N.Y. Law Raises Issues of States' Reach in Patient Care

By Chris L. Jenkins
Washington Post Staff Writer
Sunday, December 30, 2007

NEW YORK -- Susan Wezel had been committed to the city's hospital wards more than a dozen times in 10 years. Her psychosis was so deep and debilitating that she lost her career and her relationship with her son, as she refused to take her medication or follow treatment.

But because of a New York state law, Wezel hasn't been hospitalized in more than a year. She doesn't wander the streets alone at night anymore. She takes her medication willingly. She even has plans to follow her dream of singing at a neighborhood nightspot, something that was unthinkable 18 months ago.

Wezel and her caseworker agree that the transformation occurred because of the law, which allowed officials to force Wezel into an outpatient treatment program after she was discharged from a hospital.

Known as Kendra's Law, it is considered one of the most far-reaching mental health statutes in the country. It gives great latitude to doctors, social workers and relatives to take mentally ill people before a judge to force them into treatment, and it provides money for clinical services.

Just how far states can go to get mentally ill people into treatment is a key issue in Virginia. The state is struggling with changing its mental health system after a mentally ill gunman shot and killed 32 students and teachers at Virginia Tech in April before killing himself.

"All of this has saved my life," Wezel, 50, said in an interview at her caseworker's office in Queens. As part of the treatment order, she was given immediate access to a caseworker who closely monitors her through visits and phone calls. If Wezel fails to comply with her treatment, she can be picked up by police and taken to a hospital.

Wezel's experience with forced treatment underscores one of the most controversial issues in the care of the mentally ill. Seung Hui Cho, the Virginia Tech gunman, had been ordered into outpatient treatment, but officials didn't monitor whether he received it, and he never did.

Had something as detailed as Kendra's Law been in place, with its high expectation of accountability, officials might have been forced to monitor whether Cho got treatment, supporters of such measures say.

Virginia has an outpatient treatment law, but it is rarely used. Judges interviewed since the Virginia Tech rampage have said that they prefer institutionalization for the most severely endangered patients. Some judges said they think that ordering outpatient treatment is a waste of time because the lack of resources would make follow-up nearly impossible.

A survey conducted this year by the Virginia Supreme Court's Commission on Mental Health Reform found that judges used the outpatient treatment option in 5.4 percent of cases during the month studied.

Kendra's Law, named after Kendra Webdale, a 32-year-old woman who was killed in 1999 when she was pushed in front of a New York City subway train by a severely mentally ill man, allows courts to use a much lower standard than Virginia's to force outpatient mental health treatment.

To qualify for forced treatment under Kendra's Law, among other criteria, a person must have been hospitalized twice within the previous three years; must have shown violent behavior toward himself or others in the previous four years; and must need treatment to "prevent a relapse or deterioration which would be likely to result in serious harm to the person or others."

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