My month in a psych ward

I checked myself in to the inpatient psych unit of a major NYC hospital on January 23, where I would stay for nearly a month. I’m still sorting out what my next steps should be, but I thought people might be interested in some of the things I noticed.

  • The care I received was excellent and the staff were very courteous and professional. I would recommend hospitalization to anyone who is in crisis, especially if outpatient care isn’t working.
  • I received electroshock therapy and it worked like magic. There’s too much stigma surrounding this low-risk treatment that helps countless people live decent lives.
  • Hospital food sucks, as per its reputation. For some reason they put me on the Hasidic menu and never corrected it (I’m not Jewish). Then again, I never complained, largely because I developed a taste for gefilte.
  • Hospital life is hard. You’re not allowed to have pens or shoelaces. Somebody opens your door every 15 minutes to make sure you’re still alive. My roommate spoke in tongues and once tried to exorcise me. It was all worth it.
  • Nearly all the patients there were people of color– which makes me think our system is failing. Too many POC don’t benefit from decent outpatient treatment and are forced to rely on hospitalization, the most extreme treatment option. At least that’s my interpretation.

Have you ever been hospitalized? Does this shed any light on the treatment system? Let me know in the comments.

One of Brooklyn’s worst slumlords is a man of many names

Landlord Barry Hers seems to use a variety of aliases to stay in business and continue profiting off of vulnerable families.

I’m about to tell you a complex, tangled story. It’s about a Brooklyn landlord whose history seems to include bankrupting an Israeli village, assaulting his own daughter, threatening tenants and leaving his buildings in deplorable conditions.

As his story unfolds, one thing becomes increasingly baffling: New York City’s homeless department seems to have either been indifferent to his heinous record or didn’t know about it when it entrusted hundreds of vulnerable families to his care.

This is the case against a man with many names. One of them is Barry Hers.

°°°°°

I first became aware of Barry Hers in August 2005 when the New York Times printed a front-page story on a shelter he ran in my neighborhood. The article described the 83-unit building, which housed both shelter and rent-paying tenents, as dire:

Beyond the unlocked front doors of 60 Clarkson Avenue in Brooklyn, the lobby is a half-lit cavern, its ornate plaster moldings and patterned floor smeared with dirt. The windows gape onto a courtyard dense with weeds and trash. On the days when it comes at all, the elevator smells of urine.

image

According to the story, the building had 213 housing code violations in 2013. Hers told the paper there used to be more but he worked hard with the city to correct them. Hers had reportedly cut security guard services despite receiving city funding for a guard, and a detective told the Times the building was notorious at the precinct house.

The Times reported that Hers also goes by Barry Hersko and Barry Hershko. Remember those names.

Hers created his own nonprofit, We Always Care, to provide casework services to residents, flouting city rules requiring DHS to find an independent organization. Hers claimed DHS underpaid We Always Care for rent and services, making it hard for him to maintain conditions at 60 Clarkson.

image
60 Clarkson Avenue

The city acknowledged that 60 Clarkson was a problem and made plans to stop using it as a shelter. Unfortunately, this made life even harder for residents, who received multiple notices giving them only 24 or 48 hours to pack their belongings in preparation for removal. Residents said at least one of these notices was on Department of Homeless Services letterhead. Each notice was withdrawn after a burst of protest and media scrutiny.

60 Clarkson stopped serving as a shelter in October 2015, according to Gothamist. Things didn’t improve for rent-paying tenants after the homeless families left. Residents reported their gas and electricity was mysteriously cut off after some of them entered into a lawsuit with Hers. New York State’s Tenant Protection Unit is currently investigating Hers for allegations that include harassing tenents and skimping on maintenance.

Meanwhile, the city acknowledges that it still has hundreds of families in Hers-owned properties but says it plans to relocate them by the end of June. Hopefully the media will continue its scrutiny and follow up on whether the city keeps this promise. I have little hope that the press will look into whether families’ lives improve as a result of the relocations or if they’re simply shuffled to equally dilapidated corners of the shelter system.

