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A Doctor's Fight: More Forced

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Anonymous:
Wall St. Journal

February 1, 2006 Page A1

Strong Medicine

A Doctor's Fight: More Forced
Care For the Mentally Ill

Torrey's Push for State Laws Sparks
Growing Debate Over Rights of Patients

Mr. Hadd Goes Underground

By MARK FRITZ

Staff Reporter of THE WALL STREET JOURNAL

Every other week, Jeff Demann drives to
a clinic in rural Michigan, drops his
pants and gets a shot of an
antipsychotic drug that he says makes
him sick.

"If I don't show up, the cops show up
at my door and I wind up in a mental
ward," says the unemployed 44-year-old,
who lives on disability in Holland, Mich.

Mr. Demann's routine reflects a
national trend toward forcing people
with psychotic tendencies to get
treatment -- even if they haven't
committed violent acts. Driving the
trend are E. Fuller Torrey, a
68-year-old maverick psychiatrist who
believes the laws help prevent crime,
and memorabilia mogul Ted Stanley, who
has contributed millions of dollars to
the cause.

Dr. Torrey keeps an online database
with hundreds of grisly anecdotes about
mentally ill people who killed the
innocent. They include a jobless
drifter who pushed an aspiring
screenwriter in front of a subway train
and a farmer who shot a 19-year-old
receptionist to death. Influenced by
such stories, Michigan, New York,
Florida and California are among the
states that have toughened their
mental-health treatment laws since
1998, when Dr. Torrey formed the
Treatment Advocacy Center to lobby for
forced care.

The laws have become the subject of a
heated debate among mental-health
specialists, with some seeing a threat
to civil rights. "There should be a
high standard before you take someone
else's liberty," says Tammy Seltzer,
senior staff attorney for the Bazelon
Center for Mental Health Law, a Florida
nonprofit group that has fought the
Treatment Advocacy Center in
statehouses nationwide. Others say the
connection between mental illness and
violence isn't as well-established as
Dr. Torrey's anecdotes imply.

Mary Zdanowicz, executive director of
Dr. Torrey's center, retorts that such
opponents "want to preserve a person's
right to be psychotic."

It has long been common for states to
compel people to undergo psychiatric
evaluation after they have committed
acts of violence. If mental illness is
confirmed, they are likely to end up in
the psychiatric ward of a prison or
hospital.

Dr. Torrey was a key adviser to the
National Alliance on Mental Illness
when it began lobbying in the early
1980s for laws that would permit states
to impose treatment on people even if
they hadn't done something violent. The
number of states to adopt such laws has
jumped from 25 in 1998 -- when Dr.
Torrey and Mr. Stanley created their
own, more aggressive organization -- to
42 currently. Those targeted by the laws
usually are people picked up for
behaving strangely in public,
threatening family members, or refusing
to take prescribed medication after
being released from a psychiatric ward.

The laws are enforced haphazardly,
sometimes because of inadequate funding
or opposition from mental-health
activists. Implementation varies not
just from state to state, but from
county to county and judge to judge.
Many mental-health departments already
are overburdened with existing patients
and have little interest in pushing
police to round up more people to throw
into the system.

It isn't clear whether the laws have
led to an increase in the number of
people receiving forced care. Roughly
250,000 people in 1997 who weren't
institutionalized or jailed were
forcibly evaluated, monitored and
sometimes medicated, according to
federal statistics. Federal health
officials have begun a six-month study
to update that figure.

California passed a forced-treatment
law in 2003 after Dr. Torrey's group
pushed for it but has yet to use it on
anyone. Researchers say only about
eight to 10 states frequently use their
laws. Still, it is clear that Dr.
Torrey's movement marks a shift in how
the U.S. treats the mentally ill.

Beginning in the 1950s, the emergence
of behavior-stabilizing medications
helped spur a 40-year movement to shut
down huge asylums and free their
inhabitants. Emptying institutions was
supposed to be accompanied by the
creation of community-based
mental-health programs, treatment
centers, and housing and job
opportunities.

