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The Boston Globe
By Michael Rezendes Globe Staff
Massachusetts is one of only five states that have not approved a law requiring certain people with severe mental illnesses to take prescribed medications or face involuntary hospitalization, according to a study by a prominent advocacy group.
The Virginia-based Treatment Advocacy Center maintains that the absence of such a law — an issue to be taken up on Beacon Hill Tuesday — contributes to homelessness, violence, and a state prison system where nearly a quarter of the men and more than half of the women are considered mental health cases.
Backers say the need for such a law was illustrated dramatically this summer, when Edwin Alemany was accused of abducting and murdering 24-year-old Amy Lord, a Web designer living in South Boston.
Alemany, 28, has been ruled competent to stand trial for allegedly murdering Lord and attacking two other women. But he was repeatedly hospitalized for a variety of serious mental health problems, including hallucinations, and had vowed to discontinue taking anti-psychotic and antidepressant medications prescribed for him while in the custody of the state Department of Youth Services, the Globe found.
“He came out with a huge pack of medicine, and he said, ‘I’m not taking these anymore,’ ” said one of Alemany’s brothers-in-law.
The four other states that have not approved the use of court orders to make mental health outpatients take their medications are Maryland, New Mexico, Tennessee, and Connecticut.
Last December, Adam Lanza, a 20-year-old Connecticut man who allegedly had emotional problems, murdered 26 people, including 20 children, at the Sandy Hook Elementary School.
‘The problem often comes when someone with a history gets on the medications and things start going well and they feel they don’t need to take them anymore.’
The Advocacy Center, a nonprofit group, maintains that without such a law, many people with serious mental health problems are not getting the care they need.
The group timed the release of its report on mental health care in Massachusetts with a Tuesday hearing on state legislation that would allow clinicians to petition the courts for an order requiring a person with a documented history of severe mental illness to take medications designed to reduce the risk they might pose to themselves and others.
“The problem often comes when someone with a history gets on the medications and things start going well and they feel they don’t need to take them anymore,” said State Representative Kay Khan, a psychiatric nurse and Democrat from Newton who has repeatedly filed a bill requiring such treatment. “That’s where the trouble can start, with the whole cycle repeating itself.”
Khan and other supporters of an assisted outpatient treatment law in Massachusetts point to models of success in New York and North Carolina, where, studies show, the laws have reduced cases of violence among persons living in communities with serious mental health problems.
New York’s Kendra’s law, named for Kendra Webdale, a young woman killed in 1999 after being pushed in front of a subway train by a person with untreated schizophrenia, is perhaps the most well-known example of an assisted outpatient treatment law.
A Duke University study published in July also said the state of New York has saved money as a result of its assisted outpatient treatment provision, primarily because Kendra’s law has prevented people with serious mental health problems from being re-hospitalized.
Under Kendra’s law, people under outpatient treatment orders may be arrested and involuntarily hospitalized if they fail to comply with their treatment plans.
Those opposed to the Massachusetts proposal say assisted outpatient treatment laws are not a panacea for what often seems like an epidemic of mass shootings committed by people with serious mental health problems.
The 2011 mass shooting in Tucson, in which US Representative Gabrielle Giffords was severely wounded, and the 2012 mass murder at a movie theater in Aurora, Colo., occurred in states with assisted outpatient treatment laws.
Much of the opposition to Khan’s bill has come from people with severe mental illnesses and their supporters who fear the loss of civil liberties. They argue that patients should have the right to refuse to take anti-psychotic medications, which can have unpleasant side effects.
“We don’t want to be in a place where peoples’ rights are impacted,” said Lynda Cutrell, former president of the Massachusetts chapter of the National Alliance on Mental Illness. “I have heard from many people who are afraid that this is going to involve something that is forced.”
On the other hand, Cutrell said, “we do absolutely know that we need change.”
She added that the organization is reviewing Khan’s bill with an eye toward taking a position on the legislation at a later date.
Anna Chinappi, spokeswoman for the state Department of Mental Health, said the state also has reservations about Khan’s bill, for the same reason.
“Any change in the mental health system that deprives people of their civil liberties based on disabilities requires thoughtful and careful consideration and further study,” Chinappi said.
