Feb 01, 2006 03:00 AM

Strong Medicine

A Doctor’s Fight: More Forced Care For the Mentally Ill

Torrey’s Push for State Laws Sparks Growing Debate Over Rights of Patients

Mr. Hadd Goes Underground

Every other week, Jeff Demann drives to a clinic in rural Michigan, drops his pants and gets a shot of an antipsychotic drug that he says makes him sick.

“If I don’t show up, the cops show up at my door and I wind up in a mental ward,” says the unemployed 44-year-old, who lives on disability in Holland, Mich.

Mr. Demann’s routine reflects a national trend toward forcing people with psychotic tendencies to get treatment — even if they haven’t committed violent acts. Driving the trend are E. Fuller Torrey, a 68-year-old maverick psychiatrist who believes the laws help prevent crime, and memorabilia mogul Ted Stanley, who has contributed millions of dollars to the cause.

Dr. Torrey keeps an online database with hundreds of grisly anecdotes about mentally ill people who killed the innocent. They include a jobless drifter who pushed an aspiring screenwriter in front of a subway train and a farmer who shot a 19-year-old receptionist to death. Influenced by such stories, Michigan, New York, Florida and California are among the states that have toughened their mental-health treatment laws since 1998, when Dr. Torrey formed the Treatment Advocacy Center to lobby for forced care.

The laws have become the subject of a heated debate among mental-health specialists, with some seeing a threat to civil rights. “There should be a high standard before you take someone else’s liberty,” says Tammy Seltzer, senior staff attorney for the Bazelon Center for Mental Health Law, a Florida nonprofit group that has fought the Treatment Advocacy Center in statehouses nationwide. Others say the connection between mental illness and violence isn’t as well-established as Dr. Torrey’s anecdotes imply.

Mary Zdanowicz, executive director of Dr. Torrey’s center, retorts that such opponents “want to preserve a person’s right to be psychotic.”

It has long been common for states to compel people to undergo psychiatric evaluation after they have committed acts of violence. If mental illness is confirmed, they are likely to end up in the psychiatric ward of a prison or hospital.

Dr. Torrey was a key adviser to the National Alliance on Mental Illness when it began lobbying in the early 1980s for laws that would permit states to impose treatment on people even if they hadn’t done something violent. The number of states to adopt such laws has jumped from 25 in 1998 — when Dr. Torrey and Mr. Stanley created their own, more aggressive organization — to 42 currently. Those targeted by the laws usually are people picked up for behaving strangely in public, threatening family members, or refusing to take prescribed medication after being released from a psychiatric ward.

The laws are enforced haphazardly, sometimes because of inadequate funding or opposition from mental-health activists. Implementation varies not just from state to state, but from county to county and judge to judge. Many mental-health departments already are overburdened with existing patients and have little interest in pushing police to round up more people to throw into the system.

It isn’t clear whether the laws have led to an increase in the number of people receiving forced care. Roughly 250,000 people in 1997 who weren’t institutionalized or jailed were forcibly evaluated, monitored and sometimes medicated, according to federal statistics. Federal health officials have begun a six-month study to update that figure.

California passed a forced-treatment law in 2003 after Dr. Torrey’s group pushed for it but has yet to use it on anyone. Researchers say only about eight to 10 states frequently use their laws. Still, it is clear that Dr. Torrey’s movement marks a shift in how the U.S. treats the mentally ill.

Beginning in the 1950s, the emergence of behavior-stabilizing medications helped spur a 40-year movement to shut down huge asylums and free their inhabitants. Emptying institutions was supposed to be accompanied by the creation of community-based mental-health programs, treatment centers, and housing and job opportunities.

But local programs didn’t have the money, political will or expertise to handle the deluge. The result was a flood of mentally ill people on the streets and in jails.

In recent years, governments have spent more on community-based programs and a raft of new antipsychotic drugs have come on the market. Still, many mentally ill go without care, either because there isn’t a program to treat them or because they don’t want help.

