During the 1960s and 1970s, statelaws governing treatment of severe mentalillnesses, such as schizophrenia andmanic-depression, for individuals whorefused it underwent sweeping reform.Most notably, assisted treatment lawswere changed to require a court finding of

dangerousness before treatment could beprovided to those incapable ofrecognizing their need for it. While well-intentioned, reform efforts meant toprotect people with mental illness resultedin many of the most severely ill goingwithout needed treatment, and, in toomany cases, becoming homeless,incarcerated, suicidal, victimized or proneto violent episodes.

It was foreseeable that changing thelaw to require dangerousness before aperson with a severe psychiatric disordercould be treated would lead to peoplebeing incarcerated rather than treatedwhen they became symptomatic.

Philadelphia's police chief issued adirective that non-dangerous peoplewho could no longer be taken intocustody under the mental health actcould be arrested for disorderlyconduct.3

A Pennsylvania prison experienced asharp increase in the admission ofinmates with severe mental illness a fewmonths after the change in the law.4

Two years after California adopted adangerousness standard, the number ofpsychiatric hospital commitments ofindividuals found incompetent to standtrial doubled in one county.5

Two years after a court changedWisconsin's standard to imminentdangerousness, the number of criminalobservation cases in three statepsychiatric institutions nearly doubled.6

The criminalization of mental illnesshas reached crisis proportions. The PacificResearch Institute estimated that the costto the criminal justice and correctionsystems of California alone was $1.2 to$1.8 billion in 1993-1994.7

In 1999, the Department of Justicereported that as much as 16 percent of thepopulation of state jails and prisons, morethan 260,000 individuals, suffer fromsevere mental illnesses.8 While the vastmajority of these individuals are arrestedfor non-violent crimes, it is inevitable that

Inside this issue...Case for a Model Law Page 1Interest in Workshop 3B? Page 3Your Voice Page 3TAC Releases Model Law Page 4Important Aspects of the

Model Law Page 4A Supreme Decision Page 6TAC Booth at NAMI

Convention Page 8And From Ontario Page 8Wade Page 9In Memory/In Honor Page 10Other State Updates Page 11

Dr. Xavier Amador during his presentation ofthe workshop, “What Is It Like To Be Sick andNot Know It?” at the NAMI 2000 Convention inSan Diego. [See article on page 3.]

"We are literally drowning inpatients, running around trying to putour fingers in the bursting dikes, whilehundreds of men continue to deterioratepsychiatrically before our eyes intoserious psychoses. The crisis stems fromthe recent changes in the mental healthlaws allowing more mentally sickpatients to be shifted away from themental health department into thedepartment of corrections. Many moremen are being sent to prison who haveserious mental problems."

… Quote from a California prisonpsychiatrist in 1971, two years afterCalifornia enacted the Lanterman-Petris-Short Act.1

"How can so much degradation anddeath—so much inhumanity—bejustified in the name of civil liberties? Itcannot. The opposition to involuntarycommittal and treatment betrays aprofound misunderstanding of theprincipal of civil liberties. Medicationcan free victims from their illness-freethem from the Bastille of theirpsychoses-and restore their dignity,their free will and the meaningfulexercise of their liberties."

… Herschel Hardin, formermember of the board of directors ofthe British Columbia Civil LibertiesAssociation and father of a child withschizophrenia.2

Reversing a Dangerous Precedent—Makingthe Case for a Model Law

By E. Fuller Torrey and Mary T. Zdanowicz

waiting for someone to become dangerouswill culminate in violent episodes. TheNew York Times studied 100 "rampagekillings," defined as "multiple-victimkillings that were not primarily domesticor connected to a robbery or gang,"committed during the preceding fivedecades.9 Of the 100 rampage killers,"more than half had histories of seriousmental health problems" and 48 of themhad "some kind of formal diagnosis, oftenschizophrenia."10 Based on their research,the Times staff concluded that, "theincidence of these rampage killingsappears to have increased."11

A natural outgrowth of a mental healthsystem that withholds needed treatmentuntil a person becomes dangerous is thatpolice become the front line mental healthworkers. In 1976, the New York CityPolice Department took approximately1,000 "emotionally disturbed persons" tohospitals for psychiatric evaluation.12 By1986, this number had increased to 18,500and for 1998 it was 24,787.13Most policeare not trained to properly respond to"emotionally disturbed persons" and theseencounters are often fatal. From 1994 to1999, Los Angeles police shot 37emotionally disturbed persons, killing 25of them.14 In 1999 alone, police in NewYork City15, Houston16, and Tampa17, shotand killed three individuals with mentalillness in each city.

While criminalization is the fastestgrowing dilemma facing the untreatedmentally ill, years of neglect have createdother tragic consequences of non-treatment. Sadly, we have grownaccustomed to public places dominated bywasted human forms huddled over steamgrates for warmth in the winter orwrapped in blankets in the summer. Atleast 150,000 people, or one-third of thenation's homeless population, suffer fromsevere mental illnesses.18 The majority ofhomeless individuals with untreatedpsychiatric illnesses regularly foragethrough garbage cans and dumpsters fortheir food.19 Studies reveal that at leastone-third of mentally ill homeless womensuffer sexual assault, many on multipleoccasions.20

The consequence of requiringtreatment to be withheld until a personbecomes a danger to himself or herself ispredictable. By that time, he or she islikely to be either one of the 19 percent

who attempts suicide or one of the 10 to15 percent who eventually succeeds.21

Suicide is the leading cause of death injails and 95 percent of those who commitsuicide in jails have psychiatric illnesses.22

Withholding treatment also puts people injeopardy of victimization. Persons withsevere mental illnesses are nearly threetimes more likely to be victims of violentcrimes than the general population.23

Clearly, a new wave of reform isneeded. Enacting and utilizing standardsbased on the need for treatment will allowfor intervention before it is too late.Abandoning dangerousness as the solestandard for assisted treatment will notrequire re-opening hospital wards. Whilecounter-intuitive, it is logical that hospitalusage will decrease by substituting a needfor treatment standard for one based ondangerousness. The change will facilitateneeded intervention sooner rather thanlater. For the most part, the same peoplewho would be hospitalized when theybecome dangerous will simply be helpedsooner. Because intervention occurssooner, it will take less time to stabilizepatients and they will spend less time inthe hospital. At least five states that haveadopted standards based on the need-for-treatment experienced decreased hospitaladmissions after the law changed (i.e.,North Carolina, Alaska, Kansas, Texasand Colorado).24

Perhaps the single most importantreform needed to prevent the need forhospitalization and to prevent theconsequences of non-treatment is toencourage the use of assisted outpatienttreatment. When appropriate, assistedoutpatient treatment fosters treatmentcompliance in the community through acourt-ordered treatment plan. Moreover,not only does the court commit the patientto the treatment system, it also commitsthe treatment system to the patient. In themost comprehensive study to date,recently published from North Carolina,long-term assisted outpatient treatmentwas shown to reduce hospital admissionsby 57 percent.25 The results were evenmore dramatic for individuals withschizophrenia and other psychoticdisorders whose hospital admissions werereduced by 72 percent.26 Additionally, thesame study showed that long-term assistedtreatment combined with routine or

Catalyst

2

July/August 2000

Catalyst Catalyst is published six times a year by

the Treatment Advocacy Center(the Center).

