Dr. Torrey in New York Post

David Tarloff, accused of killing psychologist Kathryn Faughey and trying to kill psychiatrist Kent Shinbach, was known by his neighbors as "the crazy guy." He'd been "in and out of mental hospitals more than 20 times," says his brother, but "they kept releasing him." He did reasonably well when maintaining treatment, but he "frequently went off his medication."

Off medication, in these stories, is when the trouble usually starts...


Violence committed by seriously mentally-ill individuals who are not being treated are merely one manifestation of our egregiously failed mental-health-treatment system...

And there is abundant evidence that all of these problems are getting worse.

We know what to do, of course. Most individuals like Tarloff do very well if they are properly followed up and treated. Kathryn Faughey's killing is a failure not only of the treatment system but also of every New Yorker for not demanding a system that works - first and foremost, by holding hospital and mental-health accountable.

Until we start doing that, each mind-numbing tragedy will keep on being followed by another.

- TAC president, Dr. E Fuller Torrey in an op-ed in today's New York Post

"Heck of a job, New Mexico"

We hope New Mexico legislators who failed to pass Kendra’s Law last year are thinking hard about the consequences of their failure to act. And we hope New Mexico’s correctional facilities are prepared to help more people like Justin Quintana, since apparently killing your mother and being incarcerated is the clearest way to treatment in that state.

Patrick Kuchma said he has a "tremendous amount of anger" toward Quintana and feels he should spend the rest of his life in prison or in a mental health facility. Kuchma said he doesn't view lifelong incarceration as a tool for revenge, rather he views it as a way for Quintana to receive treatment that he has in the past refused to undertake.

"Basically what I'm getting at is, I don't think needs to be out in the public," Kuchma said. "He does not need to be out on his own because the fact still remains, he's mentally ill, he is a paranoid schizophrenic and he has the capability of not taking medication and this could happen to somebody else."

Yes, Virginia, Kendra's Law works ...

From the Washington Post December 30, 2007:

Susan Wezel had been committed to the city's hospital wards more than a dozen times in 10 years. Her psychosis was so deep and debilitating that she lost her career and her relationship with her son, as she refused to take her medication or follow treatment.

But because of a New York state law, Wezel hasn't been hospitalized in more than a year. She doesn't wander the streets alone at night anymore. She takes her medication willingly. She even has plans to follow her dream of singing at a neighborhood nightspot, something that was unthinkable 18 months ago.

Wezel and her caseworker agree that the transformation occurred because of the law, which allowed officials to force Wezel into an outpatient treatment program after she was discharged from a hospital.

Reading is fundamental

Opponents of AOT will often rely on hyperbole to argue against providing necessary assisted care for individuals with a severe mental illness. You’ll commonly hear that programs like Kendra’s Law will run roughshod over all consumers, or that it’s “social control” targeting those who may just act differently.

Of course, we know the reality is quite different. AOT programs like Kendra’s Law focus care toward the most mentally severely ill, reducing the crushing consequences of nontreatment – arrests, incarcerations, homelessness, and victimization. Unfortunately, most opponents of AOT simply haven’t even bothered to read the eligibility criteria associated with an AOT program, preferring to rely instead on overheated rhetoric.

So today, we’re providing you with an example of what eligibility criteria for an AOT program typically look like. The below example comes from New York, but could just have easily have been taken from any number of states around the country: In order to be eligible for New York’s AOT program, a court must find, by clear and convincing evidence and after a full hearing, that all of the following have been met.

The individual must:

1. be eighteen years of age or older; AND

2. suffer from a mental illness; AND

3. be unlikely to survive safely in the community without supervision, based on a clinical determination; AND

4. have a history of non-adherence with treatment that has:
a. been a significant factor in his or her being in a hospital, prison or jail at least twice within the last 36 months; or
b. resulted in one or more acts, attempts or threats of serious violent behavior toward self or others within the last 48 months; AND

5. be unlikely to voluntarily participate in treatment; AND

6. be, in view of his or her treatment history and current behavior, in need of AOT in order to prevent a relapse or deterioration which would be likely to result in:
a. a substantial risk of physical harm to the individual as manifested by threats of or attempts at suicide or serious bodily harm or conduct demonstrating that the
individual is dangerous to himself or herself; or
b. a substantial risk of physical harm to other persons as manifested by homicidal or other violent behavior by which others are placed in reasonable fear of serious physical harm; AND

7. be likely to benefit from AOT; AND

8. if the consumer has a health care proxy, any directions in it will be taken into account by the court in determining the written treatment plan. However, nothing precludes a person with a health care proxy from being eligible for AOT.