°°°°°

The tangle of names becomes confusing at this point: Gothamist reported that the nonprofit managing Hers’ property, We Always Care, was founded by one Isaac Hersko; and that residents of 60 Clarkson, their lawyers and housing organizers believed Hers and Hersko are the same person. Gothamist noted that Hers did not refute the claim that he uses this alias when asked about it. However, Gothamist later issued a correction saying state investigators think people identified in the story as Barry Hers and Isaac Hersko are two different people who are somehow related. An investigator also told Gothamist the state believed Barry Hers also goes by Barry Hersko and Barry Herskowitz. Further confusing things, the Times stated as fact that Hers, Hersko and Hershko are the same person according to records; the Times reporter clearly had extensive access to Hers and he didn’t refute this. A collection of stories about 60 Clarkson collected by the Legal Aid Society has people referring to him as Barry Hers, Isaac “Barry” Hersko and Barry Hershko.

image
A photograph of a man identified as landlord Isaac Hersko

If all of this is giving you a headache, don’t worry. The point is that all of these names revolve around a single entity who identifies himself with either “Barry” or “Isaac” and a last name beginning with “Hers.” Since multiple sources say this person uses aliases, I’m going with the simplest explanation – that all of these names belong to the same person.

And he has a nasty history.

°°°°°

Even though Hers and 60 Clarkson have been the subject of multiple news reports, nobody seems to have connected the dots in regards to his past. A few simple Google searches reveal a pattern of violence, lies, and scams that seem to have been committed by Hers under one of his aliases or names that are similar to them. The problem might be that it’s hard to prove these cases are connected – the fact that they involve similar circumstances and men with similar-sounding names is only circumstantial evidence. But if Hers is using aliases he’s presumably counting on reporters being deterred by precisely that problem.

We can’t let him get away with that. So I’ll simply present what I’ve found and let you decide for yourself.

• In 2010 a developer in Cedarhurst, Long Island named Itzhak Hershko, also known as Isaac Hershko, was sentenced to a month in jail and fined for building code violations. The judgements were dismissed by a higher court on 2012. However, the judge and lawyers in the original case noted that residents had been threatened, that Hershko had failed to pay fines and debts, and that he had created a blight. “The last few years have been hell,” one neighbor told the judge. Cedarhurst is near Brooklyn.

• According to the same article, Hershko faces an arrest warrant in Israel related to his 2008 conviction for involvement in a real estate deal that bankrupted an entire village.

• The article also says Hershko was arrested in 2007 for assaulting his own daughter.

• Fast forward to 2014 in Nyack, New York: Employees at a high-end restaurant show up to work but find the doors locked, a stack of unsigned, worthless paychecks inside. The owner’s name was Isaac Hershko, and the article used records to link him to the Cedarhurst charges. One employee who is an immigrant said he gave Hershko  $25,000 as an investment but that when he asked about payments Hershko threatened to call immigration. Follow the link to watch a man identified as Hershko yell at a news cameraman and physically push him out of the restaurant. 

• In May 2016 a tenents’ rights group called Stabilizing NYC released a list of some of New York City’s worst property owners. Among the 10 worst slumlords, according to the group: one Isaac Herskovitz. (Recall that investigators think Barry Herskowitz is a Hers alias).

Isaac Herskovitz, identified as a Brooklyn property owner, bought five buildings in Manhattan’s up and coming Hamilton Heights neighborhood for $31 million. If this is Hers he seems to be expanding into new territory – look out, Manhattan. Herskovitz was reported to own two dozen properties in Brooklyn and the Bronx, according to records.

°°°°°

Like innumerable reporters before me, I’ve tried to find ways to contact Hers. A quick online people search turns up one Isaac Meleh Hershko, 58, in Hewlett, New York. Hewlett is only two miles from Cedarhurst. There are two Isaac Herskos in New York, both in Brooklyn.

