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Now we ask the hard questions - what to do about the mentally ill?

A week has passed since the shooting spree in Tucson, AZ that claimed the life of Federal Judge John Roll and five others, and critically wounded Rep. Gabrielle Giffords.  The shooter was known to local law enforcement officials as a troublemaker, and had been dismissed from Pima Community College because of his unruliness and his crazed outbursts, which were often centered around incomprehensible conspiracy theories and a visible frustration with the "ignorant" and "illiterate" people who surrounded him. 

Clearly, Jared Loughner needed help.  Why he didn't receive the help he so desperately needed will be -- and should be --  the subject of vigorous debate.

Of course politics will once again play a major role.  The hard Left has just been gobsmacked by the stunning rebuke of their initial attempts to use the shooting as a weapon (ugh, those damn metaphors) with which to bludgeon (ugh, again!) conservatives, specifically Sarah Palin and the Tea Party movement.  They are still desperate to turn the incident into a political win, and so we can probably expect to see more articles like this one in the very near future:

It's Easer to Get a Gun than Mental Health Care

Dora Calott Wang, MD - Psychology Today Jan. 11, 2011

There will be more shooting rampages, like that which targeted Congresswoman Gabrielle Giffords in Tucson last weekend-as long as it is easier to get a gun than mental health care. Our current epidemic of mass shootings is but a symptom of our nation's broken health care system. Poor access to medical care jeopardizes an individual's health. But when the mentally ill or the seriously distressed can't access care, we are all at risk.

As a psychiatrist, I remember when I once did everything in my power to keep a disturbed patient stable, and society safe. I'd see the patient every day, or hospitalize the patient for months, if necessary. Needless to say, this degree of attention is impossible today, given limited resources, and the fights my staff and I regularly undertake with insurance companies to get even routine care approved.

For decades, the American health care system has prioritized profits, often by excluding the sick. This travesty is now coming to roost, in the form of mass violence, such as the recent shootings in Tucson, at Virgina Tech, and in communities across the country, including my own.
Medical care for our most disenfranchised citizens will never turn good profits-yet basic health care for everyone, is necessary for the stability of society.

... Effective treatments for serious mental illness only began with antipsychotic medications created in the 1950's. An older, more primary function of psychiatry-dating from the time of asylums-has always been to keep society safe.

We as a society are only as stable as the least stable individual roaming our streets.

How many more tragedies need occur, before we conclude that our mental health care system no longer functions to keep us safe? When will we learn that everyone needs basic medical care, not just for humanitarian reasons, but for the safety of all of us?

Unfortunately Dr. Wang's  "the government should pay for everything, no questions asked" solution is severely hampered by another cruel reality of our current mental health care system -- decades of lawsuits filed by civil libertarians and patient's rights advocates have made it virtually impossible for courts or family members to compel seriously disturbed adults to receive mental health care without their full consent.  This USAToday feature from 2001 explains this problem in detail:

Rodger Gambs is 28 and suffers from schizophrenia. For much of his illness, he refused care. His parents tried to push him into treatment, but in the eyes of the law, he wasn't dangerous enough to be hospitalized against his will. The standoff among parents, son, the courts and mental health professionals in San Luis Obispo County, north of Los Angeles, continued for five years. The parents begged for their son to be forced into treatment. The professionals shrugged. Sorry, they said, our hands are tied.

Then, in 1998, Rodger stole two of his father's guns to arm himself against the blood-sucking vampires he said lived in the back yard. That led to felony charges. Only then did Rodger qualify for hospitalization -- at the state hospital for the criminally insane, where he spent four months in 1999. Rodger now lives in a group home, takes medication and is recovering.

Rodger's parents, Roger and Rae Belle, are soft-spoken. But they are still outraged at a health system that allowed their son to go untreated for so long.

"You don't have to become a criminal to be treated for a heart attack," Roger says.

"No one should have to go through what we went through," Rae Belle says.

But tens of thousands of families do every day. They are at the heart of a deeply divisive debate over how this country should care for severely mentally ill people who forgo treatment. In many regards, it is a struggle between law and medicine: the legal right to control one's destiny and the medical theory that treatment, even when forced, can restore mental patients' health.

... The state of New York broke ground in 1999 by enacting a law requiring outpatients to participate in mental treatment if ordered to do so by a court. But the bill passed only after a horrific act of violence that transformed the issue from one of public health into one of public safety. "Kendra's Law" was passed eight months after a Manhattan office worker named Kendra Webdale, 32, was shoved to her death in front of a subway car by Andrew Goldstein, 31, a schizophrenic man off his medication.

Meanwhile, the number of mentally ill who go untreated is rising across the nation. Those who forgo treatment are most visible in jails and among the homeless population. Although estimates of the number of homeless vary widely, from 800,000 to more than 2 million, there is universal agreement among police and health professionals that more than a third of them are mentally ill.