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.”

Guest Blog: Pennsylvania’s Advocacy Effort to Change Treatment Laws

GUEST BLOG:
Written by Jeanette Castello, Co-Chair of the Pennsylvania Treatment Law Steering Committee

According to Pennsylvania’s treatment laws the crisis worker who told Marjorie Miller that she was not able to take Kenneth Miller to be admitted to a hospital was just following the law.

Members of an advocacy effort to change our treatments laws are currently working to see Pennsylvania Senate Bill 226 passed so individuals with severe mental illness and a history of hospitalizations, homelessness, and/or time spent in jail or prison will be able to receive the timely, compassionate treatment they need. SB 226 is modeled after the proven successful Kendra’s Law. This law helps the small minority of people - who are often non-compliant with prescribed medications - to remain in treatment and possibly avoid the tragedies of violence and victimization that too often occur.

Although violent incidents are the ones the media often report on, my personal involvement with this advocacy effort is due to the unbearably heartbreaking time when my daughter suffered from lack of insight into her illness, also know as anosognosia. During this period of time, my daughter was hospitalized 15 times, each time meant a wait for her to reach the “clear and present danger to self or others” required by law. My concern during those sleepless, stress-filled days and nights was the worry that she would be hurt while wandering, sometimes in the middle of the night, following the voices that told her to leave the house.

Opponents of changing our treatment laws say we’re trying to infringe on their rights. Which makes more sense to you? 1) allowing our loved ones to put themselves or others in dangerous situations such as happened to the Miller family or 2) requiring compassionate and timely outpatient treatment for six months (the initial period of time stated in Kendra’s Law and SB 226). As a society, we need to decide what makes the most sense.

- Jeanette M. Castello
Co-Chair, PA Treatment Law Steering Committee
send comments to Jeanette through info@treatmentadvocacycenter.org

The opinions expressed by guest bloggers are their own and not necessarily that of the Treatment Advocacy Center.

Want to be a guest blogger? Tell us why at info@treatmentadvocacycenter.org.

The how and why of an officer's death

Last Friday, Officer Jason West of Cleveland Heights, Ohio, died in the line of duty.

An article on Sunday gave details on how he lost his life.

At 9:47 p.m., police received a report of a street fight.

As Officer West approached the scene, he stopped the car of Timothy Halton, 27, as he tried to leave. As West stepped out of his cruiser, Halton shot at Officer West from inside his own car. He then exited his car and shot West at close range. West was hit in the leg and face; he later died.

An article on Thursday detailed why the officer lost his life. Its title – Suspect in officer's killing didn't take his drugs: Agency couldn't compel medication for Halton

Nineteen days before that Friday, he showed up for a psychiatry appointment. Halton, who had been skipping his monthly anti-psychotic injections, again rebuffed his psychiatrist’s pleas for treatment.

That article also describes Halton’s history of violence and run-ins with police.

The story also contains pleas for treatment law reform that are always present but typically only gain light of the media in the wake of such a tragedy.

“Psychologist Fred Frese [and TAC Board Member] of Hudson says Ohio needs a law like New York's Kendra's Law, which gives judges greater authority to force mentally ill people into treatment. The law was named for Kendra Webdale, who died after a schizophrenic man pushed her in front of a subway train in 1999.”

We can only hope that the people of Ohio take heed of Dr. Frese’s recommendation.

Media continue to explore Va. Tech tragedy

Over the past week, the media has continued to cover the Virginia Tech shootings. The reoccuring theme is that that the mental health community failed. Some, such as the Charleston Daily Mail in West Virginia have expressed thanks that their state has an assisted outpatient treatment law.

Dr. E. Fuller Torrey in the Wall Street Journal:

The tragedy of Virginia Tech is a microcosm of our failed mental health system and our confusion about civil rights. Mentally ill individuals have a civil right to receive treatment, even when their brain disease precludes awareness of their illness. And the public has a civil right to be protected from potentially dangerous individuals. We are failing both the patients and the public.

The San Antonio Express explains these tragedies happen too often:

The same week that a disturbed student exploded in a rage of killings at Virginia Tech, there were other incidents that received far less attention.Media reports about the tragic combination of mental illness and violence are all too common, with family members the most likely victims.

Ray McAllister writes in the Richmond Times-Dispatch:

With guns readily available and checks on the mentally disabled not -- we can forget wondering if there will be another killing. The only question is when and where.
And how many will die.

