"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."

Unlucky 7

Justin Quintana claimed he was God. He called police officers to saying he should be treated like the President and wanted 24-hour protection. He threatened his mother, and police had been called to Quintana’s house six times in a little more than a year. His mother – Susan Kuchma- was a state police officer, but there was nothing she could do to get treatment for her son’s paranoid schizophrenia. He didn’t chose treatment and wasn’t deemed dangerous.

One of Kuchma's family members said Friday that the officer loved her son and took great pains to document his behavior with the goal of getting him help. But her efforts were often frustrated.

"It's a lot of red tape," said Kuchma's niece and Quintana's cousin, Tenika Susana Sosa-Quintana, 28, of Mesquite. "...we all have civil liberties and Justin is an adult and Justin has not been deemed incompetent by any court.

"The whole thing comes down to whether or not a person is construed to be dangerous to themselves and/or others," said Ron Gurley, a local advocate for the mentally ill. "Well, that is in the eyes of the beholder. But locally here there seems to be a strict adherence to dangerousness being something where you have to almost present the fact that you are going to hurt somebody or hurt yourself."

Last Thursday, the seventh time police were called to Quintana’s home, officers found Kuchma dead from a gun shot wound. Maybe now that Quintana is charged with murdering his mother he’ll get treatment.

Building a “safe house” in an unsafe system

New Mexico is still one of only 8 states without AOT, and even as a handful of advocates continue to pat themselves on the back for fighting to stop the state from actually passing a compassionate treatment law, we see gems like this one.

"A lot of problems happen when families call 911 when a family member is in a mental health crisis," said Julie Medina, an advocate for Parents for Behaviorally Different Children. "More often than not, he ends up in jail. He's committed what's considered an act of domestic violence or is in a paranoid delusional state." [Valencia County News Bulletin, NM, Sep 26, 2007]

One solution being proposed now is to establish “safe houses.” This, and the suggestion about implementing “quick response teams,” both acknowledge the fact that some people with untreated severe mental illnesses need more than standard community services.

Yet proponents are quick to point out that the safe houses (which would cost the state upwards of $3 million) would be voluntary, noting that they would be places “where people can choose to go ... and take a few days to get out of crisis.”

That will be a nice additional service for those who understand they are ill and know they need help. But they won’t do a thing for those who steadfastly refuse help because they don’t think they need it.

Perhaps they should ask some family members what happens when their loved ones descend into psychosis that leads the families to call police.

If the person were capable of choosing to “get out of crisis,” you wouldn’t need safe houses.

Without the option for assisted outpatient treatment, the people who really need the safe houses are the family members, who are unable to get real help for the people they love until they become dangerous, and then must call police.

Gov. Richardson: Demand NM legislators get it right

Statement from TAC Executive Director Mary Zdanowicz:

New Mexico is again on the verge of denying critical treatment to the sickest people with severe mental illnesses, discriminating against them because they are too ill to ask for help.

Gov. Bill Richardson has publicly supported mandated community treatment legislation since Rep. Joni Marie Gutierrez first introduced it in 2006. Despite passing the House this year, the bill stalled in a Senate committee, a victim of political infighting and the work of one of Gov. Richardson’s own cabinet members, Secretary of Human Services Pam Hyde, who refused to rise in support of the measure despite her Governor’s position.

We urge Gov. Richardson to right this wrong, following up his supportive words with real action. He should add to his list of expectations for legislators that they exhibit true concern for people with debilitating brain diseases and the inability to choose treatment. Other bills to be addressed in a special session purport to protect the rights of New Mexico families and prevent them from violent harm – these criteria are also the case with the mandated community treatment legislation.

READ MORE ...

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)

A real look at Kendra's Law

I invite ... you to spend a night in a house with my brother - an untreated, paranoid schizophrenic.

Try not to cry as you listen to him pound on walls, scream, swear and make threats at some unseen person.

Watch as my mother, who should be enjoying her senior years, has to call the police when it becomes too much for her to take.

Be there when the staff at the psychiatric hospital tells her that, true, her son is psychotic, but he is refusing medication and that's his right - since he doesn't appear to be imminently violent.

Take him home; see how comfortable you feel with the determination that he is not imminently violent.

Watch him sink into complete insanity, tormented by demons that don't exist.

More ...

Doing a disservice

Albuquerque, New Mexico recently passed a city-wide ordinance providing for AOT for their most severely mentally ill citizens. Unfortunately, opponents of the measure have resorted to scare tactics in hopes of preventing its implementation. The federally funded Protection and Advocacy Systems has repeatedly claimed that, "Under this law, a person can be picked up if there is simply the belief they might be a danger at some point in the future.”

