Monday, March 28, 2005


TAC Newsletter 3/25/05


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March 25, 2005









CAPITAL WEEKLY (Augusta, ME), March 25, 2005

[Editor's Note: Maine Senator John Nutting's proposal to bring assisted outpatient treatment to his state was fortified this week by the strong and lengthy editorial endorsement below from Augusta's Capital Weekly. It is hard for Maine advocates to look for more than their capital city's paper branding their measure "bold, incisive - and sensitive." Our only addition to this editorial would be to highlight that Senator Nutting's primary goal with this bill is to address improve the condition of those that it is used to help.]



Sen. John Nutting of Leeds has introduced a bill that deserves the backing of the Legislature and the people of Maine.

His bill is bold, incisive - and sensitive - for it pits the rights of the mentally ill against the safety of family members, co-workers, and community members who live within range of the severely mentally ill with violent tendencies.

Nutting's proposal would allow the courts to force a small segment of the mentally ill to take their medications or face going back to the hospital, where the drugs would be automatically administered.

Maine is one of only eight states that does not have a mandatory medication law for persons with mental illness who also have a history of violence or self-destruction when they go off medication.

Nutting's bill addresses a very small slice of the mentally ill population in Maine, somewhere between 50 and 100 people, who repeatedly go off medications, then spiral downward until they wind up in the hospital. This happens over and over and over again, according to testimony from doctors and other caregivers who showed up for the public hearing on LD 151 a few weeks ago.

Right now the bill has been turned over to an impartial 15-member committee of legislators, family members, doctors and others who will study the language and make sure the proposed legislation allows for full due process.

The bill is expected to go back to the Health and Human Services Committee by May 1.

Nutting's bill is not aimed at highly functional people who take antidepressants, for example, and decide to go off them. They do not pose a threat to public safety or to other people.

But there is a segment of the mentally ill population that has a history of violence when not on medication, a history of going off medication, and for whom it has been shown that irrational or dangerous behavior disappears when the person is put back on drugs.

Under Nutting's bill, a person in that category could be forced under court order to stay on medication for six months and remain in close touch with a psychiatrist. If the person still refused to take the necessary drugs, he or she could be taken back to the hospital.

Due process would be assured during the court proceeding by having an attorney or an advocate present for the mentally ill person. And a judge might very well rule that the mentally ill person can remain off drugs if carefully monitored.

The need for Nutting's bill is obvious. Homeless shelters are repositories for the mentally ill, some of whom are dangerous, especially when drinking or on drugs. Horrific crimes have been committed in Maine by severely mentally ill people who were off medications and hallucinating. Mentally ill people are arrested every day for petty and serious crimes, arrests that could be avoided if a medication regime were adhered to.

In New York state, when a mandatory medication law was passed, violent crimes committed by the mentally ill went way down, arrests of the mentally ill went down, and 91 percent of those who were not taking medication began taking it just because that law was on the books.

The law in New York, by the way, is called Kendra's Law and is named for a young woman who was pushed in front of a subway car by a mentally ill man who was off his medications and hearing voices.

The question of patients' rights comes up at a time like this, as well it should. Advocates for the mentally ill say that patients, no matter how sick, have a right to go without medication. We disagree with that argument. A person's right extends only as far as the safety of another person. When a mentally ill person with a history of violence goes off medication, that becomes a societal issue, not a personal choice.

Advocates for the mentally ill do make some good points. They note that transportation to medical appointments is a problem because most severely mentally ill people don't have cars. There's also the problem of finding a psychiatrist who will spend more than 15 minutes with a patient and monitor that patient closely.

And it's true that community services are not what they should be. In our rush to empty out mental hospitals in the 1970s and beyond, we simply could not keep pace with community needs for the mentally ill. The result for some has been a revolving door of hospitalizations, release into a stressful world, and readmittance to the hospital.

If we had mandatory medication laws for the most dangerous segment of the mentally ill population, millions of dollars could be freed up from hospital care and transferred to community services.

Maine was once a leader in mental health care, with one of the first mental hospitals in the country. But over the years our system became frayed around the edges and gradually broke down, for lack of money and lack of will.

And somewhere along the way, the rights of patients became more important than the rights and safety of society, to the point that the patients and their advocates are calling the shots.

This has to end. And Nutting's bill would help do that.


TROY RECORD (NY), March 11, 2005

[Editor's Note: The legislation that created Kendra's Law expires on June 30. The effort to remove this expiration date on New York's assisted outpatient treatment program and to make the law permanent has already picked up some supporting editorials, including this one.]