Another directory lists a Barry Hers in Brooklyn with the phone number (917) 335-1537. The same number appears on a Legal Aid Society list of New York shelter contacts; the list says the number is for someone named Barry. The list shows this person is responsible for more than a dozen properties providing family shelter services in Brooklyn, including 60 Clarkson.

I have no doubt there’s more information out there – and more stories of human suffering.

°°°°°

It’s easy to demonize Hers – and we’re justified in doing so – but he’s successful because of a regulatory environment that doesn’t care about homeless people. Despite his abuses, New York City only took action about the horrible conditions at 60 Clarkson after sustained media coverage.

And Hers is only part of the problem. Approximately 3,000 families live in cluster site shelters, buildings like 60 Clarkson where the city pays landlords far above market rents to house homeless people in conditions that are often inexcusable. A city investigation in March found these types of shelters provide “nonexistent” security, minimal social services and poor conditions and are inferior to more traditional arrangements where the city owns and runs the shelter directly. This fits my experience as a social worker perfectly – if space permitted I’d share stories about incompetent, condescending caseworkers at cluster site shelters; unaddressed mold growing across walls and exacerbating children’s asthma; broken kids’ beds that don’t get replaced – all in apartments for which landlords collect more than they would if the city simply gave homeless people rent checks. It was in a cluster site building that I was assaulted while trying to prevent a sexual assault (the security guard hadn’t shown up for work yet).

Two additional things bother me here, and they both come down to the apparent carelessness with which DHS monitors abusive landlords. First, I can’t so much as take a leak without giving someone my social security number – was that not a prerequisite before Hers could start any of his projects? There’s a left hand right hand thing happening if Barry Hers and Isaac Herskovitz are the same person and he’s gotten permits under both names in New York City. It makes me think there should be a national database of landlords that all jurisdictions participate in.

Here’s my second concern: It took me 30 minutes to find all of this information and all of Hers’ aliases, using nothing more than Google searches. It’s upsetting that the city Department of Homeless Services wouldn’t invest half an hour on the Internet before entrusting the safety and wellbeing of hundreds of homeless people to a developer. Besides being immoral, it’s inefficient. Think how many hundreds of hours city employees have spent dealing with Hers’ crap – social workers for residents, housing court judges and lawyers, and other municipal employees are playing damage control because nobody did a simple Google search when Hers’ application to run the shelter was being considered. It was lazy, immoral and incompetent management on DHS’s part.

I can’t help but think that if we were talking about white middle class families in Park Slope the city would work harder to ensure their safety. Remember when I said the state Tenant Protection Unit is investigating Hers for abuses at 60 Clarkson? Well, that’s happening now that the homeless families have moved out and all the residents are fine upstanding rent payers. The unit was created in 2012, but they apparently couldn’t be bothered to investigate when it was homeless families who were suffering.

The fact that Hers is still in business proves we, as a society, are just as indifferent to those families’ plight.

Appendix: For anyone who wants to look into Hers further, here are all of the associated names and companies I’ve been able to find.

Barry Hers
Isaac Hersko
Shloimy Hersko
Barry R. Hersko
Barry Hers Clark
Barry Herskovitz

We Always Care
We Care
We All Care
Clark Wilson
Ettie Properties 

Waitlisted

Just try getting a shrink in New York.

You’d better be suicidal if you don’t want to wait for months.

I don’t mean vague-plan-and-means suicidal – that won’t cut it. I know. I’m vague-plan-and-means suicidal and I’ve been waiting for a month and a half for my first appointment at a large, well-known clinic that serves New Yorkers with and without insurance.

image

No, you need intent. You need to want to die. I know because whenever I call the intern who’s handling my case at the clinic to plead for an appointment he asks me about intent. At the time of the call I don’t want to die, so I say no. So he tells me I’ll have to wait, because it’s a walk-in clinic and there needs to be room for everyone. There are mornings, though, when I wake up hours after I meant to and my life feels outside of my control, when I look at my pill bottles and…

So a word to the wise: if you need help ham it up. Come in off the street with pills in your belly or self-inflicted cuts on your arms. Tear your clothes and shave your head. Make all the gestures, give all the cries for help I don’t give for fear of scaring the people who care about me.