But local programs didn't have the
money, political will or expertise to
handle the deluge. The result was a
flood of mentally ill people on the
streets and in jails.

In recent years, governments have spent
more on community-based programs and a
raft of new antipsychotic drugs have
come on the market. Still, many
mentally ill go without care, either
because there isn't a program to treat
them or because they don't want help.

Dr. Torrey, whose sister suffers from
schizophrenia, was working as a
psychiatrist at St. Elizabeth's
Hospital in Washington, D.C., in the
1970s when the district enacted one of
the earliest involuntary outpatient
programs. Before the law, patients were
discharged dozens of times with
medication, which they quickly threw
away, Dr. Torrey says. With the law, he
says, "we would have guys come in for an
injection."

The author of 15 books and hundreds of
papers, Dr. Torrey was an assistant to
the director for the National Institute
of Mental Health and worked at a
mental-health clinic for the homeless
for 15 years. He is well-known in
psychiatry for his iconoclastic views
on a range of subjects. He has
theorized that schizophrenia is an
infectious disease triggered by
environmental factors.

One of Dr. Torrey's books on
schizophrenia caught the eye of a
wealthy businessman, Ted Stanley, whose
son, Jonathan, became delusional during
college and later was diagnosed with
bipolar disease.

Jonathan Stanley says he accosted
people on the street and believed he
was being trailed by Naval
Intelligence. He says he was arrested
when he stood naked atop a milk crate
in a Manhattan diner, trying to avoid
the lethal radiation he thought was
bombarding him from a satellite dish
across the street.

The elder Mr. Stanley contacted Dr.
Torrey in 1989 and ultimately opened
his checkbook to create the Stanley
Medical Research Institute in Bethesda,
Md. "He said he'd like to help," Dr.
Torrey recalls. "He said: 'We thought
we would start with a million dollars
-- a year.' "

Mr. Stanley, 74, runs MBI Inc., a
Connecticut seller of collectible and
commemorative books, coins, figurines
and other memorabilia. Its units
include the Danbury Mint. Since the
1980s, Mr. Stanley says he has donated
nearly $300 million -- including about
$35 million in 2005 -- to Dr. Torrey's
efforts, the bulk of it for research at
universities and start-up drug companies.

Targeting State Laws

In 1998, Dr. Torrey and the Stanleys
decided to target state laws that they
believed had gone too far in
guaranteeing rights for the mentally
unstable. They founded the Treatment
Advocacy Center in Arlington, Va. Mr.
Stanley and his wife, Vada, support it
with about $600,000 a year. In many
states, the center and its allies try
to put a face on a proposed law and
link it to a grieving family.

Dr. Torrey says the laws are aimed at a
minority of mentally ill who refuse to
take medication. Some believe they
aren't sick at all. Others agree they
have problems but believe the downside
of taking drugs outweighs the benefit
because the drugs can have serious
mental and physical side effects. Dr.
Torrey says failing to control
psychotic tendencies can be dangerous.
"I catch heat for linking violence with
mental illness. This is about as
politically incorrect as you can get,"
he says at his office in Bethesda.

The center soon zeroed in on New York.
Some mental-health professionals had
been lobbying unsuccessfully for a
decade to enact a forced-treatment law.
Then came the death of Kendra Webdale, a
32-year-old receptionist and aspiring
screenwriter.

On Jan. 3, 1999, Andrew Goldstein, a
jobless college dropout, pushed Ms.
Webdale in front of a Manhattan subway
train. The 29-year-old Mr. Goldstein,
who had a history of schizophrenia and
violent assaults, blamed his illness
and failure to get medication. Amid a
public uproar, New York Attorney
General Eliot Spitzer contacted the
Treatment Advocacy Center for help in
drafting a response.

Less than a month later, Mr. Spitzer
announced his support for "Kendra's
Law." The law allowed the state to
force outpatient treatment on people if
they were judged a potential danger to
themselves or others. At a news
conference, the attorney general
introduced a man who had come to grips
with his illness and his denial of it,
received treatment and gone back to
school. He now was a lawyer for the
Treatment Advocacy Center.