Kendra's Law is a controversial mandate in New York state that offers outpatient services to the mentally ill, a good thing, but which also allows court-ordered treatment, which is where the controversy comes in.
Advocates for the mentally ill like much of the law but object strenuously to the provisions that allow families or caseworkers to petition the courts to have people potentially harmful to themselves or others ordered into a rehabilitation facility.

The law is temporary, due to expire June 30 after a five-year trial as to the law's effectiveness.
Supporters of the law are eager to see it made permanent, while many advocates are looking for major overhauls that would include striking any language that allows forcible treatment.

We believe the state Office of Mental Health is correct in praising the program and urging that it enter the permanent-law roster. The success rate in the treatment of 6,600 people over these past five years speaks for itself.

Not that we think advocates are totally out of line when they say the law may speak for itself, but who speaks for the mentally ill who are mandatorily detained against their wills.

In our opinion, the unvarnished truth is that some mentally ill people do not know what is good for them. More important, we believe the courts should have a say in what is good for society as a whole.

The American Civil Liberties Union has chimed in, raising issues of constitutionality in that people can be held for up to 72 hours without a hearing while being evaluated by health professionals.

But the courts have sided with the state.

We argue that the 72-hour limit is what makes even the odious practice of court-ordered treatment acceptable, if not completely palatable. It is not as if a person can be arbitrarily detained for an indefinite period of time.

The law is named after Kendra Webdale, a Fredonia native who was killed when pushed in front of a subway train by a sometimes-violent diagnosed psychotic who refused to take his prescribed medicine.

Caseworkers and family are the people who can most closely monitor a known psychotic and detect when a person is in danger of going over the edge. Who better to seek aid for the person in mental turmoil?

Personal rights are precious and should not be violated heedlessly, but there are times when the public good must be served, and we believe this is one of those times and that the Legislature should leave Kendra's Law on the books and intact


[Editor's Note: Who better to assess the performance of a program than the people running it? Since Kendra's Law took effect on Nov. 8, 1999, the management of Kendra's Law has been the responsibility of New York Governor George E. Pataki and his administration. The Governor's opinion of assisted outpatient treatment? - He wishes to make the program permanent.]


March 7, 2005


Report Documents the Success of Individuals Receiving Assisted Outpatient Treatment

Governor George E. Pataki today introduced legislation to make New York's Assisted Outpatient Treatment (AOT) law permanent. The measure, known as Kendra's Law, was first enacted in 1999 and is currently scheduled to sunset on June 30, 2005. It is named in memory of Kendra Webdale, who tragically died after being pushed in front of a subway train by a man with a history of mental illness and hospitalizations. Since being enacted Kendra's Law has successfully provided specialized services to more than 6,600 New Yorkers with mental illness.

"For the past five years, Kendra's Law has provided New Yorkers with mental illness access to the treatment they need in an effective manner that ensures their safety, as well as that of the public," Governor Pataki said.

"The vast majority of these individuals are already leading productive and fulfilling lives in their communities, but the results are clear -- Kendra's Law works. That's why I am proposing that this extremely successful program be made permanent."

Kendra's Law established a process for identifying individuals with mental illness who, in view of their treatment history and circumstances, are likely to have difficulty living safely in the community without supervision.

A five-year evaluation of the program was released last week by the Office of Mental Health (OMH) and has shown the program to be a resounding success. The use of mental health services by the population now being served by AOT has gone up by 89 percent over what was utilized prior to the implementation of the program.

Patricia Webdale, Kendra's mother, said, "The Assisted Outpatient Treatment program is having positive results, and I would like to commend OMH for a job well done. On a personal note, it brought tears to my eyes to see Kendra's name on the AOT report's cover. When we began this journey five years ago, my husband Ralph and I were hopeful that we could do something that would help just one person. We are very pleased to see that this program has helped so many."

Sharon E. Carpinello, R.N., Ph.D., OMH Commissioner, said, "Thanks to Governor Pataki's leadership, we have seen improved access to mental health services, improved coordination of service planning, enhanced accountability, and improved collaboration between the mental health and court systems. But when summarizing the results of AOT, it is most important to note the positive impact the program is having on the people who have successfully used it. Individuals with mental illness who participate in AOT are able to make and maintain real gains in their recovery -- the data tells us that, and so do the recipients."

