Tuesday, February 14, 2006


TAC Newsletter 2/10/06


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February 10, 2006


February 8, 2006

STATE OF NEW MEXICO – From the Commissioner of the New York Office of Mental
Health, February 8, 2006

3. BILL’S NEW VERSION RANKLES OPPONENTS – Santa Fe New Mexican, February 9, 2006

PSYCHOSIS – Statement by TAC Executive Director Mary Zdanowicz, February 8, 2006


1. NEW YORK TIMES, February 8, 2006

[Editor’s Note: The battle to bring assisted outpatient treatment to New Mexico
drew national attention this week with an indepth piece in the New York Times.

As U.S. Senator Pete Domenici said in announcing his support for this bill,
“Some argue that it is wrong to force individuals to undergo treatment against
their will. We argue that the tragic consequences are simply too monumental not
to require help under certain circumstances. The success rate of the AOT program
in other states has been well documented in both research and in practice.”

We couldn’t agree more.]


By Randal C. Archibold

SANTA FE, N.M., Feb. 7 — Against the vivid backdrop of recent killings by
mentally ill people, both sides in the national debate over whether mentally ill
people who have not committed a crime can be forced into treatment are preparing
for a showdown in the Legislature here.

New Mexico lawmakers are considering a bill, backed by Gov. Bill Richardson,
that would make the state the 43rd with a law allowing family members, doctors
or others to seek a court order forcing the mentally ill into outpatient
treatment. Typically under the laws, if mentally ill people refuse the
treatment, they can face confinement in a hospital.

Across the country, proponents have pushed the laws as a pragmatic approach to
the mentally ill who fall through the cracks of the mental health system,
particularly those who have committed no crime but could harm themselves or
others as their sickness worsens. These mentally ill people often do not need to
be in a hospital, but do need to stick to treatment, which could include
medication, therapy or both.

"We are talking about a small group of people who do not get help because they
don't want help or know they need help," Mary T. Zdanowicz, executive director
of the Treatment Advocacy Center, based in Virginia, said in a break from
lobbying lawmakers here.

But opponents say the laws infringe on the civil rights of the mentally ill, and
they suggest that teams of social and psychiatric workers could accomplish the
same thing with direct intervention on the streets. Critics also say that most
states have not provided adequate money for the services needed by those forced
into treatment.

One of the more glaring examples, the opponents say, is California. Three years
after adopting an outpatient treatment law, none of its counties, which are
charged with carrying it out, have found the money or will to put it into

Michael Allen, senior lawyer with the Bazelon Center for Mental Health Law in
Washington, who also lobbied lawmakers here, said the measures were "a political
quick fix in response to tragedies."

Like other states, New Mexico provides that violent offenders who are mentally
ill can be committed to inpatient treatment at a psychiatric hospital for a
certain period. But the proposed law is intended for the mentally ill who have
not committed crimes and have resisted treatment.

The proposal — called Kendra's law after one in New York named for Kendra
Webdale, who was killed when a schizophrenic who had been in and out of
treatment centers pushed her in front of a New York City subway train in 1999 —
arose after an Albuquerque man on a long descent into mental illness shot to
death five people, including two police officers, in August.

Jennifer San Marco, the former postal worker who capped a growing history of
psychological problems by killing seven people and herself last week in Goleta,
Calif., lived in a village about 70 miles west of Albuquerque. There is
speculation Ms. San Marco could have been helped by a forced-treatment law,
though advocates have not pushed this line of reasoning hard because little is
known about what treatment she was getting, if any.

Still, just as in many other states that have considered laws allowing forced
outpatient treatment, a specter hangs heavy over the proceedings.

The widows of the slain police officers testified in favor of the law last week,
while several people with mental illness spoke against it.

State Representative Joni Marie Gutierrez, a Democrat and the chief sponsor of
the bill, said it would provide another tool to help the severely mentally ill.

"A lot of families have been keeping this under wraps and trying to take care of
loved ones on their own," Ms. Gutierrez said. "They don't have the legal means
to petition the court for treatment."

Sherri Pabich, who said she had sought treatment for a mentally ill acquaintance
for 13 years, said the law would help because "a lot of mentally ill people do
not realize they are sick and won't seek treatment on their own."

