Compassion, Compulsion and the Mentally Ill

Wall Street Journal ^ | 9 June 2008 | E. FULLER TORREY

[shrinkermd]

The debacle of deinstitutionalization continues to worsen with each passing year. In 1955, there were 559,000 individuals in America's state mental hospitals. By 2005, there were only 47,000 state hospital beds left in the country, a number that continues to fall. Numerous studies have documented the tragic effects of releasing hundreds of thousands of seriously mentally ill individuals from state hospitals while failing to ensure that they receive treatment.

The latest, carried out by Jason Matejkowski and colleagues at the University of Pennsylvania, found that individuals with serious mental illnesses are responsible for 10% of all homicides in Indiana. That translates into approximately 1,700 out of 17,034 total homicides in the U.S. in 2006. Over the past 20 years – during which time the public mental-health system has progressively deteriorated – that would mean 38,000 of 388,311 total homicides.

...Kendra's Law, passed in New York state in 1999, established one such program. A 2005 study by the New York State Office of Mental Health showed that physical acts of violence – as well as suicide attempts and arrests – by patients compelled to undergo treatment under Kendra's Law dropped dramatically in just six months; a similar reduction in violent behavior was shown in a North Carolina study.

Despite such data, assisted outpatient treatment is seldom used in the 42 states in which it is available and does not even exist in the other eight states. Even in New York, only a few counties use Kendra's Law widely. Why not? One reason is the reluctance of mental-health professionals to mandate treatment, even for patients with a history of violence and noncompliance with treatment.

[hellbender]

individuals with serious mental illnesses are responsible for 10% of all homicides in Indiana.

I'm not saying it couldn't be true, but I'd like to have a closer look at the data behind that assertion, considering that 1) insanity defenses are popular with defense attorneys, 2) psychiatric diagnoses have proliferated to include things which are simply antisocial, amoral, criminal behavior, like "oppositional defiant disorder," and 3) some of the "mental illness" may really be the result of substance abuse.

It's also ironic that the open-borders crowd at WSJ doesn't care much about getting another crime-prone group off the streets: illegal immigrants.

[ravingnutter]

Agree with you and not only that, they don’t seem to care about how accurate their figures are...taking a 2006 figure and then spreading it over a 20 year span to come up with their rationale for forced treatment? Not up to par with any research standards I am familiar with, sounds more like someone with an agenda.

[livius]

As Supreme Court Justice Anthony Kennedy wrote in 1999: "It must be remembered that for the person with severe mental illness who has no treatment, the most dreaded of confinements can be the imprisonment inflicted by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our powers to describe."

Absolutely. Mental health care died because it met the perfect storm: leftist assertions that these people were just expressing themselves, founded on the Langian theme that mental illness was just a result of capitalism and only the mentally ill were truly sane, met conservative short-sighted cheapness.

It was going to be "more cost effective" to place these people in "community care" and finally, cheapest of all to just let them roam the streets. I hate to say it, but as governor of CA, Ronald Reagan was probably responsible for many innocent people in California being killed (usually in particularly gruesome ways) by the mentally ill, because he simply opened the doors and dumped these people onto the streets. Nobody ever took into account the huge costs in police services, prisons, emergency room and public health care, even sanitation services - not to mention business lost when the homeless mentally ill took up residence in the downtown areas of cities, and the enormous cost to society of homicide. The economic loss from the violent death of a productive citizen and its ripple effect is stunning.

The bizarre thing is that in many places, the mental hospitals remained open - but empty. New York State still has mental hospitals upstate, because they were the one employer in their towns and the state legislators kept them open. But the mentally ill were not allowed to use them.