Kendra's Law has created a procedure for obtaining court orders for certain individuals to receive outpatient treatment for mental illness. It also ensures that local mental health systems give these individuals priority access to case management and other services necessary to ensure safe and successful community living.

In addition to assisted outpatient treatment, Kendra's Law also addresses the need to ensure that mentally ill people who are moving from hospitals or correctional facilities to the community receive necessary psychiatric medications without interruption. Fully funded in the Governor's Executive Budget, the law's statewide medication grant program enables counties to provide people who are discharged from psychiatric hospitals, state prisons or county jails with psychiatric medication they may need while they are applying for Medicaid.

In addition, the law clarifies and authorizes the sharing of necessary clinical information of patients with mental illness between psychiatric hospitals as well as between psychiatric hospitals and general hospital emergency rooms. This sharing of information helps to provide clinicians with accurate clinical histories, resulting in better diagnoses and treatment.

The five year report that was recently released reviews the impact and outcomes of various elements of the AOT program from its initial implementation in November 1999 through December 2004. During that time, 10,078 individuals were referred for AOT assessment. Of those, 3,766 individuals received services under an AOT court order, and an additional 2,863 received service enhancements without a court order.

AOT participants show a significantly increased participation in case management, substance abuse, and other treatment services; increased adherence to prescribed medication; improvements in social and family functioning; and improvements in community living. They also demonstrate a reduction of harmful behaviors, including reduced incidence of hospitalization, homelessness, arrest and incarceration.


Read the full report:
Read a summary by TAC:



[Editor's Note: In the last E-News, we commented that members of law enforcement almost always favor treatment law reform. That is certainly the case in Maine. Last week we shared a resolution supporting the introduction of assisted outpatient treatment from that state's Sheriffs' Association. Below is one from the Maine Chiefs of Police Association that takes that same policy stand.

This resolution is available on our website in its original formatting at: ]




WHEREAS, the role of Maine law enforcement officers in responding to serious crises involving people with severe mental illnesses is continually increasing; the safety of law enforcement officers and citizens, particularly those who are mentally ill, is seriously jeopardized; and an inordinate amount of law enforcement resources are being expended for this purpose at a time when we can least afford it; and

WHEREAS, nationally, people with severe mental illnesses are nearly four times more likely to be killed in altercations with police. Too often these altercations arise because a person with a severe mental illness stops taking their medication; and

WHEREAS, law enforcement too often responds to preventable and heart-wrenching tragedies involving people with severe mental illnesses such as an 18-year old man committed suicide after he stopped taking medication for bipolar disorder and a mother with schizophrenia who tried to kill her 11-year old daughter; and

WHEREAS, current law in Maine prevents families, law enforcement officers, and mental health professionals from helping a person who refuses treatment for severe mental illness until the person "poses a likelihood of serious harm", and also limits the remedy that judges have to ordering inpatient hospitalization, unlike other state laws that allow judges to court order outpatient mental health services before a crisis occurs; and

WHEREAS, 42 other states have laws that allow for court-ordered outpatient treatment (also known as "assisted outpatient treatment") for people with severe mental illnesses who refuse treatment, in most cases because the illness prevents them from recognizing that they are ill; and

WHEREAS, empirical evidence from studies and states using assisted outpatient treatment (AOT) shows that AOT is effective in reducing incidents of hospitalization, homelessness, arrests and incarcerations, victimization, and violent episodes among people with severe mental illnesses who otherwise refuse treatment. AOT also increases treatment compliance and promotes long-term voluntary compliance for people with mental illnesses. Among other benefits, these outcomes reduce law enforcement contact with people with severe mental illnesses; and

WHEREAS, it is clear that providing for assisted outpatient treatment could have prevented some of our state's recent tragedies by ensuring early intervention and sustained treatment in the community for people who otherwise are unable or unwilling to access such treatment, particularly medication;

NOW, THEREFORE, BE IT RESOLVED, by the Maine Chiefs of Police Association that we support the passage LD-151, a bill providing for assisted outpatient treatment in Maine; and be it further

RESOLVED, that the incidents and tragedies cited above as well as the many not mentioned herein demonstrate the significant stake that law enforcement has in ensuring the efficacy of state funded mental health services in treating people with severe mental illnesses.

ATTEST: ROBERT M. SCHWARTZ, Executive Director


DECATUR DAILY (AL), March 13, 2005

[Editor's Note: We know it happens, we can process the concept of it, but it is almost impossible for someone who has not experienced the inexplicable gloom and rootless but overpowering hopelessness to truly understand how the symptoms of severe mental illnesses can cause people to take their own lives. Eric Fleischauer, the gifted author of this piece, provides insight into this startling phenomena and provides other educating glimpses into what it is like to have bipolar disorder.

