Kendra's Law

In 1999, New York State Enacted Legislation that provides for assisted outpatient treatment for certain people with mental illness who, in view of their treatment history and present circumstances, are unlikely to survive safely in the community without supervision. This law is commonly referred to as “Kendra’s Law” and is set forth in §9.60 of the Mental Hygiene Law (MHL). It was named after Kendra Webdale, a young woman who died in January 1999 after being pushed in front of a New York City subway train by a person who was living in the community at the time, but was not receiving treatment for his mental illness (AOT Summary).

Link to §9.60 of the Mental Hygiene Law:

http://codes.lp.findlaw.com/nycode/MHY/B/9/9.60

Kendra’s Law (New York Mental Hygiene Law § 9.60) allows courts to order certain individuals with brain disorders to comply with treatment while living in the community. This court-ordered treatment is called assisted outpatient treatment (AOT).

AOT was first proposed in New York in 1989, by families of people with serious mental illness who were concerned that current law required them to be “dangerous to self or others” before they could receive care. In 1994, NYS started a pilot outpatient commitment program at Bellevue Hospital in New York City. The three-year pilot program, recognized that "some mentally ill persons frequently reject the care and treatment offered them on a voluntary basis and decompensate to the point of requiring repeated psychiatric hospitalizations. In August 1999, New York State enacted five-year statewide legislation based on the Bellevue Pilot called “Kendra’s Law”. It provides assisted outpatient treatment (AOT) for certain mentally ill persons living in the community. The law was renewed in 2005, and again in 2010. It sunsets in 2015 (Kendra’s Law Overview).

Works Cited:

AOT Summary. (n.d.). New York State Office of Mental Health. Retrieved December 18, 2011, from http://www.omh.ny.gov/omhweb/Kendra_web/Ksummary.htm

Kendra's Law overview. (n.d.). MENTAL ILLNESS POLICY ORG.. Retrieved December 18, 2011, from http://mentalillnesspolicy.org/kendras-law/kendras-law-overview.html

The Community Mental Health Act of 1963

The Community Mental Health Act of 1963 (CMHA of 1963), also known as the Community Mental Health Centers Construction Act, was an act that was passed as part of John F. Kennedy’s New Frontier plan.  The community mental health act of ’63 helped provide federal mental health funding for community mental health centers in the United States.   

These centers were a new idea as persons with mental illness were most often placed in some form of hospital or other institution not necessarily considered to be interactive with or a part of the community or neighboring communities.

The emphasis with the CMHA of 1963 was on shifting from hospitalizations and institutions to community based housing and treatment centers aimed to help treat persons with mental illness in the community, using the community as a part of this process, rather than keeping these individuals out of the community.

While this act received “mixed reviews” and results because people were uneasy about the idea persons with mental illness in the community, it helped pave the way for providing more equal human rights for individuals with mental illness.  CMHA of 1963 helped to provided more balanced access to a sense of community and normalcy for individuals.  It helped them to feel more like people and less like patients. 

While persons with mental illness will usually require additional services such as counseling and supplemental income, moving away from institutionalization was a positive step toward helping these people rather than simply detaining them in a hospital or possibly even imprisonment. 

More information on CMHA from Duke's journal of health politics, policy and law: http://jhppl.dukejournals.org/content/9/1/1.abstract

The following video displays some treatments used for mental disorders in mental institutions during the early 20th century.

Psychiatric Care for the Mentally Ill during The Great Depression

Mental Institutions were a popular and common habitat for persons with mental illness during The Great Depression.  However, conditions in state mental institutions deteriorated as a result of Depression-era financial hardships and the resource and personnel demands of the war. Decaying physical plants and extreme overcrowding were common. (Overview of Mental Health)

Although it had come a long way from the days of simply restraining and locking away the mentally ill, psychiatric care in the 1930s was still very limited. There was essentially no treatment for schizophrenic patients, for example. Psychiatrists attempted to treat their symptoms by prescribing drugs like sedatives, which suppressed the patient's nervous system, and trying a number of different mind-body therapies. (Freeman)

There were also some new methods of treatment for the mentally ill introduced during this era.

Insulin shock and metrazol shock therapies and surgical technique of prefrontal lobotomy were developed.  Soon after, Electroconvulsive therapy replaced some of these procedures.

The original lobotomy was a medical procedure where the neural passages from the front of the brain are surgically separated from those in the back of the brain. The common result of this procedure was the patient forgetting their depressing or discouraging feelings or tendencies. This was a very delicate, time-consuming procedure that required great skill and training from the practicing surgeons. Because the lobotomy appeared to effectively alter the mental health of patients, great effort was invested into developing a more practical procedure with similar desired results. (The History of Mental Illness)

Works Cited:

Freeman, S. (n.d.). HowStuffWorks "Psychiatric Care in the 1930s". HowStuffWorks "Science". Retrieved December 2, 2011, from http://science.howstuffworks.com/environmental/life/human-biology/lobotomy3.htm

Overview of Mental Health in New York and the Nation. (n.d.). New York State Archives. Retrieved December 1, 2011, from http://www.archives.nysed.gov/a/research/res_topics_health_mh_timeline.shtml

The History of Mental Illness. (n.d.). Kathi's Mental Health Review - The Book 5150, Infantilism, BPD, Advocacy and more. Retrieved December 4, 2011, from http://www.toddlertime.com/advocacy/hospitals/Asylum/history-asylum.htm

