ARTICLE Racial Disproportion Seen in Applying 'Kendra's Law' By MICHAEL COOPER  New York Times  April 7, 2005   After Kendra Webdale was killed in 1999 by a schizophrenic young man who pushed her into the path of an approaching subway train, the state passed a law giving judges the power to force the mentally ill to comply with treatment. State officials say the statute, known as Kendra's Law, has been a great success, and Gov. George E. Pataki wants to make it permanent when it comes up for renewal in June. But an analysis of state data by a group that opposes its compulsory-treatment provision found that the law has been disproportionately applied to black New Yorkers. The group, New York Lawyers for the Public Interest, concluded that blacks were nearly five times as likely as whites to be the subject of court orders stemming from Kendra's Law. Examining court orders for treatment that have been issued since the law took effect, the group found that 42 percent of the 3,958 orders for treatment were invoked against blacks, who make up 16 percent of the state's population, while 34 percent of the orders applied to whites, who make up 62 percent. "It's important to know if our mental health policy is disproportionately taking away the freedom of groups of people who have historically been oppressed," said John A. Gresham, the senior litigation counsel for the group, a research and advocacy organization. Jill Daniels, a spokeswoman for the state's Office of Mental Health, said that it was misleading to compare the race and ethnicity of those being treated under Kendra's Law with the race and ethnicity of those in the general population, and that the proportions were similar to those for adults receiving intensive care in urban areas. Mr. Gresham's group is releasing the report this week because the State Assembly is planning to hold its first hearing on the law on Friday. Under Kendra's Law, the courts can order mentally ill adults to receive outpatient treatment if nonadherence to past treatments resulted in hospitalizations or in violence toward themselves or others. If the court-ordered course of treatment is not followed, the patient can be involuntarily hospitalized. A report issued last month by the Office of Mental Health cited reports by case managers that patients ordered into outpatient treatment under Kendra's Law were less likely to try to harm themselves or others, destroy property or create disturbances at the end of their treatments. The concept of compulsory treatment has long been controversial. Last year the state's highest court, the Court of Appeals, upheld the law in a 6-to-0 vote. "The state's interest in immediately removing from the streets noncompliant patients previously found to be, as a result of their noncompliance, at risk of a relapse or deterioration likely to result in serious harm to themselves or others is quite strong," Chief Judge Judith S. Kaye wrote. Mr. Gresham said that given the inequalities shown in his data, the parts of the law allowing the courts to compel treatment should be eliminated, while those providing greater access to mental health services should be kept. But other advocates warned against eliminating the forced treatment. "That would gut the law," said J. David Seay, the executive director of the National Alliance for the Mentally Ill of New York State, an advocacy group that wants Kendra's Law to be extended permanently, and strengthened to make it easier for families to petition the courts to issue orders. Mr. Seay added that his group would like to see the law applied more evenly throughout the state. The question of what the numbers meant was the subject of debate on Wednesday. Mr. Gresham pointed to state data showing that, even compared with demographics of who is served by the public mental health system, blacks are disproportionately subjected to court orders under Kendra's Law. But state mental health officials noted that those figures included children, who are not covered by Kendra's Law, and that the figures were comparable to recent studies of adults served by the system. Mental health advocates and city and state officials cited possible explanations for the disparity. Some noted that more than three-quarters of the court orders had been issued in New York City, which has a large black population. But Mr. Gresham said that even within New York City, blacks were the subject of a disproportionate number of court orders. Others suggested that blacks and Latinos with mental illness might not have access to needed mental health care early on, making them more likely to find themselves in the kinds of crises that lead to interventions. Whatever the reason, officials said it merited study. "It's very troubling," said Councilwoman Margarita Lopez, chairwoman of the Council's Committee on Mental Health. Source:  New York Times, http://www.nytimes.com Reprinted using Fair Use Standard _____________________________________________ Back to top

PRESS RELEASE FOR IMMEDIATE RELEASE: March 7, 2005 GOVERNOR INTRODUCES BILL TO MAKE KENDRA'S LAW PERMANENT Report Documents the Success of Individuals Receiving Assisted Outpatient Treatment Governor George E. Pataki today introduced legislation to make New York's Assisted Outpatient Treatment (AOT) law permanent. The measure, known as Kendra's Law, was first enacted in 1999 and is currently scheduled to sunset on June 30, 2005. It is named in memory of Kendra Webdale, who tragically died after being pushed in front of a subway train by a man with a history of mental illness and hospitalizations. Since being enacted Kendra's Law has successfully provided specialized services to more than 6,600 New Yorkers with mental illness. "For the past five years, Kendra's Law has provided New Yorkers with mental illness access to the treatment they need in an effective manner that ensures their safety, as well as that of the public," Governor Pataki said. "The vast majority of these individuals are already leading productive and fulfilling lives in their communities, but the results are clear -- Kendra's Law works. That's why I am proposing that this extremely successful program be made permanent." Kendra's Law established a process for identifying individuals with mental illness who, in view of their treatment history and circumstances, are likely to have difficulty living safely in the community without supervision. A five-year evaluation of the program was released last week by the Office of Mental Health (OMH) and has shown the program to be a resounding success. The use of mental health services by the population now being served by AOT has gone up by 89 percent over what was utilized prior to the implementation of the program. Patricia Webdale, Kendra's mother, said, "The Assisted Outpatient Treatment program is having positive results, and I would like to commend OMH for a job well done. On a personal note, it brought tears to my eyes to see Kendra's name on the AOT report's cover. When we began this journey five years ago, my husband Ralph and I were hopeful that we could do something that would help just one person. We are very pleased to see that this program has helped so many." Sharon E. Carpinello, R.N., Ph.D., OMH Commissioner, said, "Thanks to Governor Pataki's leadership, we have seen improved access to mental health services, improved coordination of service planning, enhanced accountability, and improved collaboration between the mental health and court systems. But when summarizing the results of AOT, it is most important to note the positive impact the program is having on the people who have successfully used it. Individuals with mental illness who participate in AOT are able to make and maintain real gains in their recovery -- the data tells us that, and so do the recipients." Kendra's Law has created a procedure for obtaining court orders for certain individuals to receive outpatient treatment for mental illness. It also ensures that local mental health systems give these individuals priority access to case management and other services necessary to ensure safe and successful community living. In addition to assisted outpatient treatment, Kendra's Law also addresses the need to ensure that mentally ill people who are moving from hospitals or correctional facilities to the community receive necessary psychiatric medications without interruption. Fully funded in the Governor's Executive Budget, the law's statewide medication grant program enables counties to provide people who are discharged from psychiatric hospitals, state prisons or county jails with psychiatric medication they may need while they are applying for Medicaid. In addition, the law clarifies and authorizes the sharing of necessary clinical information of patients with mental illness between psychiatric hospitals as well as between psychiatric hospitals and general hospital emergency rooms. This sharing of information helps to provide clinicians with accurate clinical histories, resulting in better diagnoses and treatment. The five year report that was recently released reviews the impact and outcomes of various elements of the AOT program from its initial implementation in November 1999 through December 2004. During that time, 10,078 individuals were referred for AOT assessment. Of those, 3,766 individuals received services under an AOT court order, and an additional 2,863 received service enhancements without a court order. AOT participants show a significantly increased participation in case management, substance abuse, and other treatment services; increased adherence to prescribed medication; improvements in social and family functioning; and improvements in community living. They also demonstrate a reduction of harmful behaviors, including reduced incidence of hospitalization, homelessness, arrest and incarceration. The Report on the Status of Assisted Outpatient Treatment is available on the OMH website, http://www.ohm.state.ny.us. ### _________________________________________________ Back to top

PRESS RELEASE March 9, 2005 News Release: Assemblyman Peter M. Rivera calls Governor's proposal a rush to approve a law that needs more public input and definite restructuring Assemblyman Peter M. Rivera, chair of the New York State Assembly Standing Committee on Mental Health, Mental Retardation and Developmental Disabilities, is releasing the following statement with regards to Governor Pataki's proposed legislation to make Kendra's Law permanent. "Once again, Governor Pataki has not done his homework when it comes to issues of mental health. He has now rushed to introduce legislation that will make Kendra's Law permanent without bothering to gather public input on this issue. If he had, the Governor would have realized that there are serious problems that need to be addressed if Kendra's law is to be extended," stated Rivera. He added, "We have individuals languishing in hospitals, at a tremendous expense to taxpayers, because a court order to find them appropriate housing can not be met by local mental health agencies. The system does not have adequate capacity to address the problems of the mentally ill in New York." "Our mental hygiene system is fragmented, does not adequately address the needs of its target population and is tremendously inefficient. These problems are evident by examining the data we collected on this issue," Rivera declared. "We have counties that have not sought a Kendra's Law proceeding but have managed to provide the needed treatment. On the other hand, the vast majority of court orders are being sought in a geographic location that entails Westchester County out to Suffolk County. What does this say about the selective use of a law that many mental health advocates have called coercive?" Rivera continued, "Representatives of the court-supervised Mental Health Legal Services have called the present system a huge waste of money that drains time from the court system due to the lack of services that are absent from many communities." Contact: Guillermo A. Martinex 518-455-5102 _________________________________________________ Back to top

OPINION PIECE MHW: 'Forced Treatment is Not the Answer' Source: Harvey Rosenthal, NYAPRS (New York Association for Psychosocial Rehabilitation Services) As this year's NYS Legislative session begins to move from fiscal to policy-related issues, one of the most prominent legislative issue faced by New York's mental health community this year is the brewing debate over whether or not the NYS Legislature should renew, make permanent and/or alter Kendra's Law. Approved in 2000 after a long and heated struggle amongst the state's mental health advocacy groups, the law authorized the use of court ordered medication and community services. Assembly Mental Health Committee Chairman Peter Rivera has already expressed a number of concerns about the law. Chairman Rivera will be holding two public hearings on the law, one in New York City this Friday and one in Buffalo on April 21. Following is a OP ED piece published in Mental Health Weeklyabout this nationwide controversy that represents concerns raised from numerous NYAPRS members and colleague groups. "Helping The Most Needy: Forced Treatment Not The Answer" by Harvey Rosenthal, NYAPRS Mental Health Weekly, April 4, 2005 Over the past decade, the debate over the justness and the actual impact of the use of court-ordered outpatient mental health treatment has emerged as one of the most contentious controversies in our mental health system. All too often, it has created great divides and left us with a damaging disunity among consumer and family advocates, community mental health providers, and state and local mental health officials.   At the same time, these groups have shared the same concern, seeking the reform, reconfiguration and increased responsiveness of community mental health services systems that the President's New Freedom Commission on Mental Health found were "broken," fragmented and "in shambles."   In New York state, among the most heartbreaking casualties of this broken system was the tragic death of Kendra Webdale at the hands of Andrew Goldstein. Our hearts were broken by this horrible tragedy, and all of us have marveled at the great courage of the Webdale family in their efforts to seek system changes that might spare such tragedies in the future.   Sadly, one of the most prominent "reforms" that many states have adopted is the rise in the use of involuntary outpatient treatment (IOC), euphemistically re-named "Assisted Outpatient Treatment" in New York. This move has been largely borne out of the great despair and desperation experienced by our family movement, and fanned by the disinformation machine that is the Treatment Advocacy Center. TAC typically swoops into states on the heels of a tragedy, inaccurately plays up the connection between violence and psychiatric disability and, in doing so, sets us back years in our common fight against public stigma and prejudice.   Involuntary outpatient commitment approaches are based on three false premises: o   People with psychiatric disabilities are so violent that a forced treatment program is necessary to protect the public. A 1998 MacArthur Foundation study showed that we are no more violent than the general public except when we, like they, abuse alcohol and drugs. TAC has touted distorted "research" falsely claiming that over 1,000 murders a year are committed by Americans with "severe mental illnesses."In reality, a recent study found that our group is 21/2 times more likely to be the victims of violence. o   People with psychiatric disabilities are frequently so sick that they can't understand their need for care, leading to avoidance and noncompliance. All too often, people seeking help are either rebuffed by an unresponsive system (as The New York Times found in an investigation surrounding Andrew Goldstein) or find that the acceptance of a mental illness leads to a life of stigma, poverty and isolation, and/or experience mental health services as dehumanizing if not demeaning. We have long tended to view patients' rejection of our services as their "noncompliance" and not our responsibility to provide better services in an environment that promotes respect, dignity, hope and flexibility. o   Forced treatment works. A three-year study at Bellevue Hospital that compared the impact of providing an enhanced, better-coordinated package of services with and without the use of a coercive mandate found no difference in rates of improved outcomes, yielding the conclusion that people do better when they are offered better services, not because they are forced to accept them. New York City's Pathways to Housing program has achieved an 85 percent retention rate with a group found to be among the "hardest to serve," and has done so without requiring medication compliance or abstinence and by offering a harm reduction approach with access to housing and round-the-clock support.   Nonetheless, over the heated objections of a broad coalition of consumer, provider and patient's rights groups, New York's governor and state legislature approved "Kendra's Law" in 2000, authorizing the use of forced outpatient treatment orders. Four years later, the legislation is up for renewal, which has refueled the historic controversy over IOC among New York's mental health advocacy community (see MHW, March 28).   The state legislature is considering proposals to make the law permanent and to boost the use of coercion. Much of the justification for this is the conclusion offered by recently released research conducted by the New York State Office of Mental Health (OMH), and touted by the state affiliate of the National Alliance for the Mentally Ill (NAMI-NYS), that the program has been an overwhelming success.   Once more, advocates have joined to object to a renewal of forced treatment, based on the following findings: o       Faulty research. The OMH research is based almost entirely on the opinions of case managers and, unlike the Bellevue Study, fails to provide a comparison with a control group of those who received a voluntary package of similarly improved, well-coordinated services, including housing and case management. o       Most counties have made significant improvements without relying on court-ordered care. Once you take out New York City's record of seeking over 3,000 court orders (over three-quarters of all statewide court orders since 2000), most counties have been far more successful in engaging individuals with severe psychiatric conditions without the use of forced treatment. Twenty-five upstate counties have produced better outcomes with two or fewer orders over the past four years, by using the enhanced resources and responsibilities also contained in the law. Yet, proponents have called these counties "negligent" and are seeking to strengthen the law to pressure them to produce more orders. o       Most court orders have been used to link nonviolent individuals with priority access to scant services. Must we rely on courts and cops to make our system more responsive and more accountable? Localities that are turning to court orders are using them primarily to get individuals with "high needs" to the "front of the line" for scarce services and housing. Per OMH's research, only 15 percent of those under court orders have done any physical harm and 41 percent showed "good" engagement in services prior to consideration for a court order. o       Forced treatment unjustly violates people's rights and erodes their faith in the service system. Name another group that can be ordered into care based on a doctor's prediction that they might cause or come to harm. What are the treatment costs in lost trust by clients who know that those treating them will turn them in if they do not "comply"? o       Forced treatment orders are predominantly levied at people of color. A particularly disturbing finding from the OMH research is that almost two out of every three court orders have been levied at people of color, namely African- Americans and Hispanics. What does this tell us about the adequacy of our community mental health service system in properly serving people of color?   Someday, people will look back at our use of forced outpatient treatment and will wonder why we were so incapable of providing the right kind and level of accountable, appealing and effective services that we fell to the desperation that is driving the use of IOC.   In the meantime, we must reject legislation and public policies that authorize the use of such force. At a minimum, the New York state legislature has the responsibility, in the face of unconvincing research and discriminatory implementation, to reject calls to make Kendra's Law permanent or to boost its reliance on coercion.   Harvey Rosenthal is executive director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS). End of article __________________________________________ Back to top