Approximately 5,000 people with bipolar illness and schizophrenia commit suicide each year. Details on this monumental tragedy are in our fact sheet at: ]


By Eric Fleischauer, Daily Staff Writer

Adorned with dim chandeliers and heavy silence, the Huntsville funeral home holding the ashes of Linda Beshears clashed with the view from its foyer.

The clash between inside solemnity and outside commerce echoed the self-destructive impulses within a woman who worked tirelessly for her family, but felt responsible for crimes that she could not have committed.

A Wal-Mart bustled with shoppers as last week's memorial took its course, customers' horns and voices made quiet by thick windowpanes. People yanked at doors and pulled at furniture at the U-Haul shop next door, eager to get from here to there. A steady stream of people trickled into Hollywood Video, emerging in minutes with their $4 escapes in hand.

High Cost Of Escape

For Beshears of Lacey's Spring, the cost of escape - from internal clashes between mania and depression - was high. The coroner labeled her death suicide, but the 120 people at her memorial service knew better.

Beshears died from the disease that plagued her for the last eight years of her life. She died of the internal war called bipolar disorder.

One in 20 suffering from bipolar disorder ultimately kill themselves. One in two try.

Beshears' death tracked the emotional extremes that plagued her. Doused in gasoline, she flamed in heat so extreme it melted the windows of her car.

Then she immersed her burned body in the frigid waters of the Tennessee River in Morgan County.

While Beshears' life was the most recent one snatched by bipolar disorder in this area, it was not the first.

In August, Janet Pearsall Haney, 26, killed herself with carbon monoxide by locking herself in a shed with her running car. In January 2004, 29-year-old Farron Barksdale, saddled by the disorder, shot and killed two police officers.

What Is Bipolar?

Bipolar disorder typically involves alternating cycles of mania and depression that lead to abnormal behavior. The most serious cases are a living hell as patients and families try desperately to find an unclouded reality, an emotional baseline.

People suffering from a manic episode are either euphoric or irritable. Other symptoms of mania, according to Dr. Andree Stoves at The University of Alabama at Birmingham Medical Center, include impulsiveness, decreased need for sleep, hypersexuality and dramatic increases in energy level.

"They feel grandiose," explained Stoves, who is director of psychiatric emergency services and psychiatric consultation services at UAB Medical Center. "They may even think they are having special communications from God. They often feel invincible."

The depressive episodes are just as bad.

"This is not the blues. You can't pull yourself up by the bootstraps," said Larry Cantor, Ph.D., a director at Decatur General Hospital West. "Some don't know how to live. Some feel death is the only answer."

Some with severe bipolar disorder develop a compulsion for self-injury, particularly "cutting." The term means something broader than suicide, but typically involves a laceration to the wrist.

Sometimes the intent is suicide, but at other times it is a means to break the mood cycling. At other times, it is a cry for help as a patient realizes he or she is losing his battle against suicide.

Listing the symptoms of bipolar is easy. Understanding the disorder's toll is not.

"No one understands being bipolar," said a 47-year-old woman suffering from the condition.

Like many of those suffering from the disorder, she will not use her real name due to the stigma associated with the diagnosis. She asked to be called "Rosebud."

"Other bipolars can't understand being me," Rosebud said. "I can't understand being other bipolars."

The cause of bipolar disorder is not well understood. There is a definite genetic component. Most who suffer from the disorder have a relative who also had it, but one identical twin may have bipolar disorder when the other does not.

"Extremely stressful situations can cause symptoms to manifest," according to Stoves. "So can the use of drugs. ... They may not be able to tolerate a stressor like a normal brain would."

From The Inside

The disease is bad enough. It is made worse for patients who experience social condemnation for the diagnosis.

Forty-year-old Randy said, "You can't imagine what it is like with the mental-illness label. It seems that with any other body part, it is socially acceptable for it to go bad, but if it's the brain, then you're a social leper."

Rosebud explains.

"Bipolars have to learn to be actors and actresses. People don't like us if they know what we are. I don't ever tell anyone what I am."

While the extremes of mania can be horrifying - replete with paranoia, irrational guilt and delusions - the less dramatic hypomania is sometimes pleasant.

Rosebud's nearly overwhelming anger at what bipolar disorder has done to her life includes frustration about her manic episodes.

