The Mental Health Minute

Articles and news about mental health issues

Let’s make Kendra’s Law permanent

New York subway train arriving
Image by Annie Mole via Flickr

I knew nothing of the Kendra’s Law until reading this article.  After reading it, though, I did have one of those “ah-ha!” moments and found myself wondering why this idea has taken so long to show up.  I love the idea of keeping people in their own communities whenever possible.  According to this article, with court mandated treatment added to the mix, it seems it is possible.

Unfortunately, the mental health patient is the type of patient who usually will not be compliant with treatment and will quit at any opportunity–quit therapy, quit medications, quit follow-up appointments.  It’s possible that all of this involves way too much and is overwhelming or disturbing, or maybe the patient believes he is cured and no longer needs help.  Whatever the reason, I like the idea of some type of court order to remain on medication and therapy as a condition to remaining at home in the community.

I know that there are those who will feel that this is controlling and harsh.  For those who feel that way, I can say I understand your concerns.  However, my experience with the mentally ill shows me that being mentally ill is not comfortable and does not feel safe to the person.  If getting medication routinely can remove the fear and the emotional pain, I believe it is the right thing to do.  Granted, this article is talking about dangerously ill and aggressive people who are untreated, so in the interest of social norms and safety I also have to agree with this idea to medicate as a condition of remaining out in the population.

_______________________________________________________________________________________

By D.J. JAFFE
First published: Wednesday, February 3, 2010

Eleven years ago, state government leaders were shocked into action by the death of Kendra Webdale. She was suddenly and intentionally pushed to her death in front of an oncoming New York City subway train by a man with schizophrenia whom the state Office of Mental Health had let go untreated.Shortly thereafter, Edgar Rivera was also pushed in front of a train by another mentally ill man whom the Office of Mental Health had let go untreated. Mr. Rivera survived, but lost his legs.

To help avoid a repeat, the state legislative leadership put politics aside and passed Kendra’s Law in August 1999. But the law sunsets this year. If the Legislature doesn’t make it permanent, 1,800 patients with mental illness — many of them with a history of violence — could become free to go off their medications.

Kendra’s Law allows the courts to commit a small group of potentially violent mentally ill individuals to accept treatment as a condition for living in the community. Equally important, it commits the Office of Mental Health to providing that treatment.

Kendra’s Law has proved to keep the public safer and patients healthier. It saves money by cutting down on hospitalization rates, length of hospitalizations, inpatient commitment rates and incarceration.

But if some state-funded providers of mental health services have their way, the law will die in June. That would be dangerous.

A 2005 Office of Mental Health study compared how seriously mentally ill people did for six months before they participated in the Kendra’s Law program and for six months while they participated. It found that while participating, 47 percent fewer harmed others, 46 percent fewer damaged or destroyed property, 83 percent fewer were arrested and 87 percent fewer were incarcerated.

A 2009 Duke University School of Medicine study showed the law has had a positive effect on the mental health system and the patients in it. The law allows patients to stay in the community — a less restrictive, less expensive, more humane setting than the alternative: inpatient commitment.

So why would anyone oppose making permanent a law that helps patients, keeps the public safer and saves money?

Making Kendra’s Law permanent does have support from groups as diverse as the National Alliance on Mental Illness and the New York State Association of Chiefs of Police. But, according to testimony in 2005 by the National Alliance on Mental Illness- New York State, “There is a movement to stop the law led by … a consortium of mental health rehab organizations…. These organizations do skills acquisition, not symptom management. To benefit from their programs, one must be stable and have insight into one’s illness.”

And therein lies the rub. These programs fear losing their ability to pick and choose easier to treat, more compliant, less ill people to participate in their programs.

Office of Mental Health Commissioner Michael Hogan is on record as favoring Kendra’s Law.

Yet, for some inexplicable reason, he has cut down on the number of people entering the program and increased the rate at which they leave. That helps neither the mentally ill nor the communities in which they live.

In 2005, the Legislature chose to renew the law, rather than make it permanent, to appease the anti-treatment advocates and to address their concerns with new studies. But the results are now in: The law works.

More studies cost money and divert resources. Not knowing whether the law will expire prevents programs that do help the seriously mentally ill from investing in the infrastructure to make it work.

Renewing the law, rather than making it permanent, will only give providers more time to develop more faux concerns and waste more government money proving what everyone knows: Treatment works.

This law should not be held hostage to those who want to kill it. Kendra Webdale died. Kendra’s Law shouldn’t. The Legislature should make it permanent now.