NYAPRS N E W S    R E L E A S E Advocates Call on NYS Legislature to End Kendra's Laws Authorization for Coercive Mental Health Care They Express Support for Its Service System Improvements and Call on Legislature to Continue Its Oversight Role __________________________________ March 9, 2005             Contact: Harvey Rosenthal   518-527-056 __________________________________ Mental health advocates from across New York State decried Kendras Law authorization for the use of coercive court ordered outpatient mental health care and called on the Legislature to, at a minimum, continue its close and careful oversight over the very controversial program. We have always argued that the best and most effective way of engaging at risk New Yorkers with severe mental illnesses has been to improve a mental health service system that the Presidents Mental Health Commission called broken and fragmented, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services. The Real Fix: Community Services Reforms While we are urging our state legislators to reject the use of forced mental health treatment orders, we want to urge their support for innovative and progressive improvements to our mental health services, said Jack Guastaferro, executive director of the Restoration Society, a Buffalo-based mental health service agency. The progressive provisions of Kendra's Law have done so, by improving access to mental health services, fostering improved coordination of service planning, enhancing state, local and provider accountability, improved collaboration between the mental health and court systems, installed mental health professionals in local jails to facilitate appropriate discharge plans and introduced a medication grants program to ensure they get needed medications while they are waiting for Medicaid authorization, Guastaferro continued. Community mental health providers have had serious concerns about the use of court orders. Coercive Treatment as a System Failure Rather than celebrating the advent and use of coercive mental health care in New York, we must instead view every court order as both an individual treatment failure and as system wide failure of our service system to properly engage and serve individuals with high needs, said Steve Coe, executive director of Community Access, a New York City-based mental health service agency. The Real Answer: Better Services ACL represents 120 residential providers statewide - many of whom have concerns about the Kendra's Law statute.  It is our experience that assisted outpatient treatment is only one way, and not necessarily the best way, to insure that adequate or enhanced services are delivered to the most at-risk or in-need individuals in the system, said Antonia Lasicki, executive director of the Association for Community Living, the state's trade association for residential care providers. We have programs operating out of New York City, which initiates by far the greatest number of court orders, that successfully engage the hardest to serve: those with histories of multiple institutionalizations and incarcerations and who have histories of threatening behavior, linked particularly to substance abuse, said Rosenthal. Such programs offer comprehensive outreach and round-the-clock supports linked with appropriate community housing and get an 85% retention rate from individuals typically considered to be among the most non-compliant. The Myth of Violence The rationale for forced treatment has been based on the belief that New Yorkers with psychiatric disabilities have a greater propensity for violence. Yet, recent studies have found that not only are people with psychiatric disabilities no more violent than the general public, they are actually more than 11 times often the victims of violent crime. The advocates claimed that, in actuality, Kendras Law court orders have actually not been used primarily for individuals thought to be a threat to others, but to move people in need to the front of the line for scant local service openings. While Kendra's Law-related court orders were originally presented as a means to contain people who commit random acts of violence, that is not how it is actually used, said John Gresham of New York Lawyers for the Public Interest. It is used mainly on people who have been hospitalized more than once. The state's own figures indicate only 15% of the people subject to orders had done any kind of physical harm to others in the period prior to the orders - which means that 85% had not. Questions About the Research Calls to make Kendra's Law permanent rest largely on claims that the program has demonstrated a unique ability to reduce relapse and promote recovery among those served. Yet, the OMH study does not offer a comparison between those who received court orders and improved, better coordinated and responsive services. This is in stark contrast to research conducted in 2000 on a similar demonstration program of forced treatment operated out of Bellevue Hospital, which measured the impact of a program of improved services alone and one associated with court orders. The study found that both groups improved at the same rate, yielding the conclusion that it is improved services, not court orders, that produce improved mental health outcomes.  A Violation of Patients Rights And experts in the successful engagement of people with severe psychiatric disabilities objected to the use of forced outpatient treatment. Forced treatment unfairly and unacceptably singles out people with psychiatric disabilities, said Peter Ashenden, executive director of the Mental Health Empowerment Project. Not only does it violate their basic human rights, but the research has made clear that it all too often has the opposite effect of driving people away from the treatment this law is aimed at helping them to accept. Many Counties Have Improved Service Outcomes Without Force Further, we must examine carefully how and why it is that the vast majority of local mental health service systems have been able to successfully engage some individuals with high needs without a systemic reliance on forced treatment, said Ashenden. According to the most updated OMH statistics, 4/5 of those individuals who have been recommended for court ordered care were either found to be inappropriate for forced treatment or were successfully engaged on a voluntary basis. And once you take out New York City's 3,000+, which represents over ï¾¾ of all court orders, most counties have been far more successful in engaging individuals with severe psychiatric conditions without the use of forced treatment. For example, 13 counties have not produced even 1 court order: Clinton, Cortland, Essex, Franklin, Hamilton, Herkimer, Lewis, Oswego, Greene, Allegany, Livingston, Ontario and Yates. 12 counties have produced 2 or less forced treatment orders: Cattaraugus, Chemung, Genesee, Niagara, Tioga, Schoharie, Sullivan, Cayuga, Chenango, Delaware, Madison and St Lawrence. And, this pattern of serving people in a non-coercive manner is not just the province of upstate counties. New York City has produced 3,017 forced treatment orders of a statewide total of 3,958. It has ultimately backed orders for 3 out of every 5 investigations; in contrast, Onondaga County (Syracuse), has only sought court order for 1 out of every 12. Why is that?, asked Rosenthal. What does it tell us about how some counties are comparatively better at engaging people voluntarily while others, most notably New York City, are not? Disproportionate Use Of Force For People Of Color A particularly disturbing finding from OMH's recently released research study is that almost 2 out of every 3 court orders have been levied at people of color, namely African Americans and Hispanics. The outrageously high proportion of people of color who have been subjected to forced outpatient treatment forces many of us to ask the questions: why is this and what does it tell us about the adequacy of our community mental health service system in properly engaging and serving people of color? said David Gonzalez, the Coordinator for Support Services for The Mental Health Empowerment Project. With all the recent advances in community services, can't we find a better, more culturally appropriate and responsive to engage people of color than forcing them into treatment? Gonzalez asked. Conclusion Today, we come seeking the end of authorization for forced treatment and are instead calling for an even greater commitment by New York State to a better coordinated, more responsive and appropriate array of services, said Guastaferro. The Kendra's Law program, and the current research that has been presented do not justify making this highly controversial use of forced treatment a permanent fixture of New York's mental health service system. Too many unanswered questions have been raised, said Rosenthal. At minimum, the state Legislature must not surrender its appropriate, careful oversight over the highly controversial use of coercive mental health care, said Rosenthal. It must reject the proposal to make Kendra's Law permanent and instead continue to require ongoing reports until all of these questions we raise today are satisfied. This 'Mental Health E-News' posting is a service of the New York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of people who use and/or provide community mental health services dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights. End of Press Release Return to top

Kendra's Law Hearing Reopens Coercion Controversy, April 11, 2005 (An overview and comments by Jean Arnold, National Stigma Clearinghouse) Kendra's Law (KL), New York's experiment with court-ordered psychiatric medication for outpatients, is due to expire on June 30th. Should the experiment continue? Judging from testimony at a public hearing in Manhattan on April 8, 2005, no one is satisfied with the current law. With KL about to expire, the Assembly's Mental Health Committee Chairman, Peter M. Rivera, and Codes Committee Chairman, Joseph R. Lentol asked members of the mental health community for their views. The Assemblymen heard eight hours of passionate testimony and recommendations from advocacy organizations, public officials, psychiatric survivors, families, clinicians, services providers, and legal experts. Five years ago, the battle for KL pitted NAMI-NYS and the Treatment Advocacy Center (TAC) of Arlington Virginia, a group whose primary interest is psychiatric medication, against the community of psychiatric survivors and their allies who view forced medication as counter-productive. At the recent Assembly hearing, KL supporters called for greater family access to obtaining court orders; KL opponents cited negative effects of coercion and the success of high-quality alternatives. For more information about NAMI-NYS and NYAPRS positions, go to http://www.naminys.org and http://www.nyaprs.org. By our count, ten TAC and NAMI-NYS speakers and supporters recommended that KL become permanent. Twenty other speakers consider permanent enactment premature, but would continue the experiment for 3 to 5 years. Ten people objected to KL's continuation. Nearly everyone who spoke in favor of letting the experiment continue called for improved accountability and more relevant outcome data from New York's Office of Mental Health. Psychiatric survivors who support KL's limited continuation made clear that they do not support its coercion clause. All speakers agreed on one basic issue. High quality community services are in desperately short supply. KL is rarely able to deliver the full package of treatment components it promises. Meanwhile, successful voluntary programs are forced to compete with KL for already barebones resources. The most critical shortages are a lack of case managers, appropriate housing, and dual-diagnosis treatment programs (50% of KL patients have a mental illness combined with a substance abuse problem). County administrators spoke of increased liability risk when essential programs are understaffed or missing altogether, and of new costs to counties with the addition of unfunded mandates. Dr. Antonio Abad of the Association of Hispanic Mental Health Professionals said additional treatment models could improve outcomes of people who are not good candidates for KL; he also called for more bilingual services. From an antistigma point of view, the lasting negative effects of KL's publicity has been our main concern. The law's passage was won in 1999 on a "public safety" platform; negative fallout from this heavy emphasis on violence still haunts the mental health community. Nassau County Director Harold Sovronsky referred to the public's misguided perception, fanned by KL advocates, that KL protects public safety. Sovronsky said that in fact, "there is little if any consequence to those who violate court-ordered treatment." Nothing was said at the hearing about the framing of Andrew Goldstein to get KL passed. Goldstein had to be shoehorned into the "non-compliant patient" role. Michael Winerip, a New York Times reporter who investigated the Andrew Goldstein case, wrote in December 1999 that "by the summer of 1999, the newly disclosed facts of the Goldstein case justified what mental health advocates had been arguing for years: a lack of state spending was crippling the system. To cut costs, the state had set quotas for reducing the patient population at every public hospital in New York, making it extremely difficult to get long-term care. Mr. Goldstein was a perfect example." Winerip recounts that Goldstein (who voluntarily committed himself for treatment 13 times) acted violently even in hospital settings numerous times. Still, the system stalled his admissions and repeatedly recycled him to the street, despite his requests for treatment of his uncontrollable violent urges. ADDITIONAL NOTES AND COMMENTS: 1) Several key administrators, including Joyce B. Wale of the New York City Health and Hospitals Corporation (HHC), recommended a limited extension (3 years) of the KL experiment. She stressed the need for scientific longitudinal research and improved accountability. Ms. Wale also suggested the inclusion of peer counselors throughout the state based on their excellent performance in NYC. 2) John Gresham of Lawyers for the Public Interest testified that KL has produced a pattern of racial imbalance. Court orders target Black patients 3X more than whites, and Hispanic patients 2X more than whites. Gresham has found no reasonable explanation for this disproportion to date. 3) Shelly Nortz, Coalition for the Homeless, suggested that KL is being used to effect the hospital discharge process. She noted that the New York/New York program met this need without using court orders. The program served well over 10,000 homeless mentally ill adults with dramatic results. For the record, Clarence Sundram, former head of the Commission on Quality of Care, noted in 1999 that "Coercion is needed, but to enforce laws already on the books that are routinely disregarded with impunity, either because of the scarcity of resources or because of conflicting pressures." 4) It should be noted that Julio Perez, who attacked speaker Edgar Rivera in 1999 causing the amputation of his legs, had tried to get help just before his violent act. Five hours before the attack, Perez went to the emergency room of the Veteran's Administration Hospital, the police headquarters, and the criminal courts building, saying that his enemies were following him. Times reporter Nina Bernstein wrote (6/28/99): "Each sent him to another part of the same disjointed system that had been shuttling him between hospitals, jails, shelters and the streets of New York since 1995." The Times said Perez had tried to get medicine, but his Medicaid card had expired. Our records show that when a rare violent act by a person with mental illness occurs, often the person has been recently denied a voluntary request for help. 5) Hannah Craven, a NAMI-Metro member (not representing NAMI), limited her testimony to statistical errors and confusion in OMH's report of March 2005 on KL performance. Craven submitted an analysis of OMH's questionable figures and requested that these be corrected before the law reaches a vote. 6) Medication is the cornerstone of every court order under KL. The testimony of Eileen McGinn, MPH, a family member, names three assumptions that, if true, would support compulsory medication. The assumptions are: that psychotropic drugs are effective, that they are safe, and that people stop taking them for inappropriate reasons. In an extensive review of clinical trials, McGinn found these assumptions to be blatantly untrue. KL gives a false sense of security about medication that endangers the health of court-ordered patients who have little autonomy. Medication choices are a trial-and-error process where mistakes can be fatal, and medication monitoring requires doctor and patient to work as a team. Just before KL passed in 1999, a man diagnosed with schizophrenia died in Albany's jail from negligent mis-medication and restraint. The man, Gregory Lee Richardson, was In jail for traffic-related incident. A law to prevent such atrocities, "Gregory's Law," did not move forward however. Return to top __________________________________