TREATMENT ADVOCACY CENTER3300 NORTH FAIRFAX DRIVE

SUITE 220ARLINGTON, VA 22201PHONE: 703-294-6001

FAX: 703-294-6010WEB SITE: WWW.PSYCHLAWS.ORGE-MAIL: INFO@PSYCHLAWS.ORG

BOARD OF DIRECTORSE. FULLER TORREY, M.D., PRESIDENT

JAMES COPPLE, SECRETARYGERALD TARUTIS, ESQ., TREASURER

RAY COLEMANED FRANCELL, JR., M.S.W.

FRED FRESE, PH.D.CARLA JACOBS

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EXECUTIVE DIRECTORMARY T. ZDANOWICZ, ESQ.

EDITORLORRAINE GAULKE

FUNDING SOURCESSTANLEY FOUNDATIONINDIVIDUAL DONORS

___________________The Center is a nonprofit organization

dedicated to eliminating legal and clinicalbarriers to timely and humane treatmentfor the millions of Americans with severe

brain diseases who are not receivingappropriate medical care.

Current federal and state policies hindertreatment for psychiatrically ill

individuals who are most at risk forhomelessness, arrest, or suicide. As a

result an estimated 1.5 million individualswith schizophrenia and manic-depressive

illness (bipolar disorder) are not beingtreated for their illness at any given time.

The Center serves as a catalyst to achieveproper balance in judicial, legislative and

policy decisions that affect the lives ofpersons with serious brain diseases.

(Case for Model Law - page 7)

Why all the interest inWorkshop 3B?By Jonathan Stanley, J.D.

People were interested in Workshop3B at the annual convention. People filledevery seat; people were sitting four acrossin the aisle; people were standing threedeep at the back; and, we regret, manyothers were turned away. Audiocassettesof workshops were on sale at theconvention, and, although it was held onthe last day of presentations, the tape of3B was the first to sell out. Yes, there wasinterest. But why all this attention?

Strangely, the focus of 3B, presentedby the Treatment Advocacy Center, was aneffect of mental illness that seemsobvious. Entitled, What Is It Like To BeSick and Not Know It?, the workshopdetailed from both a clinical and personalperspective how a person can be overcomeby mental illness, yet be completelyunaware that what they are experiencing iscaused by the illness. One of the mostdisturbing ramifications of this effect isthat people in need of help because of theirillness, will at times not seek treatmentbecause they do not believe that they aresick.

Moderator Mary Zdanowiczintroduced the workshop's featuredspeaker, Dr. Xavier Amador, Professor ofPsychology in the Psychiatry Departmentof Columbia's College of Physicians andSurgeons. Dr. Amador is among theforemost experts on why people withmental illness often refuse treatmentdespite their obvious need for it.

He and others in his field have foundand documented in numerous studies, asDr. Amador lucidly described, that aprevalent effect of mental illness is that aperson can lose, or have impaired, the

ability for self-assessment. This is aphysiological symptom of mental illnessknown as anosognosia. It is akin to theresults of physical trauma to certain partsof the brain. Dr. Amador convincinglyshowed that what are commonly termed"treatment denials" instead result fromillness making a person unable to assesshis or her own condition.

Following Dr. Amador were fivepeople who have experiencedanosognosia. Each spoke of how thisconfounding condition left him or hercompletely unaware of being very, veryobviously sick.

Ken Kress enthralled the crowd with awit and a speaking style worthy of a spoton the Letterman show. He told of hisexperiences with a long-time friend whowas also bipolar. When his friend wouldbecome symptomatic, Ken would attemptto coax him into getting help, and thefriend would try to do the same when Kenstarted to drift towards mania. But neithercould ever convince the other that he wassick. Neither could break through theeffects of anosognosia on the other.

Donna Orrin movingly told of herillness causing her to believe self-mutilation was her best course of action.She said, "I didn't think I was hurtingmyself, I just had to do it to keep themfrom coming in."

"I thought that my first suicide attempt[30 years before] had succeeded and thateverything else in between was an illusion.I thought I was already dead," was thereason for Bernie Zuber's perilous andirrational actions at one time. Both Bernieand Donna had no idea that it was thesymptoms of mental illness that werecausing their worlds to convulse. Bothwere victims of anosognosia.

Jonathan Stanley described the worst

physical pain he had everexperienced. Searing ra-diation, nonexistent radi-ation that was a productof his psychosis, causedit. He was that sick. Hewas also so sick that hehad no idea he was ill.

Last to speak wasFred Frese, and he was asonly Fred Frese can be.The room shook withlaughter. He intertwinedmultiple, seemingly

tangential points. And, when he was done,Fred had not only entertained the packedroom, but had perfectly summed up andpunched home the essence of theworkshop's message.

Dr. Amador has just released areadable but comprehensive and helpfulbook on anosognosia and strategies to gettreatment for those affected by it. Part ofthe proceeds from the book will go toNAMI. For information or to order I AmNot Sick, I Don't Need Help, visitwww.vidapress.com or call 800-431-1579. [Mr. Stanley is Assistant Director ofthe Center.]

Your Voice—Will Make a Difference

Thank you for your excellentCatalyst—very timely and much needed. Itgets to the heart of the difficult situationsthat MI imposes on us. I was especiallytaken with the IMD Exclusion issue andwill lobby locally to get this repealed.

NAMI Winston County is our localgroup and we would like five copiesmailed at each publication—will see thatthese get passed around. I plan on being inSan Diego and will look for your booth.Thank you in advance for coming.

The enclosed check is in honor of mybrother Virgil Davis, who has sufferedwith schizophrenia since 1959 when hewas 18. Betty Hooper

Double Springs, AL

We lived in Maryland when K.S.Hardman [Scott] was born. His father isour nephew. We were so proud of hisbeing in The Boy's Choir ... and so sadwhen he became a teenager and tragedyoccurred.

3

Catalyst July/August 2000

Members of the panel who presented information and answered questions at a workshop sponsored by the Treatment AdvocacyCenter at the recent NAMI 2000 Convention. Left to right: Jonathan Stanley, Kenneth Kress, Bernie Zuber, Donna Orrin, and FredFrese. The workshop was about one of the devastating symptoms of severe mental illness, anosognosia.

