Killings Loom Over Debate on Treating Mentally Ill
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 practice.
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 voluntarily.
"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 action.
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."
Copyright 2006The New York Times Company