Marylou Sudders, a former commissioner of the state’s Department of Mental Health who has opposed passage of an assisted outpatient treatment law for a decade, argues that it’s not necessary since judges already have the power to order outpatient treatment of people with severe mental health problems through the appointment of what is called a Rogers guardian.
But supporters of an assisted outpatient treatment law counter that Rogers guardianships are seldom used and can involved drawn-out hearings in the state’s probate courts.
Sudders said she also opposes adoption of an assisted outpatient treatment law because the state’s diminishing mental health budget won’t support one.
“We do not have the services and programs in place to serve individuals in outpatient treatment,” Sudders said. “You have to have the services in place. Then, if the services don’t work, we can have this conversation.”
Since 2001, state leaders have reduced the state mental health care budget by nearly $100 million, or more than 12 percent, according to the Massachusetts Budget and Policy Center, a nonprofit, nonpartisan group that adjusted the figures for inflation.
Kathryn Cohen, the legislative and policy counsel at the Advocacy Center, said it’s impossible to say whether an assisted outpatient treatment law in Massachusetts would have prevented Lord’s death, but she said there is little doubt the law would have applied to Alemany, requiring him to take prescribed medications and participate in a community treatment plan. “With a history of untreated mental illness, re-hospitalization, and violence, Alemany certainly would have qualified for [assisted outpatient treatment] in many states,” Cohen said.
Backers say the need for such a law was illustrated dramatically this summer, when Edwin Alemany was accused of abducting and murdering 24-year-old Amy Lord, a Web designer living in South Boston.
Rejecting an insanity defense, a jury Monday convicted Edwin Alemany of first-degree murder in the death of Amy Lord, a 24-year-old who was fatally stabbed nearly two years ago after being kidnapped outside her South Boston apartment.
Lord’s friends and family, including her parents, burst into tears as the jury delivered its verdict after less than a day of deliberations. Several friends cried out “yes,” and embraced in relief.
In July 2013, Alemany attacked Lord in the vestibule of her apartment, forced her into her Jeep, and ordered her to take out nearly $1,000 from several bank machines in Dorchester and South Boston. He then killed her at the Stony Brook Reservation in Hyde Park, strangling her and stabbing her dozens of times.The murder was part of a daylong rampage in which the Mattapan man attacked two other women, a random, senseless spree that unnerved and horrified residents.
Alemany’s lawyer, Jeffrey Denner, conceded Alemany’s guilt, but urged jurors to take his mental state into account. During the trial, a psychiatrist testified that Alemany was raped as a child and beset by mental illness from a young age.
A conviction of first-degree murder carries a mandatory sentence of life in prison without parole. Alemany is scheduled to be sentenced Tuesday morning.
In a hushed Boston courtroom, the jury said it reached its decision under every legal theory presented by prosecutors, finding that the crime was premeditated and committed with extreme atrocity and cruelty.
Daniel Conley, the Suffolk district attorney, said the jury arrived at “the right verdict” by rejecting the insanity defense.
“He acted with clarity of mind,” Conley said of Alemany. “He knew exactly what he was doing.”
Conley described Lord as a young woman with “a tremendous future ahead of her,” the kind of ambitious young professional that fills Boston with energy. He praised homicide detectives for their tireless work in assembling the case.
“There were thousands and thousands of hours of investigative work,” he said.
Lord, a Bentley University graduate from the town of Wilbraham, was working at a digital marketing and Web-design firm.
Denner had urged the jury to see Alemany’s brutal crimes as evidence of a deeply troubled man, describing him in closing arguments last week as “helpless, hapless, and hopeless.”
After the verdict Monday, Denner acknowledged that the insanity defense was a tough sell, saying the jury was understandably reluctant to find someone not guilty of “crimes of this magnitude.”
“It’s asking too much,” he said, adding that jurors might fear that Alemany eventually would be released if not found guilty.
Denner said Alemany was a “very sick man,” who had not gotten the psychiatric help he desperately needed.
“There should be a system in place,” he said. “He’s still the same sick kid he was when he was 17.”
Alemany, 30, spent several stints in psychiatric hospitals as a teenager for mental health problems that included hallucinations and severe depression. During the trial, Alemany tried to hang himself inside his jail cell, but was stopped by corrections officers.
In brief remarks outside the courthouse, juror Marilyn Stout said the panel agreed that Alemany was criminally responsible for his actions, despite obvious psychiatric troubles.