(Your Voice - page 9)

Treatment Advocacy CenterReleases Model Law AtNational ConventionBy Rosanna Esposito, J.D.

The Treatment Advocacy Centerconducted a workshop, "Introducing theTreatment Advocacy Center's Model Lawfor Assisted Treatment" at the NAMIConvention on Saturday, June 17th. TheCenter's Mary Zdanowicz, JonathanStanley and Rosanna Esposito presentedthe Model Law to the many conferees whoattended this special session.

Mary Zdanowicz, Executive Director,opened the session with a look at why andhow the Model Law was created. Sheexplained that outdated state laws of the1960s and 1970s have resulted in many ofthe most severely ill going without neededtreatment and, in too many cases,becoming homeless, incarcerated,suicidal, victimized or prone to violentepisodes. Ms. Zdanowicz stated thatprogressive assisted treatment laws mustbe crafted to reflect the significantadvances that have been made in the lastdecade in our understanding and ability totreat severe mental illness. We now knowthat these conditions are treatablebiological brain diseases and not lifestylechoices, as was the prevailing thoughtthree decades ago. In drafting the ModelLaw, the Center solicited advice andassistance from individuals who arediagnosed with severe mental illnesses,their families, and medical and legal

professionals.Jonathan Stanley, Assistant Director,

highlighted some important aspects of theModel Law and noted that it is acompilation of the most effectiveprovisions of existing state laws. TheModel Law enables treatment for thoseovercome by severe mental illness, whoare adjudicated to be dangerous, gravelydisabled or chronically disabled. The lasttwo criteria also require that a person iseither unaware that he or she is ill or isotherwise incapable of making rationaldecisions concerning proposed treatment.The Model Law also adopts proceduresfrom various states that promote clinicaland judicial efficiency, such as having acombined commitment and treatmentproceeding. The only "new" provisions,not in state laws currently, are for theadditional protection of the rights andwell-being of those placed in assistedtreatment.

Rosanna Esposito, Attorney, detailedthe Model Law provisions for assistedoutpatient treatment. If an individualmeets the criteria for assisted treatment,that individual may be placed in eitherinpatient or outpatient care. The ModelLaw requires that an assisted outpatienttreatment order include provisions for casemanagement and services. Ms. Espositoalso reported findings from the mostrecent studies that demonstrate thatassisted outpatient treatment is effective inreducing hospitalization and violence.

The Model Law is now available onthe Center's Web site:

www.psychlaws.org. To receive a hardcopy of the Model Law by mail, pleasecontact us at 703-294-6001.[Ms. Esposito is an attorney with theCenter.]

Important Aspects of theModel LawBy Jonathan Stanley, J.D.

The Treatment Advocacy Center'sModel Law for Assisted Treatment is acautiously considered proposal topromote the provision of care for thosewho need it because of the effects ofsevere mental illness. At the same time,the Model Law includes numerousoverlapping protections to safeguardthose under court-ordered treatmentand to ensure that only those for whom

it is appropriate are placed or remain inassisted treatment.

The Model Law is more remarkablefor what it is not than for what it is. It isnot entirely revolutionary nor does iteradicate the basic constitutionalprotections provided by current treatmentlaws. There are familiar provisions foremergency treatment; a subsequentcertification for a treatment hearing by anexamining doctor; a more lengthy processto petition for the treatment of someoneless sick; under different names, outpatientcommitment and conditional discharge;periodic reviews and possible renewals oftreatment orders; and a host of othermechanisms common to current laws forsecuring treatment for those overcome bymental illness.

A cursory examination may give theimpression that the Model Law maintainsthe status quo, when it is actually acompilation of the most effectiveprovisions of existing state laws.Variations of virtually all of this proposal'ssections are the current law somewhere inthe United States. In essence, we havecombined each of the best availablecomponents into a statutory model betterthan any currently in effect.

Only in one area have we dared to becreative: the protection of the rights andwell-being of those placed in assistedtreatment. There we put forth proceduresmore extensive and vigilant than thosenow in place anywhere in the nation.

Following is a description of some ofthe key aspects of the Model Law.

July/August 2000

4

Catalyst

Jonathan Stanley, Assistant Director, and Rosanna Esposito, Attorney, both on the staff of the TreatmentAdvocacy Center, sit on the panel at the Model Law workshop during the NAMI 2000 Convention held recentlyin San Diego.

July/August 2000

5

CatalystSTANDARDS

In developing a system to placeindividuals in psychiatric care, the mostcrucial question is, "When is such anintervention appropriate?" The answer isfound in the legal standard that a personmust meet in order for his or herplacement in treatment to be allowedunder the law. The Model Law sets outfour alternative criteria that, if met, justifyassisted treatment.

1. Chronically disabled: Only a fewstates have criteria designed to helppeople stuck in the "revolving door" ofrepeated hospitalizations, symptomaticbehavior, and, for many, incarcerations."Chronically disabled" allowsconsideration of possible harm to a personwith symptomatic mental illness in lightof past psychiatric history (which wouldinclude previous non-compliance withtreatment), current likelihood of treatmentcompliance, and the risk of deteriorationwithout treatment. This standard is thustailored to assist those who are stuck inthe revolving door.

2. Gravely disabled: A number ofstates have included "gravely disabled" asgrounds for treatment placement. Most ofthese laws define this condition as when aperson becomes so incapacitated bymental illness as to lose the ability toprovide for his or her basic needs, withthese normally delineated as food,clothing, shelter and, sometimes, medicalcare. The Model Law mimics the moreprogressive of the jurisdictions withgravely disabled criteria by explicitlyincluding someone who is likely to suffersignificant harm without treatment.

Incapable of making an informedmedical decision: While not anindependent ground for treatmentplacement, the "gravely disabled" and"chronically disabled" criteria each alsorequire that the person is either unawarethat he or she is ill or is otherwiseincapable of making rational decisionsconcerning proposed treatment. Non-dangerous individuals who are capable ofmaking informed medical decisionsshould not be placed in assisted treatment.

3. Danger to others: Every state allowsfor the court-ordered treatment ofindividuals who because of mental illnessare a significant threat to the safety ofother people. The Model Lawincorporates a definition of "dangerous to

others" similar to that of most states, butmakes clear that presenting a threat to aperson in one's care, such as a child, orhaving caused intentional damage to thesubstantial property of another shall beevidence of dangerousness.

4. Danger to himself or herself:Similarly, every state allows for theassisted treatment of those who aredemonstrated to be a danger tothemselves, but the Model Law makesclear that a person's past related behaviorshall be considered when making thedetermination as to whether someonemeets this treatment standard.