In reality, the ordinance specifies that individuals are only eligible for AOT if they meet eight specific criteria; criteria that have been carefully crafted to focus only on the most severely mentally ill. But you won’t hear that from AOT’s opponents. Instead of discussing the realities of AOT, you only hear exaggerations and fear mongering. And that does a disservice to everyone involved in the process.

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.

Albuquerque Mayor Chavez: "We're not waiting"

When the New Mexico Senate failed to act to pass Kendra’s Law in January, despite overwhelming support from the Governor, Senator Domenici, and a unanimous vote in the House, Albuquerque Mayor Martin Chavez decided that he would not let inaction on the part of the state harm the people he was elected to protect.

"We're not waiting. The consequences are too severe," Chávez told the Albuquerque Journal on Sunday. "When the state fails to act, I am still charged with protecting the public in Albuquerque."

The Albuquerque Journal agrees. To the argument that you need more services before you can implement an assisted outpatient treatment law, the paper’s editorial board had this to say:

That's a pointless chicken-and-egg argument for families of the mentally ill, who say they can't wait for a new program or building. Their loved one is in crisis now. Perhaps once judges start ordering treatment, the state and the health-care community will finally find the wherewithal to assure its availability.

Unwilling to join in the hand-wringing as another Albuquerquean commits suicide by cop or kills a police officer on a mental-health pickup, and unwilling to join in the whining that there aren't enough treatment facilities so it's best to do nothing, Chávez has stepped up to help those who aren't able to help themselves.

Services can fail when treatment law is weak

An intensive outpatient program that is being discontinued, "changed my life" according to an Albuquerque woman who had been hospitalized for mental illness and suicidal thoughts.

All outpatient programs in New Mexico are voluntary because the state is one of eight that does not have assisted outpatient treatment. So it should not be a complete surprise "that many patients weren't showing up for the nine required hours per week,” according to Dr. John Lauriello, executive medical director at the UNM Psychiatric Center.

If they didn't show up for a full nine hours, insurers wouldn't reimburse UNM for the service.

Opponents said "mandated treatment wouldn't work in New Mexico, due to a lack of services." But, this is a case where services didn't work, in part, because New Mexico does not have AOT.

It is important to have as many options as possible to increase treatment compliance, including AOT, particularly in communities that have a dearth of services. Nonadherence to treatment has significant fiscal (and clinical) implications.

For example, medication nonadherence is a significant factor in hospital readmissions. A study of Medicaid recipients with schizophrenia in California revealed that “individuals who were [medication] nonadherent were two and one-half times more likely to be hospitalized than those who were adherent.” The same study found that those who are non-adherent incur 43 percent more in service costs than those who adhere to medication.

AOT can help reduce such costs by improving medication compliance. Under AOT in New York the number of individuals exhibiting good adherence to medication increased by 103 percent and good service engagement increased by 51 percent.

Last week NAMI gave a D+ grade to the state that spends the most per capita on services – this could be because Pennsylvania is a state that has an overly restrictive AOT law that is rarely used, making services ineffective and inefficient – like New Mexico.

Grading the States: New Mexico, C-

NAMI today released a state-by-state report card called “Grading the States.” It shows that most states are dramatically failing those with mental illnesses.

Initial reaction from U.S. Senator Pete Domenici on New Mexico’s dismal C minus:

"While our efforts so far have raised public awareness about mental health issues, it's clear that more needs to be done."

Domenici said the [New Mexico] Legislature should have passed Kendra's Law to allow a patient's family or doctors to obtain a court order requiring the patient to get treatment. The law is named for Kendra Webdale, a New Yorker killed by a schizophrenic.

Read Domenici's earlier statement on Kendra's Law.

Kendra's Law coming to Albuquerque

In New Mexico, Kendra’s Law was passed unanimously by the House – but the constitutionally mandated end of the session came before it could be called for a vote on the Senate floor. The law was widely supported – the science and data clearly registered with legislators more than the emotions and fear tactics of opponents.

And proponents like Mayor Chavez, Rep. Gutierrez, and Senator Domenici are clear about their intentions. Next week, Albuquerque Mayor Chavez will introduce Kendra’s Law for the city – and Rep. Gutierrez has promised to reintroduce the bill statewide the first day of the next session.

Stay tuned.

Families in NM support Kendra's Law

There have been many letters to the editor in support of bringing AOT to New Mexico. NAMI New Mexico supports this bill because too many families have had an experience like this one.

