Wednesday’s Albuquerque Journal editorial expressing the need for a State law mandating out-patient treatment for seriously mentally ill persons, while provocative and while expressing a widely-held point of view, reaches a faulty conclusion. This is especially true when it attempts to link the need for this “Kendra’s Law” approach to the tragedy involving James Boyd.
The editorial correctly points out that mandated out-patient treatment legislation has been considered and rejected several times by the Legislature in recent years. However, nothing in the Boyd situation changes the terms of the debate or the reasons I’ve opposed Kendra’s Law in the past. Nor does it minimize the importance of finding a solution to both the need for more and better mental health resources and the need for APD to stop shooting mentally ill people. While it is tempting to see forcing treatment on unwilling citizens as a single answer to two different issues, I actually don’t think it solves either.
To get to the heart of the matter, “mandating” treatment essentially means jailing, or at least threatening to jail someone who has not done anything wrong—yet. If they’ve actually committed a crime, they can be jailed under current law and at least in Bernalillo County, if they are mentally ill can receive psychiatric services in jail. The Metropolitan Detention Center in Albuquerque is the largest psychiatric in-patient unit in the state, with over 250 patients.
If someone is genuinely a threat to themselves or others we already have well-established commitment procedures. But it is difficult for a physician to predict the future, so taking that step is not done lightly. Yet this is what Kendra’s Law would require of them. Once a patient proves uncooperative, it means sending them to jail for the possibility that they might harm themselves or others. APD will continue to arrest (and confront) mentally disturbed individuals who don’t want to be treated. Kendra’s Law could actually increase the number of incidents, not reduce them.
In almost all of our communities there are already long waiting lists to receive services for those who are voluntarily seeking them, and in many instances, no services available. “Mandating” treatment will almost certainly mean the jail option becomes the only option for getting “help.”
Many families of the mentally ill understandably support Kendra’s Law. But other families and treatment professionals worry that court-ordered treatment will mean a merry-go-round of incarcerations and life outside the law. We simply have not adequately funded support services needed to assist the mentally ill to live outside our new network of mental institutions: our jails.
The reality is that the Administration’s actions last year have drastically diminished available behavioral health resources. And placing all Medicaid dollars for behavioral health under four separate primary care managed care organizations further complicated an already Byzantine maze that those seeking help must navigate. What New Mexico’s mentally ill population desperately needs is a blueprint for how services will be made available to them. We also need to provide the budget to finance those services to ensure that help is truly accessible. We are dead last among the states in the amount we spend per capita on behavioral health care.
The hopeful fact is that out-patient care is far less expensive than institutional care. Supportive work can help even the most disoriented of individuals to gradually move toward accepting help, including trying different, less-enervating medications. Jailing reluctant patients, if they won’t agree to treatment, will prolong the problem not solve it. We need more resources, not more laws.