Saturday, April 22, 2006

TAC to SCOTUS: Crime, anosognosia, weak laws

The Treatment Advocacy Center filed a “friend of the court” brief filed in the Clark v. Arizona case, that said in part:

[A]nosognosia increases the likelihood that victims of severe mental illness will reject or fail to seek treatment. This problem is exacerbated by antiquated state civil commitment laws that forbid treatment interventions until individuals pose an immediate physical danger to themselves or others. Because untreated severe mental illnesses are closely correlated to an increased risk of violence, anosognosia and these commitment laws operate together to ensure that mental illness will cause some of those it afflicts to engage in criminal behavior.

Some states are reacting to the tragic ramifications of untreated mental illnesses, and consequently anosognosia, by adopting more comprehensive commitment schemes with less restrictive, more flexible standards. New York’s improved law, known as Kendra’s Law, has resulted in dramatic reductions in incarceration, arrests, homelessness and hospitalizations of the severely mentally ill. [1]

Extensive clinical research has found analogous outcomes for reformed commitment laws in numerous states. [2]

TAC respectfully submits that reforms such as these, as opposed to unduly limiting—if not completely obliterating—the insanity defense, are the proper method to balance safety concerns of States with the due process rights of the mentally ill.

The staff and board of directors of TAC thank the attorneys from the Dechert law firm who provided invaluable pro bono services on TAC’s brief:

David A. Kotler
Megan Elizabeth Zavieh
William Gibson, and
Elliot M. Gardner
Princeton, NJ 08543-5218

[1] See N.Y. Mental Hyg. Law § 9.60 (Consol. 2005). Individuals in the first five years of New York’s assisted outpatient treatment (“AOT”) program experienced fewer hospitalizations (77%), episodes of homelessness (74%), arrests (83%), and incarceration (87%), and had improved medication compliance (fifty percent) and participation in substance abuse treatment (65%). Fifty-five percent fewer recipients engaged in suicide attempts or physical harm to themselves. Three out of every four of the program participants reported that Kendra’s Law had helped them regain control of their lives; four out of five said that AOT helped them to get and stay well. See New York State Office of Mental Health, Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment (2005).

[2] See, e.g., Marvin S. Swartz et al., Can Involuntary Outpatient Commitment Reduce Hospital Recidivism?, 156 Am. J. Psychiatry 1968, 1973 (1999) (hospital admissions reduced by 57% when used for at least six months and combined with routine mental health services); Jeffrey Swanson et al., Involuntary Out-Patient Commitment and Reduction of Violent Behaviour in Persons With Severe Mental Illness, 176 Brit. J. Psychiatry 224 (2000) (assisted outpatient treatment of six months or more combined with routine outpatient services reduced the incidence of violence in half (24% versus 48%)); Jeffrey Swanson et al., Can Involuntary Outpatient Commitment Reduce Arrests Among Persons with Severe Mental Illness?, 28 Crim. Just. & Behav. 156, 182–83 (2001) (same); Virginia A. Hiday et al., Impact of Outpatient Commitment on Victimization of People with Severe Mental Illness, 159 Am. J. Psychiatry 1403 (2002); Gustavo A. Fernandez & Sylvia Nygard, Impact of Involuntary Outpatient Commitment on the Revolving-Door Syndrome in North Carolina, 41 Hosp. and Community Psychiatry 1001, 1003 (1990) (median readmissions decrease from 3.7 to 0.7 per 1,000 days); Virginia A. Hiday & Teresa L. Scheid-Cook, The North Carolina Experience with Outpatient Commitment: A Critical Appraisal, 10 Int’l J. Law & Psychiatry 215, 229 (1987) (over six months, 30% medication refusal versus 60% absent orders); Robert A. Van Putten et al., Involuntary Outpatient Commitment in Arizona: A Retrospective Study, 39 Hosp. & Community Psychiatry 953, 957 (1988) (“almost no patients” without orders voluntarily maintain treatment in mental health system versus 71% who do in group with orders); Guido Zanni & Leslie deVeau, Inpatient Stays Before and After Outpatient Commitment, 37 Hosp. & Community Psychiatry 941, 942 (1986) (hospital readmissions decrease from 1.81 to 0.95 per year).

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