Arlington, VA— For the second time
in less than four months, New Yorkers are stunned by a tragic subway pushing incident.
Once again, the pusher appeared to be suffering from delusions, which can be a deadly
symptom of untreated severe mental illness. Julio Perez reportedly told police that gangs
had been following him for days and that he had been in a mental institution. Andrew
Goldstein claimed that a spirit entered his body and forced him to push Kendra Webdale to
her death in January.
New Yorkers should not be surprised that the pusher has a history of mental illness. A
1992 study of 36 subway pushing incidents in New York, published in the Archives of
General Psychiatry, found that the overwhelming majority of people responsible were
suffering from psychotic symptoms, resulting from untreated schizophrenia and
manic-depressive illness. Over the years, New Yorkers have read about similar incidents
involving fellow citizens with untreated severe mental illnesses. 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 in 1995. Jaheem Grayton, who
also had a history of violence and severe mental illness pushed Naeeham Lee to her death
after struggling to steal her earrings in 1996. Mary Ventura pushed Catherine Costello
into the path of a subway train in 1985, three weeks after being discharged from a
psychiatric hospital.
New Yorkers today must be asking: "Why do these random acts of violence
continue?" and "What can be done to prevent them?" These incidents occur
because nearly half of those who have schizophrenia or manic-depressive illness have no
awareness of their disease. They do not realize they are sick and in need of treatment
because their disease affects the brain’s self-evaluation function. They do not
recognize that the symptoms of their illness – hallucinations, delusions, paranoia,
and withdrawal – are, in fact, symptoms. They do not believe they are sick, so they
refuse to take their medication and this is perfectly acceptable in the eyes of the
current law.
There are effective means of preventing these tragedies. Attorney General Eliot Spitzer
offered a solution to this problem in February when he proposed Kendra’s Law to make
assisted outpatient treatment available in New York. Assisted outpatient treatment (also
referred to as outpatient commitment) effectively ensures that the most severely mentally
ill individuals who need treatment in the community actually get it. Under Kendra’s
Law, an individual would be required by a court order to comply with a treatment plan,
which can include medication. Professionals would monitor each individual’s treatment
compliance and intervene if the individual becomes non-compliant. Unlike New York’s
current law, this intervention would occur before the individual becomes dangerous.
Assisted outpatient treatment 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 39 states have implemented outpatient commitment programs, New York has yet to do
so. A recent study of New York’s Bellevue Hospital outpatient commitment 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.
People are uncomfortable talking about mental illness and the need to help those who do
not recognize they are ill, like the homeless and incarcerated mentally ill. But, that
discomfort is nothing compared to the suffering these illnesses cause. Victims of
untreated schizophrenia suffer delusions and hallucinations – alterations of their
reality. Many people spend their lives trying to escape demons that do not really exist.
And when those demons cause the mentally ill to commit random acts of violence, the lives
of others like Edgar Rivera, Kendra Webdale and their families are destroyed as well.
Attorney General Spitzer may have to rename his proposal "Kendra’s and
Edgar’s Law." New Yorkers must support the Attorney General’s plan to
address the treatment needs of New York’s individuals who are suffering from
untreated severe mental illnesses. We cannot afford to add any more names to the title of
Spitzer’s bill. The bill must be passed into law before it becomes a legacy
for other victims.
