By Treatment Advocacy Center Executive Director, Mary T. Zdanowicz, Esq.
FOR IMMEDIATE RELEASE
May 19, 1999
Assisted Outpatient Treatment Will Help Reduce Preventable Episodes of Violence, Homelessness and Incarceration in New York
Arlington, VA –The historic and heroic efforts of Governor George Pataki, Attorney General Eliot Spitzer and Assembly Speaker Sheldon Silver to implement assisted outpatient treatment statewide for individuals with severe mental illnesses will substantially improve the quality of life for all New Yorkers. We commend them on their landmark initiatives and appreciate their soliciting the Center’s counsel in drafting such long-overdue and much needed legislation.
We also extend our admiration and gratitude to the Webdale family who have bravely fought for better treatment of the mentally ill since Andrew Goldstein, who was not being treated for his illness, pushed Kendra to her death in the New York City subway system earlier this year. We commend their valiant and selfless efforts to eliminate barriers to treatment for New York’s vulnerable psychiatrically ill in the wake of their profound grief.
‘Kendra’s Law’ will help ensure that individuals like Andrew Goldstein, Julio Perez, Michael Laudor, and Larry Hoag would have taken the medications needed to control the symptoms of their disease, thereby lowering the likelihood of violent behavior. Each of these men suffers from schizophrenia and none was taking medication when he committed tragic fatal violent acts. ‘Kendra’s Law’ will prevent these individuals from spinning endlessly through the revolving door of hospital admissions and readmissions, only to be abandoned to the streets with no follow-up care. ‘Kendra’s Law’ also will help eliminate random and senseless acts of violence such as that which tragically ended Kendra Webdale’s life. New York State legislators must stop the deadly pattern of untreated severe mental illness and enact assisted outpatient treatment statewide.
At least 39 states now use some form of assisted outpatient treatment to substantially improve the lives of those suffering from severe mental illness and enhance the communities in which they live. Long-term assisted outpatient treatment has shown repeatedly to be more effective in improving outcomes for severely mentally ill individuals than routine outpatient care. For example, among patients who had been outpatient committed in Arizona, 71 percent voluntarily maintained treatment contacts six months after their court orders expired compared to almost none of the patients who had not been put on outpatient commitment. A study in Iowa showed that 80 percent of patients in outpatient commitment complied with their treatment programs. After their outpatient commitment term expired, some three-quarters of that group remained in treatment on a voluntary basis.
A recent study of New York’s Bellevue Hospital assisted outpatient treatment pilot program revealed that individuals who received court ordered treatment in addition to enhanced community services spent 57 percent less time in psychiatric hospitals than individuals who received only enhanced services. During the 11 months of the study, individuals who had both court ordered treatment and enhanced services spent only six weeks in the hospital, compared to 14 weeks for those who did not receive court orders.
Nearly half of those individuals who have schizophrenia or manic-depressive illness, the two severest forms of psychiatric illness, lack awareness of their disease. They do not recognize that the symptoms of their illness – hallucinations, delusions, paranoia and withdrawal – are, in fact, symptoms. These individuals consistently refuse to take medication because they do not believe they are sick, and commonly will only take it under some form of assisted treatment.
Untreated, the symptoms of these brain diseases can be extraordinarily disabling. For example, schizophrenia interferes with a person’s ability to think clearly, manage emotions, make decisions, and relate to others. An individual with schizophrenia experiences delusions and hallucinations; alterations of the senses; an inability to sort and interpret incoming sensations, and therefore to respond appropriately; an altered sense of self; and changes in emotions, movements and behavior. Individuals diagnosed with manic-depressive illness, or bipolar disorder, also can experience delusions and hallucinations, coupled with mood swings that alternate from periods of severe highs, or mania, to extreme lows, or depression. These mood swings are out of proportion or totally unrelated to events in a person’s life and affect thoughts, feelings, physical health, behavior, and functioning.
The consequences of failing to treat these illnesses are devastating. While Americans with untreated severe mental illnesses represent less than one percent of the total U.S. population, they commit almost 1,000 homicides in the United States each year, or between four and five percent of all murders annually. At least one-third of the estimated 600,000 homeless individuals suffer from schizophrenia or manic-depressive illness, and 28 percent of these people forage for some of their food in garbage cans. At least 10 percent, or 170,000 individuals, of our jail and prison populations suffer from these illnesses, costing American taxpayers a staggering $8.5 billion per year. Moreover, studies suggest that delaying treatment results in permanent harm, including increased treatment resistance, worsening severity of symptoms, increased hospitalizations and delayed remission of symptoms. In addition, persons suffering from severe psychiatric illnesses are frequently victimized. Studies have shown that 22 percent of women with untreated schizophrenia have been raped. Suicide rates for both males and females suffering from schizophrenia and manic-depressive illness are 10 to 15 times higher than for the general population.
It’s time to reverse course. Mandatory treatment for those too ill to recognize their need for treatment is a much more humane intervention than what we have now: mandatory non-treatment. The legal standard for assisted treatment should be the need for medical care, not dangerousness. Society has an obligation to save people from degradation, not just death.
This does not mean that we will have to reopen all the psychiatric hospitals that have closed as a result of deinstitutionalization. Most individuals with severe mental illnesses who have experienced severe deterioration in rational thought can live in the community. But, their living in the community must be conditioned on continued medication compliance. Assisted outpatient treatment, conditional hospital releases, and conservatorships must be widely used to ensure that discharged patients continue to take their medication. ‘Kendra’s Law’ will protect all New Yorkers by ensuring that its vulnerable citizens, like Andrew Goldstein, continue to receive appropriate treatment to control the negative symptoms of their brain disease.
The Treatment Advocacy Center (www.treatmentadvocacycenter.org) is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. TAC promotes laws, policies, and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.