News Article Source: The NewStandard, http://newstandardnews.net/ Law to Force Mental Illness Treatment Raises Ire of Civil Libertarians by Michelle Chen With no easy way to approach mental illnesses sufferers who do not seek out treatment, critics say a codified system of coercion may cause more problems than it solves as well as violate patients' rights. New York City , Apr 15 - People are typically willing to accept a doctor's advice, but the mental health community has long struggled with the question of what to do when a mentally ill person refuses treatment. One controversial response is a system that orders some mentally ill people into psychiatric treatment, whether they want it or not. Under "Assisted Outpatient Treatment" (AOT), the doctors' orders come by way of a judge. This month, advocates for the mentally ill are speaking out about Kendra's Law, New York State's AOT initiative. Supporters of the law, who advocate making it permanent when it expires in June, believe the measure is an effective means of preventing harm to psychiatric patients and others. But critics say the law violates basic civil liberties and deflects attention from deeper problems plaguing the mental health system. Advocacy groups have contended that the negative side effects of forced treatment include a deepening of the stigma surrounding mental illness, a disproportionate impact on minorities, and the system's increasing reliance on coercion at the expense of voluntary treatment methods that are comparably effective. Kendra's Law was passed in 1999, partly as a response to the death of Kendra Webdale, a young woman who was pushed into the subway tracks by a schizophrenic man. The state legislature reacted to public fears by mandating psychiatric care for severely mentally ill people who, in the view of a civil court, pose a public safety risk. Currently, 36 other states and the District of Columbia have statutes to order "resistant" mentally ill people into treatment, according to the Bazelon Center for Mental Health Law, a public interest law group specializing in the rights of the mentally ill. Five years on, many still doubt whether Kendra's Law really benefits either the patient or the public. At a recent State Assembly hearing on Kendra's Law, New York City Councilmember Margarita Lopez testified that in light of recent cuts to community-based voluntary treatment programs, it would be misguided for legislators to "put more money in a program that is … about nothing else than taking away personal freedom." David Gonzalez, a peer specialist at the Mental Health Empowerment Project, a support group for mental health consumers and survivors, gave a patient's perspective of forced treatment when voluntary treatment is in short supply, commenting ironically, "[If] I seek treatment voluntarily, I'm denied services, but if I'm willing to forfeit all of my constitutional rights, I can get all the treatment I want." Also in attendance were family members who told stories of their mentally ill children's progress under court-mandated treatment and implored legislators to renew the law to keep their children from relapsing. Ione Christian, president of the National Alliance for the Mentally Ill of New York State (NAMI-NYS), dismissed the opposition's view that "taking someone to court who hasn't done anything criminal is wrong.… This law in particular is designed not to punish but to help." Both sides agree that too many people needing mental health services are neglected by the system. The political and scientific rift centers on the question of how best to meet these treatment needs. From Coercion to Commitment What troubles many mental health advocates is the law's vaguely defined target population: a subgroup of the mentally ill population that supposedly lacks the capacity to engage in a "necessary" course of treatment. The criteria for AOT eligibility under Kendra's Law include whether a mentally ill adult "is unlikely to survive safely in the community without supervision"; has "a history of non-adherence with treatment" leading to hospitalization, incarceration, or violence; and poses a risk of future "physical harm" to self or others. Among those who can initiate AOT petitions are relatives, roommates, treatment providers, hospital officials and parole officers. If a civil judge orders treatment, the AOT program administration develops a treatment plan for the patient and assigns a case manager. AOT program coordinators have the authority to prescribe a particular medication, commit the patient to a certain housing facility or require regular drug testing. A patient who refuses to comply with any part of the plan could be forcibly removed by police to a hospital for a 72-hour "medical observation." According to data released by the New York State Office of Mental Health (OMH), to date, the law has led to investigations of roughly 11,000 people and produced more than 4,000 court orders. The OMH's five-year report on Kendra's Law cites improvements in the mental health of AOT patients. According to the reports of case managers, after six months, the percentage of patients surveyed who demonstrated "good adherence to medication" rose from 34 percent to 69 percent. Criteria like maintaining personal hygiene and preparing meals also saw gains. In the two pages of a 64-page report dedicated to evaluating the opinions of treatment recipients, the OMH stated that of the 76 outpatients interviewed, approximately 60 percent reported that "all things considered, being court-ordered into treatment has been a good thing for them." Derick Adams, a patient currently on an AOT plan following a hospitalization, acknowledges that his treatment has been helpful, yet he does not believe his case demonstrates the benefits of coercion. Stating his opposition to the renewal of Kendra's Law before NY State Assembly members, he testified that the court order had little to do with his recovery. Adams said that as long as he complied with the treatment for his schizoaffective disorder, the court order itself was "like nonexistent" to him. To benefit from intensive treatment, he said, "you don't need to be coerced." The reason he objected to AOT, he said, was that the coercive element of his treatment plan, if anything, hindered his progress. He recalled that when he progressing rapidly under treatment, AOT administrators tried to hold him back. He clashed with his treatment providers over whether he was ready to move forward with a training program to be a mental health caseworker. As the expiration of his treatment plan approached, his team of treatment specialists pushed to have it extended against his wishes. With the help of a lawyer, he negotiated to have his sentence reduced to a "voluntary" status, though he said his treatment regimen has basically remained unchanged. Adams distinguished between the positive aspects of therapy and the court mandate itself, saying that the program operates with "a good purpose. But it's mental slavery, now." Weighing the Carrot against the Stick AOT supporters focus not on the coercive aspect of the law but on its ability to make limited services more available to those who need them. Riding on Kendra's Law as it glided through the legislature in 1999 was an unprecedented infusion of funding into the mental health system: $125 million for case management programs to help facilitate AOT, along with $32 million to cover the administration of the law and medications for court-ordered patients. Even those who criticized Kendra's Law on principle welcomed the funding influx, especially considering that aside from the AOT initiative, the Governor has allowed billions to be slashed from the mental health budget. Mary Zdanowicz, executive director of the Treatment Advocacy Center, a national organization that lobbies in favor of AOT legislation, believes that rather than oppressing the mentally ill, Kendra's Law codifies the "responsibility of the government to care for people that aren't able to care for themselves." In 2004, the New York State Court of Appeals ruled that "the state has a compelling interest in preventing emergencies and protecting the public health" through coerced treatment under the law. Jeff Keller, director of NAMI-NYS, believes AOT strengthens accountability for both service providers and patients. Responding to the argument that AOT undermines civil liberties, Keller asked, "What are you fighting for? … The right of the individual to recover from the illness, or the [right of the] illness to basically maintain control of that person's mind and life, and probably eventually kill that person?" The Ethical Paradox of Forced Care Critics of AOT have a different view of the role personal rights play in an individual's recovery. Civil rights lawyers and mental health advocates across the country argue that Kendra's Law mistakenly defines an impaired awareness of mental illness as a lack of "legal competence," a relatively conservative standard by which courts determine decision-making capacity. Coerced treatment to preempt future harm, said Michael Allen, legal counsel at the Bazelon Center, "really amounts to 'We know better than you do.' And that's not the standard that the Constitution requires for substituted decision-making." He added that Kendra's Law also endangers confidentiality principles because case managers must report on patient progress to the AOT administration. "It ought to be a very rare occasion when the power of the state is mobilized to do this to someone," said Allen. Technically, Kendra's Law enables the patient "to actively participate in the development of the treatment plan." But Dennis Feld, a lawyer with Mental Health Legal Services, which represents petition subjects in nearly all hearings, said that in his experience, patient input is "minimal," since "for the most part, the plan's already in place" before the patient is consulted. Another supposedly protective provision of the statute calls for the "least restrictive" means of treatment, opening an opportunity for a willing subject to engage in treatment on a voluntary basis. But Feld said that often AOT administrators seek court-mandated treatment whenever possible, perhaps viewing it as a form of "risk management." He estimated that in roughly 20 to 30 percent of cases he has observed, people request voluntary instead of mandatory treatment. But according to Feld, local AOT representatives tend to override such pleas and pressure the judge to issue a court order anyway, claiming these individuals "really don't have … the judgment or the commitment to carry it through." Feld also noted that some patients for whom coercion might not be necessary submit to a court order anyway, fearing that AOT is their only means for accessing high-demand outpatient services. In this case, said Feld, all three parties -- the petitioner, the patient and the judge -- often see "a need to fudge it a little bit, because otherwise the person may not get the services they need." And for patients seeking a way out of a psychiatric hospital, agreeing to AOT as a condition of their release may be their only option. Ron Bassman, a psychologist affiliated with the National Association for Rights Protection and Advocacy, a mental health advocacy group, said the irony of Kendra's Law is that "you move to the top of the list to get services, but you're also … in a kind of prison that you carry around in a can." Compassion or Criminalization? Although Kendra's Law professes to be "compassionate, not punitive," any court-ordered treatment, in Allen's view, "conveys to the public that these people are damaged, dysfunctional, dangerous â€" 'better that you get them away from you and me.'" In testimony gathered by the Mental Health Empowerment Project, a peer advocacy group, one patient complained of being trapped in the system. Although she claimed she has never been violent, in the AOT bureaucracy, she said, "there is no way to prove that." Reflecting on two years of forced treatment, she added, "The worst thing is not being free, not having the privacy I deserve -- that my future is determined by things I have no control over." Pointing to glaring racial disparities among court-ordered patients, New York Lawyers for the Public Interest (NYLPI) has charged that Kendra's Law is both unjust in its statute and biased in its implementation. From 1999 to 2004, Blacks and Hispanics constituted 42 and 21 percent of all court orders respectively, while they make up just 16 percent and 15 percent of the state's general population, according to 2000 census data. NYLPI attorney John Gresham also noted that the mental health system generally reflects this demographic pattern. According to the 2003 statewide mental health patient survey, the adult population identified as "severely and persistently mentally ill" is roughly 24 percent black and 17 percent Hispanic. Gresham thus argues that beyond Kendra's Law, there seem to be "significant problems with the way the mental health system serves people of color." For Zdanowicz, of the Treatment Advocacy Center, however, the racial data does not detract from her belief that AOT is improving lives. She argued that if the treatment imposed on people of color is "helping to make these individuals more likely to be able to get and hold a job. … Why would you complain about offering that to any population?" Gresham is less optimistic. "Whatever is wrong here," he said, "we shouldn't be trying to remedy it by disproportionately taking away the freedom of people of color." Isolating the Variable in Court-ordered Treatment Numerous studies associate AOT with positive treatment outcomes, but according to the opposition, the research is based on questionable science and does not vindicate the use of force. In an overview of clinical research on involuntary treatment, the policy think tank the RAND Institute determined that overall, there is still no concrete proof that court orders per se lead to better treatment. Improvements in patients, said researchers, correlate most strongly with "enhanced services and enhanced monitoring" in treatment, not coercion. Opponents also question the public safety rationale behind AOT, pointing to scientific evidence that the mentally ill are no more likely to be violent than the general population, and to the OMH's own data, which indicates only 15 percent of surveyed AOT patients were reported to have "physically harmed others" in the three months preceding the order. Ron Bassman had a first-hand look at the science underlying Kendra's Law as a researcher with OMH from 1999 to 2005. When the legislation was still in its infancy, he told The NewStandard, he sought to design a study to evaluate the effects of coerced treatment. But he reports that OMH officials frustrated his effort, demanding final say over how the results would be presented. To date, Bassman said, the government has "never conducted adequate research … to look at the efficacy and the value of the law." Critics say a good system would not require force Opponents of AOT say that many of the "noncompliance" issues among the mentally ill might be due not to a given patient's disease but rather to the current system's failure to meet people's needs. Harvey Rosenthal, a former psychiatric patient and executive director of New York Association of Psychiatric Rehabilitation Services, called Kendra's Law "an unjust and poor replacement for the real answer, which is to improve our services and to make them more responsive and more engaging and more flexible." The Corporation for Supportive Housing (CSH), an organization that advocates for "assisted living" housing projects across the country, looks for ways to inspire, not coerce, a commitment to treatment. CSH programs combine housing with intensive therapy. The group supports urban housing projects that engage an underserved group similar to one of AOT's target populations: homeless individuals, largely black and male, who have battled with mental illness, drugs, and incarceration. Carol Wilkins, director of inter-governmental policy at CSH, said the success of supportive housing shows that the mental health system lacks not coercive authority, but programs "that are really individualized … and really start by addressing people's basic needs, like a place to live." One study on specialized housing programs in New York City, comparing the two-year periods before and after placement, found that in the sample populations studied, the average number of days spent in state psychiatric hospitals fell by nearly 60 percent, and the drop in incidences of incarceration was five times greater than the decline in a control group. People under Kendra's Law AOT orders also experienced dramatic reductions in homelessness and hospitalization, according to OMH data. But unlike Kendra's Law, supportive housing programs are offered on a completely voluntary basis, and in New York City, retention rates have been reported at more than 75 percent one year after placement. Drawing from her experiences with supportive housing clients, Wilkins reflected that coercive mental health programs tend to push people away because they "require people to give up a degree of autonomy, and dignity, and control over their own lives that is not acceptable." To proponents of Kendra's Law, what is unacceptable is that the state should be barred from imposing what they view as treatment in order to serve the public interest. Many opponents, meanwhile, are unwilling to accept anything short of the broadest possible protection for self-determination of the individual patient, which they believe is the crux of any effective treatment. At the State Assembly hearing, recalling her days as a mental health outreach worker, City Councilmember Margarita Lopez reflected, "Help cannot be forced on people. Help has to be accepted." © 2005 The NewStandard. -------------------------------------------------------------------- Return to top