Officials estimate that up to 100 people a year would get treatment under the
law. People who defy the court order could be committed to a state hospital.

But opponents said New Mexico already had an underfinanced mental health
treatment system that could frustrate even those who sought treatment

"There already are long waits for treatment here," said Sarah Couch, an
Albuquerque woman who has bipolar disorder. Ms. Couch and others want more
financing for voluntary mental health programs, rather than the threat of court

Both sides have been conscious of history; more than 30 years ago, states moved
away from warehousing the mentally ill in large institutions that earned a
reputation for abuse and shoddy care.

A wave of patients' rights laws made it difficult to commit people against their
will or force them to take medication, and proponents of a new law here have
been careful to assert that the vast majority of mentally ill are not violent
and will not face court orders.

Both sides have offered competing studies on the effectiveness of the approach,
with a New York State report last year getting particular attention.

Reviewing information from case managers from 1999 to 2004, the New York Office
of Mental Health said people ordered into treatment under the law committed
fewer crimes and were less likely to end up homeless or in psychiatric hospitals
or harm themselves or others.

A little over one-third of the 10,000 cases referred to court, most of them in
New York City, resulted in forced outpatient treatment, according to the report,
which Gov. George E. Pataki cited in declaring Kendra's law a success.

But Harvey Rosenthal, executive director of the New York Association of
Psychiatric Rehabilitation Services, flew to New Mexico this week to dispute the
state report's findings.

Mr. Rosenthal cited a report by a legal advocacy group, New York Lawyers for the
Public Interest, which asserted that blacks were five times as likely as whites
to face court orders. In addition, he said, counties have unevenly applied the
law, skewing the results of the study.

"New York's law is not the model it is made out to be," he said.

In recent years, opponents of the laws have scored victories in New Jersey and
Connecticut, which considered laws for involuntary outpatient commitment but did
not approve them and are among the eight states without them.

In addition to New Mexico, the others are Maine, Massachusetts, Maryland,
Tennessee and Nevada, Ms. Zdanowicz said.

The bill's fate here is uncertain, but it has support from influential
politicians like Mr. Richardson, a Democrat, and Senator Pete V. Domenici, a
Republican who has been an advocate for mental health causes across the nation.

Mr. Richardson's advisers had argued against the proposal, but his health
secretary said she now supported it because legislators agreed to provide about
$2 million for outpatient programs.

Representative Gutierrez said lawmakers were considering setting a two- or
four-year limit for the law, which could then be renewed after a review.

Ms. Gutierrez said the state would still face challenges in providing treatment
for people forced into treatment. New Mexico has a shortage of doctors and
mental health professionals, she said, and the state's rural nature often means
patients have long drives to few clinics.

State officials are trying to recruit more professionals and, in a move watched
by other states, recently consolidated the work of 15 public agencies to enhance
and more efficiently deliver mental health and substance abuse services.

"We are working towards doing better every day," Ms. Gutierrez said. "This bill
is part of it."


February 8, 2006

[Editor’s Note: Who knows better if Kendra's Law is working in New York than
the New York Office of Mental Health? The Commissioner calls the successes of
New York’s Kendra’s Law “undeniable and well documented” – and offers her
assistance to her colleague in New Mexico.]


RE: Implementing Kendra’s Law in New Mexico

Dear Secretary Grisham:

I understand that you and Governor Richardson are working to establish a version
of assisted outpatient treatment (AOT, a.k.a. “Kendra’s Law”) in New Mexico,
similar to the New York State statute proposed and signed into law by Governor
Pataki in 1999.

Kendra’s Law has proven extremely successful in New York State, so it is unclear
why reports of our program’s purported failure have entered the debate in your
state. Our evaluation of AOT has clearly shown that Kendra’s Law is working,
and is working well.

To evaluate the program, New York has collected extensive and targeted data on a
spectrum of measures and from a variety of sources. We know conclusively that
the program has been invaluable for individuals who, without Kendra’s Law,
previously had limited success in using voluntary mental health services.

Individuals receiving services under Kendra’s Law are able to make and maintain
real gains in their recovery, and show significantly increased participation in
case management, substance abuse, and other treatment services. During
participation in the AOT program, rates for hospitalizations, homelessness,
arrests and incarcerations have declined dramatically, as have those for harmful

Perhaps most encouraging are the reports from people in the program, which were
collected and assessed via an independent survey. Three out of every four
reported that Kendra’s Law had helped them regain control of their lives; four
out of five said that it helped them to get and stay well.