"I am Jonathan Stanley and I'm one of
the people this law was designed to
help," the younger Mr. Stanley said.

Seven months after the slaying the New
York state legislature passed "Kendra's
Law," allocating $52 million to finance
it. In a nod to opponents, the law was
subject for renewal in five years.

From 1999 to 2004, more than 10,000
people were investigated for acting
strangely, most of them in New York
City, with nearly 4,000 forced into
outpatient treatment.

Sharp Differences

When New York's law was up for renewal
last year, there were sharp differences
over whether it was a success. A state
report said the law led to a drop in
homelessness and arrests among those
receiving forced treatment. John A.
Gresham of New York Lawyers for the
Public Interest says the law was
applied unfairly, with a
disproportionate number of
African-Americans forced into care.

As they have elsewhere, opponents said
the money would be better spent on
those who are seeking care, not
refusing it. New York state lawmakers
extended "Kendra's Law" for another
five years.

In Michigan, Dr. Torrey's group
enlisted the aid of the parents of
24-year-old Kevin Heisinger, a college
student beaten to death in 2000 at a
Kalamazoo bus station by a Vietnam
veteran with a history of
schizophrenia. A year later a proposed
"Kevin's Law" was unveiled.

In Florida, the group teamed with the
Seminole County sheriff after a plumber
who was diagnosed as mentally ill
wounded two deputies in 1998 and shot
another to death. They quickly won the
lobbying clout of the Florida Sheriff's
Association.

In California, a law backed by the
Treatment Advocacy Center passed the
Assembly in 2000 but was rejected by
the Senate. Then on Jan. 10, 2001, a
deranged catfish farmer went on a
rampage in a small Northern California
town, killing three people and igniting
public outrage. Backers reintroduced the
legislation as "Laura's Law," after
19-year-old Laura Wilcox, the youngest
of the victims.

"We added a face to this issue and we
may have been instrumental in getting
it passed," says Laura's father, Nick
Wilcox.

California lawmakers hired Rand Corp.
to study pre-emptive outpatient
treatment in other places. The research
group said there was little evidence the
idea worked, although the reasons
varied. In some cases laws weren't
enforced. Rand also said some
mental-health facilities saw the laws
mainly as a liability shield rather
than as a therapeutic tool. By signing
up a mentally ill person for forced
care after discharge, the facilities
could protect themselves against
lawsuits by anyone the ill person might
injure.

Ultimately, California in 2003 passed
"Laura's Law." But the nation's largest
state allocated no money and forbade
counties from shifting resources from
other mental-health programs. The law
has yet to be used. In 2004, California
voters approved a 1% tax on people with
incomes of at least $1 million to be
used for mental-health programs, and
Dr. Torrey's group wants to see some of
that go for Laura's Law.

Michigan and Florida experienced
similar battles. Their laws didn't go
into effect until last year. Florida
has only had about a dozen cases of
involuntary outpatient commitments,
says John Petrila, chairman of the
Department of Mental Health Law &
Policy at the Florida Mental Health
Institute.

Still, the laws are having an effect on
some people. Gabriel Hadd, a 26-year-old
unemployed musician from Saginaw, Mich.,
was diagnosed as schizophrenic. He says
he has been repeatedly forced to take
drugs he believes do more harm than
good.

Mr. Hadd spent part of the past year
hiding out in the home of a Colorado
woman who is part of an underground
network of mentally ill activists. The
program was set up in late 2004 by
MindFreedom International, an Oregon
organization of 10,000 mentally ill
people that opposes coerced drug
treatment.

Mr. Hadd says his mother falsely
accused him of threatening to commit a
violent crime. She couldn't be located
for comment. "They can accuse you of
all sorts of things," Mr. Hadd says. "I
was in a courtroom, drooling and
twitching from the drugs." He recently
slipped back in Michigan and says he is
trying to maintain a low profile.

