New Mexico Declines to Board Outpatient Commitment Bandwagon
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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Published online: 17 March 2006
Published in print: March 17, 2006
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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.
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