I APPLAUD MAYOR Martin Chávez for his support of assisted outpatient treatment for the mentally ill. I am a Democrat who strongly supports civil liberties and the rights of the disabled. As an attorney, I have worked to protect both. But I am also a sister to an untreated, paranoid schizophrenic.

Because the illness, by its nature, makes [my brother] paranoid and untrusting, he refuses treatment. He hallucinates constantly. He is tormented by the voices he hears, which are violent enemies in pursuit. He cannot care for himself.

Despite his condition, we are repeatedly told that we can do nothing to help him until he hurts himself or someone else. Imagine your loved one being terribly sick and your government actually preventing you from getting them the medication they need. My family's only choice is to wait for a horrific crisis. It's an ongoing nightmare that takes its toll on my entire family. We worry every day that he will hurt someone or that a well-meaning police officer will hurt him.

- Excerpt of letter from Susan Warren, Albuquerque Journal, January 10, 2006

Consequences are too great to wait

As U.S. Senator Pete Domenici said in announcing his support for bringing an assisted outpatient treatment law to New Mexico:

"Some argue that it is wrong to force individuals to undergo treatment against their will. We argue that the tragic consequences are simply too monumental not to require help under certain circumstances. The success rate of the AOT program in other states has been well documented in both research and in practice."

We couldn’t agree more.

Top Policymakers Support AOT for New Mexico

New Mexico is one of only 8 states without an assisted outpatient treatment (AOT) law. That means someone who is too ill to make an informed treatment decision must be left untreated until they are in a crisis, posing a “likelihood of serious harm to themselves or others.”

Who supports bringing AOT to New Mexico? Republicans and Democrats alike have rallied behind the effort to update New Mexico's mental illness treatment laws.

• Rep. Joni Gutierrez (D-Las Cruces), who introduced the bill in the House, said that "existing New Mexico law essentially forces people who lack insight into their illness to hit rock bottom before they can be helped ... Forced deterioration is cruel and inhumane."
• U.S. Senator Pete Domenici has strongly endorsed the legislation, pointing out "Some argue that it is wrong to force individuals to undergo treatment against their will. We argue that the tragic consequences are simply too monumental not to require help under certain circumstances. The success rate of the AOT program in other states has been well documented in both research and in practice.”
• Governor Bill Richardson held a news conference to endorse the measure, saying "We need this law to prevent events like the tragic murders in Albuquerque last summer. We have to do everything we can to prevent this from happening to another family, another police officer, or another community, ever again.” [Read more about the news conference.]
• Albuquerque Mayor Martin Chávez is a strong supporter, noting that 20 percent of the 55 homicides in Albuquerque in 2005 were related to mental illness.
• The bill is supported by the state and local chapters of the National Alliance for the Mentally Ill (NAMI).

GET THE FACTS

What is assisted outpatient treatment?
Why does New Mexico need AOT?
How is it working in other states that are using it?
Why do some people refuse treatment for severe mental illnesses?

Among other things, assisted outpatient treatment:

• Reduces homelessness, psychiatric hospitalizations, arrests, incarceration, and harmful behavior, and improves treatment compliance
• Reduces caregiver strain
• Is retroactively endorsed by participants

Some individuals and organizations have raised concerns about assisted outpatient treatment. Most of these fears are based on misinformation or misunderstanding. Educate yourself about the myths surrounding assisted outpatient treatment.

Tools to help?

The Mentally Ill and the Criminal Justice System: A Review of Programs (Paul W. Spaite and Mark S. Davis, June 2005) offers an overview of tools that have emerged to deal with mentally ill people in the community – like Crisis Intervention Training (CIT) and mental health courts.

The authors note that one of their goals is to “persuade communities that have not yet adopted programs to deal with their difficult-to-treat population, to do so.” [In fact, author Paul W. Spaite would like to hear from anyone who knows of similar activities.]

Many are trying ...

• Creating a mental health court (La Crosse County, Wisconsin)
• Training cops for the mentally ill (New Utah, Utah)

Because something must be done ...

• Too soon to judge, not too soon to learn (Albuquerque, New Mexico)
• Air marshal shooting sad, but not surprising (Miami, Florida, incident)

New Mexico’s latest tragedy spurs call for reform of treatment law

John Hyde, 48, shot and killed five people in Albuquerque, New Mexico, in mid August, including two police officers dispatched to bring him in for an evaluation.

For at least five months, according to his family, Hyde had been off medication for schizophrenia and bipolar disorder – in April, police responded to his home at the request of his 80-year-old mother, but there was nothing they could do to help. New Mexico remains one of eight states without an assisted outpatient treatment law (also known as involuntary commitment). Now many are questioning if it is time to change that.