Ham it up. And when you get help, tell me what it’s like.

Why social work isn’t changing – and why that’s hurting consumers

I vividly remember my social work field placement at a residential drug treatment program. The one licensed social worker on staff was so burnt out she’d taken to listening to Leonard Cohen’s “Hallelujah” with her office door closed. With no meaningful guidance I was in a constant state of panic.

image
Not music therapy

The staff psychiatrist, meanwhile, would jet in like a rock star. He always seemed happy and people lined up to see him.

It was a vivid demonstration of a real problem: as social workers we fail to advocate for ourselves, and in the end this hurts our clients.

image
My wallet's never looked like this

Society wants us to work – and work cheap

The baby boom is aging, the healthcare system is changing, and demand for social workers is only going to grow. Demand for most kinds of social workers (mental health, substance abuse and healthcare social workers) is expected to explode by 19% between 2014-2016, far outpacing the average for all industries (around 6%) and exceeding the growth rate for psychiatrists (15%).

Despite this boom in demand, social workers’ salaries are not keeping up. According to surveys from Payscale.com, the average social worker increases their earnings by only 37.5% over a 20-year career, going from $40,000-$55,000. In contrast, a psychologist will increase their earnings by 50% ($60,000-$90,000 per year) and a psychiatrist will increase their earnings by 24%-but that’s from an already high starting salary of $174,000 per year, capping out at $216,000.

image
Salary of social workers, psychologists and psychiatrists after 20+ years in field

For some in society – nonprofits and government agencies – this has obvious short-term benefits. Bossman loves cheap labor. (Indeed, it’s probably worth noting that social work is more populated by women and minorities than psychiatry and psychology – I’d suspect that’s one reason for the lower pay). Whatever the cause of the salary gap, it has serious long-term consequences – and not just for social workers.

The sick reality is that interns and beginning social workers are charged with the most vulnerable, high-need people. Survive in the field for 20 years and you can get rich helping millionaires with public speaking anxiety.

The cost of low pay

Most social workers don’t last for 20 years in the field, according to Salary.com’s survey, a fact that isn’t true of psychiatrists and psychologists.

This high burnout rate might create opportunities for beginning social workers, but is that really such a good thing? Not for clients.

Would you read a SocialWorked newsletter? If enough people sign up I’ll start writing. Click here to join the SocialWorked mailing list. I promise not to share your information.

I’m thinking of the jobs and field placements I’ve had so far. I’ve been an intern with zero experience with responsibility for the emotional wellbeing of recovering drug addicts with extensive trauma histories. My first job out of grad school was as a preventive worker with families involved with Child Protective Services – an incredibly demanding job that involved trauma-informed therapy, legal advocacy and intense casework. These are jobs that should have been performed by somebody with years of experience.

I don’t buy the argument that beginning social workers make up for their lack of experience with enthusiasm – how many domestic violence survivors have been forced to pin their hopes on somebody who was working with a client for the first time? Would you want to be in that position? If it was your mother would you want her to see an intern or someone with 10 years’ experience?

The sick reality is that interns and beginning social workers are charged with the most vulnerable, high-need people. Survive in the field for 20 years and you can get rich helping millionaires with public speaking anxiety.

By the way, if you’re thinking psychiatrists and psychologists deserve higher pay because they have expertise your thinking is part of the problem – they have expertise in their fields, but do they know how to advocate for somebody in court? Or get someone into a domestic violence shelter?

Moving forward

It’s a truism – but also true – that in order to care for our clients we must also practice self-care.