NYAPRS' Public Testimony on Kendra's Law at Recent Assembly Hearing   NYAPRS Note: Following is testimony given on behalf of NYAPRS at the April 8 Assembly Public Hearing on Kendra's Law  in New York City that was co-chaired by Assembly Mental Health Committee Chairman Peter Rivera and Codes Committee Chair Joseph Lentol. Look tomorrow for a posting of testimony given by David Gonzalez of the Mental Health Empowerment and co-chair of the NYAPRS Cultural Competence Committee.  Testimony Before the NYS Assembly Codes and Mental Health Committees Public Hearing on Kendra's Law, April 8, 2005   New York Association of Psychiatric Rehabilitation Services Presented by Harvey Rosenthal, Executive Director On Behalf of NYAPRS Members and The NYAPRS Public Policy Committee Co-Chairs:  Ray Schwartz, Vuka Stricevic   NYAPRS Board of Directors Steve Miccio, Lenora Reid-Rose, Co-Presidents; Donna Colonna, Josh Koerner, Vice Presidents     Thank you, Chairman Rivera and Chairman Lentol and the other members of the Codes and Mental Health Committees for this opportunity to present to you the concerns of the thousands of New Yorkers represented by the New York Association of Psychiatric Rehabilitation Services, a unique statewide partnership of New Yorkers with psychiatric disabilities and the community mental health professionals who support them in over 160 community mental health service settings from every corner of the state.   I'm Harvey Rosenthal, NYAPRS Executive Director and with me today is the Co-Chair of the NYAPRS Cultural Competence Committee David Gonzalez, who is affiliated with the Mental Health Empowerment Project.   The following testimony that we will present incorporates the direct input of almost a thousand NYAPRS members who gathered at local forums in New York City, Long Island, Elmira, Poughkeepsie, Olean, Elmira, Syracuse, Watertown, Glens Falls, Buffalo and Rochester during the last two months.    After decades of being represented by others, New Yorkers with psychiatric disabilities are at long last speaking for themselves in support of their personal recovery, rehabilitation and rights.            As you can see, state mental health policy is a very personal matter for the NYAPRS community. David and I, along with many of our Board members and regional leaders all share a common personal journey of recovery from a psychiatric disability.   I think it is also important to state here at the outset that we are not a group of extremists, who challenge the existence of a psychiatric disability or want to take down the mental health system. Quite to the contrary, we have worked together, often in tandem with groups like NAMI, to push for better services, services that are adequate, appropriate and responsive to the needs of New Yorkers with psychiatric disabilities.    You will find that we do not disagree about the chief cause of the problem we are here to discuss today, the failures of our statewide and local mental health service systems to adequately engage and serve all of us, including those who are sometimes labeled as the 'hard to serve.'  We simply and unequivocally disagree about the solution.   Over the past decade, the debate over the justness and the actual impact of the use of court-ordered outpatient mental health treatment has emerged as one of the most contentious controversies in our mental health system. All too often, it has created great divides and left us with a damaging disunity among consumer and family advocates, community mental health providers, and state and local mental health officials.   At the same time, all four of these groups have shared the same concern, seeking the reform, reconfiguration and increased responsiveness of community mental health services systems that the President's New Freedom Commission on Mental Health found were 'broken,' fragmented and 'n shambles.'   In New York State, among the most heartbreaking casualties of this broken system was the tragic death of Kendra Webdale at the hands of Andrew Goldstein. Our hearts were broken by this horrible tragedy, and all of us have marveled at the great courage of the Webdale family in their efforts to seek system changes that might spare such tragedies in the future.   Sadly, one of the most prominent 'reforms' that many states have adopted is the rise in the use of involuntary outpatient treatment (IOC), euphemistically re-named 'Assisted Outpatient Treatment' in New York. This move has been largely borne out of the great despair and desperation experienced by our family movement, and fanned by the disinformation machine that is the Treatment Advocacy Center.   TAC typically swoops into states on the heels of a tragedy, inaccurately plays up the connection between violence and psychiatric disability and, in doing so, sets us back many years in our common fight against public stigma and prejudice.   What's the result of their approach? Public policy being made from outrageous headlines in the New York Post and Daily News about the wackos, psychos or lunatics who should never have been released from the antiquated state mental hospital system that dominated the care of the 1950's. Under those circumstances, you wind up with public policy that is derived more from political fears of being too 'soft on crime.' In fact, for many at the time it was originally passed, Kendra's Law was not seen as a mental health initiative but a public safety measure. And so you wind up with mental health policy that is developed by lawyers and politicians, rather than qualified experienced mental health treatment experts.   Involuntary outpatient commitment approaches are based on three false premises:   o      People with psychiatric disabilities are so violent that a forced treatment program is necessary to protect the public. A 1998 MacArthur Foundation study showed that we are no more violent than the general public except when we, like they, abuse alcohol and drugs. TAC has touted distorted 'research' falsely claiming that over 1,000 murders a year are committed by Americans with 'severe mental illnesses.' In reality, a recent study found that our group is 2ï¾½ times more likely to be the victims of violence.   o       People with psychiatric disabilities are frequently so sick that they can't understand their need for care, leading to avoidance and noncompliance. All too often, people seeking help are either rebuffed by an unresponsive system as both the NYS Commission on Quality of Care for the Mentally Disabled and the New York Times found in an investigation surrounding the case of Andrew Goldstein. All too often, people we are trying to help find that, in seeking that help, that the acceptance of a mental illness leads to a life of stigma, poverty social isolation and sexual dysfunction, and/or an experience of mental health services as dehumanizing if not demeaning. We have long tended to view patients' rejection of our services as their 'noncompliance' and not our responsibility to provide better services in an environment that promotes respect, dignity, hope and flexibility.   o      Forced treatment works. A three-year study at Bellevue Hospital that compared the impact of providing an enhanced, better-coordinated package of services with and without the use of a coercive mandate found no difference in rates of improved outcomes, yielding the conclusion that people do better when they are offered better services, not because they are forced to accept them. New York Citys Pathways to Housing program has achieved an 85 percent retention rate with a group found to be among the 'hardest to serve,' and has done so without requiring medication compliance or abstinence and by offering a harm reduction approach with access to housing and round-the-clock support.   Nonetheless, over the heated objections of a broad coalition of consumer, provider and patient's rights groups, New York's governor and state legislature approved 'Kendra's Law' in 2000, authorizing the use of forced outpatient treatment orders.   The state legislature is considering proposals to make the law permanent and to boost the use of coercion. Much of the justification for this is the conclusion offered by recently released research conducted by the New York State Office of Mental Health (OMH) and touted by our otherwise regular advocacy partners at the National Alliance for the Mentally Ill (NAMI-NYS) that the program has been an overwhelming success.   Once more, advocates have joined to object to a renewal of forced treatment, based on the following findings:   o       Faulty research. The OMH research is based almost entirely on the opinions of case managers and, worse, fails to qualify as adequate research because it fails to provide a comparison with a control group of those who received a voluntary package of similarly improved, well-coordinated services, including housing and case management.   This is in stark contrast to research released in 1999 by Policy Research Associates on a more appropriately constructed demonstration program of forced treatment that was operated out of Bellevue Hospital for a three year period. The study measured the impact of a program of improved services alone and one that offered improved services in combination with court orders.   The study found that both groups improved at the same rate, yielding the conclusion that it was the improved services, not mandated care, that produced improved mental health outcomes.  To quote the study's findings 'Force had no effect on improving outcomes' and 'There was no justification for the introduction of a coercive program of involuntary outpatient commitment.'   The study went on to conclude that if the program does indeed support improved client outcomes, it appears that those are due to the efforts of the program's Coordinating Team in the "mobilization, coordination and follow up" of an "enhanced" package of services that were delivered in a climate of "ongoing and flexible negotiations." It emphasized that due perhaps to the "tenacious follow up" and the "heightened sense of accountability extended by the Coordinating Team", the program largely served to make available to its participants a more adequate array of community-based services delivered by more responsive and accountable service providers.   This research, it must be said, is also in stark contrast to that presented today by NAMI-NYS, research that was culled from interviews with 20 selected families and 40 NAMI local representatives.   o        Most counties have made significant improvements without relying on court-ordered care.  According to the most updated OMH statistics, 4/5 of those individuals who have been recommended for court ordered care were either found to be inappropriate for forced treatment or were successfully engaged on a voluntary basis.   And once you take out New York City's 3,000+, which represents over ï¾¾ of all court orders, most counties have been far more successful in engaging individuals with severe psychiatric conditions without the use of forced treatment.   For example, 13 counties have not produced even 1 court order: Clinton, Cortland, Essex, Franklin, Hamilton, Herkimer, Lewis, Oswego, Greene, Allegany, Livingston, Ontario and Yates. 12 counties have produced 2 or less forced treatment orders: Cattaraugus, Chemung, Genesee, Niagara, Tioga, Schoharie, Sullivan, Cayuga, Chenango, Delaware, Madison and St Lawrence.   And, this pattern of serving people in a non-coercive manner is not just the province of upstate counties. New York City has produced 3,017 forced treatment orders of a statewide total of 3,958. It has ultimately backed orders for 3 out of every 5 investigations; in contrast, Onondaga County (Syracuse), has only sought court order for 1 out of every 12.   What does it tell us about how some counties are comparatively better at engaging people voluntarily while others, most notably New York City, are not? We must examine carefully how and why it is that the vast majority of local mental health service systems have been able to successfully engage some individuals with high needs without a systemic reliance on forced treatment.   o       Most court orders have been used to link nonviolent individuals with priority access to scant services. Must we rely on courts and cops to make our system more responsive and more accountable? While Kendra's Law-related court orders were originally presented as a means to contain people who commit random acts of violence, that is not how it is actually used. It is in fact used mainly on people who have been hospitalized more than once. The state's own figures indicate only 15% of the people subject to orders had done any kind of physical harm to others in the period prior to the orders - which means that 85% had not. Further, OMH's research indicated that 41% showed 'good' engagement in services prior to consideration for a court order.   The truth is that localities that are turning to court orders are using them primarily to get individuals with 'high needs' to the 'front of the line' for scarce services and housing, services that remain scarce despite almost $150 million in new housing and mobile treatment initiatives introduced by the Governor in 2000 and re-authorized this year by the Legislature.   o       Forced treatment unjustly violates people's rights and erodes their faith in the service system. Name another group, other than contagious TB patients, who can be ordered into care based on a doctor's prediction that they might cause or come to harm. Forced treatment unfairly and unacceptably singles out people with psychiatric disabilities.   And not only does coercive treatment violate their basic human rights, but the research has made clear that it all too often has the opposite effect of driving people away (59% of respondents to a California survey) from the treatment this law is aimed at helping them to accept. What are the treatment costs in lost trust by clients who know that those treating them will turn them in if they do not 'comply'?   o       In fact, coercive treatment should be viewed as a system failure. Rather than celebrating the advent and use of coercive mental health care in New York, we must instead view every court order as both an individual treatment failure and as system wide failure of our service system to properly engage and serve individuals with high needs.   o       Forced treatment orders are predominantly levied at people of color. A particularly disturbing finding from the OMH research is that almost two out of every three court orders have been levied at people of color, namely African- Americans and Hispanics. What does this outrage tell us about the adequacy of our community mental health service system in properly serving people of color? Why is has the treatment of choice for people of color been coercive, delivered through disproportionate use of court orders or, even worse, disproportionate dispositions into scandalously inappropriate incarcerations in our county jails and in our state prisons, where people of color with psychiatric disabilities make up the greatest proportion of those inmates who are committed suicide in outrageously inhumane confinements in 23-hours-a-day-in-the-dark solitary confinements in the Box, the term for special housing units (SHUs).   In closing, there is simply no proof to make Kendra's Law permanent or, worse to strengthen its authorization for coercive outpatient treatment.  There is no proof that people with severe psychiatric disabilities are more violent, no proof to therefore to suggest that this initiative is an effective public safety measure, no proof that court orders, rather than more responsive, more accountable, better coordinated and funded services, have created the improved outcomes we have heard presented today and no proof that those counties that have foregone the use of court orders and focused instead on such improved care should be considered innovative and progressive and not 'negligent.'   In fact, the only incontrovertible truth we can agree on is which group has been the greatest target of court mandated care and that is people of color and that is dead wrong.   And there is proof that innovative service models that operate right here in New York City can successfully and cost-effectively engage 'hard to serve' individuals without the use of any force&but by simply responding to people's actual stated need&.a safe place to live, some decent food to eat, and some friendly people to provide some comfort and support.   The NYS legislature cannot and should not remove itself from its current oversight authority that allows New York to make responsible public policy based on adequate research data. At minimum, we call on you to resist efforts to make this legislation permanent unless and until adequate proof is provided.   Someday, people will look back at our use of forced outpatient treatment and will wonder why we were so incapable of providing the right kind and level of accountable, appealing and effective services that we fell to the desperation that is driving the use of IOC.   In the meantime, we believe that, at a minimum, the New York state legislature has the responsibility, in the face of unconvincing research and discriminatory implementation, to reject calls to make Kendra's Law permanent or to strengthen its reliance on forced treatment.   We urge the state Legislature to not surrender its appropriate, careful oversight over the highly controversial use of coercive mental health care. We urge you to continue to require ongoing reports until all of these questions we raise today are satisfied.   Thank you for the much appreciated opportunity to address you today. This 'Mental Health E-News' posting is a service of the New York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of people who use and/or provide community mental health services dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights. ________________________________________________ Return to top

David Gonzalez Delivers Public Testimony on Kendra's Law Testimony Before the NYS Assembly Codes and Mental Health Committees Public Hearing on Kendra's Law, April 8, 2005 by David Gonzalez  Mental Health Empowerment Project Co-chair, NYAPRS Cultural Competence Committee   As a consumer/survivor, what concerns me most about Kendra's Law is the blatant disparity in the racial and ethnic make-up of the people being court mandated.   I speak to this panel from my own experience - not only as a person who has been hospitalized both voluntarily and involuntarily - but as an American citizen of Hispanic descent who has experienced the 'catch 22' of being turned away when I voluntarily sought treatment.   In 1995, the last time I was hospitalized, I was severely depressed and suicidal. I knew that I was in desperate need of help and just like Andrew Goldstein I frantically sought services at every hospital accessible to me. And just like Andrew Goldstein I was turned away by every hospital I went to for help.   Unlike, Andrew Goldstein, however, who was turned away 8 separate times, the thought of hurting another human being was not an option for me, so not surprisingly I did the only thing that seemed to make any sense at the time. I ingested a massive overdose of prescription pills and illicit drugs in a pathetic attempt to commit suicide.   Consequently, I began to experience visual and auditory hallucinations as a result of what was obviously a drug-induced psychosis. One of the last things I can vividly recall, as I lapsed into unconsciousness, was a friend dragging me into the backseat of his car.   As fate would have it I woke up two days later, with tubes dangling out of every orifice in my body, in the emergency room of the very last hospital I had gone to pleading for help. They finally admitted me, but only after death came knocking at my door.   To this very day I don't know what angered me more, my pathetic attempt at suicide, or a system that totally failed me!   Herein lies the irony:   According to OMH's Final Report on Kendra's Law, 63% of people being court-mandated under Kendra's Law are identified as Black and Hispanic.    So if I seek treatment voluntarily, I'm denied services, but if I'm willing to forfeit all of my constitutional rights, I can (supposedly) get all the help I need!   The OMH Report opens up with the following introduction: 'Kendra's Law was named in memory of Kendra Webdale, a young woman who died in January, 1999 after being pushed in front of a New York City subway train by Andrew Goldstein, a man with a history of mental illness and hospitalizations.'   The implication here is obvious. The question of violence and mental illness is as old as psychiatry itself. What most people don't know is that Kendra's Law is merely the culmination of old policies and old laws, which have been re-packaged under a new name. At one time these laws were passed to allegedly protect 'the mentally-ill' from themselves, today they are passed to allegedly protect society from 'the mentally-ill.' Which, by the way, have never worked, which is why we are sitting here today.   The reason why these laws had to be repackaged was because the constitutional rights of the person made it difficult to apply them. So in order to solve this problem, advocates of forced treatment latched onto Kendra Webdale's tragedy to convince the public that this was not an isolated incident, but the beginning of a terrifying new wave of crime - knowing full well that fear and emotion all too often override reason and rationale.   Allow me to quote a Daily News editorial released that very same year: 'In our newfound complacency, we have forgotten a particular kind of violence to which we are still prey. The violence of the mentally-ill.'(New York Daily News 11/19/99)   Ironically, in 1999 - the year Kendra's Law was passed - the Surgeon General's Report on Mental Health concluded that minorities:   o        have less access to, and availability of, mental health services o        are less likely to receive mental health services when needed   These findings were confirmed and validated in the Final Report of the President's New Freedom Commission on Mental Health in 2003.   So since the main thrust of Kendra's Law is to force people into treatment - regardless of whether or not they have a history of violence, which is borne out by the fact that 85% of people being court-mandated have no history of violence - is it any wonder that minorities who 'have less access to and are less likely to receive mental health services' become the target of this law?   The most widely publicized figure is that '1,000 murders a year are committed by Americans with severe mental illnesses.' And although this figure is not supported by any figures from the Department of Justice or culled from any studies conducted by impartial researchers, this self-admitted calculation made by the leading advocate of forced treatment is accepted as fact by the American public.   In contrast, according to a 1998 study by the MacArthur Foundation, individuals with mental illness are no more violent than the general public unless they're abusing drugs and alcohol, which applies across the board, whether an individual has a history of mental illness or not.   Once again, this finding was affirmed in 2003 in the Executive Summary of the President's New Freedom Commission on Mental Health, which states that:   '61% of Americans think that people with schizophrenia are likely to be dangerous to others. However, in reality, these individuals are rarely violent. If they are violent, the violence is usually tied to substance abuse.'   Am I saying that individuals with mental illness don't commit acts of violence? Absolutely not! To even suggest such a thing would be disingenuous and dishonset.   Am I saying is that individuals with mental illness are no more violent than the general public? Yes! That's exactly what I'm saying!!!   In fact, in August of 2003, Nicholas Regush, former producer of ABC's Nightline and World News Tonight with Peter Jennings, asked in his online column, Second Opinion:  "Where is the science that supports the need to use coercion so often when it comes to the treatment of patients, as opposed to, say, offering a wide range of community-based services? In all my research on violence for a book published several years ago, I had not seen one credible study showing that society has more to fear from patients labeled "mentally ill" than other people in the community. For example, there has never been any appropriate follow-up of patients that has determined whether the absence of treatment leads to violence. The very foundation of forced treatment is ideology and fear-mongering and not science."   Interestingly enough, nowhere throughout their 23-page report on Kendra's Law does NAMI quote any independent research. They openly admit that their research is based solely on discussions with a selected group of 20 families and 40 local NAMI leaders.   So the real question is: 'If it is true that individuals with a history of mental illness are no more violent than the general public, could this tragedy have been avoided?'   To find the answer to this question I ask you to consider the words of Andrew Goldstein himself the day he was arrested when asked by a reporter why he did it. His response to the reporter was:   'Do you think I can get some help now?'   One of the things that struck me the most about the OMH report is that while the report suggests significant positive outcomes from Kendra's Law, it totally fails to demonstrate what produced those outcomes: better access to services or court-mandated orders?   A three-year study at Bellevue Hospital compared the impact of providing an enhanced service package, with and without the use of mandated services, and found no difference in the rates of improved outcomes - suggesting that people do better when they are receiving better services, not because they are forced to accept them.   Allow me to conclude by pointing out the following quotes from two people who asked that their feelings about Kendra's Law be shared at this hearing. One of these people is a person who is court-mandated and the other is a provider who oversees court-mandated individuals:   Court-mandated individual:   'The AOT order states two things. 1. That I am a danger to self or others. And 2. That I would be unable to survive in the community independently. Neither of these statements is true, but there is no way to prove that. There was no evidence that I was violent but my future has been ruined.'   (Sidebar: in a criminal court of law, the defendant is 'innocent until proven guilty,' in a mental health court of law, the defendant is guilty until proven innocent.' DG)   Provider who oversees court-mandated individuals:   'AOT robs individuals of their self-determination and creates an atmosphere of distrust between the consumer and the provider. It sets the providers against the very people they serve. It engenders what I refer to as 'Big Brother' anxiety.'   In closing, I'd like to suggest that the solution to this problem is to keep the enhanced services portion of this law and to remove any form of coercion. The forced treatment aspect of this law is merely a diversionary tactic intended to deflect attention away from what started this problem in the first place, a fragmented mental health system. This fact is reflected throughout the whole report from the President's New Freedom Commission on Mental Health, which calls for a major overhauling of the entire mental health system in the United States.   Is it just a coincidence that this commission was called the President's New Freedom Commission?  And their report was titled 'Achieving the Promise.'   Does Kendra's Law truly achieve this promise? Source: 'Mental Health E-News' posting service of the New York Ass'n of Psychiatric Rehabilitation Services (NYAPRS) _______________________________________________ Return to top