D.J. Jaffe is an advocate for the seriously mentally ill and a co-founder of the Treatment Advocacy Center (http://www/kendraslaw.org). His e-mail address is djjaffe@treatmentadvocacycenter.org.

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February 20, 2010 - Posted by | Mental Health | , , , , , ,

27 Comments »

  1. Thank you for posting this. You can read my op-ed in Albany Times Union at http://www.timesunion.com/AspStories/story.asp?storyID=896401&category=OPINION and a new study on it’s success at
    http://www.healthcanal.com/mental-health-behavior/5834.html

    I am TheRealMrMe on Twitter
    We encourage individuals to learn more at kendraslaw.org and we are looking for orgs to sign up as endorsers. (Non NYS residents visits treatmentadvocacycenter.org)

    Comment by DJ Jaffe | February 20, 2010 | Reply

  2. I see you are a psychiatric nurse. If you have contacts at the National or NYS Association of Psychiatric nurses, we would love to have their support.

    Following are just a few of the many articles demonstrating the violence to Nurses who work in psychiatric units that we believe could be reduced through enactment of Kendra’s Law:

    American Psychiatric Nurses Association 2008 Position Statement on Workplace Violence
    http://www.apna.org/i4a/pages/index.cfm?pageid=3786

    Psychiatric Services Article on Violence and aggression in psychiatric units
    http://psychservices.psychiatryonline.org/cgi/content/full/49/11/1452

    Contemporary Nursing Article on Violence against Psychiatric Nurses
    http://www.contemporarynurse.com/archives/vol/21/issue/1/article/681/violence-against-psychiatric-nurses

    http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=692114

    You can sign up to be listed as a supporter of Kendra’s Law and get inside updates at kendraslaw.org

    Independent studies in NYS show Kendra’s Law was a huge success:

    • 74 percent fewer experienced homelessness;
    • 77 percent fewer experienced psychiatric hospitalization;
    • 83 percent fewer experienced arrest; and
    • 87 percent fewer experienced incarceration.
    • 55 percent fewer recipients engaged in suicide attempts or physical harm to self;
    • 49 percent fewer abused alcohol;
    • 48 percent fewer abused drugs;
    • 47 percent fewer physically harmed others;
    • 46 percent fewer damaged or destroyed property; and
    • 43 percent fewer threatened physical harm to others.
    ( source: http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=169 )

    The law sunsets in 2010 which would mean several thousand mentally ill people who are required to stay on meds would be freed to go off them. We want the law made permanent and funded in light of the success above. It’s a more humane way to treat patients and is safer for the public.

    We would like to list as many state and local Nurse organizations as possible as supporters. When we release the list it will include numerous major advocates for the mentally ill, professional organizations, and public safety groups.
    Please sign up to be listed as a supporter of Kendra’s Law and get inside updates at kendraslaw.org
    Thanks

    Comment by DJ Jaffe | February 20, 2010 | Reply

  3. For your assumption that the mentally ill must be required to take their medications to earn their constitutional and human rights; wouldn’t you first want to prove the medications and similar treatments are not doing more harm, than good.

    I’m always amazed how those that believe they are qualified to make one size fits all choices and laws that make themselves feel somehow superior or safer from the supposed/targeted lesser than people.

    If you have worked in this field as long as you claim; then you would know first hand that it’s a poorly constructed revolving door debacle at best. If the drugs we use really worked as effectively as claimed(and you know that’s pretty much all the vast majority will get in a locked environment), we would not have the rampant re-hospitalization rates, a deteriorating mentally ill population with a life span some twenty years less than average, and an emerging epidemic of mental health related problems taking strangle hold upon our society.

    Of course who would dare question the ghost written and questionable science, those god doctor key opinion leaders, NAMI (aka drug company marketing reps), and those global influential giants in pharmaceutical corporate profit heaven.

    In fact many of the medications being forced upon patients today may actually cause psychosis and related mental health problems on top of an already very challenged constitutional make up or environmental situation. Not to mention the tremendous risk/cost in psychically debilitating side effects from these drugs.

    So I gather in your opinion, psychiatrist and mental health professionals know better and should be given the power to circumvent a persons judicial rights.

    If you had cancer, would you be in favor of forced treatment with a drug cocktail you believed was harmful.If you were overweight, would you want to be forced into a perhaps dangerous diet of someone Else’s choosing, as just a couple examples of where the “forced medication/treatment modality leads and has gone a rye into true insanity.

    Being a mental health professional or medical professional does not qualify anyone to choose a person’s course of treatment against their will, their expressed wishes, or the choice not to be treated at all.

