Psychiatr News March 17, 2006
Volume 41, Number 6, page 7
© 2006 American Psychiatric Association
New Mexico Declines to Board Outpatient Commitment Bandwagon
Rich Daly
Mental health advocates plan to develop a comprehensive approach to
preventing violence by patients with mental illness following rejection of a
bill to mandate outpatient psychiatric treatment.
The New Mexico legislature adjourned February 17 without passing a version
of New York's so-called Kendra's Law that would have permitted involuntary
outpatient treatment for those with psychiatric illness convicted of violent
crimes.
The measure would have allowed judges to order assisted outpatient
treatment if they determined that a criminal defendant with mental illness had
been incarcerated or violent too frequently within too short of a prescribed
period of time.
State officials describe the procedure proposed in the New Mexico bill as
similar to that for a civil inpatient commitment, in which a physician
proposes a treatment plan and a hearing is required with counsel to represent
the person with mental illness. The plan for the outpatient commitment was to
require an expiration date, but if warranted, the treatment could be
extended.
The Psychiatric Medical Association of New Mexico (PMANM) was neutral on
the legislation, although it does support some form of mandatory assisted
outpatient treatment, said George Greer, M.D., the district branch's
legislative representative.
The PMANM has joined a group of legislators and patient activists to
develop legislation for next year to plan and fund a comprehensive system to
help in the treatment, housing, and care of mentally ill people.
Kendra's Law is named after Kendra Webdale, a woman who died in January
1999 after being pushed in front of a city subway train by an individual who
had failed to take the medication prescribed for his mental illness.
The New York State Psychiatric Association (NYSPA) supports this type of
program, with caveats, said Barry Perlman, M.D., president of the NYSPA. If
such a program is well funded and its implementation is carefully monitored,
research has found that such programs can reduce hospital recidivism and
improve community integration for some with mental illness. "It's
important to pay for psychiatrists' treatment of patients and for court
appearances they have to make," Perlman said.
Psychiatrists differ on some aspects of the program, he noted, such as
whether the program should allow mandatory medication in the community instead
of in a hospital, where the New York program requires such medication to be
administered.
Forty-two states and the District of Columbia have outpatient commitment
statutes, though there are many variations in the implementation of such
laws.
Patient advocates opposed the New Mexico program over concerns that it did
not protect the civil rights of patients with mental illness.
"New Mexicans have turned the tide on forced treatment and rejected
the simplistic approach represented by Kendra's Law," said Michael
Allen, a senior staff attorney at the Bazelon Center for Mental Health Law.
"This victory for a sane mental health policy will resound across the
country, refocusing public attention where it should be—on adequate
funding for the services and supports needed by people with mental
illnesses."
Harvey Rosenthal, executive director of the New York Association of
Psychiatric Rehabilitation Services and a member of the Bazelon Center's board
of trustees, also lobbied against the bill in New Mexico and plans to work
with state officials and legislators on "real solutions and real reforms
of the public mental health system."
Improvements should begin with adequate funding for evidence-based
practices, such as supportive housing and peer support.
The text of HB 174 are posted at
<http://legis.state.nm.us/lcs/_session.asp?chamber=H&type=++&number=174&Submit=Search&year=06>.
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