Since New York City Voices has devoted its March/April 2000 issue to mental illness and violence, we thought this editorial, originally published in the Schenectady Gazette, represented some of the best and worst ideas being proposed to solve the problems associated with mental illness and violence. "Publisher's Voice" will return in our next issue.
Over the last 30 years or so, New York and other states have mostly emptied their mental institutions. But large numbers of mentally ill are still in institutions -- only different kinds, known as jails or prisons. It doesn't have to be this way -- and wouldn't be if the mentally ill got the services and medication they need to live successfully in the community.
According to a July 1999 study by the Justice Department, as many as one in six inmates in state prisons and local jails, or 283,000, are mentally ill. Some of them are nonviolent; others as dangerous as Andrew Goldstein, the man accused of pushing Kendra Webdale under a New York City subway train last year, killing her. Goldstein was able to get himself arrested, but wasn't able to get himself an extended stay in a psychiatric hospital, which he had repeatedly tried to do.
Medication allows many mentally ill people to lead a normal life, but some, like Goldstein, don't want to take it. The state Legislature addressed this issue last year when it passed "Kendra's Law," which allows for involuntary confinement of mentally ill people who refuse to take their medicine. This is generally a good idea, but forced treatment should be limited to those who otherwise would pose a real danger to themselves or others.
"Kendra's Law" can help reduce the number of mentally ill in jail. So could some proposals made by Gov. George Pataki last year, such as temporarily stopping the reduction in beds in psychiatric hospitals (to assess the effects of "Kendra's Law"), creating 2000 new community housing units for the mentally ill and improving transitional care from institutions to the community.
One major obstacle to a smooth transition is that when a person is arrested and jailed, he loses Medicaid benefits, which often are used to pay for medication and treatment. Not only must jails and prisons pick up the cost in these cases, but inmates must wait 45 days or longer after discharge to become eligible again. By that time, many are back behind bars. Making discharged prisoners immediately eligible for Medicaid (which is funded 50 percent by the federal government) would be cheaper, more effective and more humane than waiting until they commit another crime and then returning them to jail.
Reprinted with kind permission from the Schenectady Daily Gazette.