    When did a few years in school, an MD, RN, and some hospital experience make anyone qualified to make those decisions for others (this is why INFORMED CONSENT was created). Why don’t you take a few of these magical medications and get back to us on how well your doing in let’s say a year or five?

    I have also put my time in working professionally with the whole gambit of mental health populations, and see this problem in an entirely different light. Obviously not everyone is walking in lock step to these intrusions upon a patients very humanity.

    Comment by MsPiggy | February 28, 2010 | Reply

  4. If you have questions about the law (vs. me) I would be glad to answer them. Kendra’s Law specifically prohibits medication over objection and instead, relies on prior law which requires a finding of lack of capacity.

    Kendra’s specifically requires doctors to consider the postive and negative side-effects and to solicit consumer input in developing any treatment plan.

    As far as your attack on me, I led opposition to how Sandoz marketed clozapine and how respiridol was being marketed when NAMI was sitting on sidelines approving of it. You can search the Wall St. Journal or NY Times if you want.

    Also, for whatever it’s worth, I do have cancer (leukemia) and am on a med: zoloft. I also am willing to accept responsibility for what I say by using my real name.

    When you are willing to do the same, let’s talk.

    Comment by DJ Jaffe | February 28, 2010 | Reply

  5. DJ Jaffe, You are directly out Fuller Torrey’s “Treatment Advocacy Center” correct. So I take it you are in sync with Torrey’s cat matter virus theory causing mental illness, and with his claim that Haldol is an anti viral drug. You also do know that Fuller Torrey holds the patent for the under the skin long acting Haldol disc.

    You also do realize Torrey has admitted in public speaking engagements to being completely delusional and having no science to back up his claims. Just maybe you have read some of articles at “Furious Seasons” blog related to your organization and Fuller Torrey.

    I can tell you this much in fact about your group, it has nothing to do with Patient Advocacy.

    I certainly hope your not saying Zoloft is a treatment for cancer here?

    In closing I was not attacking personally, but stating a difference of opinion responding to the article, to your comments, and to your organizations efforts.

    Comment by MsPiggy | February 28, 2010 | Reply

  6. By the way it’s really hard to take your prior comments about NAMI seriously since you were on their board hiding the huge amounts of money being funneled in by Pharma.

    DJ JAffe:

    Board Member
    Treatment Advocacy Center
    (Marketing and Advertising industry)
    1997 — 2009 (12 years )

    Board Member
    National Alliance for the Mentally Ill
    (Marketing and Advertising industry)
    1984 — 1999 (15 years )

    2/3 of NAMI funding came directly from the Pharmaceutical Industry, while NAMI promoted/lobbied public policy and laws that would benefit the pharmaceutical industry. Would you like to disclose all finanacial connections between Pharma and TAC for me here?

    Would you like to comment on the connections between the (TAC and Fuller Torrey ran) Stanley Foundation’s financial connection to Harvard’s Dr. J. Biederman’s in his Risperdal trials on children, the tainted results, the unethical protocol violations in the research, and all the conflicts of interest under Senate investigation across the board?

    Being the TAC spokesperson, I’m quite sure you would like to respond and explain these and other questions.

    I will not even ask about F. Torrey’s procured brain collection and the scandal behind it.

    Comment by MsPiggy | March 1, 2010 | Reply

  7. re”Unfortunately, the mental health patient is the type of patient who usually will not be compliant with treatment”

    First you must identify voluntary and involuntary patient.
    If he/she is voluntary, he/she is indeed a patient.
    If he/she in not voluntary, he/she is a prisoner not a patient. There are no physical test for mental illness.

    “Treatment” is a change in behaviour that authority needs-wants, not a cure of a disease such as a virus or bacterial infection.

    The free will of person is their choice to do good or evil.
    If a person can not control their actions like a person with epilepsy, they should not be in public. But most everyone has this ability. The action of pushing someone onto train tracks is a criminal action due to its complexity- coordinated action. It is not a medical one.

    With freedom we all have the choice to perform evil or good actions, even myself an unmedicated “schizophrenic”.

    Only when a crime has occured can “we” jail and “treat” people.
    Medicating people for life is the same as jailing them for life. If medicated for life, I hope the patients proven crime justifies that “medical treatment”.

    Comment by markps2 | March 1, 2010 | Reply

  8. Challenging Society’s perception of violence and people labeled with mental illness labels:

    http://bipolarsoupkitchen-stephany.blogspot.com/2009/10/challenging-society-perception-mental.html

    From the General Archives of Psychiatry

    “Because severe mental illness did not independently predict future violent behavior, these findings challenge perceptions that mental illness is a leading cause of violence in the general population. Still, people with mental illness did report violence more often, largely because they showed other factors associated with violence. Consequently, understanding the link between violent acts and mental disorder requires consideration of its association with other variables such as substance abuse, environmental stressors, and history of violence.”

