Tuesday, October 09, 2007

What assisted outpatient treatment can... and can't... do

Last Saturday, Lee Coleman evaded his family’s attempts to have him hospitalized and went on a rampage – stabbing two people with knives he stole from a Manhattan restaurant before being shot by an off-duty police officer who had just paid his check.

It is the type of gripping tragedy that leads to unfortunate, big-lettered headlines in a city’s papers, such as PSYCHO STABBER from the New York Post, as well as editorial pleas with titles like Stop The Insanity On The Streets. And when the general community peers into the most often ignored world of severe mental illnesses, the possibility of reform emerges. On Monday, Governor Eliot Spitzer expressed his support for creating a panel tasked with investigating how to treat the most severely ill and thereby protect the public from those in that group whose symptoms would otherwise escalate to violence. New York is home to Kendra’s Law, the best-known and most thoroughly documented assisted outpatient treatment (AOT) law in the United States. Yet despite the availability and success of Kendra’s Law, tragedies intertwined with non-treatment continue in New York. Does that mean Kendra’s Law has failed? Hardly.

Kendra’s Law neither is nor is purported to be a cure-all.

For starters, an AOT program cannot help someone who is not in it. As is appropriate with any form of court-ordered treatment, the eligibility standard for Kendra’s Law is targeted at those incapable of managing and maintaining their own care. And even if Coleman was eligible at some point, the Kendra’s Law program is not tasked with searching out those who are sick and need AOT.

AOT is also not a mechanism designed for times of extreme crisis. The law has no mechanism for immediate intervention other than for those already under AOT orders.

The purpose of Kendra’s Law is to give intensive and sustained outpatient treatment to those that courts order into the program, treatment designed to help some of those most overcome by severe mental illnesses stay out of the hospital, off the streets and away from jail. It does that exceptionally well.

Failure in the case of Lee Coleman can be pinned to New York’s still-restrictive standard for emergency intervention and inpatient hospitalization, which requires immediate and demonstrable physical danger. Coleman’s uncle pled with police for help after his nephew frantically fled attempts for treatment and disappeared. The police told him they were powerless because “there was no history of violence.”

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