As social workers many of us seem willing to sacrifice everything we have, including our financial security, for the greater good. But in the end this is catastrophic, not only for social workers but for the people we serve.

If we advocate for ourselves – by demanding raises and salaries that reflect our good work – the result will be satisfied, dedicated social workers who remain in the field longer during these times when we’re needed more than ever.

Stand up for yourself! And let me know in the comments what you think the best way to do this is. Should social workers unionize? Do we need a culture shift?

The Weed Truck, Part II

This is the second installment in a multi-part story I’m writing for Child Abuse Awareness Month. Everything happened as described. Names have been changed. Nobody’s innocent.

Click here to read The Weed Truck, Part I

Panic comes flooding up my throat. It tasted like stomach acid.

“Chris Chris Chris Chris Chris,” I say.

Chris, my supervisor, strolls over. A bit older than me at 32 and fashionably dressed, he tries to keep his people calm and productive. He’s white, like I am.

“What’s the deal?” he says laconically.

I show him the note: “New CPS case re: Ms Tambora. Charges prostitution / drug use.”

“That’s not good,” he says. “Is it true?”

“It’s bullshit,” I say.

“Who’s the worker?”

I log into the computerized system that logs families’ Child Protective Services involvement – a catalogue of failure and suspicion. I navigate to Ms. Tambora’s new case.

“Patricia Black,” I say.

“I don’t know her,” Chris says.

The panic in my throat has receded somewhat, met in my throat by a generalized sadness, a despair mixed with acceptance that this is my life.

“Guess you’re about to,” I say.

* * * * * * * * *

Would you read a SocialWorked newsletter? If enough people sign up I’ll start writing. Click here to join the SocialWorked mailing list. I promise not to share your information.


I take three deep breaths before dialing the phone.
The deep breaths never work.

Ring. Ring. “What.”

“Um hello, Ms. Black. This is [—] with [—]. I’m Ms. Tambora’s preventive worker.”

I don’t know why I’m so nervous. The panic is back.

“Oh yes, the prostitute.”

“Well, about that. She’s actually a very good mother. I don’t think – -”

“Do you need something?”

“I thought it would help if I joined you when you make a home visit to the family.”

“Fine. 3 o’ clock today.”

“Great. I’ll let Ms. Tambora know to expect us.”

“Please don’t. I like to catch families when they don’t expect me. I don’t want her having time to hide anything.”

“Fine.”

“3 o’clock. I’ll be wearing black.”

“Really?”

“Really what?”

“Nothing. See you at 3.”

I hang up the phone. The panic is gone again. This time it’s anger that’s pushing it down. A righteous, durable anger.

My next call is to Ms. Tambora.

* * * * * * * * *

I show up 30 minutes early to prepare Ms. Tambora, but when I knock on the door Ms. Black is already there. “Bitch,” I think. She’s standing above Ms. Tambora, who’s sitting at her kitchen table. A framed picture of her daughter is on a curio shelf behind her; as always, she’s clutching her daughter on her lap.

Ms. Black is younger than I expected – about my age, late twenties – white and, as she said, dressed entirely in black. I wonder if she was aware of the symbolism when she got dressed this morning – a woman in black, here to take your children.

image

I try to remember the last time I thought of Child Protective Services as people who help.

Ms. Black doesn’t acknowledge me. She’s giving Ms. Tambora a release form. Like me, Child Protective Services workers need written permission from a caregiver before talking to a child’s provider. A strange facade of respect, I think – how odd what we choose to care about.

“Sign this so I can talk to Helena’s doctor,” she says.

“Ms. Tambora, is the doctor’s name filled in?” I ask.

She hesitates, looking at Ms. Black, then at me. “No.”

“Then signing that form would let her talk to anybody.”

Ms. Black bends down and scribbles on the form. “I was going to fill in the doctor’s name later, but whatever makes you happy,” she says.

Ms. Tambora signs the form.