Our experience with Kendra’s Law has resulted in fundamental changes to New
York’s system of care for those incapacitated by the symptoms of severe
psychiatric illness, including those who do not meet the program’s eligibility
criteria. Under Governor Pataki’s leadership, we are seeing improved access to
mental health services, improved coordination of service planning, enhanced
accountability, and improved collaboration between the mental health and court

Given that the success of Kendra’s Law in New York has been undeniable and well
documented by statewide data, renewal of the law was strongly backed by Governor
Pataki and had virtually no opposition from our stat’s legislators. Discussion
of the program in the last legislative session focused not on whether to
maintain Kendra’s Law, but on quality improvement issues. After reviewing the
data, even those who had opposed the adoption of Kendra’s Law in 1999 urged a
time-limited renewal of the program. When the law was extended last year,
several changes were made to further strengthen the program.

In addition, I have established a quality panel of experts and stakeholders
which met for the first time this past January. This panel will fine-tune an
already proven and effective treatment program, and their efforts will go far to
expand the benefits of Kendra’s Law in areas of our state that have not yet
fully utilized the program.

I would be pleased to pass on the lessons of our experience with Kendra’s Law to
help your office further the adoption and implementation of assisted outpatient
treatment in New Mexico.


Sharon E. Carpinello, R.N., Ph.D.
New York State Office of Mental Health


3. THE NEW MEXICAN, February 9, 2006

[Editor’s Note: Assisted outpatient treatment is obviously not the single answer
to the many and complex problems facing state mental health treatment systems.
Most certainly, an AOT law cannot ensure care for every person who wants or
needs it or repair decades of problems with service availability.

Consumers who are able to testify at legislative hearings and speak cogently to
reporters are unlikely to meet the strict criteria for Kendra’s Law – but
ironically, passage would help them anyway. Because these laws go beyond helping
the small group of desperately ill people who need them, by improving the system
as a whole and making existing services more effective. That will benefit
voluntary users as well as the 75-100 people who will likely be in the program
(based on the number in New York).]


By David Miles

Safeguards for patients were added Wednesday to a bill to allow court-ordered
outpatient treatment for mentally ill adults who are judged to be in danger of
harming themselves or others, but opponents said they remained unhappy with the

The House Judiciary Committee temporarily set aside the bill (committee
substitute for HB174) on Wednesday. The panel plans to make more changes to the
measure Friday.

The latest version of the bill specifies that before courts can order mentally
ill New Mexicans to receive outpatient treatment, noncompliance with treatment
must have been a significant factor in necessitating hospitalization or other
services at least twice in the previous 36 months or resulted in at least one
act of “serious violent behavior” in the previous four years.

The bill already included the following requirements for court-ordered
outpatient treatment — mentally ill New Mexicans who are at least 18 years old;
are unlikely to live safely without supervision; are unlikely to voluntarily
receive treatment; would likely benefit from treatment; and need treatment to
prevent “serious harm” to themselves or others.

“This bill might not be the answer, but it’s one step,” said Rep. Joni Marie
Gutierrez, a Las Cruces Democrat who sponsored the bill.

Albuquerque Police Department Sgt. Carol Oleksak, who was shot in the head by a
mentally ill transient in 2003, called the bill an important piece of
legislation. “This may not be perfect, but even if we can save one or two lives
on this, it’s very important,” Oleksak said.

But others complained that New Mexico lacks the necessary services and bed space
for the mentally ill.

Sarah Couch, an Albuquerque resident with bipolar disorder, said she has
struggled for years to receive necessary medications and treatment. “If there
had been a Kendra’s Law when I was first struggling, I would not have had the
courage to be evaluated, and if the law passes, I will carefully censor what I
share with my doctors and my family members,” Couch said.

The bill is named Kendra’s Law after Kendra Webdale, a New Yorker who was killed
in 1999 when a schizophrenic pushed her in front of a subway train.

Peter Bochert, statewide drug-court coordinator for the Administrative Office of
the Courts, said the legislation would necessitate an additional eight to 14
judges in New Mexico, as well as more staff and attorneys. “Each petition will
require several court hearings,” Bochert said.

