Arlington, VA –The historic and heroic
efforts of Governor George Pataki, Attorney General Eliot Spitzer and Assembly Speaker
Sheldon Silver to implement assisted outpatient treatment statewide for individuals with
severe mental illnesses will substantially improve the quality of life for all New
Yorkers. We commend them on their landmark initiatives and appreciate their soliciting the
Center’s counsel in drafting such long-overdue and much needed legislation.
We also extend our admiration and gratitude to the Webdale family who have bravely
fought for better treatment of the mentally ill since Andrew Goldstein, who was not being
treated for his illness, pushed Kendra to her death in the New York City subway system
earlier this year. We commend their valiant and selfless efforts to eliminate barriers to
treatment for New York’s vulnerable psychiatrically ill in the wake of their profound
grief.
‘Kendra’s Law’ will help ensure that individuals like Andrew Goldstein,
Julio Perez, Michael Laudor, and Larry Hoag would have taken the medications needed to
control the symptoms of their disease, thereby lowering the likelihood of violent
behavior. Each of these men suffers from schizophrenia and none was taking medication when
he committed tragic fatal violent acts. ‘Kendra’s Law’ will prevent these
individuals from spinning endlessly through the revolving door of hospital admissions and
readmissions, only to be abandoned to the streets with no follow-up care.
‘Kendra’s Law’ also will help eliminate random and senseless acts of
violence such as that which tragically ended Kendra Webdale’s life. New York State
legislators must stop the deadly pattern of untreated severe mental illness and enact
assisted outpatient treatment statewide.
At least 39 states now use some form of assisted outpatient treatment to substantially
improve the lives of those suffering from severe mental illness and enhance the
communities in which they live. Long-term assisted outpatient treatment 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 assisted outpatient treatment 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, lack 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.
Untreated, the symptoms of these brain diseases can be extraordinarily disabling. For
example, schizophrenia interferes with a person’s ability to think clearly, manage
emotions, make decisions, and relate to others. An individual with schizophrenia
experiences delusions and hallucinations; alterations of the senses; an inability to sort
and interpret incoming sensations, and therefore to respond appropriately; an altered
sense of self; and changes in emotions, movements and behavior. Individuals diagnosed with
manic-depressive illness, or bipolar disorder, also can experience delusions and
hallucinations, coupled with mood swings that alternate from periods of severe highs, or
mania, to extreme lows, or depression. These mood swings are out of proportion or totally
unrelated to events in a person’s life and affect thoughts, feelings, physical
health, behavior, and functioning.
The consequences of failing to treat these illnesses are devastating. While Americans
with untreated severe mental illnesses represent less than one percent of the total U.S.
population, they commit almost 1,000 homicides in the United States each year, or between
four and five percent of all murders annually. At least one-third of the estimated 600,000
homeless individuals suffer from schizophrenia or manic-depressive illness, and 28 percent
of these people forage for some of their food in garbage cans. At least 10 percent, or
170,000 individuals, of our jail and prison populations suffer from these illnesses,
costing American taxpayers a staggering $8.5 billion per year. Moreover, studies suggest
that delaying treatment results in permanent harm, including increased treatment
resistance, worsening severity of symptoms, increased hospitalizations and delayed
remission of symptoms. In addition, persons suffering from severe psychiatric illnesses
are frequently victimized. Studies have shown that 22 percent of women with untreated
schizophrenia have been raped. Suicide rates for both males and females suffering from
schizophrenia and manic-depressive illness are 10 to 15 times higher than for the general
population.
It’s time to reverse course. 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 must be conditioned on continued medication
compliance. Assisted outpatient treatment, conditional hospital releases, and
conservatorships must be widely used to ensure that discharged patients continue to take
their medication. ‘Kendra’s Law’ will protect all New Yorkers by ensuring
that its vulnerable citizens, like Andrew Goldstein, continue to receive appropriate
treatment to control the negative symptoms of their brain disease.