Two of the most enduring memes of the Left are "Reagan created the homeless" and "Reagan emptied out the mental hospitals."  An honest examination and discussion (the key word here being "honest") of the de-institutionalization trends of the 1960's, 1970's, and 1980's would reveal both of those memes to be patently false.  The movement toward de-institutionalizing the mentally ill was lengthy and complicated, and was primarily centered around "least restrictive" methods of care that became standard in the 1970's.  These changes were advocated by liberal groups and enacted largely with the aid of lawsuits filed by the ACLU.  There was also a strong social component, fueled by works such as Ken Kesey's explosive novel (and later Academy-Award winning film) One Flew Over The Cukoo's Nest

But did we do the right thing?  From the comments at the Snopes link above:

My wife worked for the chief of the psychiatric department at the Brentwood VA in California during the early 80s. From the mid-70s to mid-80s there was a strong 'patients rights' movement generated by the mental health advocate community. Although there were many facets to this movement, one of the primary elements was a re-examination of the criteria for institutionalizing patients. 

... Begining in the late 70s, the advocacy groups began to demand a lower standard. As long as a patient could merely wash and dress himself, and could perform the mechanical tasks of shovelling food into his mouth, then every effort was made to force the institutions to release them. My wife's boss spent many months both in court and testifying before the state assembly trying to stop this lowering of standards. Unsuccessfully.

Predictably, most of the newly discharged patients were unable to take care of themselves in any meaningful sense of the word, and became the homeless people on the street. It's no coincidence that the decline in California's mental health insitution population closely matched the sharp increase of homeless (in California, at least) during the same period. In fact, for about two years, my wife literally was on a first name basis with every homeless person we ran across in the Westwood/Santa Monica area. They were all former patients who had been 'sprung' from the VA by well meaning advocate groups who then simply walked away and left these guys hanging.

If we are serious about helping those with mental illness, then a re-examination of the criteria necessary for full-time institutionalization is certainly appropriate.  And if we decide that expanded mental health services and compulsory institutionalization for mentally ill individuals who are either a danger to society or who cannot take care of themselves is warranted, then we will have to figure out how to pay for it.

On second thought, maybe we should just blame everything on Sarah Palin.  That'd be a hell of a lot easier.

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Comments (14)

Excellent piece. But I dou... (Below threshold)

Excellent piece. But I doubt the left wants to have this discussion.

The Lanterman, Pettis, Short Act (LPS) was what 'freed the inmates' in California. If they could find food (dumpster), clothing (Goodwill bin), shelter (freeway underpass), they were good to go on their own.

"Community clinics" were to be set up and funded by the state. As it turns out, Political Power decided where and how much was dispensed for these community services. A couple of years ago, my COUNTY finally got more state health care dollars than the CITY of San Francisco. It took a federal lawsuit to cut through the political crap used to divide up the available funds. And don't forget, the mentally ill have 'rights', up to and including the right NOT to take medication.

As you point out, the streets, jails and prisons are filled with the mentally ill.

By the same token, the 'mentally ill' are not stupid. Years ago I could only involuntarily commit people based on personal observation and knowledge. Only later could I also include what was heard/seen by others. Those who'd gone through the mental health system revolving door also have learned what to say, and what not to say when the cops show up. Many states still require that 'personal observation' by officers prior to an involuntary commit.

As for Wang and her "Poor access to medical care jeopardizes an individual's health." That's a bullshit cop-out! Perhaps someone should point out the "Hotlines" available in the phone book. As far as I know, all the County Mental Health facilities in California have an open front door. "Poor access" my ass.

Pima College had their campus police escort Loughtner from the school grounds. He could not come back without a psychiatric report that said he did not 'present a danger to himself or others'. THAT is grounds for a 72 hour commit, even in Arizona. The Kampus Kops did nothing!

Solutions cost money. Political blame can pay dividends.

"Political blame" has insur... (Below threshold)

"Political blame" has insured that Sarah Palin will never be President or Vice-President of our country.

In my view, "political blame" is a good thing.

But I know conservatives will agree that blame is a good thing. At least, I'm sure they see the value in it because it's been a non-stop blame-fest ever since Obama got into office.

But since there is a very good chance that Obama will win re-election, conservatives will I'm sure also agree that libs are better at playing this game then conservatives.

Conservatives blame more and blame louder - but when liberals engage in this practice we wait until there is an element of truth behind it. That's the difference.

I know this is off on a tan... (Below threshold)

I know this is off on a tangent, but phrasing like this:

A week has passed since the shooting spree in Tucson, AZ that claimed the life of Federal Judge John Roll and five others, and critically wounded Rep. Gabrielle Giffords.

has been bothering me more with every passing day. Six people died and thirteen were wounded, several critically. Yet Judge Rolls and Representative Giffords are the only ones who get named in most of the discussions about it. Can you even name the other five who died, let alone the other twelve wounded?

