New York Must Strengthen Assisted
Treatment Laws for Mentally Ill to Prevent Tragic Episodes of Violence
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 monitoring and treatment for his brain disease.
The horrific incident that occurred yesterday 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.
The fact that the pusher had a history of mental illness should not be a surprise. A
1992 study of 36 such incidents in New York published in the Archives of General
Psychiatry found that the overwhelming majority of people responsible for such heinous
crimes were suffering from psychotic symptoms, resulting from untreated schizophrenia and
manic-depressive illness.
Over the years, New Yorkers have read about several other similar incidents involving
fellow citizens with untreated severe mental illnesses. For example, three weeks after
being discharged from a psychiatric hospital, Mary Ventura pushed Catherine Costello into
the path of a subway train. Reuben Harris, who suffered from paranoid schizophrenia, had
12 hospitalizations and a history of violent behavior, pushed Song Sin to her death in the
same manner. Jaheem Grayton, who also had a history of violence, severe mental illness,
and substance abuse, pushed Naeeham Lee to her death after struggling to steal her
earrings.
These incidents occur because nearly half of those who have schizophrenia or
manic-depressive illness lack insight into their illness. They do not realize they are
sick and in need of treatment because their brain disease has affected their ability for
complete self-awareness. They do not recognize that the symptoms of their illness
– hallucinations, delusions, paranoia, and withdrawal – are, in fact,
symptoms. Since they do not believe they are sick, and since there are no community
services in place to help them, they refuse to take their medication, which is perfectly
acceptable in the eyes of the law.
One effective means of ensuring that those who need treatment get it is the use of
outpatient commitment programs. Outpatient commitment has been shown to increase treatment
compliance in study after study, and in state after state. For example, among patients who
had been outpatient committed in Arizona, 71 percent of them voluntarily maintained
treatment contacts six months after their orders expired compared to almost no patients
who had not been put on outpatient commitment. A study in Iowa showed that 80 percent of
patients participating in outpatient commitment complied with treatment programs. After
outpatient commitment was terminated, some three-quarters of that group remained in
treatment on a voluntary basis.
While 38 states have implemented outpatient commitment programs, New York has yet to do
so even though outpatient commitment has been shown to be effective in other states. A
pilot program at Bellevue Hospital, which is now being reviewed by the New York City
Department of Mental Health, should be extended statewide. Outpatient commitment could
prevent the tragic suffering these illnesses cause its victims like Kendra Webdale and
Andrew Goldstein.
