Kendra’s Law: Justice Renewed?

Ten years ago there were a number of injuries, amputations, and deaths occurring in the New York Subway system when persons displaying severe and untreated mental illness pushed unsuspecting commuters onto the tracks.

One victim was Kendra–her family, organizations for the mentally ill, civic groups and newspapers clamored for and succeeded in getting passed legislation that mandates outpatient treatment for seriously mentally ill persons who pose a danger to others and are not cooperating with their treatment, particularly taking prescribed medication as prescribed by their psychiatrist.  New York State Office of Mental Health offers a detailed Web site on Kendra’s Law, including criteria for participation and medication grants

One central feature of the law is mandated psychiatric medication, which can be given against a person’s will. I am a full supporter of Kendra’s Law and strongly support its renewal. However, it brings up ancillary questions needing to be answered through theological, political, and medical reflection.

Many of the psychiatric patients (this word is used instead of “clients” due to the need for these persons to be medically cared for in a structured and intensive manner) affected by Kendra’s Law are those with severe schizophrenia or bipolar disorder. For these conditions, well-meaning suggestions about using less medication are overwhelmingly not applicable. The proper combination and balanced dosage (titration) of psychiatric medications required a highly skilled psychiatrist who knows the patient well and has frequent visits and contacts with the patient, family, and others who are involved. The relationship of the psychiatrist to the patient is highly important. Doctors who impart concern and hope may get better results with the same medications than doctors who do not possess these qualities.

A small number of groups including the New York Civil Liberties Union have opposed Kendra’s Law. Despite my full support, there are ramifications that need careful review.

We know that psychiatric medications have been used to deaden political dissent–this is well-known knowledge about the manner in which the Soviet Union treated its dissidents in the last half of the twentieth century. Within our own government, are we sure that the myriad agencies with three-letter acronyms have not experimented with or currently use psychiatric drugs for purposes other than care and treatment?

Especially with children, parents face increasing pressure to medicate children displaying conditions such as Attention Deficit Hyperactivity Disorder, Depression, and even Oppositional Defiant Disorder. The pressure often come from teachers or school administrators, who are not physicians. If a teacher says something like “your child needs to take Ritalin,” that teacher has crossed a line and is giving medical advice, a crime in most jurisdictions. I have even heard of school districts reporting well-intentioned and caring parents for medical neglect for keeping a child off medication, which can be the right decision, and these parents have been faced with expensive second opinions to clear their name.

Within our own tradition, we view the human spirit and soul as sacred; Thomas Aquinas asserted that the brain is a vehicle for expression of our soul and that certain infirmities can limit true freedom. Therefore medications must be considered carefully, and there are all too many instances when this is not done and disrespect is shown to what is our essence of being human.

With these compelling caveats in mind, however, it is helpful to reflect on the value of psychiatric medications in these extreme conditions, and their potential to help prevent victims of persons with severe psychiatric problems who are out of control.

Bishop Howard J. Hubbard of Albany, New York has praised the role of psychiatric medications in helping to heal obsessive-compulsive disorder, and his views are relevant to the severe pathology displayed by persons who may be included under the mandate of Kendra’s Law: “To understand that these emotional and psychiatric problems can be due to a causation that is beyond one’s ability to control by the will, but can be assisted either through therapy or drug treatment, or a combination of these. I think these therapies are not only acceptable, but are actually something very good, and it should be seen as one of God’s gifts to humanity that we now have resources such as these available.”

William Van Ornum