On 1 June 2010, E. Fuller Torrey MD wrote an op-ed column for the New York Times, “Make Kendra’s Law Permanent.” Dr Torrey is the founder of the Treatment Advocacy Center (TAC), a nonprofit group whose sole purpose is to lobby states for the passage of so-called assisted outpatient treatment (AOT) laws like Kendra’s Law in New York and Laura’s Law in California. The New York law is named after Kendra Webdale, who was killed by Andrew Goldstein in 1999.
Dr Torrey and TAC will tell you Mr Goldstein had untreated schizophrenia. They’ll tell you people like him are dangerous, they’ll tell you people like Mr Goldstein are often so sick they don’t understand they’re ill and need treatment, and they’ll tell you they know best. They won’t tell you that Mr Goldstein had been seeking treatment desperately and been turned away repeatedly.1
They’ll tell you there are no racial disparities in the implementation of assisted outpatient treatment despite 34% of AOT orders being imposed on African-American New Yorkers and 30% imposed on Hispanic New Yorkers; they make up 18% and 16% of the total population respectively, while non-Hispanic whites, who received 34% of AOT orders, make up 63% of the general population.2 The Services Effectiveness Research Program in the Department of Psychiatry and Behavioral Sciences at Duke University Center was awarded the contract to evaluate New York’s assisted outpatient treatment program under a requirement of the 2005 reauthorization of the law. (The Wikipedia entry on Kendra’s Law states, wrongly, that the Duke University study was independent.) Their findings were that there were no racial disparities — when the data were controlled for factors such as poverty and diagnosis with serious mental illness such as schizophrenia.
Which, if I’m reading that right, says that when they control for the effects of racism in society (poverty disproportionately affects non-white people) and racism in the mental health professions (non-white people are disproportionately diagnosed with schizophrenia when white people presenting with similar symptoms are diagnosed with less ‘serious’ mood disorders), the racial disparities in the implementation of assisted outpatient treatment disappear. It’s fucking magic. Okay, so this particular program may be following the same rules as everything else, but those rules are set up to have a disparate impact on non-white people already.
Make no mistake, the assistance provided in assisted outpatient treatment is the armed force of the state ensuring that persons who fall under the purview of this law and those like it comply with any and all aspects of the court-ordered treatment plan. Assisted outpatient treatment is strictly from Minority Report — the person needs have no actual history of violence and need not be judged to be in immanent danger of harming ouself or others.
I can’t get the actual text of the law (the site for the New York Legislature keeps giving me internal server errors when I try to get the Mental Hygiene Law) but here’s some excerpts from a summary on the law from the New York State Office of Mental Health3:
No person may be placed under an AOT order unless the court finds by clear and convincing evidence that the subject of the petition meets all of the following criteria:
- Is at least 18 years old; 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 that has:
- prior to the filing of the petition, at least twice within the last thirty–six months been a significant factor in necessitating hospitalization in a hospital, or receipt of services in a forensic or other mental health unit of a correctional facility or a local correctional facility, not including any current period, or period ending within the last six months, during which the person was or is hospitalized or incarcerated; or
- prior to the filing of the petition, resulted in one of 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 forty–eight months, not including any current period, or period ending within the last six months, in which the person was or is hospitalized or incarcerated; and
is, as a result of his or her mental illness, unlikely to voluntarily participate in the outpatient treatment that would enable him or her to live safely in the community; and in view of his or her treatment history and current behavior, is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to result in serious harm to the person or others as defined in §9.01 of the Mental Hygiene Law; and is likely to benefit from assisted outpatient treatment.
A court may not issue an AOT order unless it finds that assisted outpatient treatment is the least restrictive alternative available for the person.
There are other troubling parts to the law: damn near anyone can file a petition to have a person placed under assisted outpatient treatment, including any adult room mates, parents, spouses, adult children or adult siblings of the person. There are confidentiality problems with the way information is treated under the law, distributing clinical information about persons with AOT orders to mental health facilities across the state.
And it’s not necessary. Andrew Goldstein had been seeking treatment. The non-coercive parts of Kendra’s Law, the grants for community treatment and medications, those are helpful and helping. We need access to effective community treatment. Unfortunately in this age of budget shortfalls and funding cuts I don’t see access to community mental health treatment increasing.
This quote from Dr Torrey’s op-ed piece struck me as particularly telling:
The people who could be treated under Kendra’s Law account for only one in 10 seriously ill psychiatric patients. But when these people are untreated, they also make up one-third of the homeless population, and at least 16 percent of the jail and prison population. These people are ubiquitous in city parks, public libraries and train stations. And a small percentage become dangerous, even homicidal.
One in ten is not an only, one in ten is a very large fraction of any population. We — I am seriously mentally ill (and not compliant with every treatment recommended) — are over-represented in jails and prisons because we can’t get adequate treatment in our communities. We stop taking meds that make us sick because newer meds with fewer unpleasant side effects are, well, new. And expensive. Seroquel is still under patent; risperdal isn’t.
We are unsightly. We make parks and libraries and train stations unpleasant for non-mentally ill folk. We make things difficult for our families when we don’t take our meds. Dr Torrey and TAC and the National Alliance on Mental Illness and all the other family-of-but-not-mentally-ill advocacy groups out there want it to be easier to make us take our meds. So they play on fears and tragedies. Because we aren’t actually any more likely to commit violent crimes than the population as a whole. It’s just that when we do commit them we fit neatly into an existing and convenient (and heavily reinforced thank you ever so much every TV and film cop drama ever) narrative that mad people are violent and unpredictably so. Even homicidal!
But Dr Torrey knows how to save everyone from us. He just has to convince enough people that we shouldn’t have the same rights to due process as everyone else.
So far it’s not been that hard. Almost every state has some version of an assisted outpatient treatment law, largely thanks to the lobbying efforts of Dr Torrey himself and his organisation. He decries that the laws aren’t used enough. (Someone in his organisation is likely responsible for the ghastly Wikipedia entry on Kendra’s Law, which portrays opponents to making it permanent as anti-psychiatry and *gasp* liberals. Sheesh.)
And Andrew Goldstein has pleaded guilty to manslaughter, after one trial where the jury failed to reach a verdict, a second trial where he was convicted and sentenced to twenty-five years to life — but the conviction was overturned on appeal because a witness gave second-hand information — and I suppose he didn’t want to go through it a third time. He’s been sentenced to twenty-three years in prison plus five years supervision. I expect he’ll be forced to comply with court-ordered psychiatric treatment for the rest of his life.
- Source: Time Magazine, “Will the Real Andrew Goldstein Take the Stand?” ↩
- Sources: New York State Assisted Outpatient Treatment Program Evaluation, Wikipedia: Demographics of New York, New York Times, “Racial Disproportion Seen in Applying ‘Kendra’s Law,” 7 April 2005↩
- Source: New York State Office of Mental Health: AOT Summary ↩