Remembering Kendra

By E. Fuller Torrey
New York Post

In 1999, Kendra Webdale, an aspiring young screenwriter, was pushed to her death under an oncoming subway train. The assailant was a man with schizophrenia who refused to regularly take medication needed to control his psychotic symptoms.

Webdale’s horrible and unnecessary death was the catalyst for New York State to revise its outdated mental health treatment law, making it possible for courts to order mentally ill individuals (who meet specific, constitutionally-permissible criteria) to follow treatment orders in the community or risk hospitalization.

The result was “Kendra’s Law,” one of the most demonstrably successful pieces of legislation passed by the State Legislature in recent years. For those assigned to outpatient treatment under the law, it has reduced homelessness by 74 percent, psychiatric rehospitalization by 77 percent, arrests by 83 percent and jailings by 87 percent.

It is a law New Yorkers can be justifiably proud of.

When Kendra’s Law was being debated in 1999, a small group of critics loudly cried wolf. They claimed that “tens of thousands” of people with mental illness would be caught in massive dragnets each year. The civil rights of individuals with mental illness would be decimated. Kendra’s Law would destroy the therapeutic relationship between providers and patients and drain fiscal resources from other mental health programs.

Kendra’s Law is now up for renewal and is again being debated by the Legislature. And the same critics are back crying wolf. Before we listen to their hysterical cries this time, let’s look at the outcome of their previous claims.

They said that Kendra’s Law would catch “tens of thousands” of people each year in a mental health “dragnet.” In fact, an average of only 747 people each year, one out of every 26,000 New Yorkers, has been affected. If anything, Kendra’s Law has been used too infrequently, especially in some upstate counties.

They said that people’s civil rights would be decimated. But are we protecting civil rights by guaranteeing a psychotic person’s continued ability to sleep on the sidewalk and eat from a dumpster? As Wisconsin psychiatrist Darold Treffert notes, “The ‘right’ to be demented, agonized and terrorized in the face of treatment which cannot, because of legal prohibition, be applied is no right at all – it’s a new form of imprisonment.”

They said that Kendra’s Law would destroy the therapeutic relationship. Yet when individuals subjected to Kendra’s Law were interviewed, 87 percent said that they continue to be confident in their case manager’s ability to help them, and 90 percent said the law makes them more likely to take their medication and keep appointments at the psychiatric clinic.

Critics also said that Kendra’s Law would drain fiscal resources from other mental-health programs. In fact, it has markedly reduced many costly services for participants, such as emergency services and hospitalizations, and costs of law-enforcement response time and repeated jailing.

Yet now these same critics are back, crying the same alarms – with a few new ones for good measure.

At last week’s state Assembly hearings on the law’s reauthorization, critics claimed that what is really needed is better services. In fact, while everyone’s for improvement, services alone will not stop tragedies such as Kendra Webdale’s.

The man who pushed her to her death had had 199 days of inpatient and emergency room psychiatric services in the two years prior to his violent act. What was needed, in addition to services, was something like Kendra’s Law to ensure that he followed his treatment plan when he was discharged back into the community.

The critics also raised the reliable bogeyman of racism, claiming that the law was being used disproportionately for Blacks and Hispanics. State officials countered by pointing out that the racial figures are in line with recent studies of adults in New York City receiving similar intensive community services. (In any case, the argument is meaningless – since the law helps those it targets.)

In Aesop’s fable, the boy who cried wolf cried it so often that nobody believed him when the real wolf finally appeared. Critics of Kendra’s Law should restrain their hysteria long enough to look at the data – the law is truly helping people and saving lives. But New York’s mental-health system is far from perfect, and there are plenty of real wolves to fear. So let’s not waste any more time and breath on phantoms.

Kendra’s Law works and should be made permanent.

Dr. E. Fuller Torrey is a nationally known psychiatrist and author of 20 books, including “Surviving Schizophrenia” and the president of the Treatment Advocacy Center (psychlaws.org) in Arlington, Va., a national nonprofit organization working to eliminate barriers to treatment of severe mental illness.

New York Post

April 18, 2005