"So I am stuck ... in this hell-hole of depression. I can't even be a decent bipolar," Rosebud said. "I can't go full-manic because of my ministry background. It holds me back from being the bad-girl, hypersexual person."

Forty-year-old "Shout" said the disorder is nerve-wracking even when its symptoms dissipate.

"Bipolar is never knowing who you really are," Shout said. "When you are manic, you are wonderful and when depressed, you are s---. When you're stable, you spend much of your time worrying that it won't last."

Manic Episodes

One person with bipolar said he woke up at 3 a.m. in a manic phase and proceeded to paint his basement in tropical colors. On Sept. 11, 2001, he feared the planes were headed for him, so he hid behind a chair with his "last meal," a bowl of cereal.

Some of those suffering from severe mania have a bond with their co-sufferers. Some can laugh at their antics, but not for long.

One man had a "magic pen" during a manic episode. He talked to it and it talked back as it helped him write a novel.

Another woman recalled pulling her pants down in a crowded restaurant, mooning a table of businessmen. The story triggered amusement from others who share her diagnosis, until she continued. "I want someone to put their arms around me and tell me it will be OK. I'm flying free, but scared."

Before shooting two police officers last year, Barksdale suffered severe paranoia as a result of his bipolar disorder, his lawyer said. Paranoia is sometimes a symptom of mania.

Beshears was apparently delusional, believing that she was responsible for terrorist attacks. She told a rescuer that the only way she could stop the violence she caused was to kill herself.

Treatment Of Bipolar

Stoves said this is an exciting time in the research of treatments for the disorder. She hopes that ongoing genetic research will lead to treatment, and an increasing number of medications are available to ease symptoms.

"Several drugs have gotten FDA approval for the management of manic episodes, and drugs are being found almost daily that modulate symptoms. There is even some research suggesting certain nutritional things, changes in food and diet, can affect the outcome," Stoves said.

Most people with bipolar disorder respond well to mood-stabilizing medication. For some, the problem is making themselves take it.

Cantor said one reason it is difficult to get bipolar patients to take medicine is that it disrupts the pleasure they feel during their hypomanic episodes. Some experience boundless optimism and creativity during these phases.

Their self-impression is not always off. Cantor said many successful businessmen and artists suffer from the disease. During their manic stages they are geniuses, but they come down hard when the depressive episodes hit.

"Some feel able to get a lot done, very confident," Stoves said. "The last thing they want is for someone to rain on their parade."

Getting patients to take medicine during depressive episodes is difficult for other reasons.

"They feel so depressed that they may be too exhausted to physically get up and get their medications," Stoves said. "Sometimes they feel so hopeless that they decide there is no need to take the medicines anyway, that it won't help."

For some patients, the disease becomes a part of their identity.

A bipolar woman reacted with fury to a bad interview question. Once her anger abated, she explained.

"My reaction to you describing my illness as 'hideous' was understandable when you consider how closely some of us identify with our disease. How could I not take your description personally?" she said.

The unwillingness to take medication is fodder for many an academic debate.

"I have always felt strong about civil rights," explained Cantor, "but this is a tough issue."

Alabama has an involuntary commitment law, but some consider it hard to use and sometimes slower than necessary for the protection of the patient or for the protection of others.

Limestone County Probate Court records indicate Barksdale was committed on several occasions. He would stabilize on medications, be released, and then stop taking them.

"What do we do? We know if we could just put them asleep for 72 hours, they would wake up as a different person," Cantor said.

While counseling is an important part in the treatment of those with bipolar disorder, it is not always successful in preventing suicide. Lessons learned between episodes may not stick.

"It's very difficult for people when they are in a given mood state to recall clearly when they didn't feel that way," Stoves said.

"Guilty ruminations," the term doctors use to describe symptoms such as those expressed by Beshears, are often present in severe bipolar disorder. They sincerely believe they are responsible for things over which they have no control.

"For most (bipolar) people who commit suicide," Stoves said, "if you really understand their thought processes, the suicide is a rational thing from their point of view. If I am to blame for all this, they figure, I don't deserve to live."

While the efforts of Stoves, Cantor and others have improved treatment, many remain in the disorder's deadly grasp.

"I rapid cycle, and when I am manic I am filled with rage and often don't remember clearly what I do," said Chilly, a 34-year-old man. "Then the guilt hits."

"Sometimes," he continued, "my mind races so much, the only way to slow it down is by cutting."