"Kendra's Law, Not Ours" by John McManamy, Fall 1999 Source: McMan's Depression and Bipolar Web http://www.mcmanweb.com He begged for treatment, which they refused. Then the legislature turned around and passed a law calling for forced measures to treatment he may still have no access to. Confused? Read on. "On the day of the attack, he actually presented himself in the emergency room." A man in the crowd was acting strangely. Then, according to an article in the New York Times, he wheeled about and shoved Edgar Rivera, father of three, onto the tracks as the No 6 train screeched into Manhattan's 51st Street Station. The victim's legs were severed. Police arrested Julio Perez, 43, a homeless man with schizophrenia and a long history of violence. The event, which occurred on April 28, 1999 was eerily similar to another subway attack in January. In that case, Andrew Goldstein, a 29-year old with schizophrenia considered by those who knew him as gentle but weird, pushed Kendra Webdale, who dreamed of being a writer, to her death in a subway station. Starting from 1995, Julio wandered the streets of New York City, shuttling back and forth between homeless shelters, mental institutions, the streets, and outpatient clinics. In February 1999, he began experiencing paranoid delusions which escalated in March and resulted in his eviction from a shelter. Although a caseworker recommended that Julio be hospitalized, this did not happen. Two weeks before the subway incident, Julio called a friend, panic-stricken because he needed medicine and his Medicaid card had been canceled. Two days before the attack, he again called his friend, saying he wanted to go into a hospital, but he failed to make a planned rendezvous. On the day of the attack, he actually presented himself in the emergency room of a VA hospital, and later that day appeared at a police station and a courthouse to file a complaint against his "enemies". Then he made his final stop. Andrew's story is not far different, notwithstanding more promising beginnings. He graduated from a New York high school for gifted students, despite early signs of schizophrenia. His illness intensified during college and he was admitted to a state-run hospital in Queens. Eventually he settled into a small basement room. According to fellow tenants, he would fail to take his medications, which left him disassociated and lethargic, with stiff muscles. Newer antipsychotics do not have these severe side effects, but they are more costly. Andrew's records revealed a classic case of "slipping through the cracks" in the system, of a desperate person begging and being denied the care he needed and ultimately winding up on the streets untreated and without supervision. A state report noted that Andrew, as well as his mother and social workers, repeatedly tried to get him supervised services, only to be turned away. Eighteen days after his last discharge he killed Kendra Webdale. But New Yorkers did not know that at the time. To them, he was just some crazy man who had refused to take his medications. The subway attacks resulted in a public outcry that ended in an "assisted outpatient treatment" measure called "Kendra's Law". The legislation authorizes judges to issue orders requiring people to take their medicine, regularly undergo psychiatric treatment, or both. Failure to comply could result in commitment for up to 72 hours. Prior to Kendra's law, a psychiatric patient had to be considered dangerous to be forcibly committed. Now, under the broad wording of the law, a patient could find himself before a judge for simply disagreeing with his psychiatrist. The law is one of the harshest forced treatment laws in the US. Some 39 states have "assisted outpatient treatment" laws on its books, but only three others are as severe as New York's. According to Governor George Pataki, as he ratified the passage of the legislation: "If [the mentally ill] refuse to accept needed treatment, we will act to protect all New Yorkers." He was joined by victim Edgar Rivera and Kendra's family. The Treatment Advocacy Center, which lobbied hard for the bill's passage, hailed the new legislation as "our first successful step in preventing the unnecessary suffering of individuals who are disabled by their illness but are unable to recognize their need for treatment". But Julio did not need someone else to make decisions for him. Up until the final hour, practically, he had been begging for treatment. In a state that has seen the population in its mental institutions shrink from 93,000 in the 1950s to 6,000 today without a corresponding rise in community care and outpatient clinics, there was simply no place for him to go. As for Andrew, access to the right medications might have made him compliant by choice. Access to community-based programs might have made a difference. Ironically, as a killer on trial, Andrew is now receiving the treatment denied him for so long. But the good people of New York weren't thinking about all that. The Julios or Andrews of this world will continue to "slip through the cracks." One or two might even throw themselves in front of a train, and believe me, unlike poor Kendra, no one in New York will be shedding a tear on their behalf. Postscript:  Nov 9, 1999 Last week a Manhattan jury failed to reach agreement on whether Andrew Goldstein was guilty of second-degree murder in the killing of Kendra Webdale or not guilty by reason of insanity. The case will almost certainly be retried. Update:  March, 2000 Last week a jury found Andrew Goldstein guilty of second degree murder, a penalty that carries 25 years to life, either in prison or in a psychiatric facility. Jurors who were interviewed after the trial thought that Andrew had a mental illness, but were convinced he had his wits about him when he pushed Kendra Webdale to her death. Violence Study A 2002 Duke University study based on 802 interviews has found that less than two percent of people with severe mental illness reported acting violently in the past year. However, that figure rose with respondents who had one or more of three "risk factors," including having been a victim of violence during childhood, living in a neighborhood where violence is common, and having a substance dependence problem. Those having two risk factors had a nearly 10 percent likelihood of violent behavior, and adding a third upped the risk to 30 percent. "If we're worried about violence among people with serious mental illness, we need to pay far more attention to finding safe housing in decent neighborhoods, mitigating the effects of physical and sexual victimization, and aggressively treating substance-abuse issues," said Marvin Swartz MD, one of the study's authors. End of article ________________________________________________ An online discussion about the above article is posted at its end: click http://www.mcmanweb.com/article-66.htm. Return to top

News Release Source: E-Mail from NYAPRS, May 2 CALL ALBANY TOMORROW TO OPPOSE MAKING KENDRA'S LAW PERMANENT Tomorrow (Tueday, May 3), upwards of a hundred mental health advocates who represent thousands more from across New York State are coming to Albany to advocate against forced outpatient treatment and, instead, to press for a more responsive and responsible mental health service system. The best way to do that currently is to convince NYS lawmakers to reject current calls to make Kendra's Law permanent and, instead, to extend the legislature's oversight powers for several more years. During that period, as the largest implementer of the program, the NYC Health and Hospitals Corporation, has urged, the state would be required to produce better research aimed at truly, scientifically, demonstrating whether more and better services or forced treatment initiatives will best help our most needy, while at the same time reassuring a frightened public. And it can use that same time to further invest in the creation of a more responsive rehabilitation and recovery-based system of care.  There's still time to make arrangements to come join us tomorrow: we'll be gathering in front of the Legislative Office Building in Albany at 10:30 am, conducting a noon press conference and spending the afternoon meeting with legislators and staff: call NYAPRS at 518-436-0008 for more details. For those of you who want to see better services delivered in a just, humane and voluntary fashion but who can't join us, you can show your heartfelt support by making 4 calls to key state legislative leaders tomorrow, as detailed below. Don't be silent in the face of forced treatment: there are those who, out of their own despair over our unresponsive mental health service system, are seeking to increase the specter of force across the state. To be silent...to be passive..in the face of these false solutions is to give away more of our rights, our respect and our dignity. Call Albany tomorrow...and ask as many of your peers, colleagues, friends and family members as you can to do the same. We all want a better mental health service system....one that's not 'broken' or fragmented as the President's Commission has suggested. Let's stand up for one that is truly responsive...and that doesn't have to rely on court mandates to prod state and local governments and community agencies to do their very best. Call Albany to make sure we get better services...not court mandates that provide a very small group with access to scant community housing and supports, while thousands more continue to wait for real permanent solutions. Stand up for reform, responsibility and respect and for recovery, rehabilitation and rights and come to or call Albany tomorrow.    Mental Illness is not a Crime!   COME TO ALBANY  TOMORROW MAY 3RD   Speak Out Against Forced Outpatient Treatment!  Oppose Efforts to Make Kendra's Law Permanent!   -------------------------   MAKE A PHONE CALL Join Rights Advocates from Across the State Tomorrow and Call the 4 Key Decision Makers!   Assembly Speaker Sheldon Silver at 518-455-3791   Assembly Mental Health Committee Chair Peter Rivera at 518-455-5102   Senate Majority Leader Joseph Bruno at 518-455-3191   Senate Mental Health Committee Chair Thomas Morahan at 518-455-3261   and leave the following message:   Serious questions have been raised about Kendra's Law. I'm a registered voter from (your locality) calling to urge you to extend the legislature's oversight over Kendra's Law for 2 more years to get needed improvements and better research about the program's outcomes! � This 'Mental Health E-News' posting is a service of the New York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of people who use and/or provide community mental health services dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights. Return to top

News Release Advocates Assail Kendra's Law Reliance on Forced Treatment, Oppose Permanence Source: E-mail message, enews@nyaprs.org N E W S    R E L E A S E Advocates Urge Legislature to Extend Their Oversight Over Controversial Program and to Insist on True System Reform, Better Research   May 3, 2005    Contact: Harvey Rosenthal   518-436-0008   Mental health advocates from across New York State came to Albany today to call on the New York State Legislature to extend its oversight role over the next few years to revamp the state's implementation of Kendra's Law's highly controversial program of court-ordered treatment for many nonviolent individuals with psychiatric disabilities.   "We are urging the state Legislature to not surrender its appropriate, careful oversight over this nationally debated use of court ordered care and to continue to require the state to provide ongoing reports until all of the questions we raise today are satisfied," said Harvey Rosenthal, executive director of the New York Association for Psychosocial Rehablitation Services   A number of groups who testified at recent Assembly public hearings, including the state's primary implementer of Kendra's Law, the NYC Health and Hospitals Corporation, have urged the Legislature to extend its authority for an additional period and to seek more convincing research to support it.   Advocates have long maintained that the forced treatment program is unfounded, unjust and unnecessary, and one that has inappropriately transferred the responsibilities of state and local mental health authorities to the courts.   "We must stop making mental illness a crime," said Jack Guastaferro, executive director of the Restoration Society in Buffalo. "The real crime is in our current policy to drag troubled nonviolent individuals into court just to get them access to scant openings in local mental health services that the vast majority would accept voluntarily and that the state has a responsibility to adequately provide."   The coalition represented a broad alliance of mental health advocates, community mental health service providers, legal rights groups and, most significantly, New Yorkers with psychiatric disabilities.   A Watertown-based advocate who tragically lost her uncle to an attack by a homeless man who she said had been dumped out into the street from a psychiatric inpatient unit without proper supports nonetheless has strongly opposed the use of court ordered care.   "The young man who killed my uncle for his Social Security check so he could buy food and rent a room had been homeless without help for many weeks not because he chose to," said Elizabeth Patience. "Had he been released with an appropriate discharge plan that included medicines, appointments with therapists, housing and other life essentials that most of us take for granted, the outcome may have been totally different."   "Forced treatment is not the real answer; it should be replaced with better-coordinated community services and adequate funding for mental health programs," said Patience.   The advocates questioned the scientific reliability of a recently released report by the state Office of Mental Health that linked positive improvements in the health and lives of those served under the Kendra's Law program of enhanced service delivery and, for some, court ordered care.   "Calls to make Kendra's Law permanent rest largely on claims that the program has demonstrated a unique ability to reduce relapse and promote recovery among those served," said Lawrence Berg, former Columbia County Mental Health Commissioner and Director of the Law and Psychiatry Institute. "Yet, the state's study does not offer a comparison between those who received court orders and an enhanced service package with those who only received better services, so we don't know that court orders have anything to do with people's improvement."   "There is simply no proof to make Kendra's Law permanent or, worse, to strengthen its reliance on coercive outpatient treatment," said Venture House's Ray Schwartz. "But we have plenty of research that shows that innovative service models successfully and cost-effectively engage "hard to serve" individuals without the use of any force but by simply responding to people's actual stated needs.a safe place to live, some decent food to eat, and some friendly people to provide some comfort and support."   "Ultimately New York must reject legislation and public policies that fail to provide the real solutions by adequately funding appropriate, responsive service models we already know will work," said Rosenthal. "In the meantime, the legislature has the responsibility, in the face of unconvincing research and imbalanced implementation, to both reject calls to make Kendra's Law permanent or to boost its reliance on coercion and should cease making non-violent individuals subject to court orders." ------------------ Researchers, County Officials, Community Mental Health Service Providers, New Yorkers with Psychiatric Disabilities, Legal Rights Groups and Mental Health Advocates All Agree: Don't Make Kendra's Law Permanent, Require Better Research, Reject the Use of Forced Treatment in Favor of Voluntary, Compassionate, Innovative and Well Coordinated Services!   What Does The Research Tell Us: It's the Services, Not the Court Orders That Make the Difference! The Bellevue Study: A three-year study at Bellevue Hospital that compared the impact of providing an enhanced, better-coordinated package of services with and without the use of a coercive mandate found no difference in rates of improved outcomes, yielding the conclusion that people do better when they are offered better services, not because they are forced to accept them. The Rand Study: Proponents of Kendra's Law like to dismiss the Bellevue study's findings and to cite a Duke University they believe found involuntary outpatient commitment an effective intervention. Yet, a 2001 prestigious Rand study concluded that "the Duke study does not prove that treatment works better in the presence of coercion or that treatment will not work in the absence of coercion." NYS Office of Mental Health Report: The OMH research is based almost entirely on the opinions of case managers and, unlike the Bellevue Study, fails to provide a comparison with a control group of those who received a voluntary package of similarly improved, well-coordinated services, including housing and case management. While participants demonstrated impressive outcomes, no scientific proof is offered to show that this wasn't due to better service delivery, irrespective of court mandates.   Community Mental Health Providers Don't Seek Permanence, Engage Same "Hard to Serve" Groups Voluntarily with Equally Impressive Results, Favor Increased Resources over Force, Seek Voluntary "Right to Treatment"   Joyce B. Wale of the New York City Health and Hospitals Corporation, the state's primary implementer of Kendra's Law: HHC does not recommend making Kendra's Law permanent, seeking instead a 3 year extension to allow more extensive longitudinal research "to include a control and an experimental group in order to specifically determine the long range impact of court oversight" and that look at the impact of boosting a psychiatric rehabilitation-based models of recovery "that includes employment and educational goals and interventions care." HHC also believes studies that measure potential reductions in institutional care "should be used to determine whether the Legislature should permanently enact Kendra's Law." (NYS Assembly Public Hearing). Dr Sam Tsemberis, Pathways to Housing, New York City recently released new data that promoted an 80% service retention rate and general stability among a group of primarily young men of color with psychotic disorders and previous histories of homelessness and non-participation with services, the very same group of those who have been "incapable of living and maintaining treatment in the community" that Kendra's Law proponents would have us believe can only be served via court order. And he does this without mandating treatment adherence or abstinence but by offering "housing first" via a model that merges supported housing and ACT team services. Steve Coe, Community Access: "Do we really have to take away people's freedom to realize that the system is stretched beyond its capacity, and that when and if we add the right resources, clients WILL be better served by willing providers?"  Ray Schwartz, Venture House, New York City: "What works for some of the folks we see isn't a court mandate, but the power of Kendra's Law to essentially act as a "right to treatment" for those in need. People in need definitely need and deserve to have access to the services and supports they need to make a good transition into the community and to successfully pursue their recoveries. We need a law that holds government and providers accountable to serve those in need, and a fiscal policy that allows them to do that. All the court orders in the world won't change that."   Current/Former County Officials Favor Compassion Over Coercion, Moratorium on Court Orders, Redistribution of Funds for Services Nassau County Mental Health Commissioner Howard Sovronsky: "We must not lose sight of the fact that it is largely the availability and access to community-based services that has the greatest impact on our most needy citizens. It is the support and encouragement we provide that is the most valuable aid. It is compassion not coercion that must drive our system." (NYS Assembly Public Hearing). Former Columbia County Mental Health Commissioner and Director of the Law and Psychiatry Institute Lawrence Berg: "At the very least, New York should impose a moratorium on court ordered involuntary outpatient treatment. This will allow for a more complete evaluation of Kendra's Law that focuses on comparing the outcomes for people with mental illness who received enhanced outpatient services with those people who were mandated into outpatient treatment. Continued utilization of outpatient commitment orders may be clinically and personally counter-productive, financial costly and possibly unethical and in conflict with federal law under the Americans with Disabilities Act and the Supreme Court's Olmstead decision that mandated that states must serve people with disabilities, whenever possible, in the most integrated community setting, surely without coercion." (NYC Council Public Hearing). Margarita Lopez, Chairperson of the Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services, New York City Council: Kendra's Law is used disproportionately with New York City residents of color and that's wrong. Dollars currently used to support the Kendra's Law program should be spent instead on more and better community services. (Assembly Hearing)   New Yorkers with Psychiatric Disabilities Back More and Better Services  Over "Unjust" Use of Force Used Disproportionately with People of Color Elizabeth Patience, Watertown: "My uncle was killed when I was eleven by a homeless man that he befriended who had been dumped out into the street from a psychiatric inpatient unit without medication, counseling or any other community supports in place. The young man killed my uncle for his Social Security check so he could buy food and rent a room. This man had been homeless without help for many weeks not because he chose to. The system is to be blamed here for my family tragedy. Had he been released with an appropriate discharge plan that included medicines, appointments with therapists, housing and other life essentials that most of us take for granted, the outcome may have been totally different. Forced treatment is not the real answer; it should be replaced with better-coordinated community services and adequate funding for mental health programs." Isaac Brown, Brooklyn: "Forced treatment unjustly violates people's rights and reduces their faith in the service system. Name another group that can be ordered into care based on a doctor's prediction that they might cause or come to harm? Heather Laney, Buffalo: "Consumers have long been represented and spoken for by other people but are now speaking for themselves about how they want to be treated. Who would want to accept a diagnosis of mental illness, and the help that acceptance brings, if he or she believes acceptance leads to a life of poverty, isolation, broken relationships, and general stigma. How can we really be surprised that people reject the system as it is now? How can we not conclude that the solution is not more coercion but instead more compassion, understanding, integration, and dignity for all involved? Kendra's law seems like an easy answer. But it is an unjust and in the long run an ineffective one. People with mental health needs deserve treatment characterized by respect and dignity." (Assembly Public Hearing in Buffalo). Hannah Craven, Board member, NAMI NYC Metro: "I agree that Kendra's Law should mandate provision of services with no coercion." (Assembly Public  Hearing).   Legal Rights Groups Decry Human Rights Violation, Urge Nonviolent Individuals Should Cease to be Subject to Coercion John Gresham, New York Lawyers for the Public Interest: "Most court orders have been used to link nonviolent individuals with priority access to scant services. Must we rely on courts and cops to make our system more responsive and more accountable? Localities that are turning to court orders are using them primarily to get individuals with "high needs" to the "front of the line" for scarce services and housing. Only 15 percent of those under court orders have done any physical harm and 41 percent showed "good" engagement with services prior to consideration for a court order. Black people are almost five times as likely as white people to be subjected to orders and Hispanic people two and a half times more likely." Beth Haroules, New York Civil Liberties Union: "Kendra's Law violates the fundamental freedoms of competent, non-dangerous persons with psychiatric disabilities. We urge the Legislature to ascertain precisely why there appears to have been divergent racial, ethnic and geographic disparities in the implementation of Kendra's Law. And we urge the Legislature to examine a variety of alternative approaches to the compelled psychiatric treatment."   Advocates: Don't Make Law Permanent, Reduce Don't Increase Force Shelly Nortz of the Coalition for the Homeless: "Kendra's Law authorizes the forced treatment for an extremely broad spectrum, including those who pose no danger whatsoever. Relapsing, and possibly needing hospitalization really ought not to be the standard for allowing court orders for mental health treatment. If someone is hospitalized, are they at risk of being coerced into an outpatient commitment order as a condition of discharge, and is this what the legislature intended? The law gives the public a false sense of security at the very unfortunate expense of those who are forced into treatment when most would gladly accept the same services on a voluntary basis."An innovative voluntary community housing initiative, "New York/New York," has achieved an 88% compliance level and an average 83% reduction in re-hospitalization, incarceration and homelessness for over 10,000 homeless severely mentally ill adults, rivaling if not exceeding corresponding rates for those ordered into treatment under Kendra's Law. We strongly advise against extending the period of the initial court order to one year." (Assembly Public Hearing) Vuka Stricevic, Community Access: "We urge you to  restore the Constitutional protections foregone under Kendra's Law by ending the over-inclusive commitment of the non-violent mentally ill" and to continue to invest in community based mental health and remove the force from (the) statute." Jack Guastaferro, NYAPRS Executive Committee: "There is simply no proof to make Kendra's Law permanent or, worse, to strengthen its reliance on coercive outpatient treatment. There is no proof that people with psychiatric disabilities are more violent or to suggest that this initiative is an effective public safety measure, no proof that court orders, rather than more responsive, accountable, better coordinated and funded services, have created the improved outcomes OMH reports and no proof that counties that have favored improved voluntary care are "negligent." There is proof, however, that innovative service models can successfully and cost-effectively engage "hard to serve" individuals without the use of any force but by simply responding to people's actual stated needs, a safe place to live, some decent food to eat, and some friendly people to provide some comfort and support." Harvey Rosenthal, NYAPRS: "Someday, people will look back at our use of forced outpatient treatment and will wonder why we were so incapable of providing the right kind and level of accountable, appealing and effective services that we fell prey to the desperation that is driving the use of involuntary outpatient treatment. In the meantime, we must reject legislation and public policies that authorize the use of such force. At a minimum, the New York state legislature has the responsibility, in the face of unconvincing research and imbalanced implementation, to reject calls to make Kendra's Law permanent or to boost its reliance on coercion and should instead cease making non-violent individuals subject to court orders. We urge the state Legislature to not surrender its appropriate, careful oversight over the highly controversial use of coercive mental health care and to continue to require ongoing reports until all of the questions we raise today are satisfied." This 'Mental Health E-News' posting is a service of the New York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of people who use and/or provide community mental health services dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights. Return to top