* * * * * * * * *

Ms. Black is finally getting ready to leave.

“Can you tell me anything else about this family?” she says.

“Just that they seem to me like a great family. I’ve never seen a sign of drug use, prostitution or anything else.”

“Will Helena’s doctor tell me anything is wrong?”

“I haven’t spoken with her doctor yet.”

Ms. Black wags her finger. “It’s your job to communicate with the child’s providers, Mr. [—]. When Child Protective Services contracts a family out to your agency that’s one of our expectations.”

“Right, sorry. I’ve left the doctor messages.”

“Very well. The next step for Ms. Tambora will be to take a drug test. I’ll arrange that. See that she takes it.”

“She’ll take it.”

“Very well. Good bye.”

She says good bye to me, of course – not to Ms. Tambora. Then she leaves.

Ms. Tambora is still clutching Helena, tighter than ever. She looks terrified.

“I can’t take the drug test,” she whispers, even though we’re alone.

“Why not?”

“I’ve been going to the weed truck.”

To be continued

The secret history of mandated treatment

Mandated treatment is about society’s needs, not the mentally ills’.

On the evening of January 3, 1999 Kendra Webdale stepped onto the platform of the uptown R train at the West 23rd St station in Manhattan. She was 32, blonde and had a reputation for being kind to a fault, so it must have been typical for her to exchange words with the man beside her.

image
Kendra Webdale

Then the man pushed her in front of an oncoming train, decapitating Webdale.

The man, Andrew Goldstein, had a history of hospitalizations for schizophrenia. When asked why he killed Webdale he later said he “just had the urge to push her.”

image
Andrew Goldstein

In response to what he did that evening state lawmakers would pass Kendra’s Law, far-reaching legislation that lets judges mandate mental health treatment. But like any ambitious mental health program Kendra’s Law says as much about society’s fears as it does the needs of the mentally ill.

To understand what mandated treatment is really about, we need to understand those fears.

Kendra’s Law is a marketing tool designed to assure affluent white people that the problem of dangerous, crazed loners is under control.

Kendra’s Law is sweeping. It lets judges require people to submit to mandated treatment for up to a year at a time if they’re judged not to be safe without supervision and establishes teams of workers to provide services and monitor compliance. Though often justified with the rhetoric of public safety, a person doesn’t need to have a history of violence to be mandated under the law.

The law was used more than 8,700 times by mid-2007, with more then 5,600 of those people seeing their mandated services extended. Most people affected by the law (70%) are in New York City; many upstate counties don’t use the law at all.

That’s the law. Understanding the law’s purpose requires knowing a bit about New York – and Kendra Webdale herself.

Webdale was in many ways the prototypical New Yorker. An aspiring screenwriter from Fredonia, NY, she was drawn to the city by its parks and museums.

She wasn’t the first person to die on the subway tracks. Subway crime was down in 1999, but according to the New York Post, “even in safe times, a common fear haunt[ed] riders standing on a crowded platform. It’s of being shoved in front of a speeding train by a crazed attacker.” People remembered Renee Katz, who lost a hand in a similar attack, and several other people not named in the article (a 63-year-old grandmother, a Staten Island chemist, a 20-year-old mother described as having “cheap costume jewelry”).

Why did Webdale’s death merit a response from then-mayor Rudy Giuliani and eventually lead to a landmark state law while these other victims have been forgotten?

The numbers tell the story – a story of race, money and politics.

In the 1970s New York City was in trouble. Plagued by crime and a bad economy, white people and families fled in record numbers, to the point where whites were nearly a minority group. In the 1980s the population started to rebound, but the increase was driven by immigrants, who made up for a continuing exodus of white people. Crime was still rampant, and
the city’s image was reflected in the unstable loner Travis Bickle, Robert Dinero’s character in Taxi Driver. It wasn’t until the 1990s, the decade that Webdale moved to New York, that the city’s population really began to take off, growing by nearly 1%. By now the bleak image painted by Taxi Driver was being supplanted by Seinfeld and Friends – images of a kinder, more liveable city.

image
I love New York!