SUMMIT DAILY NEWS (CO), March 15, 2005

[Editor's Note: With an able pen, Bonnie Norling highlights the catastrophic connection between mental illnesses and suicide along with the "choice" her own brother made because her state's treatment laws forbade his getting needed care.]


Letter to the Editor

By Bonnie Norling, Silverthorne

Thank you Kimberly Nicoletti, for your informative and sensitive article about mental illness and suicide.

Thank you for bringing it forward even though denial is much more comfortable. After the personal experience of my Schizophrenic brother killing himself 4 years ago, I am painfully aware of the ramifications of these issues.

I listened for years as the "mental health" workers told us their hands were tied, because of current laws, to give him the help he really needed. He was an "adult" and had choices. The mentally ill are victims of their illness.

My brother was unable to make a healthy choice regarding the ramifications of not being on helpful drug therapy or his future well being. The tormenting voices and despair plagued him until he made his final "choice."

President Reagan's shooting, Willie Morrison's murder in Alma, and many suicides that we've experienced here in Summit County are results of mental illness.

The tragedies will continue if we aren't willing to recognize and talk about the need at a personal and community level.

With fearless attention and compassion, I believe there are solutions. So thank you Kim for bringing, once again, an important issue forward for discussion and hopefully thoughtful action.


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Monday, March 07, 2005


TAC Newsletter March 4, 2005


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March 4, 2005


Today's E-news is one of the shortest we've had; it is also one of the most important ever.

The Treatment Advocacy Center's first legislative campaign was the one for Kendra's Law in 1999, which brought assisted outpatient treatment (AOT) to New York. This week, that state's office of mental health released a report on the first five years of its AOT program; it is by far the most comprehensive statewide examination to date of court-ordered community treatment. And the results of AOT in New York are astounding, astounding in how much better the program has made the lives of thousands who before were among those most severely ill with mental illness.

We ask you to please read the new Kendra's Law report - it is the single best tool for advocates seeking to either gain or increase the use of AOT in their states. If you are going to read only one mental health report this year, it should be this one. It is available on the NY OMH website at:

The Treatment Advocacy Center's briefing paper on the Kendra's Law report is below. You can also find it in its original formatting on our website at

Also on that page is a link to a PDF version, which will allow you to get an exact copy to distribute to the policy makers in your state and local community.



SUMMARY: Kendra's Law is New York's law for assisted outpatient treatment. The New York State Office of Mental Health released its "Final Report on the Status of Assisted Outpatient Treatment" on March 1, 2005, which details the outcomes for the first five years of Kendra's Law. Assisted outpatient treatment drastically reduced hospitalization, homelessness, arrest, and incarceration among the people with severe psychiatric disorders in the program, while at the same time increasing their adherence to treatment and overall quality of life. The adoption of assisted outpatient treatment also resulted in fundamental changes to the overall New York mental health system, leading to enhanced accountability and improved treatment plan collaboration for all service recipients - effectively committing the system to the patient, not just the patient to the system.

* * *

Kendra's Law Helps Those Who Need It Most

As of March 1, 2005, 3,908 individuals received treatment orders under Kendra's Law (note 1). An average of 62 individuals per month, or 747 individuals per year, were ordered to maintain treatment under the program (note 2).

As intended, the individuals placed in assisted outpatient treatment (AOT) were among the most severely ill. In the three years prior to the court order, almost every participant - 97 percent - had at least one psychiatric hospitalization (with an average of three hospitalizations per recipient). When compared with a similar population of mental health service recipients, those placed in AOT had been twice as likely to have been homeless, 50 percent more likely to have had contact with the criminal justice system, and 58 percent more likely to have a co-occurring mental illness and substance abuse condition.

Kendra's Law Reduces The Severest Consequences From Lack Of Treatment

As compared to the three years prior to participation in the program, AOT recipients experienced far less hospitalization, homelessness, arrest, and incarceration. Specifically, for those in the AOT program:

*** 74 percent fewer experienced homelessness;

*** 77 percent fewer experienced psychiatric hospitalization;

*** 83 percent fewer experienced arrest; and

*** 87 percent fewer experienced incarceration.

Kendra's Law Reduces Costs For The Most Expensive Services

Inpatient hospitalization is by far the most expensive form of psychiatric treatment available today. One of the most dramatic benefits to individuals participating in the Kendra's Law program was a marked reduction in the total number of days spent hospitalized. On average, AOT recipients spent 50 days in the hospital for psychiatric care during the six months prior to AOT, a number that was reduced 56 percent for participants during a matched period. Even after the termination of the court order, the decline continued - during the first six months following the end of the AOT order, total hospital days were reduced to an average of 13, a 73 percent reduction from the pre-AOT total. Individuals who meet Kendra's Law strict eligibility standard typically already consume significant inpatient and outpatient treatment dollars. Assisted outpatient treatment can reduce costs by reducing the ineffective use of existing services.