Mental Hygiene and the End of the Asylum

Progressive Era reformers believed that mental illness was the product of environmental factors and that it was both preventable and progressively serious.  These beliefs gave rise to the Mental Hygiene Movement, which as characterized by the psychopathic hospital, child psychiatry and outpatient clinics.  All of these innovations were intended to prevent the emergence of mental illness or to provide early treatment designed to avert serious mental disorder. (Overview of Mental Health in New York and the Nation)

Treatment methods began to often include medications.  The person most responsible for changing the way medicine and society viewed the mentally ill was Sigmund Freud, who espoused psychoanalysis as a valid approach for the treatment of mental disorders. These techniques for treating the mentally ill were first introduced to the American medical community during the first decade of the 1900s.

Carl G. Jung, one of Freud's most prominent followers, was one of the first to employ psychoanalytic techniques with severely disturbed (psychotic) individuals, particularly schizophrenics. While Freud's techniques were readily adapted to “office practice, “ Jung's methods were useful with more severely disturbed, hospitalized patients.

In 1900 there were only 222 psychiatrists, but thanks to the work of Freud and Jung, mental illness in America began to transform. Psychiatry became a recognized medical specialty, and a requirement in most medical schools.

Thankfully, the days of the asylum, the only “therapeutic tool" of the 19th century, were numbered in 1909 and would soon disappear. (jzbick@tnonline.com, J. Z.)

Works Cited:

Overview of Mental Health in New York and the Nation. (n.d.). New York State Archives. Retrieved December 10, 2011, from http://www.archives.nysed.gov/a/research

jzbick@tnonline.com, J. Z. (n.d.). Treatment for the insane improved in the early 1900s | Times News Online. Times News Online. Retrieved December 9, 2011, from http://www.tnonline.com/2009/oct/16/treatment-insane-improved-early-1900s

Moral Treatment

Beginning in the late eighteenth century “moral treatment” had become the prevalent school of treatment in the United States. Replacing the model of demonic possession, “moral treatment” hypothesized that insanity was caused by brain damage from outward influences on the soft and fragile brain.  Removing patients to an appropriate environment where they could indulge in clean, healthy living, and would be offered exercise, work, education and religious instruction, was thought to facilitate their cure.  But the “moral treatment” method was riddled with problems.  As doctors and other hospital personnel grew frustrated by their lack of progress and a shortage of willing qualified staff, conditions often deteriorated.  Faced with overcrowded hospitals, and concerned about the rise of the spiritualist movement (which some attributed to the “moral treatment” method), many superintendents resorted to physical restraints.  By the middle part of the century, heredity also was considered a root cause of mental illness.  Many in the field believed that weak family and vices, like alcoholism and masturbation, could lead to madness.  The mentally ill were considered “genetically inferior” and eugenics and warped interpretations of Darwin’s theories suggested that mental illness could be eliminated through social engineering.  (American Experience)
 
However, there were many problems with how these understandings were applied into practice.  Hospitals and Mental Institutions were created to help “cure” the mentally ill, but several problems arose.

The expectation in the United States that hospitals for the mentally ill and humane treatment will cure the sick does not prove true. State mental hospitals become over-crowded and custodial care supersedes humane treatment. New York World reporter Nellie Bly poses as a mentally ill person to become an inmate at an asylum. Her reports from inside result in more funding to improve conditions.  (Asylums)

Check out Nellie Bly's reports here: (http://www.pbs.org/wgbh/amex/world/sfeature/memoir.html)

Works Cited:

Asylums, t. 1., true, s., sensational, s., oversight, a. i., & psychiatry., p. a. (n.d.). Untitled Document. McCarter Theatre. Retrieved December 12, 2011, from http://www.mccarter.org/education/mrs-packard/html/6.html American Experience | A Brilliant

American Experience | A Brilliant Madness | Timeline. (n.d.). PBS: Public Broadcasting Service. Retrieved December 12, 2011, from http://www.pbs.org/wgbh/amex/nash/timeline/index.html

Persons with Mental Illness

Values in our community affect the social welfare services of persons with mental illness in several different ways. First off, as with all other neglected and/or oppressed groups, the persons with mental illness are in the minority against those without mental illness.  This gives persons with mental illness a small voice in obtaining and/or fighting for their human rights.

Many mental illnesses require or would at least be aided by adequate food and shelter, medications, counseling, skill building, and many other services.  But without proper health insurance, adequate income, knowledge of one’s own mental illness, advocacy, etc, individuals often go without and their human rights are diminished and violated.

Often times these oppressed population groups intersect.  The mentally ill are often poor.  If one is mentally ill; he will have a greatly increased chance of struggling in obtaining and/or keeping employment. And there is evidence to suggest that this works the other way around as well.  If one is or becomes poor, he will be more likely to develop mental illness (http://www.treatmentsolutionsnetwork.com/blog/index.php/2011/04/06/link-between-poverty-and-mental-illness/).  

Society as a whole considers the mentally ill to be somewhat of a taboo population group.  Many don’t believe that the mentally ill are a group worthy of receiving social welfare services.  There is a lack of understanding of mental illness in our society.  This ignorance creates a huge barrier in providing persons with mental illness the services that they deserve so that their human rights can be fully realized.

                                                             Mental Illness: A Taboo