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Kendra's Law Update

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Kendra's Law Hearing Reopens Coercion Controversy, April 11, 2005

 by Jean Arnold, National Stigma Clearinghouse

 Kendra's Law (KL), New York's experiment with court-ordered
psychiatric medication for outpatients, is due to expire on June 30th.
Should the experiment continue?

 Judging from testimony at a public hearing in Manhattan on April 8,
2005, no one is satisfied with the current law.

 With KL about to expire, the Assembly's Mental Health Committee
Chairman, Peter M. Rivera, and Codes Committee Chairman, Joseph R.
Lentol asked members of the mental health community for their views.
The Assemblymen heard eight hours of passionate testimony and
recommendations from advocacy organizations, public officials,
psychiatric survivors, families, clinicians, services providers, and
legal experts.

 Five years ago, the battle for KL pitted NAMI-NYS and the Treatment
Advocacy Center (TAC) of Arlington Virginia, a group whose primary
interest is psychiatric medication, against the community of
psychiatric survivors and their allies who view forced medication as
counter-productive.

 At the hearing, KL supporters called for greater family access to
obtaining court orders; KL opponents cited negative effects of coercion
and the success of high-quality alternatives. For more information
about NAMI-NYS and NYAPRS positions, go to www.naminys.org and
www.nyaprs.org.

 By our count, ten TAC and NAMI-NYS speakers recommended that KL become
permanent. Twenty other speakers consider permanent enactment
premature, but would continue the experiment for 3 to 5 years. Ten
people objected to KL's continuation. Nearly everyone who spoke in
favor of letting the experiment continue called for improved
accountability and more relevant outcome data from New York's Office of
Mental Health.

 Psychiatric survivors who support KL's limited continuation made clear
that they do not support its coercion clause.

 All speakers agreed on one basic issue. High quality community
services are in desperately short supply. KL is rarely able to deliver
the full package of treatment components it promises. Meanwhile,
successful voluntary programs are forced to compete with KL for already
barebones resources. The most critical shortages are a lack of case
managers, appropriate housing, and dual-diagnosis treatment programs
(50% of KL patients have a mental illness combined with a substance
abuse problem).

 County administrators spoke of increased liability risk when essential
programs are understaffed or missing altogether, and of new costs to
counties with the addition of unfunded mandates. Dr. Antonio Abad of
the Association of Hispanic Mental Health Professionals said additional
treatment models could improve outcomes of people who are not good
candidates for KL; he also called for more bilingual services.

 From an antistigma point of view, the lasting negative effects of KL's
publicity has been our main concern. The law's passage was won in 1999
on a "public safety" platform; negative fallout from this heavy
emphasis on violence still haunts the mental health community. Nassau
County Director Harold Sovronsky referred to the public's misguided
perception, fanned by KL advocates, that KL protects public safety.
Sovronsky said that in fact, "there is little if any consequence to
those who violate court-ordered treatment."

 Nothing was said at the hearing about the framing of Andrew Goldstein
to get KL passed. Goldstein had to be shoehorned into the
"non-compliant patient" role. Michael Winerip, a New York Times
reporter who investigated the Andrew Goldstein case, wrote in December
1999 that "by the summer of 1999, the newly disclosed facts of the
Goldstein case justified what mental health advocates had been arguing
for years: a lack of state spending was crippling the system. To cut
costs, the state had set quotas for reducing the patient population at
every public hospital in New York, making it extremely difficult to get
long-term care. Mr. Goldstein was a perfect example."

 Winerip recounts that Goldstein (who voluntarily committed himself for
treatment 13 times) acted violently even in hospital settings numerous
times. Still, the system stalled his admissions and repeatedly recycled
him to the street, despite his requests for treatment of his
uncontrollable violent urges.

 ADDITIONAL NOTES AND COMMENTS:

 1) Several key administrators, including Joyce B. Wale of the New York
City Health and Hospitals Corporation (HHC), recommended a limited
extension (3 years) of the KL experiment. She stressed the need for
scientific longitudinal research and improved accountability. Ms. Wale
also suggested the inclusion of peer counselors throughout the state
based on their excellent performance in NYC.

 2) John Gresham of Lawyers for the Public Interest testified that KL
has produced a pattern of racial imbalance. Court orders target Black
patients 3X more than whites, and Hispanic patients 2X more than
whites. Gresham has found no reasonable explanation for this
disproportion to date.

 3) Shelly Nortz, Coalition for the Homeless, suggested that KL is
being used to effect the hospital discharge process. She noted that the
New York/New York program met this need without using court orders. The
program served well over 10,000 homeless mentally ill adults with
dramatic results.

 For the record, Clarence Sundram, former head of the Commission on
Quality of Care, noted in 1999 that "Coercion is needed, but to enforce
laws already on the books that are routinely disregarded with impunity,
either because of the scarcity of resources or because of conflicting
pressures."

 4) It should be noted that Julio Perez, who attacked speaker Edgar
Rivera in 1999 causing the amputation of his legs, had tried to get
help just before his violent act. Five hours before the attack, Perez
went to the emergency room of the Veteran's Administration Hospital,
the police headquarters, and the criminal courts building, saying that
his enemies were following him. Times reporter Nina Bernstein wrote
(6/28/99): "Each sent him to another part of the same disjointed system
that had been shuttling him between hospitals, jails, shelters and the
streets of New York since 1995." The Times said Perez had tried to get
medicine, but his Medicaid card had expired.

 Our records show that when a rare violent act by a person with mental
illness occurs, often the person has been recently denied a voluntary
request for help.

 5) Hannah Craven, a NAMI-Metro member (not representing NAMI), limited
her testimony to statistical errors and confusion in OMH's report of
March 2005 on KL performance. Craven submitted an analysis of OMH's
questionable figures and requested that these be corrected before the
law reaches a vote.

 6) Medication is the cornerstone of every court order under KL. The
testimony of Eileen McGinn, MPH, a family member, names three
assumptions that, if true, would support compulsory medication. The
assumptions are: that psychotropic drugs are effective, that they are
safe, and that people stop taking them for inappropriate reasons.

 In an extensive review of clinical trials, McGinn found these
assumptions to be blatantly untrue.

 KL gives a false sense of security about medication that endangers the
health of court-ordered patients who have little autonomy. Medication
choices are a trial-and-error process where mistakes can be fatal, and
medication monitoring requires doctor and patient to work as a team.

 Just before KL passed in 1999, Gregory Lee Richardson, in Albany's
jail for a traffic-related incident, died from from negligent
mis-medication and restraint. A law to prevent such atrocities,
"Gregory's Law," did not move forward however.
 


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