PROVISIONS PROMOTING CLINI-CAL AND JUDICIAL EFFICIENCY

Many provisions of existing assistedtreatment laws make little sense. Theydelay needed treatment, are inefficientfrom either a judicial or clinicalperspective, or are concepts from otherareas of law ill tailored to assistedtreatment proceedings. The Model Lawadopts procedures from various states thatpromote both clinical and judicialefficiency.

Combined Commitment andTreatment Proceedings: Although acommon practice, the disadvantages ofhaving separate hearings on whether aperson should be committed and on his orher capacity to refuse treatment are patent.Having an interval between rulings oncommitment and treatment produces theinherently cruel circumstance of medicalprofessionals having to confine apsychotic or delusional patient withoutbeing able to provide treatment. Under theModel Law, the judicial determinationsabout treatment placement and the abilityto refuse treatment are made in the samehearing. There is no reason, eitherlogically or constitutionally, that bothdecisions should not be madeconcurrently. To be eligible for treatmentplacement under the Model Law, a personmust be found either incapable of makingan informed medical decision or to be adanger to himself, herself, or others. Eachof those conditions is a constitutionallysufficient ground to suspend anindividual's right to refuse treatment.Furthermore, the adverse ramifications ofany such finding are mitigated by theModel Law's specific prohibition againstan assisted treatment determination

impacting a person's legal rights andprivileges unrelated to the provision oftreatment.

Single standard: The Model Law hasthe same standard for the placement ofindividuals in both inpatient or outpatientcare. Some states have established distinctoutpatient and inpatient treatmentplacement standards. Because of thedifferent criteria, it is difficult in thesestates to transfer outpatients to inpatientstatus, and vice versa. A person whomeets a more permissive outpatientstandard may not meet the more stringentinpatient criteria. As a consequence, theConstitution's Due Process Clauserequires there to be a hearing to determinewhether an outpatient meets the morestrict standard before being transferred toinpatient status. Because the Model Lawhas a single standard, judicial approval isnot required to change a committee'streatment program. Nonetheless, theModel Law does provide safeguards thatensure that such transfers are appropriateand the least restrictive alternative that

SSeeingeeing

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DDouble??ouble??

IIf you are receivingf you are receivingmore than one copymore than one copy

of Catalyst and don'tof Catalyst and don'twant to, please let uswant to, please let usknow and we willknow and we willcorrect it.correct it.

CCall: all:

703-294-6001703-294-6001

EE-mail:-mail:

info@psychlaws.orginfo@psychlaws.org

will meet the patient's clinical needs.Psychiatric Treatment Board: Most

times, the decisions of whether or not toplace a person in treatment and, if so,what type of care is most appropriate areleft to a judge who has little experiencewith or understanding of mental illness.The Model Law's decision-maker is ajudicially-empowered panel made up of alawyer, a physician and a person who hasdemonstrated experience, eitherpersonally or through a close relative,with mental illness. The advantage ofhaving a tribunal with such a depth ofknowledge and variety of experience isobvious.

Treatment plans: Extensive servicesmay be included in an assisted treatmentorder providing for treatment on anoutpatient basis. A treatment plan ismandatory for a person being dischargedfrom assisted treatment.

PROVISIONS PROTECTING CON-SUMER AND FAMILY RIGHTS

Where the Model Law doessubstantially depart from existing statelaws is in enhancing the rights guaranteedto people with mental illness placed inassisted treatment and the rights of theirfamilies.

Family rights: Under the Model Law,relatives may, under certaincircumstances, become actual parties tothe assisted treatment proceeding, withthe right to have counsel, presentevidence, cross-examine witnesses, andappeal. When bringing a petition, familymembers are also eligible for theassistance of designated counsel.

Consumer rights: The Model Law hasan extensive number of protections forthose placed in assisted treatment.Subjects of assisted treatment petitionshave the rights delineated in most statelaws; i.e., to have designated counsel, topresent witnesses, to appeal, to not haveplacement in treatment otherwise affectone's legal status, etc. Additionally, theModel Law introduces two novelprocedures. Included is a formalgrievance procedure whereby patients canbring complaints to the facility's medicaldirector and, if necessary, to thePsychiatric Treatment Board. Perhapseven more significantly, the Model Lawcalls for the examination of a personplaced on inpatient assisted treatment for

medication side effects every thirty daysby a psychiatrist or physician other thanthe one treating him or her.[Mr. Stanley is Assistant Director of theCenter].

A Supreme Decision FromSouth DakotaBy Edith Barry

On June 21st the Supreme Court ofSouth Dakota upheld an appeals courtdecision ordering forced medication in thecase of Steinkruger v. Miller, 2000 WL815956 (S.D.), 2000 SD 83. The SupremeCourt found that the South Dakota statuteallowing involuntary treatment ofincompetent, involuntarily committedpatients (S.D. Codified Laws §27A-12-3)is constitutional, regardless of the fact thatit contains no explicit least restrictivealternative requirement. Statutorylanguage suggesting a least restrictivealternative requirement was deemed bythe Court sufficient to maintain thestatute's constitutionality.

DeWayne Miller is an involuntarypatient at the South Dakota HumanServices Center in Yankton, SouthDakota. His diagnoses have ranged fromschizophrenia to bipolar disorder. Heholds delusions that "he can read minds,that he is pregnant, that all medicationsare poison" and he believes that smokingwill cure his chronic obstructivepulmonary disease. The court recognizedthat Mr. Miller's disorder has impaired hisjudgment, that he lacks awareness of hisillness and therefore refuses medication.His treating physician determined thatpsychotropic medication is the leastrestrictive treatment available for hiscondition, and that the benefits of suchmedication would "substantially out-weigh" any side effects.

In South Dakota a court may orderforced treatment if it finds by "clear andconvincing evidence" that the patient isincapable of consenting because his or her"judgment is so affected by mental illnessthat the [patient] lacks the capacity tomake a competent, voluntary, andknowing decision" regarding medication.S.D. Codified Laws §27A-12-3.15.Psychotropic medication must be"essential," "medically beneficial" and"necessary" because the patient:

6

Catalyst July/August 2000

TREATMENT ADVOCACYCENTER HONORARY

ADVISORY COMMITTEEThe Committee is composed ofdistinguished individuals who aredevoted to improving the lives ofindividuals who suffer from severemental illnesses. Each individual hasmade his or her own contributions tofurthering that goal. We thank them fortheir work and for supporting ourmission.