“Based on the facts and the evidence that was presented to us, that’s what we made our decision on,” she said.
Stout said the grisly case was difficult for the jury.
“We’re all human,” she said.
Jurors also convicted Alemany of kidnapping, armed carjacking, two counts of armed robbery, and assault and battery. They acquitted him of a count of armed assault with intent to rape.
Through the district attorney’s office, Lord’s family declined to comment on the verdict. Relatives of Alemany left the courtroom without speaking to reporters.
Prosecutors said that Alemany first attacked a 22-year-old woman as she walked along Old Colony Avenue on July 23, 2013. He beat her, dragged her into a parking lot, and threatened to kill her before he fled.
About an hour later, around 6 a.m., he attacked Lord as she left her Dorchester Street apartment.
He later attacked a third female victim, Kayleigh Ballantyne, as she entered her home, stabbing her repeatedly before fleeing when she screamed.
Edwin Alemany’s long spiral down — (The Boston Globe)
He once threatened to blow up his school, occasionally disappeared for 24-hour stretches, and oscillated unpredictably between sweetness and rage.
“At times he can be polite and the next minute he is swearing,” his teacher, guidance counselor, and middle school social worker wrote in a report just after his 14th birthday in September 1998. “Edwin’s moods change dramatically (usually from one day to the next) w/out any apparent precipitant.”
Alemany, who now stands accused of attacking two women in South Boston last month and abducting and brutally murdering 24-year-old Amy Lord, spent several stints in psychiatric hospitals as a teenager. He was prescribed medication and regularly monitored by the state Department of Youth Services and a special Boston Public Schools program for children with learning disabilities and emotional problems.
But after his 18th birthday, care from the state came to an abrupt end, according to his family members. Alemany left DYS custody, dropped out of school, and assumed responsibility for his own mental health care.
“He came out with a huge pack of medicine and he said, ‘I’m not taking these anymore,’” said a brother-in-law who has been a close presence in Alemany’s life since Alemany was 14. He asked not to be named for fear of backlash related to his relative’s alleged crimes.Edwin Alemany, shown outside court, repeatedly came in contact with the criminal justice system.
In the years that followed, Alemany repeatedly came in contact with the criminal justice system, largely for relatively minor crimes like theft and trespassing, according to interviews with several close family members and a review of more than 100 pages of criminal records and childhood mental health documents kept by his family. On at least three occasions, police officers witnessed Alemany threatening to kill himself or others, or acting eratically. But in the documentation of his 14 arrests between September 2002 and March of this year there is no indication that a judge ever ordered a mental health evaluation or that he was otherwise targeted for psychiatric care.
Family members said they believed he received some form of treatment while serving multiple sentences at the Suffolk County House of Correction. Alemany’s defense lawyer, Jeffrey A. Denner, said he was beginning to review Alemany’s psychiatric history but declined to comment further, saying he is awaiting any records that may exist of Alemany’s adult medical history.
Alemany’s immediate relatives, who agreed to be interviewed on the condition they not be named, spoke to a reporter in the living room of their Mattapan home. They said they know another side of Alemany — a loyal and loving son, sibling, and father. They say he maintained a long-term relationship with his girlfriend and relishes taking their 4-year-old daughter to the park and to the beach in South Boston.
He is an avid fisherman who likes to fix cars, they said. He tends a tank of tropical fish and cares for a tiny dog named Lily.
This spring, he stayed up until 3 a.m. filling 300 plastic Easter eggs with candy, money, and trinkets for his daughter and other young relatives to find during a party he organized in his parents’ yard, they said.
“He’s not a monster,” said his mother, red-eyed and speaking softly. “He’s a loving kid.”
But his psychiatric issues began early and seemed to grow with time, his family members said. He was diagnosed with a raft of learning disabilities and attention deficit problems.
In June 1999, when he was 14, he was prescribed Prozac and Dexedrine and admitted for one of his several in-patient stays for psychiatric care, after increasingly aggressive behavior that included throwing a garbage can at a teacher.
“I don’t have to be here,” he told a psychiatrist at Brookline’s Bournewood Hospital, who noted Alemany refused to show remorse or acknowledge a need for help.
He spent four years moving among juvenile detention centers, residential psychiatric hospitals, and his family’s apartment, while floating in and out of McKinley Middle School and McKinley Prep, both highly structured, therapeutic public schools in Boston.
