We applaud the work of NAMI Westchester, as our work at Littman Krooks LLP is aligned to their mission in helping individuals with mental health concerns.
Here are some of the reasons we sponsor NAMI Westchester’s annual walk:
NAMI Westchester works to end the pervasive stigma that society perpetuates toward individuals with mental health disorders. Both NAMI Westchester and Littman Krooks believe that individuals who have mental health challenges can lead fulfilling lives. We work to help families ensure that their loved ones have the right legal protections, services and public benefits, educational and community services.
Through their outreach programs, NAMI Westchester educates the community mental health and suicide prevention. I volunteer in the Ending the Silence program as I feel this work is critical in Westchester due to the alarming suicide rate.
We applaud NAMI Westchester’s commitment to build a community of hope through their HelpLine, support groups and educational classes, which helps families create support systems. At Littman Krooks, we work to help families navigate services and to obtain appropriate public benefits, and we advocate for changes in legislation.
The people who volunteer with NAMI Westchester are hopeful, bright and sensitive and we love being a partner and supporting this work. So many of these volunteers share their dedication on walk day that the feeling is truly inspirational.
Littman Krooks is honored to sponsor NAMIWalks Westchester and we look forward to working together this year and beyond, toward improving the quality of life for all individuals and families whose lives are affected by mental illness. I will be under the sponsor tent on walk day, and hope you will sponsor as well.
Mental Illness Awareness Week begins this week. Mental illness can have devastating consequences. For example, suicide is the third leading cause of death among young people and is often the result of mental health conditions that affect people when they are most vulnerable. Suicidal thoughts can affect anyone regardless of age, gender, or background and often signs go unnoticed. In order to help prevent suicide, one must understand the tools available to help those who may suffer from mental illness.
Teenage suicide in the United States remains comparatively high in the 15 to 24 age group with 4,000 suicides in this age range in 2004, making it the third leading cause of death for those aged 15 to 24. In 1999, the suicide rate among adults between the ages of 35 and 64 was 13.7 deaths per 100,000 Americans. By 2010, that rate climbed more than 28 percent to 17.6 suicide deaths per 100,000 people.
If you believe a friend or loved one may be suffering from mental health issues, do not ignore the problem. One can learn effective ways to talk to a person suffering from mental illness or depression and one can talk about suicide without increasing the risk of harm. Family members or friends can and must help.
New York State law provides certain means to protect individuals, even where outreach, therapy, medication and other less restrictive attempts to help have been unsuccessful. Similar laws exist in other states. This article outlines two important legal tools available in New York:
Kendra’s Law
In 1999, several incidents occurred in New York City in which individuals with untreated mental illness became violent and caused severe harm or death to others. Two particular events took place in the city subway system. In one incident, Andrew Goldstein, a 29-year-old man diagnosed with schizophrenia, pushed Kendra Webdale in front of an oncoming N train to her death. Subsequently, Julio Perez, a 43-year-old man with mental illness, pushed Edgar Rivera in front of an uptown 6 train causing the loss of his legs. Both Goldstein and Perez had been discharged by psychiatric facilities with little or no medication.
Kendra’s Law, Section 9.60 of the NYS Mental Health Law, provides a life-saving tool for families, as it can compel an individual to undergo psychiatric treatment. Enacted in 1999, the law honors Kendra Webdale and was originally proposed by the National Alliance on Mental Illness (NAMI). It grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Failure to comply could result in commitment for up to 72 hours. Kendra’s Law cannot require that a patient take medication against his or her will.
Kendra’s Law intended to create a legal procedure for certain persons, such as family members or friends of mentally ill persons, to petition the court to order alleged seriously mentally ill individuals to accept treatment as a condition for living in the community prior to their becoming “dangerous to self or others.” The legislators agreed that the law should work to prevent violence, not require it. Outpatient commitment represents a less expensive, less restrictive and more humane alternative to inpatient commitment, which requires a person to become a danger to self or others.
A person, 18 years of age or older, who meets one of eight criteria, may petition a court for assisted outpatient treatment for an allegedly mentally ill person. The allegedly mentally ill person must be at least 18 years old, suffering from a mental illness and unlikely to survive safely in the community without supervision, based on a clinical determination. The law contains seven defined criteria the court will consider based on a clear and convincing evidence standard.
If the court finds by clear and convincing evidence that the subject of the petition meets the criteria, and a written treatment plan has been filed, the court may order the subject to receive assisted outpatient treatment.
Involuntary Commitment
Involuntary commitment represents a more restrictive legal course of action to help an allegedly mentally ill person. A family member or friend, or another person who meets one of eleven categories, may request the involuntary commitment of an alleged mentally ill person.
Pursuant to New York State Mental Hygiene Law section 9.27, an alleged mentally ill person may be involuntarily committed to a mental health facility if:
two physicians agree and present certifications that the person has a mental illness for which care and treatment in a mental hospital is essential to his or her welfare,
the person’s judgment is too impaired for him or her to understand the need for such care and treatment, or,
as a result of his or her mental illness, the person poses a substantial threat of harm to self or others. “Substantial threat of harm” may encompass (i) the person’s refusal or inability to meet his or her essential need for food, shelter, clothing or health care, or (ii) the person’s history of dangerous conduct associated with noncompliance with mental health treatment programs.
Peace officers, police officers, or an ambulance service may transport the person alleged to have a mental illness at the examining doctor’s request.
Upon arrival at a mental health facility, a staff psychiatrist of any hospital, other than one of the two original certifying doctors, must examine and confirm that the person meets the involuntary standard. The patient may be held involuntarily for up to 60 days. The patient may be held involuntarily beyond 60 days if the hospital applies for a court order of retention and the court is satisfied the patient continues to meet the Involuntary Standard.
Our society needs more resources and understanding to help those facing mental illness. Individuals and organizations should advocate to the government to provide more accessible and available mental health and counseling services for persons with mental illness. Should treatment, therapy and other less restrictive interventions fail to help an allegedly mentally ill person, loved ones must know that laws exist to allow them to take action to help. Individuals should seek the help of an experienced attorney for this difficult situation.
Beginning this year, Medicare will cover more mental health care costs for older adults, addressing a long-standing issue. However, some problems with Medicare mental health coverage remain.
For many years, there was an unjustified disparity between Medicare coverage for mental health care compared to coverage for other medical services. While Medicare paid 80 percent of the bill for most medical services (after a relatively low annual deductible), a much smaller percentage of mental health services was covered. However, Congress passed legislation that began phasing in more coverage starting in 2008, and the phase-in is now complete: beginning January 1 of this year, Medicare covers 80 percent of mental health services.
While the change is welcome, full parity for mental health services under Medicare has not been reached. A lifetime cap of 190 days for inpatient psychiatric care still applies, while there is no such cap for other inpatient medical care paid for by Medicare. Meanwhile, it is unclear whether there is otherwise equal treatment of mental health services covered by Medicare compared to other medical and surgical services.
Adding to the difficulties faced by older adults who need mental health services, a study published recently in JAMA Psychiatry revealed that just over half of psychiatrists said they were willing to take payments from Medicare in 2010, a drop of 20 percent since 2005. This is due in part to the fact that Medicare reimbursement rates are relatively low when the amount of time that providers spend with patients is taken into account.
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This article does not constitute legal advice and should not be relied upon. If you need legal advice concerning this or any other topic please contact our offices to schedule a consultation with one of our attorneys at 914-684-2100 or 212-490-2020.
nal classes, which helps families create support systems. At Littman Krooks, we work to help families navigate services and to obtain appropriate public benefits, and we advocate for changes in legislation.
