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 V.15 No.36 | September 7 - 13, 2006 

Ortiz y Pino

Mandating Mental Health

Some powerful testimony was given during the day-long Town Hall meeting on Aug.31 concerning “Kendra’s Law.” It mostly came during the final two hours when more than 35 members of the audience voiced their views during public comment on legislative proposals for the city and state to require psychiatric treatment for some severely mentally ill patients.

People with lifetime struggles with their own mental illness, family members who’ve been driven to the brink of despair by the frustration of trying to find help for loved-ones’ emotional problems and treatment professionals who’ve spent entire careers devoting themselves to assisting patients diagnosed as schizophrenic, severely depressed, bipolar or suicidal all spoke with simple eloquence about how underserved this segment of our community truly is.

Listening to their stories fleshed out the sometimes dry-as-paper research findings that had taken up much of the hearing. Both kinds of information, the statistical and the anecdotal, helped to paint the full landscape that eventually emerged for attendees.

The tone for the entire proceeding was set by Sen. Pete Domenici, the day’s first speaker, when he began haltingly, seated himself … and then crescendoed in volume and vehemence.

He practically set aside the microphone when he stood up and spoke of his determination to blast his priority mental health legislation, a parity in insurance bill he’s cosponsoring with Ted Kennedy, out of the committee that has bottled it up for a decade and force the full U.S. Senate to consider it.

“When the insurance industry is required to treat mental illness like any other kind of illness in terms of coverage,” the six-term Republican stated forcefully, “then we’ll begin to see them funding research into prevention, treatment and cures just like they do with heart disease, cancer and all other conditions.”

Those who participated left with a shared sense of urgency about more realistically dealing with our mentally ill citizens.

But there was no similarly shared position on the issue of mandating outpatient treatment. On that topic, the two sides remain far apart.

Mayor Martin Chavez has deliberately linked passage of a mandated outpatient care ordinance by the city with somehow protecting Albuquerque from some of the very tragic violent episodes that have lit up our community’s media outlets in recent years.

He would like a statewide law passed mandating treatment for potentially violent mentally ill persons, but until such a law is passed, he is pushing for a city ordinance on the issue.

Civil liberties groups and many advocates for the mentally ill oppose such a law, claiming that without vastly expanded networks of treatment services, it will only lead to further loss of rights or even incarceration of mentally ill persons who have not done anything wrong but who at times may “act weird.”

Family members, many of whom belong to the National Alliance for the Mentally Ill (NAMI), seem to be just as divided on the issue, though the leadership of NAMI’s Albuquerque Chapter has aligned itself with Mayor Chavez in favor of the bill. At the hearing, members of the Valencia County NAMI applauded a member who took strong issue with the Albuquerque NAMI position.

Some points raised during the day appear incontrovertible. They should form the framework for whatever policy emerges from the debate.

First, New Mexico is dead last among the 50 states in the amount per capita we spend on mental health treatment. That figure ($28 per person) would have to be dramatically increased before we have any hope of ever responding adequately to the enormous need that exists.

Second, it truly does not make sense for the City of Albuquerque (or any municipality in the state) to go it alone with a mandated treatment ordinance. Though a city official at the Town Hall testified that our local government now spends “over $14 million annually on serving this population” and is prepared to increase that amount if needed, that figure is seriously inflated.

It included spending on substance abuse and DWI programs; it included money spent on transitional housing and social service assistance for the homeless, and it included Federal HUD funding that flows through city government channels for a variety of housing affordability programs. Most of those only tangentially impact the seriously mentally ill.

In real dollars, the city may possibly be spending something akin to $2 million a year on psychiatric outpatient treatment for the mentally ill, the specific type of assistance that may be mandated by a court for someone picked up by APD for “acting weird” in public.

Only New Mexico state government, with its Medicaid and Behavioral Health Services Block Grant resources and with the bonanza of windfall revenues from oil and gas taxes, is in a position to act on the scale that is needed. The mayor’s advocacy for more mental health spending ought to focus on persuading the Legislature of the wisdom of this course for all New Mexicans.

Finally, as Maurice Martin, himself diagnosed with several mental illnesses, put it so dramatically, “When you mandate my treatment, you take away my dignity. I have a right to choose to participate in the treatment offered. You cannot force me into mental health.”

Many states provide “assisted outpatient treatment” in addition to court-ordered commitments for inpatient care. Only a handful of states have gone the route of “mandated” treatment. In that distinction lies true mental health.

The opinions expressed are solely those of the author. E-mail jerry@alibi.com.

 

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