Dr. Torrey, whose sister suffers from schizophrenia, was working as a psychiatrist at St. Elizabeth’s Hospital in Washington, D.C., in the 1970s when the district enacted one of the earliest involuntary outpatient programs. Before the law, patients were discharged dozens of times with medication, which they quickly threw away, Dr. Torrey says. With the law, he says, “we would have guys come in for an injection.”

The author of 15 books and hundreds of papers, Dr. Torrey was an assistant to the director for the National Institute of Mental Health and worked at a mental-health clinic for the homeless for 15 years. He is well-known in psychiatry for his iconoclastic views on a range of subjects. He has theorized that schizophrenia is an infectious disease triggered by environmental factors.

One of Dr. Torrey’s books on schizophrenia caught the eye of a wealthy businessman, Ted Stanley, whose son, Jonathan, became delusional during college and later was diagnosed with bipolar disease.

Jonathan Stanley says he accosted people on the street and believed he was being trailed by Naval Intelligence. He says he was arrested when he stood naked atop a milk crate in a Manhattan diner, trying to avoid the lethal radiation he thought was bombarding him from a satellite dish across the street.

The elder Mr. Stanley contacted Dr. Torrey in 1989 and ultimately opened his checkbook to create the Stanley Medical Research Institute in Bethesda, Md. “He said he’d like to help,” Dr. Torrey recalls. “He said: ‘We thought we would start with a million dollars — a year.’ “

Mr. Stanley, 74, runs MBI Inc., a Connecticut seller of collectible and commemorative books, coins, figurines and other memorabilia. Its units include the Danbury Mint. Since the 1980s, Mr. Stanley says he has donated nearly $300 million — including about $35 million in 2005 — to Dr. Torrey’s efforts, the bulk of it for research at universities and start-up drug companies.

Targeting State Laws

In 1998, Dr. Torrey and the Stanleys decided to target state laws that they believed had gone too far in guaranteeing rights for the mentally unstable. They founded the Treatment Advocacy Center in Arlington, Va. Mr. Stanley and his wife, Vada, support it with about $600,000 a year. In many states, the center and its allies try to put a face on a proposed law and link it to a grieving family.

Dr. Torrey says the laws are aimed at a minority of mentally ill who refuse to take medication. Some believe they aren’t sick at all. Others agree they have problems but believe the downside of taking drugs outweighs the benefit because the drugs can have serious mental and physical side effects. Dr. Torrey says failing to control psychotic tendencies can be dangerous. “I catch heat for linking violence with mental illness. This is about as politically incorrect as you can get,” he says at his office in Bethesda.

The center soon zeroed in on New York. Some mental-health professionals had been lobbying unsuccessfully for a decade to enact a forced-treatment law. Then came the death of Kendra Webdale, a 32-year-old receptionist and aspiring screenwriter.

On Jan. 3, 1999, Andrew Goldstein, a jobless college dropout, pushed Ms. Webdale in front of a Manhattan subway train. The 29-year-old Mr. Goldstein, who had a history of schizophrenia and violent assaults, blamed his illness and failure to get medication. Amid a public uproar, New York Attorney General Eliot Spitzer contacted the Treatment Advocacy Center for help in drafting a response.

Less than a month later, Mr. Spitzer announced his support for “Kendra’s Law.” The law allowed the state to force outpatient treatment on people if they were judged a potential danger to themselves or others. At a news conference, the attorney general introduced a man who had come to grips with his illness and his denial of it, received treatment and gone back to school. He now was a lawyer for the Treatment Advocacy Center.

“I am Jonathan Stanley and I’m one of the people this law was designed to help,” the younger Mr. Stanley said.

Seven months after the slaying the New York state legislature passed “Kendra’s Law,” allocating $52 million to finance it. In a nod to opponents, the law was subject for renewal in five years.

From 1999 to 2004, more than 10,000 people were investigated for acting strangely, most of them in New York City, with nearly 4,000 forced into outpatient treatment.

Sharp Differences

When New York’s law was up for renewal last year, there were sharp differences over whether it was a success. A state report said the law led to a drop in homelessness and arrests among those receiving forced treatment. John A. Gresham of New York Lawyers for the Public Interest says the law was applied unfairly, with a disproportionate number of African-Americans forced into care.