In the Charleston Daily Mail in West Virginia, the editorial board is thankful for Kendra's Law in their state:

In the wake of the Virginia Tech massacre, people across the nation are wondering: How can these things be short-circuited? Could it happen here? The answer is that it's less likely in West Virginia, thanks to what is called Kendra's Law.

[Kendra’s] death caused New York state lawmakers to make it possible for courts to order people with mental illnesses to take their prescribed medications and to receive treatment. This is fair to the patient and to society as well.

Treatment reform in Illinois

The Chicago Tribune recently reported on SB 234 in Illinois; a bill that would update the strict treatment standard to provide treatment options for Illinois’ most seriously mentally ill before they are an imminent danger to themselves or others. The Treatment Advocacy Center’s executive director, Mary Zdanowicz was quoted in the article:

We have an obligation to those who are hurting to not withhold treatment.

Studies suggest that, when properly medicated, these folks are no more dangerous than the general population.

New York state data showed significant decreases in homelessness, incarceration and psychiatric hospitalization among people who were ordered into involuntary treatment under Kendra's Law. There were fewer suicide attempts and fewer cases of physically harming others or damaging property.

It's not mental illness that makes them violent, Zdanowicz said. It's untreated symptoms.

Kendra's Law- more important than ever

A recent investigative report by WABC TV in New York showed in the past 15 years, the number of inmates with mental illnesses in New York state prisons has grown by 71 percent, and that many of these prisoners have spent months, even years in total isolation, with virtually no therapy. According to Jack Beck, an attorney for a prison watchdog group:

"Often people with mental illness start their Southport Correctional Intuition sentence not because they've done some terrible act, but they've done some smaller act," Beck said. "But then, once they’re in this environment, that is so difficult for them to cope with, they start yelling and screaming and just being non-cooperative."

"Instead of having mental health beds, we have prisons and jails for the mentally ill. And that is the story."

Meanwhile, Kendra’s Law in New York has had stunningly successful results- For those in the AOT program: 77 percent fewer experienced psychiatric hospitalization; 83 percent fewer experienced arrest; and 87 percent fewer experienced incarceration.

The continued use of Kendra’s Law – a proactive approach to get treatment for people with severe mental illness before they deteriorate and commit a crime- is more important than ever.

Kendra's Law saves lives

James Masse struggled with severe mental illness for years. Eventually, he was placed in Adult Protective Services, but even that wasn’t enough to help him. When Masse was found walking into oncoming traffic, Kendra’s Law- New York’s version of assisted outpatient treatment (AOT) - was enacted for him. According to Megan Johnson, deputy clinical director at the Office of Community Services for Warren and Washington Counties:

It's a "last resort," Johnson said, but can help people avoid ending up in jail
or an emergency room.

"It is the most restrictive measure available to us, and taking away an individual's freedom of choice is not something we take lightly," she said. "But it allows us to intervene earlier, before they become an imminent danger to themselves or others.

Thanks to AOT Masse’s life has turned around. Masse says:

"I'm not ashamed of having a chemical imbalance. It's something that happened by accident; it's not like I'm being struck down for doing something bad," he said.

"If other people can help and not be the way I was, that's good."

The Shock, Grief, Panic and Guilt from the Other Side of a Tragedy

Severe mental illnesses can agonize in so many ways. The most direct manner is the impact on those who have them, but the scope can range far wider – to the families, others, and numerous critical components of our society.

Among the most heart-wrenching of anguish is that of families whose loved ones fall victim to the acute psychiatric disorder of another. We have painfully watched as families, such as those of Kendra Webdale, Laura Wilcox, and Gregory Katsnelson, bravely withstand the devastation of needless and unexpected loss. We have also been awed as members of these families have nobly turned their grief, not into revenge, but to bringing treatment to people incapacitated by illnesses like the one that ripped away their child, sibling or parent.

There is a flip side of these tragedies that rarely gets attention – the grievous turmoil of the families of the person who caused the harm, and did so only because of the symptoms of an illness that were neither asked for nor susceptible to self-control.

Imagine the turbulent mixture of shock, grief, panic and guilt experienced by the parents of Anthony Capozzi when their son, who has schizophrenia, was charged with two rapes in 1985 and later convicted of them. Was it the illness? Could his parents have prevented his actions? Something else? According to Albert Copozzi, Anthony’s father, "It is with you every moment …We don't go to bed at night without thinking about our son."

To put a twist on the Capozzis' distress that is hopeful yet also utterly confounding, imagine that – after 23 years of weekly eight-hour roundtrips to visit him in prison – Anthony Capozzi might not have done anything after all.

