Thursday, April 10, 2008

Treatment Law Reform’s Scope In Proper Perspective

As vital is the need for rational treatment laws, it might be surprising that we at the Treatment Advocacy Center often think their significance unduly exaggerated by others in the mental health field.

Progressive treatment laws can be critical in bringing care and stability for those most in crisis, but efforts for them are most emphatically not aimed at whole-scale revision of mental health systems generally. Assisted treatment mechanisms are, by design, targeted at only a small sliver of all those with psychiatric disorders – the sickest of the sick.

According to one opponent, “almost anyone who ever had a psychiatric diagnosis and disagreed with their psychiatrist’s treatment plan could be forced to take drugs in their own home” under a 2007 proposal for assisted outpatient treatment in Virginia.

It is easy to establish that people would not have been physically forced to take medication in their own homes pursuant to that measure (there was no provision for that), but it is much harder to determine how many people with a psychiatric diagnosis would have been affected. That Virginia bill never became law.

We can, however, make a very close comparison. The bill in Virginia was a version of Kendra’s Law, and New York makes available a regularly-updated wealth of data on that program.

Those decrying the 1999 legislation that created Kendra’s Law loudly labeled it a “dragnet,” estimating that 10,000 New Yorkers would be forced into treatment each year. Over nine years later, we are still waiting for that 10,000th person. At the current usage rate, he or she won’t be placed in assisted outpatient treatment until 2013.

About 770 initial outpatient treatment orders are issued each year in New York. That is about one out of every 25,000 of the state’s citizens. Annually, the law is used to help only one out of every 400 people with schizophrenia or bipolar disorder.

And that is about the right amount.