By Harvey Rosenthal, Executive Director, New York Association for Psychiatric Rehabilitation Services
(January 2000)

Following the tragic death of Kendra Webdale at the hands of Andrew Goldstein earlier this year, we were all confronted with another terrible consequence of the failure of our public mental health systems. Unfortunately, groups like the Treatment Advocacy Center, which has had a long-standing agenda to strengthen forced treatment measures across the country, quickly moved in, played up the unfounded connection between mental illnesses and violence and pressed the victims and anyone else who would listen that the major problem was 'patient non-compliance' and the best answer was passage of an involuntary outpatient commitment program such as the one authorized by 'Kendra's Law.'

Impartial investigations conducted several months later came to startlingly different conclusions. The New York Times found "tougher commitment laws...was not the problem in Goldstein's case. He signed himself voluntarily for all 13 of his hospitalizations. His problems were what happened after discharge. The social workers assigned to plan his release knew he shouldn't have been living on his own, and so did Goldstein, but everywhere they looked they were turned down."

The state's own watchdog group, the Commission on Quality of Care, concluded that "despite an awareness over the years by several mental health care providers that Mr. Goldstein required a supervised living situation and close monitoring of his psychiatric symptoms and medication compliance, and despite his mother's pleas that he be discharged to a supervised setting, he was repeatedly discharged to live in an apartment with periodic therapy and medication management from a clinic--an arrangement that never successfully kept Mr. Goldstein from decompensating."

Sadly, the Treatment Advocacy Center so manipulated the public's fears, the media and the politicians, that even after the fuller context was understood, Albany was too far down the road in its commitment to pass Involuntary Outpatient Commitment legislation. This was over the objections of almost every single mental health advocacy group in the state. This included the state's chapter of the NASW who warned, "Kendra's Law will mandate social workers to report their clients for not following their treatment plan. By violating the social worker/client confidentiality, the treatment plan will be undermined, preventing effective treatment. Imposing mandatory treatment and violating people's civil liberties are serious steps...to be considered free from the glare of media spectacles."

Where should we look to find the real answers to helping those who we currently are not reaching or who reject what we currently have to offer?

Social workers need to be given the tools so that they can provide enough service options for clients.Social workers need specialized training and support for the unique needs of the seriously mentally ill. This may include leaving their offices and making extra efforts necessary to engage the reluctant client. It involves knowing about and networking with the new generation of services and medications that are proving effective in successfully involving those who are currently failing.

We need to be committed to work as advocates for properly funded services that go beyond office-based models that only focus on symptoms, illness, and medications. Sometimes this involves working with families to help negotiate relationships. Sometimes this involves engaging a person through offering them something tangible first, like help with entitlements or housing or vocational needs and to keep coming back to demonstrate genuine concern.

We must assume the responsibility to give our mental health professionals the proper training and the proper mandates to go the extra mile and use all that we know that does indeed work. We must not stand by and allow the defamation of an entire group and an unacceptable intrusion into their civil rights borne out of fear and ignorance and prejudice that carries over into other area, like insurance discrimination and the routine devaluation of those who seek to serve people with mental health needs.

Kendra's Law and Involuntary Outpatient Commitment are false solutions and misguided public policies borne out of public fear and frustration with the failure of state and city mental health systems to properly engage and serve those most in need. Let's not be misled and satisfied with approaches that blame the patient and inappropriately bring in the courts and cops.