Wednesday, December 2, 2009

MIWatch - Models beyond outpatient commitment


In the ten years since Kendra Webdale was pushed to her death by a man who was denied services for his mental illness, discussions about what could have prevented this tragedy have occurred often. Led by New York State, more than 40 others passed laws mandating outpatient or involuntary commitment (AOT). But the issue is hardly resolved, evidenced by the activists, services providers, and psychiatrists who crowded the Columbia University law school to discuss what it means to "gain compliance in the community."

Perceptions of violence have driven coercive measures since Colonial times when jails and almshouses were filled by people with a mental disorder, said noted psychiatrist Dr. Paul Applebaum in a sweep of history. Prisons and hospital commitment are extremes, but other techniques such as money management or access to housing, along with Kendra's Law, are often used to leverage psychiatric treatment.

Despite evidence from major studies that such events are rare, in 1999 New York State passed Kendra's Law to promote public safety with forced outpatient treatment. New York said it was for people who were "unlikely to live safely in the community without supervision."

Many believe Kendra's Law and involuntary treatment is the emblem of a failed system, a common theme during a conference held at the Columbia University's law school last month where scholars, psychiatrists, activists, and service providers discussed AOT. There was almost no talk of violence, perhaps because the numbers are small. Most of the discussion pertained to services, those that exist and others that are still needed. Kendra's Law, said Dr. Marvin Swartz, one of the authors of a research study about its effect in New York, has actually been used most often for discharge planning. Still it remains controversial. And it is symbolic………

MIWatch - Models beyond outpatient commitment

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