June 4, 2012

Involuntarily Commit the Mental Health System

By DJ Jaffe

As a family member of someone with mental illness, I just can’t accept the fact that In New York State, even after spending over $3 billion annually on mental health services, we have more people incarcerated for mental illness than hospitalized. Headlines scream about the deeds of the untreated mentally ill, like the two who stabbed three police officers, the one who stabbed her baby, the other who might be responsible for Etan Patz’s murder.

The problem is that New York State inversely prioritizes services. The least ill go to the head of the line while the most seriously ill are offloaded to shelters, jails, prisons, and morgues — off the mental health budget and onto the more expensive criminal justice budget. The mental health industry knows this is happening, but doesn’t want to do anything about it.

Take Kendra’s Law. Introduced in 1999, it allows judges to order people with serious mental illness and a history of violence who are likely to refuse treatment to accept treatment. But because it also allows courts to order mental health programs to provide the treatment the industry opposed it and the bipartisan legislature had to pass it over their objections.

Twelve years of research proves the legislators were right and the “experts” wrong. Kendra’s Law reduces violence, arrest, homelessness, incarceration, hospitalization, suicide attempts and length of hospitalization for our loved ones. Those in Kendra’s Law-who were more violent to begin with were nevertheless four times less likely than a control group to become violent.

The mental health complex is loath to admit any association between mental illness and violence. While it is true that most people with mental illness are not violent, Kendra’s Law is not intended for most people with mental illness. It is only for a subset of a subset of a subset: only the most seriously ill, only the subset with a history of violence or needless hospitalizations, only the subset of that subset that refuses treatment, and only the subset of the subset of the subset that is likely to deteriorate without the treatment.

As good as Kendra’s Law is, it has dangerous cracks in it. Senator Catherine Young and Assembly member Aileen Gunther proposed the bipartisan Kendra’s Law Improvement Act to close the cracks but the mental health complex is lobbying to preserve them. They want to preserve the ability to discharge involuntarily committed mentally ill patients and mentally ill prisoners to the community without first informing mental health directors so they can determine if enrollment in Kendra’s Law or other treatment is needed to keep the community safer. They want to preserve the ability of mental health directors to not review expiring court orders and to ignore reports of mentally ill people who are becoming dangerous when those reports are received from family members.

To the extent they will admit there is a problem, the mental health industry’s position is that Medicaid reform and more voluntary services will solve it. But Kendra’s Law is only for those who refuse treatment. Changing Medicaid rates or offering more services, does not affect the ability to refuse treatment. It is disingenuous of them to use the plight of the seriously ill who they won’t treat, to justify higher rates on treating all others.

The bipartisan improvement act is supported by the Alliance on Mental Illness of New York State and the entire criminal justice community because it is families of the mentally and police who bear the burden of the mental health system’s failures.

If the mental health system won’t voluntarily focus on the most seriously mentally ill, the legislature should pass the bill to involuntarily commit them.


DJ Jaffe
Executive Director
Mental Illness Policy Org.