HONORARY ADVISORY COMMITTEE

S. JAN BRAKEL, J.D.VICE PRESIDENT

ISAAC RAY CENTER, INC.CHICAGO, ILLINOIS

JOHN DAVIS, M.D.UNIVERSITY OF ILLINOIS

AT CHICAGO

HONORABLE PETE V. DOMENICIUNITED STATES SENATE

NEW MEXICO

LAURIE FLYNNEXECUTIVE DIRECTOR

NAMIARLINGTON, VIRGINIA

JEFFREY GELLER, M.D.UNIVERSITY OF MASSACHUSETTS

HONORABLE MARCY KAPTURHOUSE OF REPRESENTATIVES

OHIO

PROFESSOR KENNETH KRESS,J.D., PH.D

UNIVERSITY OF IOWACOLLEGE OF LAW

RICHARD LAMB, M.D.UNIVERSITY OF SOUTHERN CALIFORNIA

HONORABLE JIM MCDERMOTTHOUSE OF REPRESENTATIVES

WASHINGTON

HONORABLE LYNN RIVERSHOUSE OF REPRESENTATIVES

MICHIGAN

HONORABLE TED STRICKLANDHOUSE OF REPRESENTATIVES

Ohio(Supreme Court - page 10)

July/August 2000

7

Catalyst

outpatient services reduced the predictedprobability of violence by 50 percent.27

Progressive assisted treatment lawsmust be crafted to reflect the significantadvances that have been made in the lastdecade in our understanding and ability totreat severe mental illnesses. We nowknow that these conditions are treatablebiological brain diseases and not lifestylechoices, as was the prevailing thoughtthree decades ago. Research shows that atleast 40 percent of those diagnosed withschizophrenia and manic-depressiveillness lack insight into their illnessbecause of a biologically based symptomknown as anosognosia.28 A personsuffering from this symptom does notbelieve he or she is ill and is likely torefuse treatment reasoning, "Why should Itake medication if there is nothing wrongwith me?" For those who previouslyrefused treatment because of unpleasant ordangerous side-effects of medication, amuch broader array of medications is nowavailable so that possible adverse effectsof treatment can be more effectivelymitigated.

The Treatment Advocacy Center wasestablished in 1998 to eliminate barriers totreatment caused by outdated treatmentlaws. In drafting a Model Law that wouldmeet those goals, the Center solicitedadvice and assistance from individualswho are diagnosed with severe mentalillnesses, their families, and medical andlegal professionals. The Model Law wascarefully drafted to withstandconstitutional challenge. It is consistentwith the seminal United States SupremeCourt decision, O'Connor v. Donaldson,422 U.S.563 (1974) which Judge David L.Bazelon explained held that, "personsinstitutionalized solely because they are inneed of treatment are deprived of theirconstitutional right to liberty if they aredenied treatment while confined."

The Treatment Advocacy Center'sModel Law promotes the provision ofassisted treatment of severe mental illnessat every turn for those who need it, whilezealously guarding the rights of those whoreceive it. [Dr. Torrey is President and Ms.Zdanowicz is Executive Director of theCenter.]

Endnotes1Marc Abramson, The Criminalization of MentallyDisordered Behavior: Possible Side-Effect of a New

Mental Health Law, 4 Hospital & CommunityPsychiatry 101 (1972).2Herschel Hardin, Uncivil Liberties, Vancouver Sun,July 22, 1993.3Jennifer C. Bonovitz & Edward B. Guy, Impact ofRestrictive Civil Commitment Procedures on aPrison Psychiatric Service, 136 Am. J. Psychiatry1045 (1979).4Id. 5Abramson, Criminalization, supra note 1.6Donald A. Treffert, The MacArthur CoercionStudies: A Wisconsin Perspective, 82 Marquette LawReview 760 (1999).7Lance T. Izumi, et al., Pacific Research Institute,Corrections, Criminal Justice, and the Mentally Ill:Some Observations about Costs in California(September 1996). 8Paula Ditton, U.S. Department of Justice, MentalHealth and Treatment of Inmates and Probationers,Bureau of Justice Statistics Special Report (July1999).9Ford Fessenden, They Threaten, Seethe andUnhinge, Then Kill in Quantity. N.Y. Times, April 9,2000.10Id. 11Id.12E. Fuller Torrey, Out of the Shadows: ConfrontingAmerica's Mental Illness Crisis 73-74 (John Wiley &Sons 1997).13Id.; Elisabeth Bumiller, In Wake of Attack, GiulianiCracks Down on Homeless, N.Y. Times, November20,1999.14Steve Berry & Josh Meyer, Mistakes Seen in LAPDShootings of Mentally Ill, L.A. Times, November 7,1999.15Anthony Baez Foundation, et al., Stolen Lives,Killed by Law Enforcement (1999).16Disturbed Peace, Calling Police Should Not beDeath Sentence for Mentally Ill, The HoustonChronicle, October 5, 1999.17Police Look at Policy on Mentally Ill, St. PetersburgTimes, November 22, 1998.18R.C. Tessler and D.L. Dennis, National Institute of

Mental Health, A Synthesis of NIMH-FundedResearch Concerning Persons Who Are Homelessand Mentally Ill (1989); Interagency Council on theHomeless, Priority Home!: The Federal Plan toBreak the Cycle of Homelessness. (March 1994).19Torrey, Shadows, supra note 12, at 19.20S. Friedman & G. Harrison, Sexual Histories,Attitudes, and Behavior of Schizophrenic and"Normal" Women, 13 Archives of Sexual Behavior555 (1984), L.A. Goodman, et al., EpisodicallyHomeless Women with Serious Mental Illness:Prevalence of Physical and Sexual Assault, 65American Journal of Orthopsychiatry 468 (1995).21C. Caldwell and I. Gottesman, Schizophrenics KillThemselves Too: A Review of Risk Factors forSuicide, 16 Schizophrenia Bulletin 571 (1990), F.K.Goodwin & K.R. Jamison, Manic-Depressive Illness230 (Oxford University Press 1990).22Center on Crime, communities and Culture, MentalIllness in US Jails: Diverting the Non-violent, Low-level Offender (1996).23Virginia Hiday, et al., Criminal Victimization ofPersons with Severe Mental Illness, 50 PsychiatricServices 62 (1999).24Robert D. Miller, Need-for-Treatment Criteria forInvoluntary Civil Commitment: Impact in Practice,149 Am. J. Psychiatry 1380 (1992).25Marvin S. Swartz, et al., Can Involuntary OutpatientCommitment Reduce Hospital Recidivism?, 156 Am.J. Psychiatry, 1968 (1999).26Id.27Jeffrey W. Swanson, et al., Involuntary OutpatientCommitment and Reduction of Violent Behaviour inPersons with Severe Mental Illness, 176 British J.Psychiatry 224 (2000).28Xavier F. Amador, Awareness of Illness inSchizophrenia, 17 Schizophrenia Bulletin 113(1991); S.N. Ghaemi, Insight and PsychiatricDisorders: A Review of the Literature, with a Focuson its Clinical Relevance for Bipolar Disorder, 27Psychiatric Annals 782 (1997).

