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Fatal Subway Shove Renews Debate on Forced Treatment for the Mentally Ill

Monday, December 31, 2012

bellevue hospital (Fred Mogul/WNYC)

A second fatal subway pushing in less than a month has renewed focus on a New York law that requires some mentally ill people to get psychiatric treatment.

Police have charged Erika Menendez, 31, with shoving Sunando Sen in front of an oncoming subway car last Thursday in Queens. Menendez is being held without bail and a judge has requested a psychiatric evaluation.

Police said Menendez's family members called authorities several times in the past five years because she had not been properly taking prescribed medications and they were having difficulty dealing with her. Police did not say what the medication was.

Menendez had been arrested several times. She pleaded guilty to assaulting a man in 2003, and drug possession.

Menendez was in custody and unavailable for comment.

It was unclear what lawyer was representing her, and whether she had ever been subjected to “Kendra’s Law.”

Under the 1999 law, named after a young woman who was fatally pushed onto the subway tracks by a mentally ill man, judges can force patients to receive "assisted outpatient treatment," a form of involuntary commitment to care and monitoring by mental health professionals. (Judges, however, cannot order patients to take specific medications). Patients who fail to follow treatment orders can be committed to a psychiatric institution — initially up to three days for evaluation, and potentially longer.

"New York State is the best state on paper and the worst state in practice," said DJ Jaffee, executive director of the Mental Illness Policy Organization. "Basically what the law does now is requires someone to become dangerous to themselves or others [before being forced into treatment]. We believe it should prevent someone from becoming a danger to themselves or others."

Quoting unnamed sources, The New York Times reported Menendez had been to Bellevue and Elmhurst hospitals for psychiatric treatment. The city's Health and Hospitals Corporation, which administers the hospitals, declined to comment, citing privacy concerns.

The Times also reported a case worker had repeatedly attempted to visit Menendez at home but found her missing and left medication and instructions to call.

Critics of Kendra's Law said the mental health system needs more outreach workers and mental health clinics, not more involuntary treatment.

"Kendra’s Law is a step deeper in the wrong direction for a lot more money for a lot fewer people," said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services.

Rosenthal said New York is currently developing a system that integrates mental healthcare with other medical treatment and that makes service providers more accountable.

Under Governor Andrew Cuomo, Cuomo’s Medicaid overhaul, the managed care organizations that provide most of the treatment for the mentally ill get paid partly on how well they do keeping patients out of hospitals.

"They're setting the bar higher and creating a system that's more proactive and relies more on people who are out helping people on the streets, not just in offices or hospitals," Rosenthal said. 

Dr. Bruce Link, a professor of epidemiology at Columbia University’s Mailman School of Public Health, said Kendra’s Law has been effective at reducing violence among the mentally ill – and strikes a balance between individual rights and public safety.

But he also was cautious about extending involuntary treatment to a broader swathe of the mentally ill.

"Predicting dangerousness is just a difficult thing that psychiatry really can’t do perfectly," Link said. The current system, he said, provides "a pretty good idea of who’s at risk."

Link has compared patients who were monitored by the mental health system under Kendra’s Law with similar patients who were not. He found that those who received assisted outpatient treatment became more functional and less violent over time than those who did not.

"There are a lot of success stories under Kendra’s Law," he said. "Unfortunately, you don't hear about those. You hear about the dramatic incidents, which are newsworthy" but very rare.

Kendra's Law was renewed in 2010 and is up for renewal again in 2015. In the meantime, Jaffe and others are pressing Albany to pass the Kendra's Law Improvement Act, which they say will make it easier for families to use the court system to force relatives to get treatment.

Correction: In an earlier version of this article, WNYC incorrectly identified professor Bruce Link as Bruce Felt. WNYC regrets the error.

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Comments [21]

jim from earth

There are criminals of all races. That means no one can own a gun. People with mental illness who kill people are the minority of minority. You cannot restrict the rights of everyone based on a few!

Feb. 13 2013 09:08 AM
jim from earth

Gun control against people mental illness is discriminatory. Why isn't there a law that states African Americans cannot own a gun? There are way more people killed by African American criminals than people with mental illness. How about police officers who suffer from depression and nervous breakdowns due to stress at the job? Why should those police officers with mental illness be able to carry guns while the rest of the public with mental illness cannot? People with mental illness may need to carry guns to protect themselves just like the rest of the public. IT IS DOUBLE STANDARD, and IT IS WRONG!

Feb. 13 2013 08:55 AM
WARNING

Us people with mental illness are thinking about ways to defend for our lives once our lives are threatened by force psychiatric treatment with fatal side effects. Once forced psychiatric treatment starts, most of us people with mental illness are going to die within five to ten years. Our lives are going to be cut short. WE WILL KILL THOSE WHO CUT OUR LIVES SHORT! YOU PSYCHIATRIC PROFESSIONALS WANT TO MASSACRE US BECAUSE ONE PERSON WITH MENTAL ILLNESS KILLED SOMEONE, THEN WE WILL ALSO MASSACRE YOU. YOU PSYCHIATRIC PROFESSIONALS HAVE BEEN WARNED!

Jan. 06 2013 09:13 PM
rights

Google "MEGATALKA" for Rights of People with Mental Illness.

Jan. 05 2013 04:52 PM
best treatment

To keep the public safe, the best way is to force people with mental illness to take antipsychotic medication and force them into a coma. NO one can be dangerous once they are in a coma! If they die, then that is OK as well because it is for the sake of public safety.

Jan. 04 2013 10:44 PM
treatment

Some police officers have suffered nervous breakdowns on the job. I will say lets force treatment on those police officers with dangerous psychiatric medication with fatal side effects.

