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De Blasio’s Mental-Health Blindspot

eye on the news

De Blasio’s Mental-Health Blindspot

Kendra’s Law might have prevented Deborah Danner’s unnecessary death. October 20, 2016
New York
Public safety
Politics and law

On Tuesday, an NYPD sergeant shot and killed 66-year-old Deborah Danner, an emotionally disturbed woman who attacked officers, first with a pair of scissors and then with a baseball bat. Mayor Bill de Blasio and police commissioner James O’Neill wasted no time blaming the sergeant for not following correct police protocol for responding to mentally distressed individuals. It may well be the case that the responding officers made serious errors. It may be that the sergeant’s actions were criminal. But the real mistake was the city’s Department of Health and Mental Hygiene’s neglect of Danner’s serious mental illness.

Danner’s case was known to the city. Her sister, with whom she lived, was Danner’s legal guardian, and the NYPD had been called to their house many times. Like many seriously mentally ill individuals, Danner had cycled through the city’s police-medical complex, and was apparently non-compliant with her medical regimen—that is, she didn’t take her anti-psychotic medicine as prescribed. “It’s the classic situation: someone is supposed to take meds and they go off their meds,” de Blasio said at a press conference. “Because of their illness they choose not to take their meds. Once they don’t take their meds it is very hard to get them to engage another kind of treatment.”   

Listening to the mayor, one would think that the paradox he outlined has never been addressed before. But New York, like almost every state, has a robust set of laws known generally as assisted outpatient therapy (AOT). Locally, the statute is known as “Kendra’s Law.” It has proven effective at keeping the mentally ill out of hospitals and shelters and promoting compliance with doctor’s orders. Kendra’s Law covers cases where a non-compliant and seriously mentally ill individual has previously been hospitalized, and is judicially and medically judged to pose a danger to himself or others. The law provides for a six-month period of supervision, during which the subject must comply with treatment or face possible commitment to a hospital. This rarely happens. 

Kendra’s Law is remarkably successful at helping the seriously mentally ill live relatively stable lives. The statistics are stunning: violent or harmful behaviors decrease by 44 percent; hospitalizations decrease by 77 percent; drug and alcohol abuse decrease by half. Patients report high levels of satisfaction with their participation in AOT, and the costs of care decline substantially, because outpatient treatment is so much cheaper—in financial and human terms—than incarceration or hospitalization.

Despite AOT’s track record of success, New York State rarely chooses to apply Kendra’s Law, even in seemingly obvious cases like Deborah Danner’s. Liberal critics of involuntary psychiatric commitment, still shuddering from the 1972 Willowbrook exposé, argue that any hint of coercive intervention is a violation of the civil liberties of the mentally ill. Meanwhile, the mental-health industry prefers to focus on mental illness as a public-health problem, like venereal disease or typhus. Publicity campaigns advise people on how to identify the signs of depression in themselves or their associates, or warn about the problem of stigmatizing mental illness. This epidemiological approach to mental illness fails because untreated schizophrenia is not contagious, nor is it hard to identify.

Thousands of homeless or incarcerated mentally ill New Yorkers aren’t living on the streets or in Rikers Island jail because they fear the stigma of mental illness. Rather, the city’s mental-health establishment has chosen not to deal seriously with their care.  

De Blasio speaks magnanimously about his grand approach to treating mental illness through his ThriveNYC plan, but that plan includes virtually nothing for the seriously mentally ill. Instead, the mayor is spending millions of dollars on feel-good advertising campaigns promoting peer counseling and awareness. His wife, Chirlane McCray, announced a collaboration this week between ThriveNYC and Tumblr, where people will be encouraged to submit quilt patches representing “a creative expression around changing the conversation around mental health and an individual’s relationship with mental illness.” 

Awareness isn’t the most pressing issue regarding the mentally ill in New York City. New Yorkers are already aware of the many suffering people in their midst. By making the police take up the slack for the city’s failed mental-health policy, de Blasio is being cynical and careless. Kendra’s Law is a working solution to the problems of people like Deborah Danner, but the mayor refuses to use it.

Photo by Drew Angerer/Getty Images

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