(Case for Model Law - from page 2)

NAMI Sacramento and Treatment Advocacy Center joint fundraising event at the Blue Diamond ReceptionCenter, Sacramento California. Pictured left to right: Dr. E. Fuller Torrey (Treatment Advocacy Center),Randall Hagar (NAMI Sacramento), Nancy Chavez (Legislative Consultant of Assemblywoman HelenThomson), and Judy Hansen (NAMI Sacramento, event co-chair).

8

Catalyst July/August 2000

first two years we were at theconvention."

Mary Zdanowicz noted that thisprovided one of the more comfortingaspects of the convention, "I finally hadan opportunity to meet so manywonderful people who I have developed arelationship with over the last two years."Jonathon Stanley and Rosanna Espositohad the same experience as supportersthat they had worked with over thetelephone or via e-mail came to the boothto introduce themselves.

The Center’s team also educated manyCalifornians about AB1800, the proposedLPS Reform law and its status in the statelegislature. Jonathon Stanley hadprepared packets with the latest update forpeople who had been following theprogress of the bill.

During the time prior to the Center-sponsored panels, cards were passed outwith the time and location of the sessions.Many people walked away with the cardsand while there is no way to tell, theadvance attention may have contributed tothe overwhelming turnout.

The most interesting aspect of thebooth was the opportunity to hearindividual stories firsthand. While thepersonal struggles can not all beconveyed, the idea that there are manypeople who appreciate the work theCenter is doing and need the movement tocontinue came across very clearly.

[Ms. Johanson is a legal intern withthe Center.]

And From OntarioGreat news from the North! Ontario

has enacted Brian's Law, a progressivelaw for assisted treatment.

On June 21, the province adopted apackage of reforms to its Mental HealthAct. Among these, it has added need-for-treatment criteria and communitytreatment orders, the Canadian version ofassisted outpatient treatment.

We are impressed by and evensomewhat envious of our Canadiancounterparts behind this victory for allthose denied treatment by unthinkinglaws. The measure steamed through theOntario Parliament by an astoundingmargin of 82-10.

The Treatment Advocacy Centersupplied informational and advisory helpto the proponents of Brian's Law, but cantake little credit for its passage. That goesentirely to the determined Ontarioadvocates behind the measure. We thankand congratulate them. They have savedlives.

The news of this grand success evokesthought that while the laws of countriesdiffer greatly, the problems caused byuntreated mental illness are international.One of Brian's Law's architects stated,"What it does is it allows us to provideearly intervention for people who are adanger to themselves or a danger toothers."

Sound familiar?

TAC Booth A HugeSuccessBy Anna-Lisa Johanson

The Treatment Advocacy Center setup a booth at the annual NAMIConvention in San Diego, California,June 14-17. The booth saw a steady andthick stream of interested attendeesthroughout the convention, includingCenter supporters stopping by to see whatwas new, people who had beenrecommended to the Center by a friend ora forwarded copy of Catalyst,, andnewcomers interested in finding out whatthe organization does.

The booth provided a large selectionof printed materials including copies ofCatalyst, a sign-up sheet for the mailinglist, copies of the Model Law and relatedpress release, as well as articles by Dr.Torrey and Mary Zdanowicz. There werealso copies of recent news media videosand the videotape of the conference atGeorge Washington Law School. It wasnoted that more people seemed to pauseat the booth when Dr. Torrey appeared onthe screen. The video presentation led toan unexpected number of peoplerequesting copies of other videos in theCenter’s collection to use in trainings andfor their own information. Since theconvention, additional orders for videoshave continued at a constant pace.

Several NAMI members, includingConsumer Counsel members, had heardof the Center and came to learn about theorganization firsthand. The vast majorityof consumers who came to the boothagreed with the mission of the Center andexpressed interest in learning more aboutthe Model Law. Additionally, some askedfor multiple copies of the new ModelLaw to send to other interested people intheir state. Many newcomers took sign-up sheets for Catalyst away with them,and approximately 60 people completedthe forms and left them at the table.

A number of NAMI librarians orleaders of local NAMI chapters came toorder additional materials for theirlibraries and members. A surprisingnumber of the NAMI members who cameto the table had either seen Catalyst orwere already receiving a copy throughsomeone in their organization. JonathonStanley noted that, "Knowledge of us andour issues has increased greatly over the

Ruth Posner, from New York, stops by the Treatment Advocacy Center’s booth at the NAMI Convention topick up materials and to speak with Jonathan Stanley and Anna-Lisa Johanson.

July/August 2000

9

Catalyst

We are 84 years of age now and haveseen illnesses of all kinds, but mentalillnesses are the worst! In many ways, thepublic still shuts the mentally ill up in anattic and pretends they don't exist.

... As soon as diagnosed the patientneeds to be in a controlled environment. Ifit is God's will, and we pray so, there willcome a day when a more permanent curewill be found. Meanwhile, please continueyour work and if possible send your recentissue to the list of people below. We aresorry we can do no more with financialhelp, but living on a fixed income does notallow many give-a-ways! We add ourprayers,

Blake and Lucy BeeArizona

Just a short note to convey myappreciation for the work you do. As youknow, I have been trying to piece togethera working understanding of the issuessurrounding mental illness. During thisongoing process, I have come to rely onthe Catalyst as one of the greatest sourcesof innovative ideas and compassionatecommentary on the subject.

Please convey to all associated withthe publication the respects of aninterested third party, who like so many, istrying to understand why we can't do morefor those who are mentally ill and livingon the streets.

Robert L.E. Egger, DirectorDC Central Kitchen, Washington, DC

Please let me know why the "PreventableTragedies" link and database on your TAC Website is not in operation. That database was myfavorite link for information and references onyour Web site. Maxine Hayden

[Editor’s note: The “Preventable Tragedies”database was apparently not operable, but it isnow fixed. Please try it again.]

When my son was twice hospitalized (bothtimes under the Baker Act), he was twicereminded of his option as an "adult" of the"right to refuse treatment." When I heard this Ialmost flipped out! How could any person,organization or government agency have theaudacity to tell a mentally ill person under aBaker Act involuntary commitment to receivetreatment that, "HE HAD THE RIGHTTO REFUSE TREATMENT"? Does this

make any sense?This has got to change! Because of this

"right," my son's recuperation fromschizophrenia is going on three years andhe still sometimes denies or wonders if hereally has the mental illness. Imagine ifpublic stigma is hard to fight, how hard itis to educate the mentally ill!

