Ten years ago there were a number of injuries, amputations, and deaths occurring in the New York Subway system when persons displaying severe and untreated mental illness pushed unsuspecting commuters onto the tracks.

One victim was Kendra--her family, organizations for the mentally ill, civic groups and newspapers clamored for and succeeded in getting passed legislation that mandates outpatient treatment for seriously mentally ill persons who pose a danger to others and are not cooperating with their treatment, particularly taking prescribed medication as prescribed by their psychiatrist.  New York State Office of Mental Health offers a detailed Web site on Kendra’s Law, including criteria for participation and medication grants

One central feature of the law is mandated psychiatric medication, which can be given against a person’s will. I am a full supporter of Kendra’s Law and strongly support its renewal. However, it brings up ancillary questions needing to be answered through theological, political, and medical reflection.

Many of the psychiatric patients (this word is used instead of “clients” due to the need for these persons to be medically cared for in a structured and intensive manner) affected by Kendra’s Law are those with severe schizophrenia or bipolar disorder. For these conditions, well-meaning suggestions about using less medication are overwhelmingly not applicable. The proper combination and balanced dosage (titration) of psychiatric medications required a highly skilled psychiatrist who knows the patient well and has frequent visits and contacts with the patient, family, and others who are involved. The relationship of the psychiatrist to the patient is highly important. Doctors who impart concern and hope may get better results with the same medications than doctors who do not possess these qualities.

A small number of groups including the New York Civil Liberties Union have opposed Kendra’s Law. Despite my full support, there are ramifications that need careful review.

We know that psychiatric medications have been used to deaden political dissent--this is well-known knowledge about the manner in which the Soviet Union treated its dissidents in the last half of the twentieth century. Within our own government, are we sure that the myriad agencies with three-letter acronyms have not experimented with or currently use psychiatric drugs for purposes other than care and treatment?

Especially with children, parents face increasing pressure to medicate children displaying conditions such as Attention Deficit Hyperactivity Disorder, Depression, and even Oppositional Defiant Disorder. The pressure often come from teachers or school administrators, who are not physicians. If a teacher says something like “your child needs to take Ritalin,” that teacher has crossed a line and is giving medical advice, a crime in most jurisdictions. I have even heard of school districts reporting well-intentioned and caring parents for medical neglect for keeping a child off medication, which can be the right decision, and these parents have been faced with expensive second opinions to clear their name.

Within our own tradition, we view the human spirit and soul as sacred; Thomas Aquinas asserted that the brain is a vehicle for expression of our soul and that certain infirmities can limit true freedom. Therefore medications must be considered carefully, and there are all too many instances when this is not done and disrespect is shown to what is our essence of being human.

With these compelling caveats in mind, however, it is helpful to reflect on the value of psychiatric medications in these extreme conditions, and their potential to help prevent victims of persons with severe psychiatric problems who are out of control.

Bishop Howard J. Hubbard of Albany, New York has praised the role of psychiatric medications in helping to heal obsessive-compulsive disorder, and his views are relevant to the severe pathology displayed by persons who may be included under the mandate of Kendra’s Law: “To understand that these emotional and psychiatric problems can be due to a causation that is beyond one’s ability to control by the will, but can be assisted either through therapy or drug treatment, or a combination of these. I think these therapies are not only acceptable, but are actually something very good, and it should be seen as one of God’s gifts to humanity that we now have resources such as these available.”

William Van Ornum

 

Comments

we vnornm | 5/27/2010 - 10:29pm
Father Perry,
Thank you for emphasizing our collective responsibility to helping these folks.
As I mentioned previously, I hope this will be added to the list of pro-life concerns as part of what Cardinal Joseph Bernardin (of happy memory) called the seamless garment-the many pro-life activities requiring our support and engagement. amdg, bill
we vnornm | 5/27/2010 - 10:07pm
DJ Jaffe of Huntington Post (where you can also read Father Jim Martin) sends further information. Thank you, DJ Jaffe. amdg bill   
 
I read with interest your article on Kendra's Law in American Magazine and thank you for your support. I can't address all the issues, you raised, but I did want to point out two things
 
The law was originated, long before Kendra was pushed, as a pilot project at the behest of families of the mentally ill. As such, none of us want to apply Russian era use of meds to curb dissent. The law has numerous protections built in which we want. The patient gets input into their own treatment plan. The patient gets a lawyer. No patient can be given treatment because a 'three letter' organization wants them to. All orders must be approved by courts. No orders can be for more than a year. I could list many others.
 
