It took the mentally ill to bring Governor Pataki and Assembly Speaker Silver together. Last week they both issued well thought out and virtually identical plans that help the mentally ill while simultaneously keeping communities safer. Now the question is will politics keep the Assembly and Senate from following their lead?

The proposals they came up with were named "Kendra’s Law", in honor of Kendra Webdale who was allegedly pushed to her death by Andrew Goldstein, a young man with untreated schizophrenia. Andrew was like many other people with schizophrenia: he was repeatedly hospitalized and stabilized. But when released, he repeatedly went off medicines and became violent. Research clearly shows the majority of mentally ill are not violent. But the research just as clearly shows that when people with mental illness refuse treatment, they are more likely to become violent than the general population. In fact, a brilliant story in last Sunday’s New York Times suggested, "Maybe they should have just stenciled it in large letters on Andrew Goldstein's forehead: "TICKING TIME BOMB. SUFFERS SCHIZOPHRENIA. IF OFF MEDICATION, RUN FOR COVER!" The article went on to point out that when Andrew became re-psychotic he asked to be readmitted. Sometimes he was.

Other times he wasn’t. But had he remained on medicines he wouldn’t have needed rehospitalization in the first place. Contrary to Mr. Sundram, it wasn’t just services Andrew was lacking: it was a requirement to stay on medicines.

Both Pataki and Silver worked closely with the Webdale family in fashioning Kendra’s Law. But the bill could just as easily have been called "Andrew’s Law" because not only does it protect the public, it also protects the individual with the illness. The majority of New York’s mentally ill residents do not receive services from the state. They do receive services from their parents. The family has become the institution, providing housing, case management, rehabilitation and other services. But these elderly parents need the ability to ensure medication compliance in order to continue to provide for their sons and daughters. Otherwise, they are forced to kick their children out or watch them leave home -- putting the public and their children at risk -- as Andrew’s parents were forced to do -- or watch, as they become psychotic and potentially dangerous at home. That’s no choice. That’s why Kendra’s Law is supported by the Alliance for the Mentally Ill, New York’s largest advocacy group representing people with mental illness and their families. Kendra’s Law might have saved Kendra Webdale from losing her life and Andrew Goldstein from losing his freedom.

"Assisted Outpatient Treatment", the technical name for Kendra’s Law, already exists in 40 states. Wyoming passed a law just last week. New York must do the same. After hearing all the evidence, and giving the patient free counsel, a court can order patients who must have a history of violence associated with non-compliance -- to stay in treatment and on medicines that can prevent violence. But more importantly, the court can order the mental health system to provide the case management services and housing that the mentally ill patient needs to survive safely in the community. The court can order the health care provider to work to elicit compliance, rather than simply close the case if a patient fails to show up for treatment. The court can order the state to provide the kind of services they have refused to voluntarily provide. Certain non-compliant patients could even be taken to the hospital to be examined to see if they need to be admitted. Under Kendra’s Law New York could start treating people before they become dangerous, rather than jailing them after. That’s better for the patient. Safer for the public.

Assisted outpatient treatment works. In Washington, DC, hospital admissions decreased from 1.81 per patient per year to 0.95 per year before and after assisted outpatient treatment; in Ohio the decrease was from 1.5 to 0.4; and in Iowa from 1.3 to 0.3 admissions. A pilot program at Bellevue Hospital in New York City demonstrated a 57 percent reduction in hospital days for patients receiving assisted outpatient treatment. It is because services are so limited in New York that Kendra’s Law is so desperately needed. Kendra’s Law would allow patients to live successfully outside hospitals rather than imprisoned in them. In a recent study of psychiatrically disabled patients who were treated against their will, 60% of the patients themselves retrospectively favored the involuntary treatment. It’s a win-win proposal.

Like the bill previously introduced by Attorney General Eliot Spitzer, the bills introduced by Governor Pataki and Speaker Silver are both excellent. They are gaining rapid and enthusiastic support from advocates for the mentally ill and advocates for safe streets. Two groups that don’t often agree.

Outside this mainstream stands the ACLU. The ACLU argues that the bills violate civil liberties. But as Herschel Hardin, a former director of the British Columbia Civil Liberties Union said, "The opposition to involuntary committal and treatment betrays a profound misunderstanding of the principle of civil liberties. Medication can free victims from their illness -- free them from the Bastille of their psychoses -- and restore their dignity, their free will and their ability to engage in a meaningful exercise of their liberties."

Other opposition comes from those who propose advance directives and health care proxies as the answer. It is arguable as to whether or not those are helpful, even to those likely to be compliant. Some argue that they could give the mentally ill the opportunity to refuse services in advance of psychosis and therefore cause more, not less people to need involuntary commitment. Likewise, while new services and housing are desperately needed, it is not unreasonable to expect those who would benefit from the services to take their medications as a quid pro quo. Kendra’s Law is not an alternative to community services, it is a community service.