Jan. 04 2013 06:48 PM
rights

The law states that it is legal for ANYONE to use deadly force on a person if that person threatens his or her life. Therefore, it is legal for someone with mental illness to kill the psychiatrist if the person with mental illness feels that his or her life is threatened with dangerous psychiatric treatment with fatal side effects. YES, PEOPLE WITH MENTAL ILLNESS HAVE THE RIGHT TO DEFEND FOR THEIR LIVES!

Jan. 04 2013 06:08 PM
treat

The murderer with mental illness thought every one with darker skin is a terrorist because of 9-11 and have to be killed. Her thoughts are much the same as the psychiatric professionals. Psychiatric professionals think all people with mental illness are dangerous and have to be killed with dangerous psychiatric medication. I say that we force treatment on all the psychiatric professionals for mental illness.

Jan. 04 2013 08:38 AM
rights

To prevent one murder by a person with mental illness, the government would rather kill ten thousand innocent people with mental illness with their deadly psychiatric medication.

Jan. 04 2013 08:28 AM
Marsha(former New Yorker) from Fort Myers, Florida

I have been an advocate for Kendra's Law Impovement and Expansion Act. It is not about taking away anyone's rights. The law does help the most seriously ill and also forces treatment providers to follow up and not "cherry pick" easy patients, consumers, or clients.

Jan. 02 2013 11:30 AM
Harold A. Maio from Ft Myers FL

A second fatal subway pushing in less than a month has renewed focus on a New York law that requires some mentally ill people to get psychiatric treatment.

Andrew Goldstein, who pushed Kendra Webdale to her death, was not receiving (please note Passive Coice) treatment. He had been discharged by three NYC hospitals to the streets, when his insurance ran out. Curiously, that is seldom mentioned.

Karen's parents sued the hospitals for millions and won, Andrew's parents did not sue.

On the topic of force: One of the results of Kendra's Law is that it forces agencies to provide treatment to selected individuals. We are not told how they are selected.

Jan. 01 2013 04:20 PM
Austin

Is it me or are we slowly being stripped of our freedoms? Tragedy has always happened and will always happen no matter how uncomfortable and sad you make everyone feel until they give in to bogus laws and such as this. If you think about it it'll be the gov't who sets the standards I the end they will choose what makes some "unstable" and who should go and who stay probably until everyones personality gets wiped away completely or until they make their "ideal" land

Jan. 01 2013 01:20 PM
bill

since we are banning weapons mental people use to kill other people are we going ban subway stations now? see how stupid that sounds.....

Jan. 01 2013 03:39 AM
Terry bigler

One rather simple solution is to not let people near the edge of the tracks until the train is in,this could be accomplished with a series of gates.When the train stops the gates open,It might add a few seconds to the train schedule, but it would solve the problem,and you could place the gate within a foot of the edge of the platform so no one could get behind it.While this doesn't happen often,it does happen,and I believe that they have a similar gate system in Japan in the Tokyo subway

Dec. 31 2012 09:13 PM
michael smith

Have you ever been involuntarily committed in a mental hospital even though you aren't mentally ill? If not, I would advise you to rethink Kendra's law.

Please stay up to date on current lawsuits in New York City, and readers may just as well see me taking down the New York Police Department in court for wrongful committment. The large majority of the population in this country assume that the more leeway given to police/psychiatrists to intern people in mental hospitals and force ably medicate, the safer society becomes. Here is why people are blatantly wrong: involuntary committment in a mental hospital involves NO OVERSIGHT from a judge. You are guilty until proven innocent. In New York, you can be interned for 2 weeks, locked up, and forcibly medicated, without a warrant, or any judicial consent. This basically means, that anyone, can pretty much call up the police and say you are acting weird, and so long as they convince the police, (which isn't very hard) the police will come and escort you into a hospital. You get interviewed by two psychologists for approx. 15 seconds, and most of the time they will approve the committment, since they stay on the safe side at all times, and you never really know who you are dealing with, right? It also makes the hospital a lot of money.

Dec. 31 2012 09:04 PM
Linda from California

The issue should not be forcing treatment but actually providing earlier and more effective treatment options. Much of the U.S. has seen mental health services obliterated in budget cuts. Prevention please!!!

Dec. 31 2012 08:36 PM
Karen from Desert

So we are going to have a background check and psychiatric exam now to anyone who uses the subway as a means of transportation! That will really make if safer ;)

Dec. 31 2012 08:34 PM
EdthC from US

Just going to have to ban subways!

Dec. 31 2012 08:26 PM
Dave from Bible Belt, USA

Forced treatment for mental problem? If Erika Menendez is classified as mentally ill and should be forced to check-in to a mental institution, then that means a good majority of people in the bible belt would be in mental institution, starting with governors of those southern states.

Dec. 31 2012 08:21 PM
Political Cynic

Hmm. An interesting tale here.

1. A man pushes a man under a subway train. He's locked in jail with no request for a psychiatric evaluation and is awaiting trial. no one comes to his defense as potentially being "mentally ill" or a victim of anything.

2. A few weeks later, a woman pushes a man under a subway train. She is immediately sent for pschiatric evaluation and a "debate" is "re-ignited" over treatment of the mentally ill.

Gee...I can't imagine why the two were treated differently. After all, ask any feminist-there is no such thing as anti-male sexism.

Dec. 31 2012 08:19 PM
Steve Melton from Nashville, TN, USA

So what is different. You can look them up till they start taking their meds. but once judged sane or safe, they are released till they stop taking them again. The only factor I see is maybe helping the ones on the radar.

Dec. 31 2012 08:12 PM

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