Monday, April 26, 2010

Laws with people's first names on them

There has been a growing tendency in the United States to push for laws in remembrance of the victim. So, we have "Kendra's" law, New York State legislation that forces the mentally ill into treatment programs if they meet the following criteria:

is 18 years of age or older; and
•is suffering from a mental illness; and
•is unlikely to survive safely in the community without supervision, based on a clinical determination; and
•has a history of lack of compliance with treatment for mental illness which has led to either:
◦2 hospitalizations for mental illness in the preceding 36 months, or
◦1 or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the last 48 months; and
•is unlikely to voluntarily participate in outpatient treatment that would enable him or her to live safely in the community; and
•is in need of AOT in order to avoid a relapse or deterioration which would be likely to result in serious harm to self or others; and
•is likely to benefit from AOT.

Kendra's law has a sunset provision for June 2010. According to a petition that is circulating: The proposed new law includes provisions such as increasing the original court order from 6 months to one year; not requiring doctor testimony, requiring fiscal management, allowing an expired order to be renewed 60 days after it expires without needing a new hearing, and viewing "non-compliance" with drugs, urine or blood tests, or drugs and alcohol use as grounds for "dangerousness".

I can understand society's frustration with mentally ill people who are violent and roaming the streets, but statistics show that most violent crime is committed by the "non-mentally" ill. That is no comfort to the victim or the victim's family, so we end up with laws like Kendra's, aimed at justice for the individual while claiming justice for society. My concern with Kendra's law. "Assisted Outpatient Treatment" smells like meds to me. Are meds all they're going to get? Is that it? Any real therapy going on here? It smells to me like people will be stuffed full of meds until they are so zoned out they are no longer violent, but also not employable. Kendra's law has a whiff of buck passing. Nobody wants to be responsible here, so again, make it look responsible by passing a law, get drugs into them and you've done your duty. If they fail to adhere, then there is always America's already over-crowded prison system.

One glaring absence in the reporting about Andrew Goldstein, who pushed Kendra Webdale into the path of an on-coming subway train, was Andrew's family. Where were they? It appears he was abandoned to a group home after lurching around New York City for a number of lonely years. Not one mention of his family other than the fact that his mother refused to see him. That doesn't cut it with me. How about an "Andrew's law" that would force families into therapy along with their relative and would force the family to take their relative off the streets. If you don't like Andrew's law, there's always "Kendra's law".

My "Andrew's law" social engineering proposal at least has some merits that I think are missing in Kendra's law. One is the acknowledgement that a supportive family is key and that families should be expected to be fully involved from the outset. Another is to give the individual and the family factual information about what is out there in terms of help that doesn't involve medications. A third is to let the individual/the family decide what therapy is best for them and support this choice. If they want to bring in an African shaman or a Celtic priest or decide that orthomolecular therapy is also what they want, then assume that they know best. A fourth option is a personal favorite, which is "emulation." Let people find out from other real people in real life situations what worked for them. A fifth option is to give the family some relief through short term accommodations where drugs will not be automatically administered. (The fifth option is not available in most jurisictions and is why we tried to keep Chris out of the hospital when he was relapsing.)

The "system" such as it is, discourages the family in favor of the professional and the use of medications from the start. The family is told that alternative treatments are unproven. All of this instills fear into the family, who quickly come to regard their relative as strange and hopeless.

What Andrew's family did was to warehouse him in a group home. That is harsh judgement for me to make, not knowing much more than what I read. But it's got to be said. Their son was their responsibility in the end, despite the problems with the way medical help was offered. The tragedy may have been prevented had the parents been given more hope from the onset and encouraged to be an integral part of their son's recovery process. They probably weren't told that their son could recover from schizophrenia without drugs if other interventions were in place. They were probably told instead that he had a damaged brain and that schizophrenia could only be treated using medications. If they had done more, despite the lack of help from institutions, and been encouraged with better disclosure of treatment options, perhaps there wouldn't be a Kendra's law. If real help was available for them perhaps this tragedy would not have happened.

The New York Times deals with the issue of the warehousing in the army's trauma care units. It reminded me very much of the day program Chris was enrolled in for two years. Chris never wanted to go to the day program, where he felt demeaned, despite the "best of intentions." He felt like a freak there, so he acted like one. All in all, I figured two years of "recovery" were wasted by good intentions that didn't support the family working it out for themselves in their own way. Once you enter a program, you abide by its definition of recovery and how to go about it.

The article interviewed the mother of one young man about his experiences in the transition unit.

But things are looking up, his mother believes: he will be able to stay with her in Michigan while awaiting his discharge. His mother, Sally Darrow, has already seen one son commit suicide. She believes that Michael would become the second if he had to return to Fort Carson and the transition unit. “At home, with family and schoolmates, he’s dealing with things better,” Ms. Darrow said. “He’s not safe there.”


  1. Well said, as a mother who has lived with my son for 26 years I know him. I am told I am in denial because I don't fully agree with the "medical"diagnosis and am seeking answers from varied sources. How do you refute a doctor with umpteen years of training because I have a gut feeling?? As a teacher I have often said that I will do my job if parents will do theirs!! It is so much easier to offload responsibility instead of face it.

  2. I find it almost comically ironic that you're so opposed to this law when in fact, Goldstein had stopped taking his anti-psychotic medication when he pushed her onto the tracks. The reason he pushed her onto the tracks was because he was off his meds and in a psychotic episode. If the law prevents even one death such as this then it's effective. I don't care if it offends your sensibilities.

  3. Welcome back, Jules. With a diagnosis of schizophrenia, I have learned that one can never definitely attribute a certain behavior to being on or off the meds. I have seen psychotic behavior on meds, so I think the argument that meds prevents psychotic behavior only goes so far. I think it would offend a lot of people's sensibilities to be given so drugged up that they will never get a life. The law is a blunt instrument and any law enacted has unforeseen and undesirable consequences beyond what it thinks it is fixing.

  4. P.S. If this post bothers you, so will my post on After Her Brain Broke. I urge you to read it and welcome your comments.


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