I can't address theological issues, but on the philosophical, I do point out that even John Stuart Mills in his essays, On Liberty, says something along the lines of when talking about liberties people should have, we are talking about those who have the free will to exercise them, 'we are not talking about individuals who lack the maturity of their faculties'. (Or as Herschel Hardin said in "Uncivil Liberties", schizophrenics are often "locked in the Bastille of their psychosis" and unable to engage in a meaningful exercise of free will.) Kendra's Law is an appropriate use of the state's Parens Patraie powers, even though most focus on it as use of police powers.
 
Anyway, I thank you for your support. We would love to have the support of all your organizations in our work, and I am passing your name to kendraslaw.org the group working on this.  Anything you can do to contact NYS legislators and turn your great article into action is appreciated.
 
Please look at this, http://sites.google.com/site/billcomparison/home and then
 
 
Francis Perry Azah | 5/27/2010 - 8:27pm
Bill, it is sad sometimes to see people being maltreated in public places by mentally “retarded” persons (or even sound-minded persons on the grounds of race, ethnicity or color etc.) while others around looked on unconcerned. The care of the mentally ill people in our society should be a collective responsibility so that we can collectively curb the menace of these incidences. I think treatment must be given to these patients holistically, and psychiatrists and other caregivers must cooperate in making sure that the right thing is done. I equally feel that sometimes we need to ignore the freedom and rights of these mentally ill persons who might pose nuisance to society, so that psychiatrists can have free hand to give proper treatment to them.
JANICE JOHNSON | 5/27/2010 - 6:43pm
Bill,  You referred to Dr. Peter Singer, philosophy and ethics professor at Princeton.  Frankly, his philosophy of utilitarianism terrifies me.  He sanctions the killing of infants who are born with disabilities.  Infanticide.   He and his followers have not put aany age limits on the killings of children as far as I know.  But, it is a foot in the door to euthanasia. 
 
Readers might be interested in also checking out an incredibly bright, courageous woman named Harriet McBryde Johnson.  She was born with a neuromuscular disorder that caused her to be significently physically impaired.  She was comfortable with her body and herself inspite of the difficulties.  She was adisability and civil rights attorney and advocate.  She founded a group called "Not Dead Yet".  A few yrs before she died (in 2008) she debated Peter Singer in Charleston where she lived and at Princeton.  Her account of the debate :  "Unspeakable Conversations" was published in the NY Times Magazine in 2003.   It is well worth checking out.  The conversations were so unspeakable because she exemplified  the kind of infant that Singer would condone murdering.  A contradiction in Ms. Johnson"s thinking was her pro-choice stance and Singer did call her on that. 
 
 
we vnornm | 5/27/2010 - 5:02pm
Thanks, Crystal, for bringing Dr. Thomas Szasz into the discussion. Too many things become "psychologized" when, as you point out, the human symptoms can be the result of systems encroaching upon the person. There would be much less "depression" if we could solve homelessness and poverty. There is an entire subfield called "community psychology" which seeks to identify systems which may be causing problems in individual people. best, bill
Anonymous | 5/27/2010 - 4:26pm
This reminds me of a college psych class in which we read books by  Thomas Szasz.  I understand the need to protect society from dangerous people but  incarcerating people and giving forced meds to people who haven't yet committed any crimes seems rather scary to me.  It's easier and cheaper to do this than to really address the problems of poverty, homelessness, and mental illness.
we vnornm | 5/27/2010 - 4:13pm
Thanks, Janice.
You mention developmental disabilities and psychiatric conditions occurring together. President Kennedy's Message to Congress in 1964 (was in progress being drafted when he died) envisioned both mental illness and developmental disabilities coming under the mission of one agency.
 
As has occurred, in many of not most states there are two separate systems-in New York it is Office of Mental Health and Office of Developmental Disabilities. There has always been a lack of crossover between the two systems of mental health professionals. Often the OMH professionals are skilled in medication while the ODD professionals are skilled in behavior plans, team treatment, and counseling. In the past decade there has been greater combination of both approaches. There is now a national group, "National Association for the Dually Diagnosed." I will look for the link.
 
I and others see the needs of the dually diagnosed as coming under the Church's Pro-Life umbrella. By helping these often forgotten individuals, each diocese, parish, or person can affirm the importance of lifelong Christian support for these people who are in great need and who often require more than state-sponsored programs.
Best & amdg, bill 
 
