Watching Out for the Mentally Ill.

• Author: Boulard, Garry

Many believe that mental health patients, incapable of evaluating what is Happening to need more better community supervision.

It was a nightmare--a terrifying tragedy that in all probability could have been prevented.

Just days after New Year's 1999, a 29-year-old schizophrenic walked up to a 32-year-old woman he had never before met and pushed her in front of an on coming New York City high-speed train. She was killed instantly.

The assailant a dark haired cherubic-faced man named Andrew Goldstein made no attempt to flee the scene. He told police instead that he just "had an urge" to push Kendra Webdale, a receptionist at a local record company, onto the tracks.

In the days following Webdale's horrible death, New Yorkers naturally' debated the safety of riding the city's subway. But mental health care providers and advocates viewed the tragedy differently, as only the most recent and dramatic illustration of the inadequacies of outpatient treatment programs that have little personal supervision and lack continuity and coordination of treatment.

In the wake of the tragedy, the New York Commission on Quality Care a watchdog agency overseeing the state's mental health system concluded that neither Goldstein nor the public were "well served by this fragmented and costly approach."

The agency's report added that Goldstein had been hospitalized on some 14 different occasions in the two years before Webdale's murder at a cost to the state of at least $100,000 a year.

KENDRA'S LAW

But costs alone were not the principal reason why New York lawmakers last year passed Kendra's Law which for the first time mandates assertive community treatment for those diagnosed with mental illnesses.

The commission report also noted that Goldstein had "consistently failed to take prescribed medication after discharge unless he was in a supervised setting." In fact, as police records would later show, Goldstein had not been under anyone's supervision for some 18 days before he killed webdale.

"That s the compelling argument," says Bryon McCann, an assistant counsel With the New York State Office of Mental Health who is a fan of community outreach programs. "You can help the community through a more efficient use of resources while also helping the person in question."

Indeed, according to the specific language of the legislation, Kendra's Law establishes a procedure for obtaining court orders mandating that certain individuals with mental' illnesses receive and accept outpatient treatment based upon the findings of a court appointed physician who determines whether or not a patient should be forcibly institutionalized or relegated to a community-based treatment program and forced to take medication.

If community-assisted treatment is picked, the court is then required to work out a plan by an outpatient program officer who describes to the smallest detail the kind of treatment the patient requires.

Once approved, the patient begins an intense and ongoing...