Testimony at Public Hearing We Need Better Community Services, Not Kendra's Law Presented by Heather C Laney  Mental Health Peer Connection Kendra's Law Hearing   Buffalo, NY  April 21, 2005   Thank you for this opportunity to share with you the concerns of the consumers of mental health services represented by the Mental Health Peer Connection.   I am Heather C. Laney, the Systems Advocate from the Mental Health Peer Connection. I am a person in recovery from mental health issues. Our organization is a grass roots peer-run agency that operates on the principle of peers empowering peers together.   The following testimony includes ideas from consumers I have talked with and others who have written material on their concerns about Assisted Outpatient Treatment and its impact on their lives or lives of people they know and care about.   Consumers have long been represented and spoken for by other people but are now speaking for themselves about how they want to be treated.   The particular question before us today is whether Kendra's law should be made permanent?   The overwhelming view of our agency and those we talk and work with is that it should not.   Kendra Webdale's death was a tragedy. Whenever someone is either the victim or the perpetrator of a tragedy we share the grief of everyone involved.   In this case there was a second tragedy, the tragedy of a system that failed Kendra's assailant, Andrew Goldstein. In fact, the system failed Kendra. She, like all of us, depended on the system that supports mental health treatment, to do its job well. In this case it did not.   But our response to the consequences of a broken system should not be to risk infringement of the rights of all consumers. It should be to fix the system.    Making laws that infringe rights seems to make sense after a tragedy like Kendra's death because the public seems to believe that people with mental illness are violent.   The truth is that people with mental illness are many times more likely to be victims of crime than to be perpetrators. It is ironic that these vulnerable people should be considered a threat to society, when it is society that threatens them.   As well intended as Kendra's law may be, its true effect is to reinforce unjustified prejudice against consumers.   This compounds an already serious but invisible injustice. People with mental illness already deal every day in countless ways with loss of control over their lives, their dignity and their own treatment. And this problem, in turn, actually aggravates the risk that Kendra's law is supposed to address - that some people with mental illness may not accept and follow medical directions.   Who would want to accept a diagnosis of mental illness, and the help that acceptance brings, if he or she believes acceptance leads to a life of poverty, isolation, broken relationships, and general stigma. How can we really be surprised that people reject the system as it is now? How can we not conclude that the solution is not more coercion but instead more compassion, understanding, integration, and dignity for all involved?   My agency and the community we're part of believe what is needed is broader, more compassionate, and more dignified community-based services. Truly compassionate treatment for mental health disabilities would be rejected by far fewer of the people who need it.   Where do we start? Consumers in day programs and hospitals are those with the highest needs. If system changes were made here, people would be more willing. They would be more likely to embrace the help they want but are now either denied due to inaccessibility or because they are considered 'hard to serve,' or are afraid to accept because they know they will be stripped of their dignity and rights as human beings.   I have heard from consumers about their experiences with day programs and hospitals. They say they have seen very little resembling compassion, empathy, or openness. They feel institutions are simply cold and bureaucratic.   They know they need help, but they don't want to be treated like a number. These are highly vulnerable individuals. They have the same feelings all of us do. In some cases, these feelings may cause behavior that is harmful, like refusing treatment. And tragically, a few individuals may cause harm to others.   How can we blame them for reacting as many of us would in their shoes? The blame should go toward an insensitive, fragmented system. And so should the effort to find a real solution.   Kendra's law is an easy answer. But it is an unjust and in the long run an ineffective one. People with mental health needs deserve treatment characterized by respect and dignity.   In the short run, Kendra's Law may seem to have produced favorable results in recidivism and 'compliance.'   But we would argue that this is attributable to the extra funding and resources targeted toward individuals with the highest needs. More intense forced treatment and infringement of the rights of a vast majority who have no violent tendencies even when refusing treatment are not solutions. They are failure in a new package.   Kendra's death was the result of an illegitimate system. Recovery would be the consequence of a truly responsive system.   We need to focus on the real solutions -- more supportive, respectful, and person-centered treatment services, more peer services, rehabilitation community services, housing and employment. Sadly, these are the first services to be considered for cuts each year. Instead of being able to focus on the programs, we have to fight for funding. This takes away from our ability to serve the consumers who come to us.   Medications forced and prescribed by people who don't have -- or won't take the time to get to know us and understand our needs is not the answer.   We need a system that is shaped to our real needs, not a law that re-shapes us until we don't even recognize ourselves.   Thank you for taking the time to listen to the testimony and concerns of the community of consumers who depend more heavily on your wisdom and humanity than most other segments of your constituencies.   Please retire Kendra's Law, and make some real changes to the mental health system that serves so many who need its help. End of Heather Laney testimony Source: E-news from NYAPRS Return to top