However, crime still scared both current and potential New Yorkers. And even then a quarter of the city lived in poverty, up from previous years.

When a white woman who moved to the city in pursuit of her dreams was murdered by an unstable New Yorker, then, it must have been the worst publicity imaginable for city leaders.

They sprang into action.

After Webdale’s death Elliot Spitzer, then state attorney general and a city native, proposed legislation requiring mandated treatment, and the New York Times editorialized that such a law would be good for both people with mental illness and the city as a whole. Powerful New York State Assembly Speaker Sheldon Silver, who represented a Manhattan district, introduced the bill that would become known as Kendra’s Law. Silver was clear that “the specific incident that inspired ‘Kendra’s Law’ accurately depicts this as a public safety issue” while noting that his bill would also benefit those with mental illness.

Kendra’s Law passed. But like other public safety initiatives it wasn’t applied evenly.

In 2005 New York Lawyers for the Public Interest condemned Kendra’s Law, stating that only 15% of people mandated to treatment under its provisions had a history of violence. NYLPI accused those implementing the law of bias – citing figures from the New York State government, they said black people were nearly five times more likely than whites to be subjected to Kendra’s Law orders (others would say this is because black people are less likely to receive appropriate treatment). They also noted a regional bias, stating New York City accounted for 76% of orders despite having only 42% of the state’s population – exactly what one would expect if the law was created to make the city seem safer.

The marketing seems to have worked. By 2007 the number of people moving to New York City from other parts of the country surpassed the number leaving, a “new pattern,” and immigrants from within the United States went from representing half of the inflow at the turn of the millenium to two-thirds by 2011. Incomes rose too, with the median household income going from $31,591 in 1990 to $54,310 in 2014 when adjusted for inflation.

New York City became wealthier, whiter and more appealing to people from other states after Kendra’s Law passed. The law wasn’t solely responsible, of course, but it was one of the policies that made the New York success story possible.

What does this all mean? Many conclusions can be drawn. Here’s mine: Kendra’s Law is a marketing tool designed to assure affluent white people – inside and outside of the city – that the problem of dangerous, crazed loners is under control. When a mentally ill man murdered an attractive white woman from the suburbs city leaders feared Taxi Driver New York was killing Friends New York. They sprang into action, successfully lobbying for a law that’s used almost exclusively against poor black city residents.

None of this is to deny that Kendra’s Law has been effective. Studies by Duke University and the New York State Office of Mental Health have found the law reduces hospitalizations as well as suicide attempts, homelessness and other problems associated with untreated mental illness. Supporters of the law say it’s helping people who are mandated to services and saving the city money by reducing the need for inpatient care.

Mandated treatment is clearly a complicated issue that defies easy answers. But when we debate its wisdom we should consider all of its pros and cons, including some that are often overlooked by its supporters.

For example, any discussion of Kendra’s Law should consider:

The increased burden on mental health clinics that are required to treat mandated clients;

The impact of stringent rules clinics impose to manage mandated clients, such as policies to drop clients if they miss appointments;

The waiting lists clinics create to accommodate increases in demand;

The potential clients who give up on counseling because they’ve been placed on waiting lists;

The stress experienced by therapists and social workers who must work with mandated clients;

The impact this stress has on their work;

The good things providers could be doing with voluntary clients but aren’t because they’re working with mandated clients instead;

The things that could be done with money currently spent on mandated clients;

The pain clients experience after losing autonomy.

I’ve worked in agencies that serve mandated clients and I can truly say their being mandated changes everything. They stop being clients at all; instead they are treated like difficult, ungrateful children. When a clinician constantly assumes an unwilling client won’t show up or won’t be interested in material, it’s hard to overestimate the damage that causes to the therapeutic relationship. In a 2009 study of Kendra’s Law, case managers rated 54% of participants as not being “positively engaged” a full year after services began.