Somehow, I find that says more about the incident and the reaction to it than all the arguing over 'who was responsible.'

As a psychiatri... (Below threshold)
Jay Guevara:

As a psychiatrist, I remember when I once did everything in my power to keep a disturbed patient stable, and society safe. I'd see the patient every day, or hospitalize the patient for months, if necessary. Needless to say, this degree of attention is impossible today, given limited resources, and the fights my staff and I regularly undertake with insurance companies to get even routine care approved.

The problem isn't money, as Wang would have us believe. The problem is the difficulty of involuntary commitment, because well-meant but catastrophic legal rulings by, inter alia, the US Supreme Court in 1975 in O'Connor v. Donaldson (a Florida case, following California's Lanterman-Petris-Short Act, as GarandFan correctly notes, and IIRC a California state supreme court case).

As a consequence, it is not legal to commit someone for psychiatric care against his will without a showing that

the individual must be exhibiting behavior that is a danger to himself or others in order to be held, the hold must be for evaluation only and a court order must be received for more than very short term treatment or hospitalization (typically no longer than 72 hours). This ruling has severely limited involuntary treatment and hospitalization in the U.S

(from Wiki)

Bizarre behavior, without more, doesn't make it. And for a psychiatrist to say she cannot hospitalize unstable patients today, without mentioning this problem, is intellectually dishonest. Sure, many of the mildly ill may well consent to hospitalization, and insurance companies may balk. That part of her point is valid. But the truly batshit-crazy dangerous types are unlikely to agree, and they, of course, are where the problem lies.

So pull your head out of your ass, Wang, and make a real contribution to the discussion, not just liberal talking points.

Wolfwalker,If you ... (Below threshold)
jim m:


If you are interested in finding out the names of the other victims I suggest you use this new tool on the internet called Google. It works really well for finding out information like that.

If you are complaining that the rest of us are insensitive for not listing all six names over and over again like some totem or incantation then you can forget it.

Yes it is awful for those who died and their loved ones. But the fact that others are not as openly concerned about them as you would like does not mean that they never cared.

Forgive me if I have already heard the argument that all arguments are invalid because we do not sufficiently recognize all the dead in some predetermined way to everyone's satisfaction

Wolfwalker - as far as I kn... (Below threshold)

Wolfwalker - as far as I know, the names of all six victims killed by Loughner have been released; however, I do not believe that the names of all the survivors have yet been made public.

Oh, come now, Jim M. If yo... (Below threshold)

Oh, come now, Jim M. If you were intending that to be serious, it fell rather short of the mark. If you were intending it to be offensive, well ... it still fell rather short of the mark. Surely you can do better if you try.

Michael: OK, that makes sense, about the names of the wounded not being released. Still, it bothers me that out of all the bloggers and all the blogposts I've seen about the attack, the only place I've seen a complete list of the dead is The LawDog Files.

7 comments. 2 on topic. <... (Below threshold)

7 comments. 2 on topic.

Personally, I didn't find the topic that hard.

"Now we ask the hard questi... (Below threshold)

"Now we ask the hard questions - what to do about the mentally ill?"

Vote them out of office.

poop - BLAME?? There is a ... (Below threshold)

poop - BLAME?? There is a hell of a difference between blame and revealing the truth.

Boooosh did it! He's to blame!

The truth is that the pretender in chief has surrounded himself with political cronies who have absolutely no qualifications for the positions to which he appointed them. With no one to provide him with sound advice, obama is wandering around in a self induced coma, I am surprised he can walk and chew gum at the same time.

To the subject at hand, did... (Below threshold)

To the subject at hand, didn't Kalifornia just decide to reduce or eliminate the mentally ill funding as an additional means to reduce their deficit?

"To the subject at hand, di... (Below threshold)

"To the subject at hand, didn't Kalifornia just decide to reduce or eliminate the mentally ill funding as an additional means to reduce their deficit?"

Yep, MediCal funding was among the programs that Brown wants to cut. He wants to cut a lot. Except for where it counts. Over 110 boards and commissions - home to 6 figure salaries, and populated by termed-out, or un-reelected politicians remain intact.


Wolfwalker: You are absolut... (Below threshold)

Wolfwalker: You are absolutely right in general, but you missed the big one. The news reports and blogs are filled with mention of Christina Green. In fact, I'm willing to bet up here in snow country she was mentioned more than Judge Roll.

I visited Loughner's YouTub... (Below threshold)

I visited Loughner's YouTube page hours after the shootings, and among his favorite books was One Flew Over The Cuckoo's Nest. It is my opinion that he felt outraged and empowered by this book, fueling his conspiracy theory about government mind control.






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