Mandatory medication has potential

Do you remember the name Mark Bechard? How about Virginia Green, Derek-Finn Willhelmsen, Craig Hinson or John Havlin?

Let me refresh your memory.

Bechard – off his medication and in a psychotic rage – walked from his apartment to a Waterville convent in a cold, driving rain and began randomly bludgeoning nuns.

It was 1996, and Sisters Edna Marie Cardoza, 68, and Marie Julien Fortin, 67, at the Servants of the Blessed Sacrament Convent were killed. Two other nuns were seriously injured.

Just two months earlier, Virginia Green, a well-known statewide advocate for the mentally ill and a paid consultant for the Maine Office of Substance Abuse, went off her medications and bludgeoned to death her 75-year-old mother with a 28-pound rock on Peaks Island.

In 2002, Derek-Finn Willhelmsen, 23, shot and killed Portland cabdriver Nunzi Mancini as the two sat in a taxi on Route 100 in Pittsfield. A judge later wrote in her decision finding Willhelmsen mentally incompetent: “The defendant needed medicine, and he needed help from the mental health system; he received neither.”

In 1990, minus his prescribed medication, Craig Hinson, 26, of Monson, strangled his uncle Edward Simpson to death with his bare hands. A psychiatrist testified that he may have stopped taking his medication because of its “uncomfortable” side effects.

During the weeks before Simpson’s death, Hinson’s mother had tried unsuccessfully to get her son on medication and admitted to Bangor Mental Health Institute.

John Havlin’s wife of Hampden had tried in vain to get him to seek help for a mental illness that plagued him for two years before he went into his 5-year-old daughter’s bedroom one night in 1998 and stabbed her three times. Fortunately, the girl survived.

These were the names that came to my mind this week when I read BDN health writer Meg Haskell’s front-page story on the Legislature’s consideration of a bill that would require some people with mental illness to take prescribed psychiatric medications or face involuntary admission to a state hospital.

I know that many mental health advocates will be quick to point out that these people represent just a minuscule percentage of the thousands of mentally ill people who are living among us in our communities, many of them very successfully.

But they also represent just a small percentage of the thousands of mentally ill people who live among us suffering from a lack of access to mental health services, and who wind up in jail for committing crimes they may not have committed had they been enrolled in supervised programs that could help them maintain their medicinal regimen.

You don’t hear about most of those people. You may pass them on the street as they mumble, or shout out bizarre obscenities. You may read about them in police beat as police officers all over the state struggle daily with the dilemma of what to do with them.

Many of them have loving families in the background who have spent years trying to access services and convince their loved one to take their medications.

Today, when a patient is discharged from one of Maine’s two public psychiatric hospitals, their cases are handed to an “assertive community treatment” process, or ACT.

ACT provides intensive outpatient support and monitoring with a team of mental health professionals. Interestingly, however, these ACT teams don’t have the authority to require medication compliance and (I loved this part) “often simply stop seeing patients who drop off their radar or become noncompliant, hostile or uncontrolled,” according to Tuesday’s BDN article.

So, in other words, the state may not do a half-bad job of taking care of the mentally ill patients who stay the course. Well, that’s reassuring, but apparently we don’t do such a good job of dealing with those who are spiraling into the deepest crevices of their mental illness. These are the very ones who are a threat to themselves and to others; the Mark Bechards and the Craig Hinsons who walk among us.

Forty-two other states have adopted mandated-medication laws similar to the one Haskell described, and under consideration in Maine. Most notable is New York’s, which was enacted in 1999 after two incidents in which people were pushed under subway trains by individuals with mental illness.

According to Carol Carothers, executive director for the Maine chapter of the National Alliance for the Mentally Ill, the majority of those states don’t enforce their laws.

There have been several studies to determine whether mandated-medication laws are effective. The bottom line seems to be that they can be effective – reducing hospitalization stays and the number of mentally ill patients in prisons – if the state increases its community mental health services at the same time it passes the law.

Studies show the law alone does little without these services, and adequate numbers of mobile caseworkers who can actually keep close tabs on the riskiest cases.

Maine’s initiative received almost unanimous support in the House and the Senate, but has been held over for reconsideration because it carries a price tag of about $600,000.

Lawmakers need to decide whether we can afford this bill. If their not willing to pay for it, they shouldn’t pass it.

Maine’s proposed mandated-medication law has great potential, but without the services in place to make it work, passing it would be futile.