As they have elsewhere, opponents said the money would be better spent on those who are seeking care, not refusing it. New York state lawmakers extended “Kendra’s Law” for another five years.

In Michigan, Dr. Torrey’s group enlisted the aid of the parents of 24-year-old Kevin Heisinger, a college student beaten to death in 2000 at a Kalamazoo bus station by a Vietnam veteran with a history of schizophrenia. A year later a proposed “Kevin’s Law” was unveiled.

In Florida, the group teamed with the Seminole County sheriff after a plumber who was diagnosed as mentally ill wounded two deputies in 1998 and shot another to death. They quickly won the lobbying clout of the Florida Sheriff’s Association.

In California, a law backed by the Treatment Advocacy Center passed the Assembly in 2000 but was rejected by the Senate. Then on Jan. 10, 2001, a deranged catfish farmer went on a rampage in a small Northern California town, killing three people and igniting public outrage. Backers reintroduced the legislation as “Laura’s Law,” after 19-year-old Laura Wilcox, the youngest of the victims.

“We added a face to this issue and we may have been instrumental in getting it passed,” says Laura’s father, Nick Wilcox.

California lawmakers hired Rand Corp. to study pre-emptive outpatient treatment in other places. The research group said there was little evidence the idea worked, although the reasons varied. In some cases laws weren’t enforced. Rand also said some mental-health facilities saw the laws mainly as a liability shield rather than as a therapeutic tool. By signing up a mentally ill person for forced care after discharge, the facilities could protect themselves against lawsuits by anyone the ill person might injure.

Ultimately, California in 2003 passed “Laura’s Law.” But the nation’s largest state allocated no money and forbade counties from shifting resources from other mental-health programs. The law has yet to be used. In 2004, California voters approved a 1% tax on people with incomes of at least $1 million to be used for mental-health programs, and Dr. Torrey’s group wants to see some of that go for Laura’s Law.

Michigan and Florida experienced similar battles. Their laws didn’t go into effect until last year. Florida has only had about a dozen cases of involuntary outpatient commitments, says John Petrila, chairman of the Department of Mental Health Law & Policy at the Florida Mental Health Institute.

Still, the laws are having an effect on some people. Gabriel Hadd, a 26-year-old unemployed musician from Saginaw, Mich., was diagnosed as schizophrenic. He says he has been repeatedly forced to take drugs he believes do more harm than good.

Mr. Hadd spent part of the past year hiding out in the home of a Colorado woman who is part of an underground network of mentally ill activists. The program was set up in late 2004 by MindFreedom International, an Oregon organization of 10,000 mentally ill people that opposes coerced drug treatment.

Mr. Hadd says his mother falsely accused him of threatening to commit a violent crime. She couldn’t be located for comment. “They can accuse you of all sorts of things,” Mr. Hadd says. “I was in a courtroom, drooling and twitching from the drugs.” He recently slipped back in Michigan and says he is trying to maintain a low profile.

T.J. Bucholz, a spokesman for Michigan’s Department of Community Health, says data on the program’s use aren’t available yet but anecdotally counties and judges seem to be using it sparingly. “The law has not been used maybe as much as we anticipated,” he says.

Mr. Demann, the 44-year-old Holland, Mich., man, says he has been in and out of institutions since 1987. That is when he was diagnosed as schizophrenic after he broke up with his girlfriend and accidentally overdosed on her antianxiety pills, he says.

Branded as suicidal yet constantly refusing medication, Mr. Demann says mental-health authorities are forcing him to take a drug, Risperdal, that he says causes him to be moody, angry, restless and depressed. The U.S. Food and Drug Administration in 2004 found that Risperdal and some other antipsychotic drugs can increase the incidence of diabetes. Mr. Demann agrees he needs therapy but doesn’t want drugs.

“I don’t believe in putting this stuff into my body,” Mr. Demann says. “It’s time for the system to let me go.”

Write to Mark Fritz at mark.fritz@wsj.com

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WSJ ARTICLE CORRECTION: MindFreedom is open to everyone, though a majority of our members and board are people who have experienced the psychiatric system. It is false to refer to all our members as “mentally ill.” MindFreedom is asking WSJ for a public correction.