Tragedies That Lead To Reform

Tragedies That Lead To Reform

I was reading this report by the New York State Office of Mental Health about the outcomes of New York's adoption of "Kendra's Law" back in 1999, which provides for involuntary outpatient commitment. What is that? And who is Kendra?

Involuntary outpatient commitment essentially means that a person who is mentally ill, and is considered a danger to himself (although perhaps not an imminent danger) is ordered by a court to take their medications, go to counseling, and be under the supervision of a social worker or mental health worker who is responsible for making sure that this person does not deteriorate.

Many states have such programs. California has something called "Laura's Law" that provides for such treatment--although only in a few counties so far. I mentioned earlier today a bill under consideration by the California legislature to expand the program statewide. I know that as of 1999, at least Iowa, North Carolina, Ohio, Tennessee, and the District of Columbia--had such programs--and by some accounts, all of these (except Tennessee) have been effective at reducing hospitalizations and improving the condition of mental patients who are so committed. Idaho (in some counties) has something called Mental Health Court that imposes similar rules on those with less serious criminal offenses who are mentally ill.

Of course, as with all these programs, the threat of being institutionalized is one of the mechanisms used to ensure medication compliance. For those mentally ill who are well enough to understand and respond, this works. For those who are not that well, this provides a fast way to restabilize the person, without waiting for him to get to a point where he kills someone.

And why is New York's involuntary outpatient commitment program called "Kendra's Law"? And ditto for "Laura's Law" in California. In both cases, they are named after a person who was murdered by a mentally ill person who desperately needed help from a society that was awash in bizarre fantasies about how the mentally ill would benefit from being deinstitutionalized.

The New York Times has an impressive list of articles about Kendra Webdale, who was pushed in front of a subway train in midtown Manhattan on January 3, 1999 by Andrew Goldstein.

Goldstein was one of those really smart people who was going to probably contribute something wonderful to the world, even if only in a small way. He graduated from the Bronx High School of Science, one of New York City's remarkable specialty public high schools. This isn't an easy place to get into, and being a graduate meant that he was going to be something some day. But at age 16, Goldstein started to show symptoms of schizophrenia--which became disabling in college. Eventually, after at least thirteen violent incidents, and frequent hospitalizations (usually not lasting for very long), he murder Kendra Webdale.

One of the frequent claims that I see made is that it isn't possible to interest taxpayers in paying for adequate mental health treatment. I look at this long list of articles describing Goldstein's hearings and trials--and I know that processing it through the system wasn't cheap. I do not expect that we will see Goldstein back on the street anytime soon. Public mental hospitals weren't cheap; some states in the 1950s were spending almost half their budget on just mental hospitals. But tragedies like the death of Kendra Webdale aren't cheap, either.