Kendra's Law Reduces Harmful Behavior

Kendra's Law also resulted in dramatic reductions in the incidence of harmful behaviors for AOT recipients at six months in AOT as compared to a similar period of time prior to the court order:

*** 55 percent fewer recipients engaged in suicide attempts or physical harm to self;

*** 49 percent fewer abused alcohol;

*** 48 percent fewer abused drugs;

*** 47 percent fewer physically harmed others;

*** 46 percent fewer damaged or destroyed property; and

*** 43 percent fewer threatened physical harm to others.

Kendra's Law Improves Medication Compliance

Individuals in the Kendra's Law program were also much more likely to regularly participate in services and take medication as prescribed by the treating physician.

*** The number of individuals exhibiting good adherence to medication increased by
51 percent (from 41 percent to 62 percent).

*** The number of individuals exhibiting good service engagement increased by 103 percent (from only 34 percent to 69 percent).

Kendra's Law Recipients Value The Program

Researchers with the New York State Psychiatric Institute and Columbia University conducted face-to-face interviews with 76 AOT recipients to assess their opinions about the program, perceptions of coercion or stigma associated with the court order and, most importantly, quality of life as a result of AOT. The interviews showed that prior to receiving court-ordered treatment, the majority of those entering the program felt anger or embarrassment. But after they received treatment, AOT recipients overwhelmingly endorsed the effect of the program on their lives:

*** 75 percent reported that AOT helped them gain control over their lives;

*** 81 percent said that AOT helped them to get and stay well; and

*** 90 percent said AOT made them more likely to keep appointments and take medication.

Additionally, 87 percent said they were confident in their case manager's ability to help them - and 88 percent said that they and their case manager agreed on what is important for them to work on.

Kendra's Law Improves The System's Ability To Help Those In Need

Not only is Kendra's Law helping the individuals in the program, it is also helping the system better provide treatment to all those in need. The New York Office of Mental Health detailed some of these systemic benefits in its final report: "Counties and stakeholder groups statewide have reported that the implementation of processes to provide AOT to individuals under court orders has resulted in beneficial structural changes to local mental health service delivery systems. The implementation of AOT has also supported the development of more collaborative relationships between the mental health and court systems. AOT has been instrumental in increasing accountability at all system levels regarding delivery of services to high need individuals."

The increased accountability led to a shift in the manner in which treatment to high need individuals was viewed: "Local mental health systems began to identify the potential risk posed by not responding to individuals in need, and as a result, those systems improved their ability to respond more efficiently and effectively."



1 - This statistic and all others cited in this summary, unless otherwise noted, are from the following source: N.Y. State Office of Mental Health (March 2005). Kendra's law: Final report on the status of assisted outpatient treatment. New York: Office of Mental Health.

2 - 3,908 individuals over the first 5.23 years of the program (11/8/99 - 2/1/05) = 747.7 individuals per year, or 62.3 per month. This is notably fewer people than the 10,000 people per year that Kendra's Law opponents predicted would be swept into the "dragnet" of the law.


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Wednesday, March 02, 2005



Man gets 210 years for bar shooting

Associated Press
March 2, 2005

EVANSVILLE, Ind. -- A man who pleaded guilty to shooting four people inside a bar, killing two of them, and another shooting that left a man paralyzed has been sentenced to 210 years in prison.

As Vanderburgh Circuit Court Judge Carl Heldt announced the sentence Tuesday for James E. Durham Jr., 26, the courtroom burst into applause.

Under the sentence, Durham will not be eligible for parole until 2108.

Durham was sent to the Logansport State Mental Hospital after he was first ruled incompetent to stand trial for the May 2003 shootings. Psychiatrists placed him on medication and said later he was competent to stand trial.

Two court-appointed psychiatrists testified Tuesday that Durham suffers from undifferentiated schizophrenia and a below-average IQ of 80.

"This man has a disease that's not a voluntary disease," defense attorney Cole Banks said.

Durham, of Evansville, was charged with two counts of murder and two counts of attempted murder in the shootings of four people at Stan's Place tavern.