I was fortunate to attend the NAMI2000 Conference in San Diego this pastJune 14-18 (thanks to Circles of Care whohelped with the expenses), and one of thepresentations that really interested me wasthe "What Is It Like To Be Sick and NotKnow It?" symposium. The room was sofull of people that there was no room towalk. I guess they expected a smallercrowd, but people just kept crowding in onthe floor, against the walls, on top oftables, by the stage of panelists, etc. I wasvery glad to see this turnout; perhaps onthe next Conference for 2001 (WashingtonDC), they will get the message and have astronger voice (and bigger room) toeducate family members and consumersalike. Vice President Fred Frese, a Doctorof Psychology, who had been hospitalizednumerous times, gave a very strongpresentation and viewpoint, and therewere other speaker panelists.

If anybody is interested in someliterature I brought back with me,including a copy of "I am not Sick, I don'tneed help!" reprint by Xavier Amador,please send me your mailing address and Iwill gladly forward it to you.

My appreciation goes to Rachel Diazof NAMI-Miami for taking this subjectvery personally and for having so muchinterest. Rachel has been advocating aboutthis subject for a while now. Don't give up,Rachel, your voice is getting stronger! Youhave our support!

Lou Iparraguirre, VPNAMI-South Brevard County FL

961 Golden Beach BoulevardIndian Harbor Beach, FL 32937

WadeBy JoLynn Woodland

I can still remember the day they cameand took him away. I was five years oldwhen the police came and arrested mybrother. Wade was 20 years old andheaded to prison. I remember my momsending my brother, John, and I out to rideour bikes when the police came. I did not

understand at the time why my brotherwould not be living with us anymore. I didnot believe the stories I was being told ofall the bad things he had done. I justwanted my brother to be there when I gothome from kindergarten like he hadalways been that year. He would take mefor a motorcycle ride before we sat downto have lunch and watch TV.

I can remember our trips to the IdahoState Penitentiary. We would go up onSaturday or Sunday afternoon. We had togo through a metal detector and we had tobe very quiet. John and I once got introuble for running in the halls. We had togo through big metal doors with a bigsecurity guard. We met with Wade in a bigopen room with about eight or nine tables.We would sit and talk with him and playboard games. I watched as we went to seehim and his personality slowly changed.His hands began to shake and it was hardto have a conversation with him. Wadespent nine years in prison.

I wanted more than anything for Wadeto get out of prison, and when I found outhe was being paroled I was glad, but I wasalso scared. I had thought for so long thatwhen he got out of prison he would be thesame person that he had been when he leftour home. Then when my parents told methat he was mentally ill and that he wouldnever be the same again I was worried. Ihad heard a lot about mentally ill people,much of it was not true, and I was scaredto be alone with him.

All the time Wade was in prison Ididn't want anyone to know he was there.I didn't want them to judge me or make mefeel like a bad person because of what mybrother had done. I wanted to have aperfect family just like the rest of myprimary class. So I put Wade and thecircumstance of his life in the back of mymind and I didn't deal with them. I tried toforget him the best I could, because it waseasier that way. The last few years thatWade was in prison I did not go and visithim very often. By this time I had madeWade something in the back of my mindthat didn't really exist. And, whenever myfamily talked about him, I would alwaysfeel sorry for myself and wish that I had abetter life. So I would just put the memoryaway again and not think about it, becauseit hurt.

Wade was paroled in 1996 and he wentto live in a shelter home in Blackfoot. He

(Your Voice - from page 3)

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Catalyst July/August 2000

THE FOLLOWING MEMORIALS AND TRIBUTES WERE RECEIVED BY TREATMENT ADVOCACY CENTER IN MAY/JUNE 2000.PLEASE ACCEPT OUR DEEP APPRECIATION FOR CHOOSING OUR MISSION TO SUPPORT IN MEMORY OR IN HONOR OF SOMEONEVERY SPECIAL TO YOU. . . .GOVERNING BOARD AND STAFF.

RECEIVED FROM CITY AND STATE IN MEMORY OF IN HONOR OF

JANICE & JOHN DELOOF FULLERTON, CALIFORNIA BRADLEY JOHN DELOOFDJ & ROSE JAFFE NEW YORK, NEW YORK ENGAGEMENT OF TALI GROS

& JON STANLEYBETTY HOOPER DOUBLE SPRINGS, ALABAMA VIRGIL DAVISAL & JOAN BEZNER SPRING HILL, FLORIDA SCOTT HARDMANMARY M. MAY NEW SMYRNA BEACH, FLORIDA NANCY ELIZABETH MAYBOBBY B. WAHRENBURG CHESAPEAKE, VIRGINIA ERNEST CRAWFORD &

SAMUEL E. BEALEBLAKE & LUCY BEE SUN CITY WEST, ARIZONA KENNETH SCOTT HARDMANEILEEN RORICK ORANGE SPRINGS, FLORIDA MICHAEL RORICKMELVIN R. SILVERMAN NEW CITY, NEW YORK DR. HOWARD TELSONDJ JAFFE NEW YORK, NEW YORK OLIVIADJ JAFFE NEW YORK, NEW YORK NADINE, HENRY &

CHARLES STEVENSMARY ZDANOWICZ ARLINGTON, VIRGINIA MILDRED BOYD

would come home on the holidays buthe was so different. He was still the kind,loving person he had always been, but hewas just different. He would havecomplete conversations with himself. Hesmoked cigarettes non-stop. He had nodesire to do anything besides watch TV. Itwas hard to even have a conversation withhim. He is mentally ill and the voices inhis head tell him to do bad things. While athis shelter home the voices in Wade's headgot so bad that they scared him, causinghim to break parole, so now he is backwhere he started-in prison. He does notbelong there, but there is nothing we cando to get him back to a shelter home wherehe belongs.

There is hardly a day now that goes bythat I do not think about Wade. I pray forhim, that he might be taken care of. I cryfor him. There are times when things getbad that I still wonder why I could not belike everyone around me. Their familiesseem so perfect. I often wonder if the hurtI feel now would be easier to deal with if Ihad dealt with it all along instead of tryingto hide from it. There are things in ourlives that no matter how hard they are wemust deal with them. My brother Wade isone of the things in my life that I cannotrun away and hide from, hoping that if Idon't deal with it that it will just go away.It is never going to go away and I must

deal with it. I can't hide from it any more.I am still scared to tell my friends andothers that I have a brother in prison, but Itell myself that if they are my real friendsthey will not think of me any differentlybecause my brother is in prison. I am notresponsible for the things that my brotherdid, and I do not need to feel guilty orashamed for the mistakes he made. Butsometimes I still do. Some people mayjudge me and think that I am a bad person,but I think more than others thinking thatabout me I think that about myself. I amprobably a lot harder on myself thananyone would ever be, and I alwaysimagine the worst. I am just so scared ofwhat people might think of me. I loveWade and I am not ashamed of him. Hemade some mistakes, but he is mentally illand he was when he messed up, and thatdoes not make him a bad person. I amgoing to do everything that I can to helphim, even though probably the only thingI can do is pray for him. And as much as Iwant to be able to deal with this head on, Istill find myself not thinking about it toomuch because the hurt is too hard tohandle.[Editor’s note: This story was written byJoLynn Woodland for a senior year Englishclass project. Marsha Parks, President,NAMI Magic Valley, Idaho, submitted it tous, believing that this poignant

remembrance of a young sister’s sufferingwould touch the hearts of us all and perhapsmove us to action.]

