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.

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

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.

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.

Enhanced by Zemanta
"It's A Trap!"
Maine Governor LePage is a refreshing guy