Michelle Lujan Grisham, secretary of the state Department of Health, said that
while there is no appropriation in the bill, a separate state budget measure
(committee substitute for HB2) contains an additional $2 million for behavioral
health services.

Under the bill, family members of mentally ill New Mexicans; psychiatrists;
other health and social-service providers; and parole and probation officers
could file a petition at their district court for an order for outpatient
treatment. The petition would have to be accompanied by an affidavit from a
physician who had examined or attempted to examine the mentally ill person.

Contact David Miles at 986-3036 or dmiles@sfnewmexican.com.


February 8, 2006

[Editor’s Note: Kendra’s Law bill sponsor Rep. Joni Gutierrez (D-Las Cruces)
introduced this measure because "existing New Mexico law essentially forces
people who lack insight into their illness to hit rock bottom before they can be
helped ... Forced deterioration is cruel and inhumane."

Debate over AOT laws often becomes emotional, but the bottom line is that the
research, the data, and the experiences of participants all prove that assisted
outpatient treatment laws save lives. There are only eight states that do not
have such a law. We hope soon, because of the compassion and wisdom of Rep.
Gutierrez and so many New Mexico legislators, there will be seven.]

Assisted outpatient treatment will help New Mexico's mentally ill access
treatment, free them from prison of psychosis

It is because of so many dedicated local advocates that New Mexicans may soon
have access to a law proven effective time and time again, in national studies
and real-world implementation, to improve the quality of life of people with
severe mental illnesses.

New Mexico is one of only 8 states without an assisted outpatient treatment
(AOT) law. That means someone too ill to make an informed treatment decision
must be left untreated until they are in a crisis, posing a "likelihood of
serious harm to themselves or others."

Proposed legislation (HB174 and SB335) would allow New Mexico courts to order
someone with a severe mental illness into outpatient treatment if a judge finds
they meet specific requirements.

This law has broad bipartisan support, including Gov. Richardson, Albuquerque
Mayor Chavez, and U.S. Sen. Domenici, as well as the New Mexico chapter of the
National Alliance for the Mentally Ill.

Some lobbying against this bill have been swayed by easy cliches, perhaps
unaware of the overwhelming research that assisted outpatient treatment both
saves lives and makes precious existing services more effective.

Calls to protect civil liberties betray a profound misunderstanding of that
term. There is nothing "civil" about leaving people lost to disease to live
homeless on the streets, suffering rape and victimization. There is nothing
"right" about leaving someone untreated and psychotic, rendering them incapable
of discerning whether they are attacking a CIA operative or their own mother.

Assisted outpatient treatment laws are meant to help those who are too ill to
make rational treatment decisions. It would in no way adversely affect people
with mental illnesses who are able to make informed treatment decisions, usually
those who testify at hearings or press conferences. In New Mexico, only about 75
to 100 people would be placed in the program each year. For that small group - a
group for whom voluntary services will never be enough - these laws have been
shown to reduce hospitalizations, arrests, incarcerations, victimizations,
homelessness, and caregiver stress, and improve medication compliance and
quality of life. In New York, 81% of interviewed participants said Kendra's Law
helped them get and stay well.

AOT laws also reduce violence. People with mental illnesses are usually no more
violent than the general public, but the opposite is true for people with severe
mental illnesses who are not taking medication. Pretending this statistic
doesn't exist does a grave disservice to those who are in desperate need of
help, and their families. Stigma comes not from news articles about a crime, but
from the crime itself. Helping people who are in need means fewer crimes, less
stigma, and better outcomes for the people who are ill.

Kendra's Law will improve the quality of life for a small group of New Mexicans
with the most severe mental illnesses. Don't ignore the research and science in
favor of emotion. These laws save lives. Let's work together to ensure there is
no discrimination against those who are the sickest - and that they have the
true civil right to be free of psychosis.

The Treatment Advocacy Center (www.psychlaws.org) is a national nonprofit
dedicated to removing barriers to treatment of severe mental illnesses.

Additional materials available at

Read a letter from NY OMH Commissioner to NM Secretary of Education at

CONTACT: Alicia Aebersold aebersolda@psychlaws.org or 703 294 6008


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