker Act examinations at an approximate cost of $81,000 - not including court costs, law enforcement resources, or long-term treatment.

In New York, those who opposed change warned of a "dragnet" that would pull in thousands and lock them up merely for having a mental illness. In fact, Kendra's Law affects less than one-half of one percent of all New Yorkers with either bipolar disorder or schizophrenia in any given year.

And protections in both Kendra's Law and Baker Act reform shield civil liberties so those who are free from psychosis can enjoy a meaningful exercise of their rights.

It is now clear that civil liberties were most imperiled by New York's law BEFORE it was reformed - when people were left homeless and hungry or sent to prison for misdemeanor charges to be victimized again.

Some claimed that Kendra's Law was unconstitutional. But none of the legal challenges to New York's law has succeeded. One judge wrote that the "law provides the means by which society does not have to sit idly by and watch the cycle of decompensation, dangerousness, and hospitalization continually repeat itself."

In Florida, 919 adults were "Baker Acted" four or more times in 2002. And 57 adults had 15 or more emergency evaluations in 24 months. And there was a 14% increase (from 10,696 to 12,186) in the number of adults with multiple Baker Act examinations in 2002, a number that has increased every year for at least the past five years.

Like Andrew Goldstein, these are high-volume users of emergency room services, court time, and law enforcement resources. Like Goldstein, they need real and immediate help. Like Goldstein, some are headed for tragedy.

For Florida, the time for change has arrived. Most would argue it is long overdue.

Alexander Sasha Bardey is the former director of New York's Bellevue Hospital Assisted Outpatient Treatment Program.