Dateline producer: "This is not tilting at windmills stuff"

From the blog entry of Dateline producer Lee Kamlet - Dateline will be airing a show on the Kendra Webdale story today, SATURDAY, JANUARY 20 at 8:00 pm EST:

On a damp, dreary day in January 1999, Kendra crossed paths with another New Yorker, a stranger named Andrew Goldstein. Kendra had made a last-minute decision to defy the rain, and take the subway to meet some friends. Andrew was going to take the same train home. Witnesses say Andrew stepped up to Kendra and asked the time. Then, just as the train pulled into the station, he stood behind Kendra, and with what one person called impeccable timing, shoved Kendra in front of the train. She died on the tracks.

The horrific story stunned not only New Yorkers, but the entire nation. What could have prompted someone to push a total stranger in front of the fast-moving train? To find the answer, Dateline spent 10 months investigating the story. We learned that Andrew Goldstein had quite a history ... [Read more ...]

Kendra's Law on Dateline this Saturday

Tune in to Dateline this Saturday, January 2o, for a piece by Edie Magnus on the death of Kendra Webdale 8 years ago in New York. New York's widely successful "Kendra's Law" was named for her and is in place and helping people today because of the compassionate advocacy of the Webdale family.

Find your local channel and airtime on Dateline's website.

A SAMPLE OF THE RESULTS OF KENDRA'S LAW ...

During assisted outpatient treatment (AOT):

• 74% fewer participants experienced homelessness
• 77% fewer experienced psychiatric hospitalization
• 83% fewer experienced arrest, and
• 87% fewer experienced incarceration.

Individuals in Kendra's Law were also more likely to regularly participate in services and take prescribed medication.

And AOT recipients endorsed the effect of the program on their lives. After receiving treatment, 75% reported that AOT helped them gain control over their lives, 81% said AOT helped them get and stay well, and 90% said AOT made them more likely to keep appointments and take medication.

Remembering Kendra Webdale, her family and so many others

Eight years ago today, Kendra Webdale a vibrant, beautiful young woman was pushed to her death from a subway platform in New York City by a man with schizophrenia who had a documented history of assaults and failing to follow prescribed medication regimens.

At the time, advocates like DJ Jaffe had been working for at least 10 years in New York toward a statewide assisted outpatient treatment law. Kendra family’s commitment to prevent the tragedy of untreated mental illness coupled with Governor (then-Attorney General) Elliot Spitzer’s political will finally succeeded in achieving the reality of Kendra’s Law for assisted outpatient treatment in New York. All those who are being helped by Kendra's Law in New York today are indebted to the Webdales, particularly Kendra’s mother Pat, who continues to advocate and Chairs the AOT Quality Improvement Panel sponsored by New York’s OMH.
In addition to mourning Kendra, today is a day to remember some other random victims of the violence that is sometimes a result of untreated mental illness ... and the families who have, like the Webdales, opened their hearts to try to help others.

Edgar Rivera, who lost his legs after being pushed from a NY subway platform in April 1999, epitomized grace and understanding when he lamented that although he lost his legs, at least he had his mind, unlike his assailant. Linda Gregory partnered with Alice Petrie, the sister of the man who shot her husband in the line of duty as a sheriff’s deputy. Their successful advocacy lead to Florida’s adoption of AOT and they continue to advocate for more humane treatment. Amanda and Nick Wilcox’s daughter was killed at a mental health center in California by a man with untreated mental illness. They are fighting to get their county to adopt Laura’s law.

There are so many others, too many to mention here, but we particularly want to remember 11-year-old Gregory Katsnelson who was killed, while riding his bike, by a young man whose family was told he was not “dangerous” enough to be helped. Before he killed Gregory that day, he also killed his own mother. Gregory would be 15 years old now - the Katnselsons have spent the last 4 years trying to persuade New Jersey legislators to become the 43rd state to adopt an AOT law. The Senate, under the leadership of Governor Codey, passed the bill last year.

Our hope for the New Year is that the Katsnelsons will succeed as other families have in making a terrible tragedy into a legacy of hope for others ... and that better laws and better usage of and understanding of the laws that exist will mean fewer sad anniversaries like today.

Posted by TAC executive director Mary Zdanowicz.

Is Kendra’s Law constitutional?

AOT opponents in Albuquerque said in a New Mexico court that the answer is “no.” But experiences from every other state with an AOT law prove otherwise.

