736 CHAPTER 16
hospitals, waiting lists for supervised housing at state-fi nanced group homes, waiting
lists for a state-fi nanced intensive-case manager, who would have visited Goldstein
daily at his apartment to make sure he was coping and taking his meds.
More than once he requested long-term hospitalization at Creedmoor, the state hos-
pital nearby. In 1997, he walked into the Creedmoor lobby, asking to be admitted. “I
want to be hospitalized,” he said. “I need a placement.” But in a cost-cutting drive,
New York [had] been pushing hard to reduce its patient census and to shut state hospi-
tals. Goldstein was instead referred to an emergency room, where he stayed overnight
and was released.
Again, in July 1998, Goldstein cooperated with psychiatrists, this time dur-
ing a month-long stay at Brookdale Hospital, in hopes of getting long-term care at
Creedmoor. Brookdale psychiatrists had a well-documented case. In a month’s time,
Goldstein committed three violent acts: punching the young woman on the subway;
attacking a Brookdale therapist, a psychiatrist, a social worker and a ward aide; strik-
ing a Brookdale nurse in the face. This time, Creedmoor offi cials agreed in principle
to take him, but explained that there was a waiting list, that they were under orders
to give priority to mental patients from prison and that they did not know when they
would have an opening. Days later, Goldstein was discharged from Brookdale.
(Winerip, 1999a)Those who work with the mentally ill said that Mr. Goldstein seemed poorly served
by the system. “We’re really concerned that there are huge gaps in the mental health
system,” said Jody Silver, director of advocacy for Community Access, a Manhattan
program that provides supported housing for people with psychiatric disabilities. “He
had a place to live, but he didn’t have support. It sounds like he needed a program with
an intensive support service, where he would be visited daily by a caseworker who
would monitor his medication and help him with his life. He was totally alone in the
community. This person was grossly underserved.’’
(Kleinfield & Roane, 1999)
Not only was Goldstein underserved, but so was the public at large. When appro-
priate services were available to him, Goldstein made good use of them. He spent a
year in a residential setting on the grounds of the state hospital—he did well, was
cooperative and friendly, and regularly took his medications. But personnel at state
hospitals are under pressure to move patients to less expensive programs, even if the
patients aren’t ready. Goldstein was considered too low-functioning to qualify for
a program that provided less supervision, but he was discharged from the residen-
tial program nonetheless—to a home where he received almost no support. A year
before the murder he tried, without success, to return to a supervised group but no
spaces were available (Winerip, 1999a).
Unfortunately, Goldstein’s history with the mental health system in New York is
not unique (see Case 16.4). People with severe mental illness generally don’t receive
the care they need (which is also in society’s interest for them to receive) unless their
families are wealthy and willing to pay for needed services—long-term hospitaliza-
tion, supervised housing, or intensive daytime supervision. Even when a defendant
is deemed to be mentally ill and ordered to be transferred to a psychiatric facility,
space may not be available in such a facility; the options then are to hold the de-
fendant in jail or to release him or her and provide a less intensive form of mental
health treatment (Goodnough, 2006).
As discussed in Chapter 12, deinstitutionalization is a reasonable option for
those who can benefi t from newer, more effective treatments, and providing treat-
ment in the least restrictive alternative setting is also a good idea. Unfortunately,
however, such community-based forms of care are not adequately funded, which
forces facilities to prioritize and provide treatment only to the sickest, leaving every-
one else to make their own way in the system. Thus, most people with severe mental
illness lack adequate supervision, care, or housing. They may be living on their own
in tiny rented rooms, on the street, in homeless shelters that are not equipped to
handle mentally ill people, or they may be in jail. The law may mandate treatment
for severely mentally ill individuals, but that doesn’t mean they receive it.
After the murder of Kendra Webdale, New York State passed Kendra’s law,
allowing family members, roommates, and mental health clinicians to request