(1) "presents a danger to himself orothers;" (2) "cannot improve or hiscondition may deteriorate without themedication;" or (3) "may improve withoutthe medication but only at significantlyslower rate." S.D. Codified Laws §27A-12-3.13, 12-3.15.

Mr. Miller's attorneys argued thattreatment refusal statute violatessubstantive due process because it doesnot specifically require that the treatmentbe the least restrictive alternative.However, because the statute requires thatforced medication be "essential," theCourt held that this language amounts to aleast restrictive alternative requirement.The Court also found that there was notreatment available for Miller that wouldbe any less intrusive. Miller had refused toparticipate in the local outpatientcommunity program IMPACT(Individualized and Mobile Program ofAssertive Community Treatment).

The Court also recognized that, "SouthDakota has a strong parens patriae interestin caring for mentally ill persons andpsychotropics retain a vital place in mentalhealth treatment. It would be cruel

(Supreme Court - from page 6)

July/August 2000

11

Catalystforbearance to allow incompetents toreject senselessly the medicine necessaryto restore their mental health."

The case is significant beyond theobvious implications of validating theconstitutionality of South Dakota's law. Itis evidence that courts are becoming muchmore sophisticated in applying thescientific advances in our understandingof severe mental illnesses to concepts inthe law. The correlation between "lack ofinsight caused by illness" and the legalconcept of "incapacity to make aninformed medical decision" is drawn inthis case. The court's recognition of theState's parens patriae interest and the"cruel forbearance" not to care for those inneed are particularly significant and asource of hope that the law is beginning toacknowledge the need for treatment.

[Ms. Barry is a legal intern at theCenter.]

Other State UpdatesCALIFORNIA

AB1800, Assemblywoman HelenThomson's progressive legislation toreform the treatment restrictiveLanterman-Petris-Short Act, has been on aroller coaster. Riding with it have been thehopes for rational treatment laws, as wellas the enormous efforts, of the members ofthe California Treatment AdvocacyCoalition ("CTAC").

On May 24 there was victory. TheAssembly Appropriations Committeeunanimously voted AB1800 to thathouse's floor. But at the same time therewas defeat, the committee cut the $350million funding request thatAssemblywoman Thomson had made partof her bill.

However, this year's California budgetnegotiations made the loss of theallocation far less significant than it couldhave been. Those involved in the budgetnegotiations planned on coming to a totalfigure for increased mental healthspending. Thus, unlike last year withKendra's Law in New York, fundingdesignated for AB1800 would not increasethe total amount spent on mental health bythe state.

On May 31, AB1800 blazed throughthe full Assembly. Despite the late hourand being inundated with bills stacked up

in the face of a legislative deadline, theentire Assembly devoted over half an hourto the bill-as much time as any legislationreceived all day. AB1800 passed 53-16, 77percent of those voting favored rationaltreatment laws and two-thirds of the totalAssembly supported the bill. This life-saving legislation seemed on the path tothe Governor's desk.

But then came Senator John Burton,the Senate's President Pro Tem, majorityleader, and most powerful legislator.

Perhaps it is the jerk of a civillibertarian knee in an inappropriatedirection, but Senator Burton hasimprisoned AB1800. The normal processis for a bill approved by the Assembly togo to a policy committee for a publichearing and the possibility of a vote on theSenate floor. Senator Burton has had hisRules Committee assign AB1800 directlyto a study committee from which it cannotemerge without the Senator's permission.He is trying to stop the representatives ofthe people from considering thisprogressive measure—no consideration,no debate, no chance of a vote.

More mystifying than Senator Burton'sopposition to AB1800, is why he wouldtry to keep from the Senate a bill that hassuch wide and deep support. NumerousCalifornian newspapers and publicofficials as well as major civic andprofessional organizations throughout thestate have endorsed the bill. Even SanFrancisco Mayor Willie Brown hasenthusiastically backed this life-givinglegislation. But this vital proposal is nowthreatened with a most undemocratic end.

But even if this year's campaign endswhere it now stands, it will have been asuccess. The Assembly is now familiarwith the need to reform LPS, almost all thenewspapers have endorsed it, and CTAChas gone from nothing to hundreds unitedin the fight for treatment. The members ofCTAC and NAMI California areattempting to educate Senator Burton, toconvince him to loosen his grip onAB1800. Believing him sincere butmisinformed, we hope he can be made tounderstand that to wait will harmthousands. But even should he remainunmoved, John Burton's procedural ploywill only prolong what we now know isinevitable. The flood of compassionatereform in California can be held back onlyso long.

CONNECTICUT

Tuck away this year's experience inConnecticut for future reference. Just overa year ago, a person overcome by, and whohad a history of non-treatment for, mentalillness killed Reverend Robert Lysz nearHartford. In response, RepresentativeRoger B. Michele introduced legislationthat would allow for assisted outpatienttreatment (AOT) in Connecticut, one ofonly nine states without it. Rep. Michelefought valiantly for his bill, and ultimatelya "Father Lysz's Law" became law. It wasnot, however, AOT that Rep. Michelegained for Connecticut.

The new law will establish a pilotprogram offering intensive communitysupport and peer-engagement specialiststo individuals who have threatened to beor been violent in the last five years. Thissounds similar to a Kendra's Law typeprogram. And it is, except participation inthe Connecticut version will becompletely voluntary-a compromise madeduring the legislative process.

Yet, it is those incapable of makingrational treatment decisions, unaware thatthey are ill, or incapable of maintainingparticipation in outpatient treatment thatAOT is designed to help. For peoplewilling to voluntarily select an intensiveoutpatient program, AOT is, most likely,unnecessary.

We are heartened that the new programwill enhance Connecticut's voluntaryservices in a portion of the state.Hopefully, it will become a model for theinfrastructure of a future AOT program.We also hope that it is, if proven effective,expanded statewide. At the same time wesee that Connecticut's provisions for theassisted treatment of those most in need ofhelp are unchanged. And we note that thelaw named in honor of Robert Lysz, wouldnot have, if in effect at the time, saved hislife.

Rep. Michele is undeterred by havingto weaken the content of his legislation topass through potentially fatal proceduralroadblocks thrown in its path. He hassworn to come back again next year, thenext, and the next,-as long as it takes tosecure rational treatment laws forConnecticut. And when he returns, theTreatment Advocacy Center will standwith him.

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