Witnesses told investigators that a man entered the bar and began talking "biblical gibberish." When the man was asked to leave, he pulled a gun and began firing, killing Steven W. Winnecke, 50, and Marsha Fraser, 52, and wounding two others.

Durham also pleaded guilty to attempted murder for shooting Joseph Scales in the neck the day before the tavern attack. The shooting left Scales a quadriplegic.

Tuesday, March 01, 2005


Tony Kiritsis

Tony Kiritsis, 72, found dead of natural causes
In '77, he wired a shotgun around the neck of a mortgage company official, paraded him through Downtown, kept him hostage for days.

Anthony G. "Tony" Kiritsis held a shotgun to the head of Richard Hall on Feb. 10, 1977. After a live, profanity-laced television news appearance, Kiritsis released Hall. Kiritsis later spent 11 years in mental wards until his release in January 1988. -- Jim Young / The News

By Rob Schneider
January 29, 2005

Anthony G. "Tony" Kiritsis, who made national headlines when he wired a sawed-off shotgun around the neck of an Indianapolis mortgage company executive in 1977 and paraded him through Downtown streets, was found dead in his home Friday.

Kiritsis, 72, virtually held the city at bay for more than two days before ending the 63-hour hostage ordeal at his apartment. Found not guilty by reason of insanity, Kiritsis spent 11 years in mental wards until his release in January 1988.

On Friday, he was found dead at his Speedway home in the 1500 block of Mickley Avenue by an acquaintance, who notified police. The Marion County coroner's office said Kiritsis died of natural causes.

Efforts to contact family members Friday were unsuccessful. It is unclear what Kiritsis had been doing since his release from custody.

The events of Feb. 8, 1977, elevated Kiritsis to an instantly recognizable household name as he talked repeatedly on the air with veteran radio newsman Fred Heckman of WIBC-AM (1070). Kiritsis also insisted on live television coverage of him reading a statement -- all while his shotgun was still wired around the neck of Richard O. Hall, with whom Kiritsis was angry about a business deal.

The incident would forever change the way broadcast journalists cover such incidents and would lead to what some called "The Kiritsis Law" after he was found not guilty by reason of insanity. His acquittal prompted Indiana legislators to amend the law to provide for verdicts of "guilty but mentally ill" and "not responsible by reason of insanity."

Kiritsis confronted Hall in his office at 129 E. Market St., angry about a possible foreclosure on land Kiritsis had hoped to develop. Kiritsis, who described himself as having been angry all his life, attached Hall to a wire noose bolted to the end of his shotgun and put his finger into a metal ring that was wired to the trigger.

He led Hall through Downtown Indianapolis, surrounded by police and horrified office workers, until he reached Washington Street and Senate Avenue. There, he commandeered a police squad car and drove to his apartment at Crestwood Village. Kiritsis contended the apartment was wired with explosives.

After negotiating with authorities, he left his apartment with Hall still wired to the shotgun, walked into the lobby of the complex and demanded that television cameras be turned on. In a profanity-laced proclamation, Kiritsis called himself a national hero.

The incident proved to be a "watershed" story for television, said Mike Ahern, who retired in December as the longtime news anchor at WISH (Channel 8).

Back then, local stations had just acquired the capability of going live with "mini-cams," Ahern explained. "We honestly didn't know what we were doing then; those cameras were so new."

Ahern, who had been out to the apartment complex, was back at the station when the hostage ordeal ended. He remembers looking up at a television screen and watching as the face of John Wayne (on an awards show) was replaced by the ranting and raving face of Kiritsis.

Tom Cochrun, news director at WISH, was a news reporter for WIBC at the time and remembered wondering how Kiritsis' tirade would end.

"Tony's moods would vacillate from anger, rage and frustration, where he was screaming and yelling to where he was crying, and then he would laugh," Cochrun said.

The station's telephone lines were flooded with calls by people angry about Kiritsis' foul language being aired, but Ahern was more worried about viewers seeing an execution in their living rooms.

"We didn't know what to do. Our hands were tied at that point because Kiritsis had demanded live coverage. If we pulled the plug, who knows what would have happened?" Ahern said.

But the larger question is whether the station should have been plugged in to begin with, Ahern said. "Should we have gone out there 'willy-nilly' with our cameras running because we had these new toys in our arsenal?"

In retrospect, Ahern said, the answer is no.

"If that thing taught us anything, it's caution and perspective and responsibility," he said. "It taught us a lot about how vulnerable we can be in a situation like that."

Call Star reporter Rob Schneider at (317) 444-6278.

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