In fact, 42 states have assisted outpatient treatment laws, some for over 20 years, and NONE have been ruled impermissible.* Most relevant, since the New Mexico bill is based on New York's Kendra's Law, the law in that state was unanimously ruled constitutional by the state's highest court (In the Matter of K.L.).

No challenge to an AOT law or its standard has succeeded.

Interestingly, in her comments in court about the Kendra's Law case, Judge Huling indicated that she was concerned not about whether the law itself was constitutional, but whether the city council overstepped its powers by legislating in an arena pre-empted by state legislation. It appears that the case will turn on an issue of home rule.

It would be unfortunate for the city to be prevented from using the ordinance immediately when it becomes effective. It is a beneficent law with numerous patient protections and great potential to reduce hospitalizations, arrests, incarceration, homelessness (outcomes proven in other states).

But if the court finds that a state technicality will keep Albuquerque from helping its citizens immediately, it is just more pressure on the state to get the law passed so everyone has access to this proven treatment mechanism.

* See In re Detention of LaBelle, 728 P.2d 138 (Washington Supreme Court 1986); State of Wisconsin v. Dennis H., 647 N.W.2d 851 (Wisconsin Supreme Court 2002); In re K. L., 806 N.E.2d 480 (New York Court Of Appeals 2004)

Kudos for Kendra's Law

Albuquerque Journal editorial praises Mayor Chavez and the City Council for their persistance in getting Kendra's Law to Albuquerque citizens. [Read more from New Mexico.]

Albuquerque passes Kendra's Law

The Albuquerque City Council last night passed Kendra's Law. The measure now goes to Mayor Martin Chavez for signature. Chavez has been an outspoken advocate for the law, which will help a small number of Albuquerque's sickest citizens who cannot make informed treatment decisions.

In an editorial supporting the ordinance – and a statewide version of the law as well - The Albuquerque Tribune said, “[U]ntil the country and the state get serious about mental health, this city ordinance is a responsible step toward helping those in need and protecting society from any harm they might inflict on others.”

New Mexico - Recycling the old fallacy about Andrew Goldstein

The Albuquerque Tribune ran commentaries for and against Kendra's Law, the "for" argument authored by TAC executive director Mary Zdanowicz.

In the "con" commentary, the authors note in part:

The reported incidents of violence cited as justification for Kendra's Law, including the incident for which Kendra's Law was named, involved perpetrators who had repeatedly asked for help and were turned away. Our position is if there had been adequate resources, including stable housing, treatment and case management, these incidents would have not occurred.

This is one of those old fallacies that is recycled anew each time AOT is debated. If you look at the actual report on Andrew Goldstein (pseudonym David Dix), you will see that in the two years prior to pushing Kendra Webdale to her death in front of a New York City subway train, Goldstein received 199 days of inpatient and emergency room services, on 15 different occasions, in six different hospitals from 1997 to 1999. Four different clinics provided outpatient services in this time period.

This is hardly the profile of a patient who was refused services. In fact, it was Goldstein who often refused services. He consistently stopped taking his medication after discharge from a hospital unless he was closely monitored. When he wasn't taking medication, he exhibited hallucinations, delusions, and unprovoked acts of aggression. On some occasions, when his untreated symptoms deteriorated to the point where he suffered anxiety, insomnia, or other unpleasant conditions, he went to an emergency room seeking relief. Other times, he was brought to the emergency room following a violent outburst.

And in 1998 alone, the State of New York and the federal government expended $95,075 for his mental health and residential care.

So the oft quoted "fact" that he frequently asked for help but was turned away is untrue.

Sad day in New Mexico

While the Albuquerque City Council continues to weigh the option of a citywide Kendra's Law ordinance, Albuquerque's two major newspapers call them on the delay in strongly worded editorials.

The editorial in the Albuquerque Tribune notes somberly that August 18 "is a day to reflect on the horrific costs of mental illnesses ignored."

The Albuquerque Journal's editorial ("City missed first step in helping mentally ill") blasts the Council's delay in acting and clarifies some misconceptions:

Chávez's proposal balances public safety with protecting civil liberties. There is no picking up the odd, the quirky or the angry on somebody's whim. A relative, social worker or police officer would have to petition the court, and a judge would have to rule a person needed mandatory care and approve an enforceable treatment program, be it taking medication or having a supervised living arrangement.

Relying on the criticism that there aren't enough services for the mentally ill is a delaying tactic that creates a dangerous circle— there aren't enough services so there isn't any treatment, there isn't any treatment because there aren't enough services. Kendra's Law would target only the most extreme and dangerous cases of mentally ill residents who need help.