Sunday, December 30, 2007

Help for the Mentally Ill: NY Law Looks Good

New York leapfrogs over many grinding tragedies by permitting judges to order mentally ill persons to take their meds and to order them back on their meds if they stop.

What may at first quick blush look like a return to the paternalism of four decades ago when the mentally ill were warehoused in barren bedrooms in far away institutions, this new approach looks like it has just the right amount of muscle and the right amount of freedom. At least one person, Susan Wezel, interviewed for the article, is an enthusiastic benefgiciary.

The New York law is definitely not a shoo in for families or the police to force treatment on the mentally ill. Rather, as the Washington Post writes today, to qualify for forced treatment under the 1999 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.'"

As a DC attorney who has watched numerous wards, for whom I have been appointed guardian or conservator, ride the rollercoaster in and out of the mental health system, or bump along the painful lower edges of instability, delusion, unhappiness and poverty, a similar law would help to bring a lot of people back to life.

One current ward leaves endless voicemail messages filled with detailed lists of needs and demands, ranting threats of violence to anyone who would help her and finally pleas for help and declarations that she is very very ill and unhappy. And, of course, she claims to have something very, very wrong with her, that most definitely is not mental illness. She once was a happy family member who took her meds, worked and had a life. When she stopped and refused to take them, she fell into a life on the edge of eviction because she can't keep any order in her apartment, with no income for the time being, and and suffers misery and loneliness, depending entirely on her family and her court appointed conservator.

And she is one among many many such persons.

The mentally ill in the District of Columbia, which has a more useful threshold for involuntary committment than Virginia, for example, could benefit immensely from an expansion into something like the New York law.

Such a law would have to establish threshholds for commitment, including prior failures of less intrusive measures, a present danger to self and/or others, and a likelihood of continued danger and instability. Such a law would also have to be accompanied by a revamping of the mental health system and its funding to free case workers to actually have few enough clients to be able to monitor successfully the clients they have and to provide the support system of health care workers and medications to maintain essential levels of service.

What a liberating law! DC officials -- from the doctors at St. Elizabeth's to the lawyers assigned to help -- now simply must shrug their shoulders, with sympathy, but helplessness, at the rollercoaster life of those they are charged with caring for.

Such a law would go a long way, also, to bringing a number of the homeless off the streets. Not that clearing the streets of the homeless is the objective, but that giving people back the choice of living a life they choose freely rather than being driven by their demons into dungeons of glassy-eyed despair is the right and the kind thing to do.

We have the medications. Do we have the sensible wisdom to give the law the possibility of nudging those who can't admit their illness into a better orbit?