MORE ABOUT KENDRA'S LAW - posted May 22 (1) Kendra's Law Teaches How To Play "The Violence Card" (2) The Railroading of Andrew Goldstein (3) Remember Andrew, the Other Victim (4) References Kendra's Law Teaches How to Play "the Violence Card" (May 2005) by Jean Arnold "Laws change for a single reason, in reaction to highly publicized incidents of violence." This wisdom is from D. J. Jaffe, a co-founder of the Treatment Advocacy Center (TAC) in Arlington, Virginia, speaking at a national NAMI conference in the summer of 1999. Jaffe told the NAMI audience that a law permitting court-ordered outpatient medication, or any other law, will be enacted if framed as crucial to public safety. In preparation, Jaffe had taken TAC's forced medication proposal to an array of law enforcement agencies where he found instant receptivity. He advised the advocates, "Forget the mental health community, take this out to the public at large. You will find there is very little opposition to changing the law once you get it outside a mental health arena." Jaffe's "highly publicized incident of violence" occurred on January 3, 1999 when a man diagnosed with schizophrenia, Andrew Goldstein, gave aspiring writer Kendra Webdale a fatal shove as a train approached a Manhattan subway station. TAC contacted Kendra's shocked and grieving mother, Patricia, explained to her their "public safety" agenda, and won her support. Under TAC's guidance, an overwhelming family tragedy came to symbolize a menace to every New Yorker. In Jaffe's words, "The media goes and interviews these people, and because we've been to them first, they are telling our story." The final boost for Kendra's Law came when incoming Attorney General Eliot Spitzer and Governor George E. Patai joined the campaign with full support. Just six months after Kendra's death, the New York legislature voted overwhelmingly for a five-year trial of court-ordered outpatient medication. Never mind that legislators later commented that the true culprit in the Webdale tragedy was New York's relentless cost-cutting and dismantling of its mental health system. And never mind that when Andrew Goldstein's history was detailed by a New York Times reporter, Michael Winerip, Goldstein was found to have needed supportive services and a decent place to live, not court-ordered medication. With the Kendra's Law experiment due to expire on June 30th, old issues are flaring once again. To impress legislators with the need for forced medication, last week the law's supporters cited 18 studies assembled by TAC to prove that lack of psychiatric medication causes violent behavior. However, 14 of the studies make no mention of medication in their descriptions. Oddly, violence prevention seems a low priority in the implementation of Kendra's Law. Only 15% of the program's clients have been noted as violent with no explanation of the term. This low rate of violence is not surprising, however. In 2002, a Duke University research team found that people with severe mental illnesses are highly unlikely to become violent toward others unless they have additional risk factors combined with their psychiatric disorder. Without any of the risk factors -- having been a victim of violence during childhood, living in a neighborhood where violence is common, and having a substance abuse problem -- those with severe mental illnesses were no more likely to engage in violent behavior than people in the general population without a psychiatric disorder. "Acts of violence by people with mental illness are rare" said Jeffrey Swanson, Ph.D., associate professor of psychiatry and behavioral sciences, a sociologist at Duke and lead author of the study. Swanson noted, "violent crimes committed by psychiatric patients become big headlines and reinforce the social stigma and rejections felt by many individuals who suffer from a mental illness. But our findings suggest that serious violence is the rare exception among all people with psychiatric disorders" (Jeffrey Swanson et. al., American Journal of Public Health, Sept. 2002). What's next for Kendra's Law? Many families of individuals with psychiatric disabilities, closely allied with TAC leaders, are calling for Kendra's Law to be made permanent. They acknowledgte flaws in the law but cite promising results in some areas of the state. A seond group, a broad statewide coalition of mental health advocates, opposes permanent status for the law. They are asking the New York State legislature to extend its oversight role for an additional period (2 years) and to seek more convincing research to support its continuation. Most of these advocates reject coercion and call for access to high quality programs. A third group opposes any continuation of the law. These are advocates with first-hand experience of mis-medication, mis-diagnosis, incompetence, inappropriate programs, and the loss of human and civil rights. After the law's hasty passage in 1999, Assemblyman Edward Sullivan (Manhattan) summed up his objections. "What bothers me is the political nature of this bill. There has been a great deal of pressure to contain antisocial behaviors of some people with mental illness. And there's also been a great deal of political pressure to keep costs down. These have often proved to be contradictory pressures. People in charge of the state's budget-making have absented themselves from this problem. ... Let's go back to the budgeters and find the money!" End ________________________________________________ ARTICLE: The Railroading of Andrew Goldstein by Patricia Warburg Cliff Source: The Journal of California AMI V.11,1.3 (September, 2000) The failure of the legal profession, the court system and the public to grasp the vital concepts involved in the two trials of Andrew Goldstein further reinforce the fact that we at NAMI have much work to do. In January 1999, Andrew Goldstein, an unmedicated, delusional person with paranoid schizophrenia who had been unsuccessfully seeking help at various hospital emergency rooms, pushed Kendra Webdale to her death on the tracks of the New York City subway. Unfortunately the terrible tragedy of this young woman's death clouded public perception of the situation which allowed this to occur: the failure of the public system to offer the required state-financed housing with day services, clinic visits and an intensive case manager, to this seriously ill young man. It was, however, not the system which was on trial, but the other "victim" of this tragedy, Andrew Goldstein himself. The first trial ended in a hung jury, because two jury members had had some limited experience with the mental health system and consequently understood the nature of Goldstein's illness and his inability to form the necessary intent to commit murder in his psychotic state. The public's outcry for revengeful punishment did not, however, cease. In late February, 2000, a second trial was commenced. After hearing the evidence, the judge instructed the jury that they had the option of convicting the defendant of manslaughter in lieu of the second degree murder charges, if they found that he had acted with "depraved indifference," but without the requisite intent necessary for a conviction of second degree murder. It took the jury only two hours to reach the verdict of second degree murder. The irony of the situation should not be overlooked: Andrew Goldstein was being held at Bellevue Hospital following his arrest where he was willingly receiving treatment for his illness and consequently would not be able to appear sufficiently psychotic at his trial to demonstrate to the jury the disabling effect of this illness on his judgment. The defense pinned its hopes on taking Mr. Goldstein off his antipsychotic medication and putting him on the stand, to better show the jurors his mental state at the time of the attack. This novel concept was thwarted when Mr. Goldstein struck a social worker, further indicating his violent state of mind when unmedicated. Judge Berkman insisted that Mr. Goldstein be offered the choice of taking his antipsychotic medication, which he chose to do. The result was that the jury was able to see a passive, sedated individual and not the person whose delusions caused his violent behavior. NAMI's suggestions to the defense counsel to utilize the virtual reality videos produced by pharmaceutical companies which demonstrate the psychotic state of mind, as well as comparisons to the diminished capacity suffered by individuals who are experiencing the onset of a diabetic coma or an epileptic seizure, fell on deaf ears. The subsequent result demonstrates the ignorance of the judge, jury and defense counsel with respect to paranoid schizophrenia. Andrew Goldstein never got a fair chance. At the conclusion of the trial, the jurors were convinced that punishment, not treatment, was warranted. Mrs. Webdale, the victim's mother spoke at the sentencing hearing: "It is my contention that if Andrew Goldstein had been held responsible many incidents ago, there would not have been 13 assaults and one homicide committed by him. His ongoing aggression was tolerated and acceptable." The presiding judge concurred saying that the attack stemmed from the state mental health system's failure to punish Mr. Goldstein for past assaults. On May 5, 2000, Judge Berkman gave Andrew Goldstein the maximum sentence of 25 years to life in prison for the murder of Kendra Webdale. What is wrong with this picture? Has the "justice system" reverted to a witch hunt to punish the violent mentally ill whom the public system has dismally failed? Are we, as a society, going to be content with the gross misunderstandings of mental illness which were demonstrated in this trial? How are we going to educate the judiciary about these issues? The ultimate irony is that the New York State legislature, ever reluctant to provide sufficient funding for treatment for the mentally ill, hastily passed a bill, commonly referred to as "Kendra's Law," allowing for court ordered treatment or commitment of the mentally ill under certain circumstances. Andrew Goldstein who is now rotting in the state prison system, had tried repeatedly to get help before the attack. He even sought his own commitment when he realized that he was out of control. The misnomered "Kendra's Law" would not have prevented this tragedy. PATRICIA WARBURG CLIFF, an attorney and mental health advocate in New York City, serves on the national board of NAMI as well as on the board of NAMI-NYC Metro. Her only child, Kenneth Johnson, succumbed to depression in 1995, as a result of the private health care system's failure to adequately diagnose and appropriately care for his illness. End of article _____________________________________________ EDITORIAL: Remember Andrew, the Other Victim by Janet Susin Source: PATHways (NAMI-Queens/Nassau newsletter) July 1999 By now, you must have seen Michael Winerip's disturbing New York Times Magazine cover story of May 24 about how the mental health system failed Andrew Goldstein and led to the fatal subway pushing which took Kendra Webdale's life. This gripping, meticulously documented account of how Goldstein tried thirteen different times to get help, but was discharged each time without adequate support or housing, should make us all feel ashamed -- politicians who are indifferent to the plight of this vulnerable population, New York State residents who go about their business and accept the inevitability of this shameful neglect, but most of all Governor Pataki, who has turned a deaf ear to pleas for supervised housing and additional supports. The article has finally roused Albany politicians from their torpor. Assemblyman Brennan has said he will introduce a bill to authorize a $200 million appropriation for 2,500 additional beds, although no mention was made of the supervised beds Goldstein would have needed. And Senator Libous, Chair of the State Senate Committee on Mental Health, introduced a bill to use $5 million to provide and coordinate services for what the New York Times describes as "a small goup of particularly troubled former patients who are mentally ill." In the wake of Winerip's article, which provided detailed documentation of repeated discharges without appropriate follow-up, the Webdales are filing a lawsuit against several hospitals. Could this be our Willowbrook? Let's hope that this story stays on our politicians' radar screens long enough for them to pass some meaningful legislation--not just the kind that promises to get things under control but fails to provide the financial support to back it up. JANET SUSIN is co-president of NAMI-Queens/Nassau in Long Island New York. Her editorial comments in the organization's newsletter may not reflect the views of her organization. End of editorial _____________________________________________ REFERENCES: New York Times, Magazine Desk, May 23, 1999 "BEDLAM ON THE STREETS. Increasingly, the Mentally Ill Have Nowhere to Go," by MICHAEL WINERIP NY TIMES ABSTRACT - Michael Winerip article discusses case of Andrew Goldstein, a mentally ill man with history of assault that culminated in January with murder of Kendra Webdale, who Goldstein pushed under subway train in New York City; notes Goldstein voluntarily sought professional help at various state hospitals, cooperated with psychiatrists and made number of attempts to obtain long-term hospitalization at Creedmoor, state hospital; maintains there is long list of institutions and individuals who should be held accountable for what happened to Goldstein and Webdale, but at the top of the list belong Gov. Pataki and the State of New York, for it is states that have primarily responsibility for citizens who are mentally ill, and it is the states that have persisently shirked that responsibility; photos (L) D. J. JAFFE'S SPEECH AT 1999 NAMI CONVENTION. A candid outline of strategy used by the Treatment Advocacy Center to achieve their political goals. We have not found the full document online. Transcripts are available on request from stigmanet@webtv.net. TAC'S SELF-SERVING DISTORTION OF RESEARCH RESULTS. Time and again, the Treatment Advocacy Center has tagged their own assumptions onto the research of others, then claims the studies support their view. The resulting errors are hard to spot and near-impossible to correct. For more about this practice, go to STIGMATIZING FEAR TACTICS Return to top

Posted May 24, 2005 NYS Residential Providers Seek Kendra's Law Extender, Improved Reports Association for Community Living: Kendra's Law Report May, 2005   Kendra's Law was signed into law by Governor Pataki in August of 1999, and became effective in November 1999.  The law allows the courts to involuntarily commit New Yorkers with serious psychiatric illnesses to community based treatment, including medication regimens, treatment programs, supervised living arrangements, and other categories of service that are determined necessary to enable them to remain successfully in their communities.  The statute has very clear eligibility requirements, and may only be used "if the patient is unlikely to survive safely in the community without supervision..."     ACL's member organizations (120 providers of residential services to people with severe and persistent psychiatric illnesses) have provided housing and services to over 1,000 clients on AOT status.  Despite this very hands-on experience, ACL has not developed a position decidedly for or against, because many of our members have seen clients with AOT court orders start on the road to recovery after years of treatment failures, while others are convinced that it is the quality of the outreach and the appropriateness and flexibility of the services offered that engage clients. This is a question that we will not settle here.    However, all of ACL's members can agree on some of the weaknesses and problems in Kendra's Law from a provider perspective.  ACL conducted two surveys: one in 2002 that yielded 53 surveys, and one in 2005 that yielded 89 surveys with 50 more recently submitted that will be analyzed and that will update this paper.....      RECOMMENDATIONS INCLUDE:    We urge the legislature continue its oversight and to set a new sunset date 3 years from now.    We recommend that OMH be required to submit another interim and final report to the legislature that includes: - An analysis that identifies any correlations between the types of court-ordered services and the types of improvements in client outcomes.  - Mechanisms to ensure that providers in the community, particularly residential providers, are surveyed on pertinent issues relating to their ability to fulfill their contractual and legal obligations related to Kendras Law.   We further recommend separate legislation as follows: - Support a2895 that establishes a housing wait list so that OMH can plan for the number of housing units needed to accommodate AOT clients, high-risk high need clients, as well as the others in the system who need this level of service but who often move to the bottom of the list. - Support legislation that would establish minimal staffing ratios in programs funded and licensed by OMH but operated by not-for-profit agencies along the lines of A3928/S207, which establishes the same for state operated programs. ACL can recommend appropriate staff/consumer ratios. We also recommend that residential programs undergo a full assessment, and that program and fiscal changes be made in order to insure that the clients the programs are now asked to serve, the staff, and the communities in which they reside, are served adequately and safely. At a minimum, we expect that the following will be needed: - Immediate increase in staff/consumer ratios, so that no staff person works alone. -The addition of specialized staff, e.g., CASAC's, nurses, and CSW's. - The modification of existing Community Residences to accommodate specialized populations, e.g. long-term care for geriatric clients, enhanced MICA residences for young adults, crisis residences to avoid costly and traumatic hospitalizations, step-down programs so that clients can be discharged as soon as is clinically possible, etc. - Additional targeted financial increases to bring the programs up to where they should be relative to the consumer price index, and  - A mechanism to insure regular, trended increases. SOURCE: E-News from NYAPRS NYAPRS Note: Another leading statewide advocacy group, the Association for Community Living which represents community  residential service providers, has opposed making Kendra's Law permanent at this time, seeking instead a 3-year extender and improved evaluative reports. ACL joins the Schuyler Center for Analysis and Advocacy, the Mental Health Empowerment Project and NYAPRS in taking similar positions. The Coalition for the Homeless has sought the abandonment of court ordered outpatient treatment but, if the law is to be extended, has rejected efforts to enhance the coercive nature of the program.

Posted May 24, 2005 Newsday Calls for Kendra's Law Extension of Enhanced Services and Intensive Follow-up Forcing treatment on the mentally ill appears to benefit them and society Newsday Editorial,  May 23, 2005 It's an unexpected pleasure when Albany does something that actually works. It did when it enacted Kendra's Law, giving courts the power to force mentally ill outpatients with histories of violence and hospitalizations to stay in treatment. The legislature should extend the commonsense law that sunsets on June 30. But it shouldn't make it permanent unless studies show that the court orders, which circumscribe the rights of the mentally ill, are critical to the law's success. They may be, but a previous experiment with assisted outpatient treatment suggested that the key component could be the enhanced services and intensive follow-up the law mandates. Albany should continue funding those services while reviewing whether the legal compulsion really helps. Kendra Webdale, for whom the 1999 law is named, was pushed from a subway platform to her death by a psychotic man with a long history of hospitalizations. The mentally ill are no more prone to violence than the rest of us. But patients who do well with medication and treatment can become dangerous without them. That deterioration is painfully predictable. But, before Kendra's Law, patients could be treated against their will only if they were a danger to themselves or others. Relatives of the mentally ill had to stand idly by until their loved ones devolved to that point. Under Kendra's law, the refusal to comply with treatment itself can trigger action. It authorized the courts to impose outpatient commitment orders compelling treatment and to involuntarily hospitalize patients who failed to comply. It worked. According to the state Office of Mental Health, for 3,766 patients under outpatient treatment orders, the incidence of arrest, incarceration, psychiatric hospitalization and homelessness declined by more than 74 percent. Harmful behaviors, such as drug abuse, declined by more than 46 percent. But there were significant racial, ethnic and geographical disparities. Sixty-three percent of those under court order were black or Hispanic, and more than 3,000 were in New York City, Suffolk and Nassau counties. Officials need to find out why race and geography played such powerful roles, and whether patients in other locales benefited from enhanced services without court orders. Kendra's Law works. Now Albany needs to find out why. Source: NYAPRS E-News _____________________________________________________ Return to top

Posted June 27, 2005. Journal News article Kendra's Law: Fear, politics and mental illness By LISA TARRICONE (Original publication: June 12, 2005) Journal News, http://www.journalnews.com We have a propensity to create feel-good acts of justice when things go wrong. In order to appease public unease during times of random violence, laws spring up to pay homage to certain victims while professing to better serve the public. Kendra's Law is one such example — a seemingly well-meaning response to the sensationalized death of Kendra Webdale, who was pushed under a New York City subway train in January 1999 by Andrew Goldstein, an individual with a lengthy history of mental illness and hospitalizations. The legislation is due to expire on June 30 of this year and, in its five-year run, has created an unconscionable standard of court-ordered treatment for certain individuals with psychiatric disabilities. Although Kendra's Law is strongly supported by Albany lawmakers and the National Alliance for the Mentally Ill, advocates for persons with mental illness feel differently, citing that it violates the civil rights of individuals with psychiatric symptoms through court-sanctioned treatment and forced institutionalization. Public reaction to anything that is more feared than understood takes its most tangible form in legal sanctions. Kendra's Law took only eight months to pass the state Legislature. The August 1999 legislation provides for court-ordered assisted outpatient treatment (AOT) for people with mental illness who have a history of medication noncompliance that has led to hospitalizations or that has resulted in at least one act of violent behavior. A parent, spouse, adult roommate, psychiatrist or social services official can file a petition with the court for an individual they feel meets the stated criteria for AOT. The court will then set a hearing date for that individual and, if the criteria for AOT are met, the individual will be required to accept a written treatment plan. Some persons who are considered to be a danger to themselves or to others can be involuntarily committed to a psychiatric hospital. Since the law was adopted, more than 10,000 cases have gone to courts, and approximately 4,200 court-ordered AOT plans have been issued. The average court order lasts about 16 months. Mental-health advocates charge that the law is a quick-fix solution that fails to address the fragmented community-service system. Andrew Goldstein sought help at least 20 times before he pushed Kendra Webdale. He repeatedly checked himself into psychiatric facilities only to be discharged a few days later. He asked for, and was denied, long term-placement and was not taking his medication at the time of the killing. The advent of antidepressant medications and new treatment options for individuals with psychiatric symptoms led to the closings of large state-run institutions in the 1970s and 1980s, ushering in a new era of outpatient care. Moreover, enormous amounts of funding have been pulled out of the community-service system over the last decade, increasing waiting lists and making it far more difficult to provide services to people who need them. This consequential shortfall of crises beds for the mentally ill combined with dwindling hospital insurance coverage have made criminal incarceration the only 24-hour per day answer for individuals with emotional problems. In essence, jail has become the poor person's mental hospital, housing a current inmate population of which more than 16 percent are persons with mental illness. Public attitudes about mental illness due to a lack of education and awareness, and media stereotyping that links medication noncompliance with acts of violence have fostered the stigmatization of individuals with psychiatric disabilities. According to the first Surgeon General's Report on Mental Health, it is the "fear of violence of people with mental illness" that keeps the stigma vibrant and stereotypes rampant. However, the FBI's Behavioral Science Unit reports that crimes in America "are committed by people with all levels of functioning and personality types" and that only "3 percent of violence in American society can be attributed to mental illness." State data conclude that only 15 percent of the people who have been required to accept AOT plans under the legislation had demonstrated any kind of physical harm to others in the period prior to the order. Forced treatment unfairly singles out individuals with psychiatric disabilities and continues to deepen the cultural stigma that connects mental illness with dangerous behavior. Kendra's Law should not be made permanent nor should it be re-authorized for another three to five years, as it is now being considered by legislators. We should not let court-ordered treatment impose force and steal personal civil rights as a substitute for adequate, well-coordinated, flexible, responsive and accessible community-based services.   Copyright 2005 The Journal News, a Gannett Co. Inc. newspaper serving Westchester, Rockland and Putnam Counties in New York. (Reprinted using Fair Use standard) Return to top

