Albuquerque Health Care For The Homeless feels compelled to respond to Brian Stettin of the Treatment Advocacy Center’s recent op-ed urging “Kendra’s Law.” Given that Health Care For The Homeless serves people experiencing homelessness, many with mental illness, we are deeply concerned about misinformation provided by the center and upon which many mandatory community treatment proposals are based.
Our greatest concern is that this community takes the opportunity to do what works using the best information available. Our greatest fear is that action and allocation of resources based on measures that are not informed by evidence will not only create a false sense of security, but also will do so at the expense of the rights of some of our most vulnerable neighbors.
For instance, the Treatment Advocacy Center ignores Department of Justice findings that the Albuquerque Police Department is “using force that is unnecessary and unreasonable against individuals who pose little, if any, threat, or who offer minimal resistance … [including those with] mental illness, physical disabilities, intoxication and other incapacity.”
The need to impose extremes on people struggling with mental illness in Albuquerque is not even established.
And the center implies that New York’s Assisted Outpatient Treatment law and experience are generally applicable to other states that use it; this is woefully misleading.
A 2009 study by national experts (Swartz, et al) states “[t]he introduction of New York’s AOT Program was accompanied by a significant infusion of new services dollars and currently features more comprehensive implementation, infrastructure and oversight of the AOT process than any other comparable program in the United States … because New York’s program design is unique, these evaluation findings may not generalize to other states, especially where new service dollars are not available.”
About 70 percent of assisted outpatient treatment cases are concentrated in New York City, with over 8.3 million people. New Mexico’s population is just over 2 million in the sixth most sparsely populated state in the United States, with an underfunded service system already stretched thin – and not comparable. It is disingenuous to say that “in the states that have such laws and use them, the results are impressive,” as does the Treatment Advocacy Center, without offering further evidence.
The center doesn’t go the next step to address how an inadequate system, not structured or funded for the purpose of assisted outpatient treatment, could “hold the treatment system responsible for careful monitoring of the person and for delivering the services outlined in the court-approved plan.”
Who would do that in New Mexico? Who will pay for it?
Albuquerque Health Care For The Homeless believes behavioral health care begins with housing as a necessary component of an integrated community system that connects individuals to an array of voluntary resources in a non-judgmental manner. This includes outreach, crisis intervention, permanent housing, transitional living services, case management, peer supports, assistance in getting identification and public benefits, and medication-assisted therapy when – and only for as long as – it is deemed necessary.
These are all evidence-based practices that are unfortunately too few here. Building an effective health care infrastructure is where our emphasis ought to be, not in passing a law that diverts resources, disrupts civil liberties and will have no certain long-term benefits for New Mexicans.
Moreover, New Mexico should suspend, rather than terminate, Medicaid benefits when someone is in jail. This will enable quick reinstatement upon release and facilitate timely connection to Medicaid-funded behavioral health services, eliminating the revolving door from jail to the streets and back to jail again.
Our state should continue its work to develop these kinds of strategies and tools. We believe the community can step in to assist a person in mental illness crisis, as in any other medical crisis. That is our way forward.
Jennifer L. Metzler is executive director and Jay Crowe is behavioral health program manager at Albuquerque Health Care For The Homeless, Inc.