we vnornm | 5/27/2010 - 4:01pm
Norm, 
Thanks for writing. The orders are good for only one year and can only be reviewed for one year. So this is a built-in mechanism, as well as having a case manager and participation of anyone desired by the patient.
I'm not sure if there is an independent review, such as an audit by another physician not affiliated with the first doctor, or a review of the intensity and quality that JCAHO-approved hospitals and clinics go through.
Participation in this program costs the state money; we have seen how managed care of mental health is apt to approve a minimum of treatment rather than lifetime commitments as in "The Cuckoo Clock Days." So I suspect persons might be in the program shorter than longer, but that is just my speculation.
Anyone have further knowledge about this?
Thanks, Norm. Independent reviews prevent disasters like Willowbrook and we need to strive to have them in programs like this. best, bill
JANICE JOHNSON | 5/27/2010 - 1:59pm
Bill, your essay has great meaning to me both personally and professionaly.  Dealing with mental illness is and has been a reality for me for many years.  It was in the 60's when I was a social work intern at Cleveland Psychiatric Institute that the mental hospitals started discharging (dumping) their patients into the communities with the plan that they would be given needed treatment  there.  We all know that that didn't happen.  Witness the large number of mentally ill among the homeless.  And as you so correctly point out, the number of tragic crimes of violence committed by severely mentally ill patients who are without treatment and medication.
 
My son, who is now 44 years old was diagnosed with developmental disabilities as a child.  When he was 28 yrs old he had his first mental breakdown and was subsequently diagnosed as having schizophrenia.  He has been on anti-psychotic medications ever since.  It is a continual matter of adjusting dosages  under the care of a psychiatrist.  We are so grateful for these meds and for the doctor who has cared for him for 16 yrs.  I agree that the consistency of having the same doctor is very helpful and important.  My son actually enjoys seeing his psychiatrist.  We are fortunate that my son is compliant with taking his meds and he has promised me that when I can no longer care for him, he will continue to do so.  He is in the hands of God.
 
I am well aware of families whose mentally ill members refuse to take meds, saying they don't need them and they don't like the side effects.  The son of one of my friends committed suicide.  After a family member is age 18 the family has no control over the person.  There are 72 hour holds and inadequate treatment.  As you say, we will wait to see what the new health law brings.  I would support Kendra's Law and like Michael would advocate for a similar law for in-patient treatment.  Both with the caveat of continual supervision and control.  For years the families of persons having mental illness have been in the forefront of advocacy  for them and I would hope they will continue to do so and also monitor laws, such as Kendar'a Law for abuses.   Articles like this one, are so important in presenting the complexity of the problem and highlighting the needs of very vulnerable persons.  As members of the Body of Christ we are all called to service of our brothers and sisters, no matter the personal or societal cost.
we vnornm | 5/27/2010 - 12:51pm
Michael,
While de-institutionalization has given many freedom, it has saved all of us much money, these two factors being more intertwined than we think. There are many severely disturbed persons who do not receive the lengthy care in a quality hospital that they need and deserve. When others with severe problems commit crimes or present life/death safety issues for others, there is cause for concern and thoughts of mandated treatment arise. 
I'm looking to see how the Mental Health Parity Law and National Health Insurance will apply to the severely disturbed..much as I hate to say this, I suspect there will not be as much money devoted to their care so as to fund the entire enterprise. Let's wait and see and hope the advocates are watching closely. thanks for writing. amdg. bill
we vnornm | 5/27/2010 - 12:44pm
Brian, good points and with historical perspective. Reminds me of "blessed are the poor in spirit" and "the poor you will always have with you." Somehow you've reminded me of those in nursing homes...are all of them getting proper care and treatment? I suspect the theologians and philosophers among us could write many a tome on this.
BTW...Brian and others...if you'd like to extend this discussion in a shocking manner...do wikipedia or web search on "Peter Singer"...let me know what you think...
Thanks for writing....bill
we vnornm | 5/27/2010 - 12:38pm
Yes David, balancing, refining, and revisiting all the rules, regulations and laws we make up is so important. Right now, all of the advocates I have seen working toward renewing Kendra's Law seek to prevent tragedy for possible victims and humane treatment for the sufferers of severe mental illness. Hopefully this will be the case years from now.....but can we be really sure. thanks. amdg. bill
Michael Bindner | 5/27/2010 - 11:17am
If Kendra's law only requires outpatient treatment, it does not go far enough. I would think inpatient treatment should be mandated for the non-compliant. It should also be mandated for late stage alcoholics in relapse and people addicted to the more serious drugs (not pot, but Heroin, Meth and Crack).
Brian Thompson | 5/27/2010 - 10:45am
The way I figure, the question is an old one: are there "natural slaves"?
(you are all aware that has little necessarily to do with indentured service, and more to do with command of ones own life)
There are people who, permanently or temporarily, lack the capacity to govern and care for themselves. Justice here demands that someone take responsibility for them and guide and direct them so far as necessary (ie as much as they need, allowing them the amount of freedom they have the capacity to use)
The severely mentally ill are such "natural slaves."
Yes, the law could be abused and, yes, other regimes have silenced dissidents with drugs, but they way to address that is to deal with the practice, not attack a law which, apparently, is doing much good.