Helping the Mentally Ill Help Themselves
Anyone who has worked in the mental health system can recite a litany of patients who spin through its revolving doors over and over. They become familiar faces and stories, some loved, some disdained. This subset of patients return again and again for a variety of reasons, but the most common one is noncompliance with medications. This happens often times because of money and access, other times because of flat-out refusal. Misfortune often laughs at our weakest, and some of these people end up floating face-down in a river after successful suicide, or mumbling in the hallways of a state mental hospital where they are psychologically buffed-up to competently stand trial for some bloody violence. The rest? Well, they walk among us. As I've written in posts past, the mental health system in America is bleeding to death. The causes are most certainly legion, but the hemorrhage can be stemmed by creating law and infrastructure to get the most seriously mentally ill treated. How to do this? Assisted Outpatient Treatment (AOT) Realistically, mental health's black sheep status is more a matter of evasion than indifference, of exasperation than antipathy, although there is a mix of all those. Sometimes they coalesce to create a perfect storm. Kendra Webdale Andrew Goldstein was one of those caught in the revolving door of mental health. His life had started full of promise as he possessed an exceptional, perhaps beautiful, mind. It was a promise broken, though, when he had first psychotic break as a college freshman. Diagnosed a paranoid schizophrenic, Andrew went through multiple psychiatric hospitalizations and, in spite of the fact he had assaulted thirteen strangers without provocation-all of them women-and had expressed fears he would act on his violent impulses towards even more women, he was released, again and again. As you might expect, Andrew had not been compliant with his medications, mostly because of debilitating side effects, and was continually released before he was truly stable. In the aftermath of this horrific episode, New York passed an Assisted Outpatient Treatment law for the mentally ill and named it Kendra's Law. Not long afterward, another tragic incident would underscore the failures of the mental health system, this time 3,000 miles away in California. Laura Wilcox As with Andrew, Scott had not been compliant with his treatment, including medications. By the time he went on his shooting spree, he had descended into a delusional hell where he was being tormented and stalked by the FBI. His family stood by, helplessly watching his unraveling, unable to do anything to compel him into treatment. Like Kendra, Laura did not die in vain, either. Lawmakers California would enact their own AOT law, largely based on Kendra's, and call it Laura's Law. What It Is Flaws in the Laws: Comparing New York and California One longtime patient I know goes off his medication regularly and methodically to purge his system so he can go on a "tweekend" of crystal meth and sex. We know when this is happening because he disappears from his outpatient therapy. In a drug-induced psychosis he will reenter the hospital to endure the depressive crash to come. A few days later he's released and the cycle repeats itself over and over. If he were in New York, his plans might be foiled. At the first notice of his absence from therapy, he could be collected and hospitalized. But in California, he could be detained for assessment then promptly released to party on. This is not to say that Kendra's Law is substantially tougher than Laura's. A blemish in both of them is that neither allows non participation in treatment to be grounds for contempt of court. But this is precisely the kind of consequence that needs to be established, if for no other reason than as a deterrent to professional patients who are abusing the system. I'm reminded of a man who has virtually lived in Los Angeles County's psychiatric hospitals, floating from one to the next, costing taxpayers millions of dollars in the process. Is he mentally ill? Aside from being deranged enough that he elects to chill in psych wards, the answer is no. What's his game, then? Simple arithmetic. By crashing in hospital beds and not his own, he has amassed enough cash from his disability checks to cruise around in a Mercedes Benz and buy untold other something-somethings. I can tell you therapy isn't one of them. Imagine that AOT law compelled him into treatment for his phony mental maladies and found him in contempt of court if he was a no-show. I don't think we'd ever see him in Club Psych again, freeing up the bed and the monies to someone else who actually needs help. It is money that is the decisive difference between the New York and California AOT structures. New York has a well-organized and funded program. California's is a little-known legislative mandate with no finances to implement it. For the Golden State, it's all talk and no action, at least for now. Meanwhile, the investment has paid off handsomely for New York, both in societal costs and the toll of human suffering. To wit: A 59% reduction in repeat hospitalizations, a 75% reduction in incarcerations, a 57% reduction in homelessness, and a 53% increase in medication compliance. If that's not enough, the Office of Mental Health's web site features even more impressive data. Patient's Rights If you're a patient who has chronic paranoid schizophrenia, 20 or more psychiatric hospitalizations over the last two years, and a pesky penchant for dope on which you spend your entire monthly government check, do we as a society not have a vested interest, if not moral obligation, to force you into treatment? Or, perhaps we just really don't care if you end up dead at 35 behind some Skid Row trash dumpster. One less loser to worry about, right? Final Thoughts: Rights Can Be Wrongs Continuing with a business-as-usual approach is, in fact, the greatest violation of a mentally ill person's rights we can commit. The AOT laws may not be perfect, but they are a good first step for our patients' recovery. |
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