    Stanley Medical Research Institute, Joseph Biederman, Fuller Torrey and TAC

    http://bipolarsoupkitchen-stephany.blogspot.com/2009/03/stanley-medical-research-institute.html

    Superior Court of New Jersey
    In re: Risperdal/Seroquel/Zyprexa
    Litigation

    Video Deposition of Joseph Biederman, MD
    Friday February 27, 2009
    Boston, MA.

    page 342

    Q. What is the Stanley Medical Research Institute?

    A.(Biederman) The Stanley family has a foundation that is called now the Stanley Medical Institute that funded us for a few years to conduct the psychopharmacological research on pediatric bipolar illness.

    Q. How many studies has the Stanley Medical Research Institute funded of yours?

    A. They funded a center, so there was a group of studies, studies that involved neuroleptics and studies that followed up, but mostly a study that involved treatment.

    Q. What center did they fund?

    A. They funded the center for the treatment of pediatric mania, so we conducted studies examining Zyprexa, Seroquel, Risperdal(risperidone).We did a study of preschoolers, these type of things.

    Q. So the center for Pediatric Mania has been funded exclusively by the Stanley Research Medical Institute?

    A. (Biederman)Yes.It’s the center for treatment of pediatric mania.That’s probably correct.

    Comment by Stephany | March 1, 2010 | Reply

  9. TAC/Treatment Advocacy Center, Fuller Torrey, Stanley Foundation

    Stanley Foundation Brain Harvesting Illegal in Washington State.

    “2005 article of interest:

    “Virginia Hendricks can’t help but feel betrayed. Just a few days after her son Jim died unexpectedly, the King County Medical Examiner’s office called, asking to take a sample of her son’s brain. Instead, without permission, the county sent Jim’s entire brain, plus his mental health and medical history files to the Stanley Medical Institute in Bethesda Maryland.”

    “The sister of a homeless, mentally ill man named Bradley Gierlich is suing King County as well. In a lawsuit filed late Friday, the family claims nobody ever gave permission to harvest organs. Bradley Gierlich’s brain was sent to Stanley medical by King County anyway.”

    (link to that article in my previous comment)

    TAC is nothing but a fearmongering association directly attempting to forcibly drug innocent people based on their personal stats, which always promote stories of violence, yet these are rare events in society, and it all is directly tied to pharmaceuticals, and the fact that Jaffe came to this blog to ask for a nurses association to follow suit, appears like a pharma rep in a doctor’s office, shady and self-serving.

    Comment by Stephany | March 1, 2010 | Reply

  10. Easy to criticize TAC until you find yourself living with a psychotic schizophrenic family member whose illness is complicated by anosognosia.

    TAC helped us force our adult son into treatment.

    Yeah, I’m otherwise a libertarian, but you’re in denial if you think that forced treatment for psychosis isn’t sometimes absolutely necessary.

    Disclaimer: after TAC helped us, we have subsequently contributed financially to them (and really, really appreciate their help).

    Comment by Norm Petterson | March 3, 2010 | Reply

  11. “Norm” Peterson was a character on the American television show Cheers, portrayed by George Wendt.
    He drank a lot.

    Alcohol instead of neuroleptics to quiet the demons ?

    The one with the Gold rules, your son has no gold and can not earn any gold, so he gets to be a child forever more.

    Once named by the priests a “psychotic schizophrenic” what chances does he have of finding a job and (son presumably straight) a wife?

    What is your sons motivation?

    Is it what you wanted?

    Comment by markps2 | March 8, 2010 | Reply

    • Alcohol is also a drug and is frequently used by the masses to “self-treat” signs and symptoms of mental illness. What makes one better than the other? I don’t have an answer. I do know that both prescription drugs and alcohol have an effect on the human body that is not beneficial if used in excess.

      I also agree that being diagnosed with a mental illness leads to stigma and isolation for some people. What we need to have happen is for the general population as a whole to be taught about these illnesses–because that is exactly what they are–and to remove the fear.

      Please feel free to comment anytime. Your remarks gave me something to think over.

      Comment by Shirley Williams | March 8, 2010 | Reply

  12. What kind of drugs (medications) do you take? What are you ‘diagnosed’ as?

    Are you saying that we should drug you too?

