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Dr. Leonard Davidman

Understanding mental illness and violence

Local politicians need to reach out to our frontline hospital workers — psychologists, social workers, psychiatrists — to learn about our ideas.

Over the past few months, we have all seen the terrible headlines regarding union members of DC 37 and the police union who are victims of violence perpetrated by mentally-ill people.

  • EMT Yadira Arroyo, a DC 37 member, is killed in the Bronx after a man steals an ambulance, and runs her over as her partner watches. The killer had six admissions to psychiatric wards.
  • NYPD cop Miosotis Familia is assassinated by an ex-con while sitting in a police vehicle. The ex-con has a history of schizophrenia. The killer was seen in a psychiatric emergency room but discharged.

Because of these events, our union sisters and brothers are in pain and in mourning — our EMTs, our cops and even our psychologists.

Yes, psychologists.

Some of my fellow members of Local 1189 are psychologists at the NYPD who evaluate all police candidates and assist cops traumatized after being shot or shooting someone. Every time a cop in New York City is killed, one of our psychologists had met with and evaluated that cop. The psychologists are also aff ected by these killings.

Other psychologists work on inpatient psych units or in psych ERs along with psychiatrists. A separate psychology team works with the criminal courts in evaluating persons charged with serious crimes to see if they can assist in their own defense. They see those accused of horrible murders and even subway pushers.

Why are mentally-ill people allowed to roam the streets?

In the past three decades, the chronically mentally ill are no longer sent to state hospitals. A combination of the patients’ rights movement and a lack of funding have forced state hospitals to reduce the lengths of stay, the number of beds and, in some cases, close facilities. Advances in medication research and new treatment options have made it possible for the mentally ill to live at home. But sadly many are homeless.

Because of insurance rules, there is a push to discharge these patients rapidly. While in the past they would be hospitalized for months, they now must be sent home within 12 days, if possible.

Also, if patients are readmitted within 30 days of discharge, the hospitals are penalized. Under pressure from administrators, doctors are loath to readmit someone if they don’t have to.

Insurance companies are for profit entities. They call us daily in the psych units to ask why a patient is not discharged yet. They refuse to pay if we don’t use the right insurance and medical buzz words so we can keep them in the hospital for treatment.

The science of predicting future violence is not perfect. Some of us do have the experience. But under the law, it is not enough to keep them locked up.

I work in a locked psych unit with kids and teens, some of whom are violent. Once they are stable — and if they have not committed a crime — we discharge them. Some go to residential treatment programs, others to day treatment while more just go home and get therapy. Yes, some of my teen patients have gone on to kill people.

What can be done?

Local politicians need to reach out to our frontline hospital workers — psychologists, social workers, psychiatrists — to learn about our ideas. Instead, they go to fancy academics. When they get money, they funnel it through grants and other institutions to avoid dealing with the unions. A big mistake.

Sadly, society does not want to face this problem head on. Advocates for the mentally ill don’t even agree on how to treat them. One group of advocates promotes more medication research, which we know is very effective. Another group advocates for more freedom of choice. Hospital doctors literally have to go to court to get a judge to allow us to “medicate over objection.”

We need money to hire the best trained staff, pay for treatment and pay for research. We need lawmakers to be educated and we need a firewall between them and the insurance industry. Insurance companies funnel money into lawmakers’ coffers. Yes, it really is pay to play.

Until we find a solution, we will continue to lose our loved ones, our cops and our EMTs.

Dr. Leonard Davidman, Ph.D. is president of Psychologists Local 1189. He has worked in the New York City public hospital system for 45 years.