In 2002, when Alemany was 17, his mother signed a youth services department consent form authorizing medications including antidepressants and an antipsychotic drug for her son. The form indicated he was having hallucinations. His relatives said he wrestled with hearing voices for more than a decade and has repeatedly cut and harmed himself while threatening suicide. They said they’ve never seen him be violent toward anyone but himself.
Police records show multiple instances of physical altercations — minor compared to the horrific violence he is accused of committing in July, but also hinting at alarming volatility.
Not long after Alemany left DYS care at 18, in June 2003, the owner of a Roslindale pizza shop spotted him in a median on Washington Street, yelling and punching a traffic sign. When the owner drove past, Alemany hurled a rock at him.
The man — who had sometimes given Alemany and his friends free food at the pizza shop in exchange for washing windows — got out of his truck and threatened to hit Alemany if he didn’t stop. Alemany lunged and stabbed the man in the stomach with a four-inch folding knife, according to a police report and the shop owner.
The man, who asked that his name not be used, said he believed Alemany stabbed him only out of panic and said the boy’s friends told him Alemany was distraught over a girl.
Taken in for booking that night, Alemany “struck his head and face off the plexi-glass window and punched the wall with his right hand, trying to harm himself, and threatened suicide,” the police report said.
In April 2008, police responded to a domestic dispute on Gay Head Street in Jamaica Plain and found holes punched into walls of the apartment and Alemany with cuts on his arms and neck. Neighbors said Alemany’s girlfriend at the time had chased him with a steak knife and thrown the knife at him, while the woman told police she did so only after he yelled at her and punched her.
Each was charged with domestic assault, and the police booking form indicates that Alemany’s record showed him to be on a “suicide watch list” from a previous incarceration. The case was dismissed, apparently since neither Alemany nor the woman wanted to testify.
In January 2010, police found Alemany walking down Morton Street in Dorchester just before 8 a.m. on a Sunday, heaving orange traffic barriers into the roadway. When officers frisked him, they found a knife in his right pocket and what looked like a pistol tucked into his waist — though it turned out to be a BB gun. He was found guilty of disorderly conduct and paid a $100 fine.
Five months later, after crashing a stolen car into a pole, Alemany was taken to Beth Israel Deaconess Medical Center in handcuffs for treatment. With his legs free, his feet in sneakers, he kicked the face of a nurse who tried to insert an IV into his arm, then kicked and spat at the officers who tried to restrain him.
Alemany pleaded guilty to car theft and assault and battery with a dangerous weapon and was sentenced to two years at Suffolk County House of Correction, where he would stay until 2012. Relatives said it was painful to see him incarcerated again, separated from his infant daughter, but that at least he would receive some kind of regular medical attention.
Alemany worked sporadically between jail sentences, family members said. With a criminal record, steady employment eluded him, but he detailed cars and joined his brother-in-law periodically when the latter managed a private security outfit and a moving company.
In September 2012, a woman choked into unconsciousness while walking home in Roxbury came to with a wallet in her hand that police officials now say contained Alemany’s ID. The detective investigating the case at the time did not pursue charges against Alemany, citing a lack of probable cause. Boston police are now reexamining the incident.
In the attacks in late July, police say Alemany punched one woman and stabbed another. He allegedly assaulted Lord as she left her Dorchester Street apartment for the gym early in the morning, dragging her back into the vestibule and viciously beating her. He allegedly then drove her to five ATMs and forced her to withdraw cash. She was found stabbed and strangled to death at Stony Brook Reservation.
At a scheduled arraignment in South Boston District Court July 25, a psychiatrist who interviewed him in court found him overcome by emotion; Alemany had pulled stitches from his hand — which police say he cut while stabbing one of the women — and could barely speak, saying in a whisper that he wanted to kill himself. Alemany was sent to Bridgewater State Hospital for a 20-day competency evaluation.
He is due again in court on Wednesday, pending the competency evaluation.
Alemany’s family members, interviewed recently at their home, said they pray he will be exonerated. They presented a portrait of a close-knit family that lacks the resources to get Alemany the top psychiatric care he needs or the guardianship power to insist he follow any treatment at all.
Maria Cramer of the Globe staff contributed to this report. Eric Moskowitz can be reached at firstname.lastname@example.org.