    Everyone is MENTALLY DIVERSE! This is NO REASON to drug someone! Should we drug the ‘PORN ADDICTS’ in the gov’t who were watching porn instead of monitoring our financial system? Should we drug the ‘alcholics’? Should we drug the ‘neurotic drivers’ of NYC, perhaps diagnosing them as ‘Honker-driver disease’? Who’s next? The crosswalker! Yes, that’s the one!!!! DRUG HIM!!!

    The DSM has a category for everyone!!! Which one are you in?

    Comment by wildflowers' movement | April 24, 2010 | Reply

  13. Beware DJ Jaffe’s extremely simple extremist approach. One needs to remember that Mr. Jaffe has spent years in an effort to get people like myself — diagnosed schizophrenic by many psychiatrists — to take powerful “neuroleptic” psychiatric drugs (also known as ‘antipsychotics’) against our will. Please understand that I’m pro-choice about individuals choosing to take prescribed psychiatric drugs. But Mr. Jaffe is not. He has a fanatical belief in the power of the antipsychotics. A few questions for Mr. Jaffe: *** Isn’t it true that long-term high-dosage antipsychotics can actually cause brain shrinkage BEYOND any brain problems caused by the ‘underlying problem’ itself? *** If you are not aware of that brain shrinkage, or don’t want to discuss it, why not? *** And what about all the non-neuroleptic alternatives that are proving effective, why don’t you discuss these? ** And what about today’s NY Times article about even little children getting caught up in society’s magical belief in the antipsychotics as cure-alls see http://www.nytimes.com/2010/09/02/business/02kids.html
    . As a person who was told 34 years ago that I would HAVE to take these drugs against my will, but have not… I take ‘chemical crusades’ such as Mr. Jaffe’s personally. I encourage people to check out MindFreedom’s web site. We work with a state-wide coalition here in Oregon, fighting for human rights and alternatives. Thanks, David Oaks, Director, MindFreedom

    Comment by ocscblog | September 2, 2010 | Reply

  14. Greetings, Dr. Jaffe. Millions thank you for advocating for treatment for acute mental illness. Too often, people with schizophrenia, bipolar disorder, and acute PTSD are imprisoned rather than hospitalized or cared for in assisted outpatient programs. I featured TREATMENT ADVOCACY CENTER (“TAC”) at ASSISTANCE TO THE INCARCERATED MENTALLY ILL (“AIMI”) and often share your insightful articles with our members and online guests. We would like to follow you at Twitter if you still have an account there. TheRealMrMe seems to be deactivated. We wanted to invite you to join the BOYCOTT 4 JUSTICE, which is a shopping moratorium on the 9th of each month throughout 2011. We feel that corporate greed and government indifference led to criminalizing mental illness and many other injustices in America and that a boycott coupled with the sound reasons you give for treating rather than punishing mental illness will effect positive change. Visit AIMI online where nearly 300 Care2 members conduct a human rights march across the Internet every day asking authorities to please decriminalize mental illness. Homelessness, prison, and death must stop being America’s answer to mental illness. No one deserves to be punished for having a disability.

    Blessings!
    Mary Neal
    Website: http://WrongfulDeathOfLarryNeal.com

    Comment by Mary Neal | March 15, 2011 | Reply

  15. I’ve been browsing online more than 3 hours today, yet I never found any interesting article like yours. It’s pretty worth enough for me. Personally, if all website owners and bloggers made good content as you did, the web will be a lot more useful than ever before.

    Comment by kierunki studiow | August 1, 2011 | Reply

  16. I really enjoyed your blog, I totaly agree with your assesment here

    Comment by Florida Physical Therapist Jobs | August 3, 2011 | Reply

    • Thank you. See comment #15 on how to follow us and please encourage others to do so. Thank you

      Comment by DJ Jaffe | August 3, 2011 | Reply

  17. You really make it seem so easy with your presentation but I find this topic to be actually something that I think I would never understand. It seems too complex and very broad for me. I’m looking forward for your next post, I will try to get the hang of it!

    Comment by bucino ulje | August 8, 2011 | Reply

  18. @Bucino: You are correct. It is not an easy subject, especially to those who want to soundbite it (“lock all mentally ill up”, “take away rights”, “forced medication” all of which are false. Spend time at http://mentalillnesspolicy.org and get the info you need

    Comment by DJ Jaffe | August 9, 2011 | Reply

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    • Thanks for commenting. I wanted to respond to your query about blogging. I have 10 different blogs and have had them for a while now. They require some time, but not so much that it is impossible to maintain and have a life. My problem is that I have so many interests. Good luck on your blogging adventure!

      Comment by Shirley | October 5, 2011 | Reply

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