Tennessee is one of 6 states in the country who do not have assisted outpatient treatment. In the last 2 days 2 new bills have been filed in the Tennessee General Assembly to start an AOT program in Tennessee. At a time when the state is looking at cutting millions from its mental health budget it is hard to believe that anyone is going to really pursue a bill to commit people to an outpatient system that is being whittled away by the costs of the committal program—- but the effort is being made. Several of the next posts will be second looks at previous posts on the subject of AOT. Spread the word. Let Tennessee stay one of the 6 states without forced outpatient treatment.
Second look: ON Andrew Goldstein and other things
Andrew Goldstein killed Kendra Webdale. It was a major tragedy by any measure. A senseless act and a death that should have never happened. The tragedy didnt stop though with the death of Kendra Webdale. Her death ignited a firestorm of controversy that led to the passage of “Kendra’s Law” and the spread of what was titled “assisted outpatient treatment” (AOT) to 44 states. And there is a concerted effort this year to make Tennessee the 45 state.
The campaign has been spearheaded by an organization called the Treatment Advocacy Center and their message has been clear and direct. In their view, mentally ill people who dont take their meds are dangerous and violent. They have carefully catalogued every tragedy where a mentally ill person was violent in the last few years as proof of their position. Furthermore they believe that at least 50% of these people dont even realize they are sick and left to their own devices will refuse the very treatment and medication that will make their life better and keep us safe from them and them safe from themselves.
Their proof was Andrew Goldstein. And in their view the only thing to do was to pass a law that made it legal to force people like him to accept the treatment they either didnt want or didnt have the insight to know they needed.
The problem was they were wrong. Andrew Goldstein wanted treatment. The attached article tells the truth about his history. Bedlam on the Streets – NYTimes.com. Make no mistake Kendra Webdale was a victim of Andrew Goldstein. But make no mistake. Andrew Goldstein was not someone who refused to acknowledge he needed help. He was not someone who refused to seek help. He was someone who was passed from program to program in a system that was poorly funded, overcrowded and lacking the community resources to allow him to live successfully in the community. He was the victim of a mental health system lacking the programs, the vision, the resources to treat someone with his level of disturbance. And he was living proof if you do not pay for adequate services the result will be tragedy on every level.
I talked today with friends from New York who have done a lot of research on the AOT experience on New York. They have looked at many of the other tragic cases in New York and found the same thing: case after case of people involved in multiple treatment programs, often passed from program to program because they were difficult to deal with, who were placed in living situations that they could not sustain with little or no resources to turn to. In the end, no matter what the state, we will all reap the harvest sown by inadequate mental health systems. You can refuse to pay for services. You cannot refuse or escape the consequences of that decision.
Instead of a witch hunt for “crazy people who wont take their meds” we need to look at a system that chronically fails the people it seeks to help. Accessibility to services, both enough services and the right kind of services, is the problem. It is the cancer which destroys hope for so many people, so many families, and ultimately all of us. You cant court order people to things that dont exist.
The problem is not the antics of a few non insightful people. The numbers are truly amazing. In a previous post I talked about the county I live in. Blount County has probably somewhere in the neighborhood of 2000 people with mental illness who have TennCare. They have about 2000 people with no insurance at all. No private providers will touch any of these people. The bulk of these folks are seen by one mental health center with about 4 therapists and 2 doctors. That is 4000 to 6. The services they provide are counseling- normally one hour long session every two weeks, and medication management- an appointment with a psychiatrist every 6-8 weeks at most. The waiting list to get in is 12-14 weeks last time I checked. The community services that someone needs with a severe mental illness to stay stable in the community either dont exist or have such long waiting lists that they are basically unavailible for most people.
The largest suprise is not that Andrew Goldstein existed, but that so few Andrew Goldsteins exist.
AOT takes the attention from where it really belongs and allows us to justify the efforts we make by pointing to those who “refuse our best efforts.” Financially it will make even looking at these problems harder. New York spends 55,000,000 dollars to serve about 1000 people at a time. Most of these people live in New York City– about 600 or more. Many of the counties in New York dont even use AOT because they have found they have inadequate services to refer them to and they have found it easier to serve those they do without the added yoke of coercion around their neck. According to estimates the legal expenses for everyone brought to court are about $7500 per cases. Again for many communities a prohibitive investment.
Anyone who has done any kind of treatment will tell you that treatment with coerced clients rarely succeeds. Mountains of research in social psychology show the same thing. And when we go in the wrong direction we just go farther from the direction we need to go. If we dont take the issue of accessibility to services as the supremely important thing it is we are planting the seeds to tragedies untold.
In Tennessee this years budget will be tough at best. There are 32,000,000 dollars in one time funding from last years budget that will all have to be refought and regained. TennCare cuts may be upwards of 300,000,000 from estimates I have heard. To plant AOT in the midst of all this would be a tragic mistake.
We need help. But we need help that is helpful. The fears of many family members about their loved ones are real and need to be honored. But they need to be honored by creating a system that engages them in a treatment system that meets their needs in a timely and effective manner. Our mental health system is in need of new birth and new hope. Through support groups and other activities I have met many, many people who are mental health consumers. It is astonishing how many people see the mental health system as being as much a source of stress and pain in their lives as the illnesses with which they are diagnosed. It shouldnt have to be that way.
Nobody should have to die.