I’ve said it before, and I will repeat it. I am an overweight Jewish man from New York State with an active schizophrenia diagnosis. I have been committed to involuntary treatment numerous times for different stays at local and state psychiatric hospitals across New York State.
Despite all these hats I wear in the mental health community—or perhaps because of them—I am also a firm believer that forced treatment for V-SPMI (Violent Severe and Persistently Mentally Ill) people is justifiable.
I do not believe it is always the best treatment fit or practice that should be considered the gold standard for mental health treatment or the long-term standard milieu. Instead, we need to be continually revising our rules, moving studies and research forward to move mental health treatment into an era where forced treatment is obsolete.
As for Kendra Webdale and the day when the very ground floor of modern mental health treatment trembled and collapsed on itself, we will never forget it. For patients who have and continue to fall through the system’s cracks, Kendra’s death marked a new beginning—for many violent and chronically mentally ill patients facing possible incarceration, legal issues, and jail sentencing in New York.
I am speaking of that day in 1999 when Andrew Goldstein pushed Kendra in front of a subway train. Well, that is now all history. But we must never ignore the implications of that violent act, which forever changed the face of mental health treatment in New York and states adopting forced treatment laws.
Kendra’s death was not in vain. Because of Kendra’s premature death, the lives of so many violent mentally ill people changed—and in many cases, these folks are protected by the new laws governing the provision of mental health treatment.
Now, there is a glimmer of new hope and available treatment for this population who have been incarcerated by the justice system. Evidence points toward “offenders” ultimately re-entering the criminal justice system due to further offenses after being imprisoned. But appropriate treatment might prevent this cycle of recidivism.
Kendra’s Law was a good idea. It interrupts the cycle of prison and homelessness for V-SPMI people. Now they are mandated to receive treatment—instead of being sent to prison, only to come out with no help and be right back on the street.
But Kendra’s Law has so many dehumanizing effects for us as well. It’s not perfect and we need to keep working to create better laws that allow for our rights and freedoms as citizens to be respected.
If we genuinely want to help people have a real chance of survival from socially unacceptable and violent mental health conditions, Kendra’s signal must do more than just be a gesture to the public. We need to make radical structural adjustments to the mental health system before more people suffer tragic and avoidable loss.
Forced treatment doesn’t work perfectly for everyone in this category of mental health disorders. I have seen it firsthand as an ACT (Assertive Community Treatment) practitioner. I’ve seen the law fail clients and forced treatment create hatred, anger, and self-shaming.
Indeed, the stigma that evolves from an AOT (Assisted Outpatient Treatment) label is demoralizing. The title is humiliating, infantilizing, and demeaning for many.
V-SPMI patients under the AOT structure are mandated by the criminal justice system to receive mental health treatment. As part of that mandate, these people lose a part of their independence, autonomy, and relative status as citizens equal in the name of the law. The law places restrictions and limitations on people’s movement and personal freedoms under the AOT regulations.
AOT lays out restrictions on travel, medication administration, treatment staff choice, and frequency of contact with mental health staff and treatment teams. These mental health treatment domains are prescribed, mapped out, and monitored closely by the county government, who can, at any time when its rules are violated, pick you up at your home and take you to the hospital for forced treatment.
The loss of Kendra impacted people carrying a mental health diagnosis. We will never lose that scarlet letter that labels us, and marks us as eligible under the law to lose our rights if our conditions worsen. After Kendra’s death, our fate to make decisions for ourselves and our care will ultimately be under the law’s provision and maintenance until a new paradigm arrives. Our personal beliefs on how we want to manage our mental health affairs will continue to be ignored.
The right to fail. To live our lives as flawed, diagnosed, mentally ill people the way we see fit to do so. In New York State and many other states in the US, unless you are mandated or in an AOT or forced treatment program, you can fail out of society and be admitted to a hospital for psychiatric rehabilitation. People labeled V-SPMI cycle back into the system, from hospital to independent living.
Some states operate differently, and offer more supportive services to people who want to live independently. We must protect the freedom of choice and independence within the system. I must defend the endorsement of this freedom and dissemination of this privilege at all costs. We can never give it up.
Next to the modern mission of dignity, hope, and recovery by NY-OMH and another state mental health regulatory bodies, we must write into mental hygiene law the right to fail. To be non-adherent to treatment and discharged from care. To be left to our own devices as human beings.
Whenever you hear, “should this person or that person be allowed to live independently or be discharged from a hospital,” it boils down to nearly where the identified patient falls on this continuum of being more of a risk or maintaining stable living. But what does a regular living look like? What does failure mean? Clinicians can do their very best to assess and predict outcomes, but do we ever really know what people can do?
I have done unfathomable things during the tenure of my mental health disorder. I have also done something I still cannot express regret for or live down.
I have also done wonderful, beautiful things in my lifetime, since my diagnosis, and would never forget these memories. The light outshines the darkness every time my freedom is involved. We cannot ever give up this privilege!
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.