T.J. Bucholz, a spokesman for
Michigan's Department of Community
Health, says data on the program's use
aren't available yet but anecdotally
counties and judges seem to be using it
sparingly. "The law has not been used
maybe as much as we anticipated," he
says.

Mr. Demann, the 44-year-old Holland,
Mich., man, says he has been in and out
of institutions since 1987. That is when
he was diagnosed as schizophrenic after
he broke up with his girlfriend and
accidentally overdosed on her
antianxiety pills, he says.

Branded as suicidal yet constantly
refusing medication, Mr. Demann says
mental-health authorities are forcing
him to take a drug, Risperdal, that he
says causes him to be moody, angry,
restless and depressed. The U.S. Food
and Drug Administration in 2004 found
that Risperdal and some other
antipsychotic drugs can increase the
incidence of diabetes. Mr. Demann
agrees he needs therapy but doesn't
want drugs.

"I don't believe in putting this stuff
into my body," Mr. Demann says. "It's
time for the system to let me go."

Write to Mark Fritz at
http://online.wsj.com/article/SB113876185080261746.html

Antigen:

--- Quote ---The number of states to adopt such laws has  jumped from 25 in 1998 -- when Dr.  Torrey and Mr. Stanley created their  own, more aggressive organization -- to  42 currently. Those targeted by the laws  usually are people picked up for  behaving strangely in public,  threatening family members, or refusing  to take prescribed medication after  being released from a psychiatric ward.

--- End quote ---


Forced treatment = Stalinist reeducation

Would you mind if I were to move this thread over to Public Sector Gulags and Thought Reform I know it hasn't got much traffic now, but I have a sense that will change.

I turned to speak to God, About the world's despair; But to make bad matters worse, I found God wasn't there.
--Robert Frost, American poet
--- End quote ---

Anonymous:
Well, this may be an issue that would spark
intellectual debate, but, I don't think
this forum is the place to expect success.

Sadly ...

Here, people have their opinions and obsession
and no much listening and debate.

The fact is that the mentally ill are slowly
being jailed.

Those that refuse or don't do well on meds
get into a no win situation.

Encouraged by the "there is no mental illness"
crowd they may be encouraged to not take meds.

Schizophrenia has for years had a 85% non-complaince to medication.

They also do the worst, sadly, since the first
medication came out in 1988 that eliminated catatonia, and enabled the remaining to get out of institutionalization, some back to work, most not, the 85% no med rate is brutal.

The alternative crowd provides no written, proven, alternatives, so it is pretty much worthless to the mentally ill. It is valuable to those that sell alternative meds, and those that are idealists, but worth nothing to those that are sick.

This forum recently discussed, or was it slammed Andrea Yates.

RN, mother, home school mom, isolated, used as a breeder, delevloped psychosis, skipped meds, killed kids = fry her. It could have been you, if circumstances where altered. What then:?

I think that sums up the potential for intelligent debate. It is sad, but true.

Meanwhile there is no solution for those unstable, stigmitized and basically shit upon to avoid going to jail.

Assertive Community Treatment, obviously no one would want, even the creators and advocates for the new laws (as the article states are not used too much) to toughen up involuntary outpatient treatment. But, as an alternative to jail, it is very attractive. Got any alternatives, then perhaps a different thread would be interesting.

Those that are sick basically get ignored when they tried to post here, so they will be shit upon also.

So, since Fornits has dwindled to a SIG, special interest group, I would say just let this post be what it is. Another well written Wall St. Journal article on a confusing, desperate topic. Where the only losers are the mentally ill, and those they come into contact with.

I wish Fornits could be more, but it is not.

Deborah:
Great article. TTI advocates for Federal Laws/Regulations should consider 'adding a face' to the issue. Appears to be instrumental in getting these MH laws passed.

The questions, which kid's name to use?
The "Ian August law". Sounds good.
And the 'consequence' (treatment) for killing a kid in a program is that you get your nuts hacked off with a dull saw.
Bet they'd be finding ways to keep them safe, and fed, and all their medical needs met. No more of this, 'thought he was faking' crap.

Anonymous:
Your solution is just criticism?

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