The above points demonstrate an odd fact: while Kendra’s Law has made treatment more available for mandated clients, the result has been that treatment has become more scarce for voluntary clients – the ones who are most likely to benefit from treatment. Every time a client is mandated waiting lists grow longer, clinicians become less available and clinic policies become more rigid. NYLPI says that this “right to treatment” for mandated clients even leads some people who want treatment to intentionally become mandated so they can get the help they need.

A stunning 41% of New Yorkers with severe mental illnesses report they needed help in the past year but weren’t able to get it. Does that mean we should have more mandated treatment? Maybe – but this treatment gap makes me question the wisdom of forcing scarce mental health resources on those who don’t want it.

I don’t know whether Kendra’s Law should be changed or repealed. But let’s be real about our reasons for mandating treatment. Let’s own the harm and benefits of it – all considerable and all very real.

In other words, let’s honor Kendra Webdale, Andrew Goldstein and the 20 year old mother in costume jewelry the New York Post didn’t bother to name.

The Weed Truck, Part I

This is the first installment in a multi-part story I’m writing for Child Abuse Awareness Month.

Ms. Tambora had had enough – of me, of the system. But I didn’t know it yet.

I don’t think she knew it either.

Ms. Tambora isn’t polite – she and her partner, Mr. Greene, are obsequious. When she answers the door, 18-month-old baby in her arms, she looks like an abused child that doesn’t know if she’s in for a hug or a beating. Sweet, kind, mild Ms. Tambora.

image

Despite her demeanor I don’t feel like I’m taking advantage of her. I’m here to help.

I’m a preventive worker. I occupy a gray area between child protective services and traditional therapists. CPS contracts with my agency to provide services to families that have been reported for child abuse or neglect but who have been allowed to keep their kids. In theory, my services are accepted voluntarily. In practice, it’s often a choice between working with me or losing your children.

She lets me in, as always, with a nervous smile on her face. “Good morning, Ms. Tambora!” I say cheerily. “How are you?”

Ms. Tambora pauses for a moment, thinking. “I’m good,” she finally says.

In theory my services are voluntary. In practice it’s often a choice beween working with me or losing your child.

Today we’re talking about a domestic violence program Ms. Tambora is trying to sign up for. As we’re talking I notice she seems uncomfortable.

“You look worried.”

“I’m worried they’re going to take Helena,” she says, holding up her daughter, whom she’s clutched in her arms since I arrived.

“They’re not going to take Helena. You’re too good a mother.”

“But they took Joseph.”

I still don’t understand how Ms. Tambora lost custody of her older son, Joseph, who’s now 8. Ms. Tambora doesn’t understand it either. She only knows that a child protective services worker and two cops showed up at her door one day and “made me sign something.” The worker picked Joseph up and left. The cops blocked Ms. Tambora when she tried to follow.

Later she learned that Joseph’s father had accused her of drug use and prostitution.

The father now has custody of the child.

I know from previous visits to be careful around this topic because, five years later, discussing it still makes Ms. Tambora tearful. I like to think of myself as a traveling therapist, but honestly, I just don’t have the energy today.

“We really should figure out how to get you into this program,” I say, holding up a pile of intake documents for the the domestic violence program. “If they accept you we’ll continue this discussion, OK?”

Ms. Tambora dries her eyes with a tissue. “OK,” she says.

We finish the application and I feel satisfied when I leave. Ms. Tambora has a real shot at getting into this program, which provides domestic violence counseling, rent subsidies, legal assistance and more. They receive so many applications they basically draw winning names out of a hat.

I get to the office and I mail the application. I flirt a bit with a coworker I’d never see outside of work. I’m humming a bit when I sit down at my desk.

There’s a sticky note with a message in the receptionist’s handwriting.

“Oh Christ no.”

Ms. Tambora had been reported to child protective services for drug use and prostitution.