Posted June 27, 2005. Source: E-mail (June 22) from NYAPRS NYS Legislature Rejects Kendra's Law Permanence, Requires Independent Study NYS Legislature Insists on Extension, not Permanence, of Kendra's Law Requires Independent Study, Rejects Efforts to Expand Forced Outpatient Treatment Measure   The Assembly and Senate have reached agreement on a measure that will extend, rather than make permanent, Kendra's Law until 2010. The measure will also require an independent study of the program's implementation and impact during the next 5 years, and rejects a number of proposals that would have expanded the use of forced outpatient treatment here in New York.   The measure, A8954 and S5876, is available for review at http://www.assembly.state.ny.us/leg/.   According to the bill memo (we refer to the program as Involuntary Outpatient Commitment or IOC although commonly used language refers to it as Assisted Outpatient Treatment or AOT), the bill: extends the current law until June 30, 2010. requires OMH to contract with an 'external (independent) research organization" to conduct an evaluation of the IOC program by June 30, 2009, a year before the extender sunsets to allow for public review and comment; look for the legislature to hold public hearings at that time requires local directors of community services to document procedural timeframes for reports regarding people considered as candidates for IOC, and to provide such info to state IOC coordinators on a quarterly basis adds licensed psychologists and social workers to current list of persons authorized to petition the court for an IOC order (in many cases, these professionals already work under the supervision of a nonprofit agency director who already has such authority) requires OMH to make state employed physicians available in counties with less than 75,000 individuals to make the affadavit that must accompany IOC petitions at no cost requires service providers who are included in the written treatment plan to be so notified requires that in instances where the petitioner is not a county mental health director, the written treatment plan and the testimony of the physician who helped develop the plan must be required by a date set by the court, and not (at the last minute), on the date of the hearing requires OMH and Office of Court Administration to develop a mental health training program for supreme and county judges and court personnel requires OMH to provide to the Governor and Legislature by March 2006 and annually thereafter, a report on utilization, demographic and other 'data related to the IOC program' annually requires OMH to provide a fiscal report detailing all appropriations, allocations and expenditure data by June 30, 2006 and annually thereafter The bill memo's finds that additional evaluation of the (IOC) program is needed: "Questions remain regarding local variation in the implementation of (IOC,) the opinions regarding the experience of those under court order and the outcomes for those receiving services under a court order and those voluntarily receiving enhanced services."   The legislature did not back a number of proposals that would have likely expanded the program's reliance on court sanctions. It rejected an amendment that would have taken voluntary agreements to obtain an enhanced package of services in lieu of a court order and have made them legally binding and 'subject to the procedure for treatment noncompliance.'  It also rejected proposals to expand the period for the initial order from 6 months to a year and to permit the extension of an individual's court order based on their affadavit rather than their personal appearance at a court review.    The legislature is expected to pass the measure by session's end, this Thursday. The Governor is expected to sign the bill shortly thereafter.   A broad array of mental health and legal rights groups hailed the legislature's action. They have long lauded the law's intent to expand access to better coordinated better care for those most in need by providing more resources and requiring more local and provider accountability.   "We have always agreed with the intent of Kendra's Law to help those most in need," said Harvey Rosenthal, NYAPRS executive director. "We simply have disagreed on how to best do that, following instead the lessons of previous research that better care, not forced care gets that job done in the best, most ethical fashion."   "We're extremely grateful to both houses and their respective mental health committee chairs, Assemblyman Peter Rivera and Senator Thomas Morahan for sharing our concerns and for seeking answers to a number of unanswered questions about this controversial measure," Rosenthal said. Source: 'Mental Health E-News' posting, a service of the New York Ass'n of Psychiatric Rehabilitation Services __________________________________________________ Return to top

Posted June 27, 2005. Source: E-mail (June 23) from Tina Minkowitz, human rights activist Kendra's Law Extension Adds Regressive Measures Hello everyone, The Legislature will vote on Kendra's Law this week. There is still time to contact your legislators. Bill (Assembly 8954, Senate 5876) was not posted the full 72 hours in advance, only posted Tuesday morning. Legislators haven't had enough time to examine the provisions, and it is horrible. These are some examples of what is egregious in the bill beyond the original law passed in 1999: Judges would no longer be required to take into account directions in health care proxies when determining the court-ordered "treatment plan". Instead this responsibility is given to physicians. Health care proxies are a legally binding document and must be given judicial and not only medical consideration. Psychologists and social workers are given the opportunity to petition for court orders on people they are treating, which scares people away from services. Court order can go forward without being served on the person who is being mandated to unwanted services. OMH, an interested party, will train judges in mental health law. This undermines the principle that courts decide cases based solely on the evidence before them. OMH will choose a research organization to carry out a study - this ensures that the resulting study cannot be viewed as impartial. The proposed study does not require comparison with a control group of people who are receiving services on a purely voluntary basis. The language of the bill only requires that both people under court orders and people "receiving enhanced services" be studied. "Enhanced services" refers to diversionary agreements that operate within a context of coercion and are not actually voluntary. People sign these agreements in preference to being court ordered, but the diversionary agreements are similar in effect to court orders. All counties, even those which have chosen not to use Kendra's Law, are now required to have a Kendra's Law program, and to evaluate people for court orders if anyone makes a report on another person asking for such an evaluation. Kendra's Law was a bad idea to begin with, and it is harming people's lives immeasurably. It does not get people the services they need, but on the contrary subjects them to a virtual police state and a twilight zone of rights that is like institutionalization without walls. Best wishes, Tina Minkowitz _______________________________________________ Return to top

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May 12, 2006 - News of the Week KENDRA'S LAW TEETERS ON FALSE PREMISE System Reform Requires High Quality Programs, Not Coercion Laws The guru of forced psychotropic medication for outpatients, Dr. E. Fuller Torrey, recently acknowledged in an NPR interview that although 42 states have court-ordered treatment laws, they are rarely used. Why? Perhaps Torrey's organization, the Treatment Advocacy Center (TAC), is itself at fault. TAC has linked coercion laws to brutal deaths, winning their passage in the glare of highly emotional publicity. When the full facts emerge, however, they often reveal a trail of negligence by budget-squeezed poorly-coordinated mental health facilities. "Bad case, bad law," is a cliche that may explain states' caution in applying their court-ordered treatment laws. TAC perfected its "public safety" approach to legislation in 1999, after the fatal encounter of Kendra Webdale and Andrew Goldstein in a Manhattan subway station. Under TAC's guidance, a family's overwhelming loss came to symbolize a menace to every New Yorker. To launch "Kendra's Law," TAC first shoehorned Goldstein into the role of a "medication refuser" who lacked insight into his psychosis. Several months of intense publicity overwhelmed the actual facts of Goldstein's record, including findings by the New York Times that he had tried in vain to get the help he knew he needed. As the truth emerged, Goldstein's psychiatric history is an appalling account of mistakes made and opportunities missed by the psychiatric facilities he turned to, often voluntarily, for help. In spite of all this, a vengeful tone at his trials helped put him in prison for life, and his mislabeling continues to re-surface in the press. Innovative states are proving that high quality programs are successful without a law enforcement approach. The appeal of TAC's coercion campaign will fade further as states shift to treatments developed in consultation with people with first-hand knowlege of psychiatric conditions. These programs are promoted by the Bazelon Center for Mental Health Law, The Presidents' Commission on Mental Health, and SAMHSA. Footnote: Are forced treatment laws redundant? Has the Treatment Advocacy Center's aggressive and fearmongering stance on forced medication hindered system reform? Here are two critics' views on the law's redundancy: 1999 - "The focus of coercion upon the patient is, I submit, a misdirection of energy. Coercion is needed, but to enforce the laws already on the books that are routinely disregarded with impunity, either because of the scarcity of resources or because of conflicting pressures." Source: Clarence J. Sundram, former Chairman (for 20 years), NYS Commission on Quality of Care. "Misdiaagnosis and Non-Solutions," May 20, 1999, a statement in opposition to the then-proposed Kendra's Law. 2006 - " 'Kevin's Law' [Michigan's forced-treatment law] is unnecessary because we judges already had the authority to order medication on an outpatient basis." The quote is from Judge Patrick J. McGraw, Saginaw County Circuit Court Family Division. The article notes that "Mr. McGraw, who handles nearly all mentally ill committments in the county, says he occasionally orders outpatient medication but has yet to use 'Kevin's Law' for any person." Source: "Forced Drugging," by Scott Davis, The Saginaw News, March 1, 2006. A Comment on TAC's Inflation of Kendra's Law Outcomes: In March 2005, the New York State Office of Mental Health released an analysis of outcome data on 2,745 recipients of New York's AOT program, Kendra's Law. The Treatment Advocacy Center (TAC) has selected data out of context and is using it to win support for similar laws in other states. TAC is publicizing high rates of improvement without explaining that only a modest number of AOT's 2,745 recipients improved significantly between the time they entered the program and 6 months later. For example, TAC reports that AOT recipients experienced 87% less incarceration after AOT. What TAC doesn't explain is that prior to entering the AOT program, 23% of recipients experienced incarceration, and after 6 months in the AOT program, 3% experienced incarceration. The state's AOT report describes this as an 87% improvement for 23% of AOT's 2,745 program recipients. (To complicate matters, some data analysts would consider this a 20% improvement.) How does TAC's skewing of outcomes poison the AOT debate? Consider the preposterous claims of a forced treatment proponent in Maine: "In New York, 91% of those who were not taking medications began taking them, just because that law was on the books" and "arrests for petty and violent crimes involving people with mental illness dropped 78% and millions of dollars in hospital costs were freed up for community services." Source: Maine Times Record, March 10, 2005 We welcome readers' comments. Email stigmanet@webtv.net

May 7, 2006 - News of the Week BAZELON'S MICHAEL ALLEN REBUTS SALLY SATEL ON FORCED TREATMENT See Below for Open Letter from Allen to Satel re Article in National Review Online Friends: Have you noticed the recent upsurge in the media campaign for forced treatment?  Fuller Torrey appeared on NPR's Fresh Air  on April 17, ( Click here). He talks a lot about "lack of insight" and the intersection of outpatient commitment and homelessness and criminal justice.  The program's host challenges Torrey with Bazelon's position about "dangerous coercion" and the failure to fund real services.  Torrey agrees that it is important to fund adequate services, but says crazy people won't come in for services.  He also mentions mental health courts. For Sally Satel's article criticizing the SAMHSA Consensus Statement on Mental Health Recovery, Click here. Pete Earley, whose book provides the basis for much of the conversation, is a former Washington Post reporter whose son was diagnosed a few years ago.  His new book is CRAZY: A Father's Search Through America's Mental Health Madness, Click here. I finally got frustrated enough to compose an "open letter" to Sally Satel and have submitted it to National Review (see below), but don't think it will get printed.  So I share it with you, and ask your help in distributing it, through your own channels or by recommending a place that you think it might get published. Thanks in advance. Michael Allen Senior Staff Attorney Bazelon Center for Mental Health Law 1101 15th Street, NW, Suite 1212 Washington, DC  20005-5002 Phone: 202/467-5730, ext. 117 FAX:  202/223-0409 E-mail: michaela@bazelon.org Website: www.bazelon.org ______________________________________________ FROM:   Michael Allen  SENT:   Friday, May 05, 2006 10:22 AM TO:     'letters@nationalreview.com' SUBJECT: An Open Letter to Sally Satel, Responding to "A Statement of Madness, "National Review Online, April 5, 2006 Dear Sally:         I've noticed over the past couple of weeks that you and your allies had renewed your media campaign to undermine the rights of people with mental illnesses, and to suggest to the public that forced treatment is the only kind that will work for large numbers of people.  I wonder whether decisions by the New Mexico and Maine legislatures to reject involuntary outpatient commitment might be fueling some anxiety on your part that the tide was turning against forced treatment.         We can all agree on the objective:  helping people with serious mental illnesses lead stable, productive lives in the community.  Beyond medication, that will require stable housing, employment opportunities, and the chance to live, love, and learn with friends and family.  Research suggests that these supports yield better results, for individuals and for society.  Those states with higher rates of hospital and outpatient commitment don't necessarily produce the best outcomes for people with mental illnesses.         There is a lot of good, hard science available about what works in terms of mental health treatment, but reading your recent article belittling the Consensus Statement on Mental Health Recovery from the federal Substance Abuse and Mental Health Services Administration ["A Statement of Madness," National Review Online, April 5, 2006], I was convinced I had arrived in the Land of Oz.          Why?  Because, in oversimplifying mental illnesses and SAMHSA's response, you constructed a straw man with no brain, no heart and no courage.  That's why knocking him over was so incredibly easy.  But your criticism gets us no closer to a solution for the many poor people in this country who rely on the public mental health system for the services and supports they need to succeed in the community. NO BRAIN.  Your article revives that old canard about half the people with psychotic disorders lacking "insight" into their illnesses.  I've never understood where you found that statistic, or how you can insist on its validity given the remarkable success of programs like Pathways to Housing [see www.pathwaystohousing.org] and the so-called "AB 34" programs in California [see www.ab34.org], that are successfully engaging "the most severely disabled" (to use your term) people with mental illnesses.  Employing the very conservative principles of self-direction, empowerment and personal responsibility that you deride in the Consensus Statement, these programs are producing much better outcomes than those that feature compulsory medication. The recovery model is alive and well in this country; you would do well to acknowledge its successes. NO HEART.  You were appointed to the Advisory Council for the Center for Mental Health Services at SAMHSA by a president who champions "compassionate conservatism," but your article trashes the "recovery" orientation of his New Freedom Commission on Mental Health.  What would you recommend in its place?  Your published writings suggest you favor a broad spectrum of programs that involve involuntary treatment, including court orders for outpatient commitment, mental health courts and other forms of "leverage" to overcome the "treatment resistance" of people with severe and persistent mental illnesses.  In your willingness to inject coercion into mental health treatment, you ignore the creative ways in which mobile outreach and assertive community treatment (ACT) are being coupled with supportive housing to yield good life outcomes without force.  NO COURAGE.  The seminal contribution of the New Freedom Commission was its articulation of an unspoken truth:  "millions of dollars are spent unproductively in a dysfunctional service system that cannot deliver the treatments that work…."  [see http://www.mentalhealthcommission.gov/reports/Final_Interim_Report.doc ].  We can't—as your article advocates—reduce mental health to the question of whether someone "takes his medications."  But we've tried it your way, and it doesn't work.  Thinking people realize that real mental health depends on a broad array of personal relationships, personal strengths and professional support.  Any new vision of public mental health will upset some apple carts.  And I understand how unsettling it must be to you, as a psychiatrist, to be faced with a paradigm shift that reduces the role of medical experts in the field of mental health.  We all need to display more courage in our willingness to look at new treatment modalities that might actually work better.         Americans are hungry for new approaches to government programs.  In areas like public education, conservatives have championed school vouchers, arguing that it is important to put purchasing power in the hands of the consumer.  This, they point out, would have the salutary market effect of improving good schools and driving bad ones to reform or fail.   Putting mental health dollars and decision making in the hands of people with mental illnesses makes the same good public policy sense, and SAMHSA's Consensus Statement on Recovery sensibly recognizes that.         Sally, I invite you to join us in building a public mental health system that is as good as the American people it is meant to serve.  We're not in Kansas anymore.  We're perched on the edge of a new world, and a new vision of public mental health. Sincerely, Michael Allen Senior Staff Attorney Bazelon Center for Mental Health Law 1101 15th Street, NW, Suite 1212 Washington, DC  20005-5002 Phone: 202/467-5730, ext. 117 FAX:  202/223-0409 E-mail: michaela@bazelon.org Website: www.bazelon.org