I’ve said it before and I will say it again. I am an overweight Jewish man from New York State with an active schizophrenia diagnosis. I have been committed to involuntary treatment numerous times for different length of stays at both local and state psychiatric hospitals across upstate New York State. Aside from being a mental health correspondent for Psychreg, I am also a Licensed Clinical Social Worker (LCSW), professor of Social Work, and seasoned psychotherapist and private practice owner.
In spite of all these hats I wear in the mental health community – or perhaps because of them – I am also a firm believer that forced treatment for V-SPMI (Violent Severe and Persistently Mentally Ill) people is necessary and justifiable. I do not believe it is always the best treatment fit or a practice that should be considered the gold standard for mental health treatment or the long-term standard milieu for this population. Instead, we need to be constantly revising our practices, moving studies and research forward to move mental health treatment into a era where forced treatment is obsolete.
As for Kendra and day when the very ground floor of modern mental health treatment trembled and collapsed on itself. We will never forget it. For patients whom have and continue to fall through the systems cracks, Kendra’s death marked a new beginning for many violent and chronically mentally ill patients facing possible incarceration, legal issues, and jail sentencing in New York. That moment I am speaking of was that day in the year 1999 when Andrew Goldstein pushed Kendra in front of a subway train. Well, that is now all history now. But, we must never ignore the implications of that violent act which changed the face of mental health treatment forever in New York and states adopting forced treatment laws.
Kendra’s death was not in vain. Because of the tragic fate surrounding Kendra’s premature death, the lives of so many violently mentally ill people will be changed, altered – and in many cases, protected by new laws governing the provision of mental health treatment. Now, there exists a glimmer of new hope and available treatment for this population whom would be incarcerated without a second thought by the court system. Instead of inappropriately incarcerating V-SPMI people in jails and prisons, which, all evidence points towards their ultimate re-entry into the criminal justice system as a result of further offences or new crimes rooted in the mistreatment of an existing diagnosis and aggravated symptoms from their jail sentence.
Kendra’s death signalled to the world that we need to radically shift our methods and approach to treating people whom are violently and persistently mentally ill if we are to truly help people with a real chance at survival from their socially unacceptable and violent mental health conditions. This signal must do more than gesture to the public we need to make radical structural adjustments to the mental health system and do so before more people suffer tragic and avoidable loss. Indeed, Kendra’s loss was more than this signal, it was the sonic boom that called upon legislative bodies, advocates, and allies of people with a diagnosis to realise our paradigm for treatment of VSPMI wasn’t working.
I am not suggesting forced treatment works perfectly for everyone in this category of mental health disorders. I have seen it first hand as an ACT (Assertive Community Treatment) practitioner. I’ve seen the law fail clients and forced treatment create animosity, anger and self-shaming cognitive distortions above and beyond the original altered perception of clients without being enrolled in compulsory care and treatment.
Indeed, the stigma that evolves from an AOT (Assisted Out Patient Treatment) label under the county department of community mental health radar is demoralising to say the least. The label is humiliating, infantilising and demeaning for many connected to an AOT service.
V-SPMI patients under the AOT structure are mandated to mental health treatment. These people instead lose a part of their independence, their autonomy and relative status as citizens equal in the name of the law. The law confines, restricts, and places limitations on the movement and personal freedoms of people under the AOT regulations.
Travel, medication administration, choice in treatment staff and frequency of contact with mental health staff and treatment teams. All of these domains of mental health treatment are prescribed, mapped out, and monitored closely by the county government whom can at anytime, when it’s rules are violated, pick you up at your home and take you to the hospital for forced treatment.
The loss of Kendra, was subsumed by people carrying a mental health diagnosis, and we will never lose that scarlet letter that labels us and marks is as eligible under the law to lose our right if our conditions worsen. Our fate after Kendra’s death to make decisions for ourselves and care will ultimately, until a new paradigm arrives, be under the provision and care of the law. Instead, our personal beliefs on how we want to manage our own mental health affairs will continue to be unjustified and privilege the provider.
Maxwell Guttman teaches social work at Fordham University. He is also a mental health correspondent for Psychreg where he shares his insights on recovery and healing based from his lived experience of schizophrenia – a journey which started as an undergraduate student at Binghamton University. His diagnosis of schizophrenia wasn’t formally recognised until he was admitted to the state hospital in upstate New York. On his spare time, Max blogs on self-management at Mental Health Affairs. You can connect with Max on Twitter @maxwellguttman