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Can We Force Help on the Mentally Ill Sooner?

January 11th, 2011 at 8:01 am David Frum | 9 Comments |

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William Galston makes the case for involuntary commitment of the extremely mentally ill. From the New Republic online:

Starting in the 1970s, viagra civil libertarians worked to eliminate involuntary commitment or, view that failing, tadalafil to raise the standards and burden of proof so high that few individuals would meet it. Important decisions by the Supreme Court and subordinate courts gave individuals new protections, including a constitutional right to refuse psychotropic medication. A few states have tried to push back in constitutionally acceptable ways, but efforts such as California’s Laura’s Law, designed to make it easier to force patients to take medication, have been stymied by civil rights concerns and lack of funding.

We need legal reform to shift the balance in favor of protecting the community, especially against those who are armed and deranged. This means two changes in particular. First, those who acquire credible evidence of an individual’s mental disturbance should be required to report it to both law enforcement authorities and the courts, and the legal jeopardy for failing to do so should be tough enough to ensure compliance. Parents, school authorities, and other involved parties should be made to understand that they have responsibilities to the community as a whole, not just to family members or to their own student body. While embarrassment and reluctance to get involved are understandable sentiments, they should not be allowed to drive conduct when the public safety is at stake. We’re not necessarily cramming these measures down anyone’s throat: I’ve known many families who were desperate for laws that would help them do what they knew needed to be done for their adult children, and many college administrators who felt that their hands were tied.

Second, the law should no longer require, as a condition of involuntary incarceration, that seriously disturbed individuals constitute a danger to themselves or others, let alone a “substantial” or “imminent” danger, as many states do. A delusional loss of contact with reality should be enough to trigger a process that starts with multiple offers of voluntary assistance and ends with involuntary treatment, including commitment if necessary.

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9 Comments so far ↓

  • armstp

    David,

    Again like your comment on pot smoking, how do you know this guy was mentally ill? Where is the proof? He certainly was never medically diagnosed mentally ill. The crime was pre-meditated and was about some very specific grievences with government. That does not necessarily indicate mental illness. In fact, in a court of law that may indicate that he was not insane. It is far too easy for those on the right to fluff this off as, he was mentally ill, so we hold no responsiblity for all the violent vitriol or this was not political violence. We do not consider suicide bombers to be mentally ill. Just because Loughner held some strange views does not mean he was mentally ill, as by that definition half the people in the conservative movement would also be considered mentally ill and should be institutionalized.

  • lessadoabouteverything

    armstp, I get your point but obviously the guy was mentally ill, that does not mean he was insane and devoid of the capacity to reason. I have never seen so many Republicans rush to the defense of the insanity pledge ever though. They are obviously terrified if the correlation can be proven to be causation. Not me though. Freedom is messy. At most I would urge manners and reason, not impose it. And I could choose not to support any candidate who uses incendiary and violent laden language, which I don’t.

    As to commitment, it is a very tough issue since years ago they committed gay people, and being that you can not prove you are sane, (like with a blood test) you can only hope to convince people you are.

    But lets be honest, nowadays society doesn’t commit people because of the money involved. It is helluva expensive. They are cutting children off from basic medical care in places like Arizona, there is no way in hell they are going to spend that kind of money to care for and support the mentally ill. It is far cheaper to lock up the few who go violent and let the rest fend for themselves.

  • Joe In NH

    lessadoabouteverything is right. Even when people do act in ways that show a great potential to injury themselves or others the system refuses to acknowledge it. Why? Not because the medical people are stupid but rather because they know there is not enough money and space for everyone and they have to be realistic.

  • politicalfan

    “defense of the insanity pledge ever though”

    lessado-

    I see both sides jumping on the bandwagon. I tend to agree with armstp, by the simple point of ‘what is his diagnosis?’

    There was this movie about a guy who portrayed himself insane and even though he was ill, he was smart enough to portray himself to the letter of insanity. I can’t remember the name of the movie and of course I am speculating. There are a couple of things that are curious about his actions that have been released. I am not saying that he does not appear to be strongly unbalanced or even act that way but the story will unravel and I think that is armstp’s point (not speaking for him).

    I don’t think we can force people to get help but there should definitely be more support for mental health services in each state. Education!

  • narcissa

    Involuntary commitment needs a bit more finessing, since definitions of sanity vary, and one of the most common forms of political punishment is commitment. (See Communist Russia, See China today etc.) Plenty of people who might be in contact with troubled people really don’t understand what is or isn’t crazy. The lack of rigor that accompanies low-level mental health professionals fills me with alarm when combined with involuntary commitment.

    Women, African-Americans and others were routinely committed simply for asserting their rights as individuals. Artists in the process of creating art do not look sane, and often neglect everyday duties. Much religious expression does not fall into the rubric of normal behavior, self-flagellation, the Phillipino christians who nail themselves to a cross on Easter, handling snakes, speaking in tongues… And we haven’t even gotten to the discussion of whether hearing voices really is crazy. Many people believe, as a matter of faith, that the world is filled with spirits. Was Joan of Arc a dangerous schizophrenic or a saint? Are shamans insane or simply gifted? Most people would not be comfortable letting science decide that question.

    And how to tell the difference between a Ruby Ridge style millennialist and a schizophrenic? Beck’s language and manner seem very troubled.

    Even forcing medicine is problematic. What if you were a teen forced to take your anti-depressant medicine (the one that can increase suicide and violence in children) even though you knew it was causing you more rather than less troubled thoughts? Physicians tend to focus on fixing a problem rather than looking after overall well-being, so minimize the experience of side effects on patients. I very much doubt shrinks are any less prone to this habit.

    And how do we tell the difference between a crazy person who is dangerous and one who simply gives us the heebie jeebies. Insanity is fear invoking as a rule. We are not good judges of which instability will produce violence and which not.

    I’m not arguing that there is nothing we can do, but I think we need to define what mental health is, in a way that isn’t simply an expression of the majority view of a society. I’m sure the Nazi’s thought they were the height of sanity and I presume we can all agree that they were nuts. Slaveholders thought any slave who wanted freedom was insane, or wild. Epileptics who clearly only had physical problems with the brain were committed as well. Our shakes (I’m one) made people nervous, so they made sure they didn’t need to see us.

    It is an issue in which we need to proceed with extreme caution.

  • PracticalGirl

    lessado:

    “I have never seen so many Republicans rush to the defense of the insanity pledge ever though.”

    Was thinking about the same thing yesterday. Anybody else remember what happened in the aftermath of the John Hinckley, Jr. assasination attempt? The Insanity Defense Reform Act which made it much harder to obtain a “not guilty by reason of insanity” verdict. To be fair, it was a split majority Congress (D = House, R=Senate) but this was GOP-outcry demanded.

  • RLHotchkiss

    I recently lost a dear friend to suicide. He told me felt he had poisoned himself with his medicine. I called the police and asked for the PERT team. In San Diego they have a PERT team to help seniors with mental problems. However the PERT team is only available every other day. Regular patrol officers where sent. I explained that he had been acting erratically for days. He had hurt his food badly. I told them about this. They talked to him for ten minutes.

    Thirty minutes later he jumped off his balcony. A couple of years ago I worked in a senior hotel. A resident was banging violently on his door with his cane and shouting that there was someone in his bathroom. I called the police. I begged them for an hour to take him to a hospital. They left a few hours later he jumped to his death.

    So, yeah, it would be nice to change commitment so that a person might at least be evaluated for a few hours by medical professional instead of a few minutes by a police professional.

    But where are you going to commit these people too. The state hospitals have been closed. Insurance will only cover a few days in the hospital. The Governor of California wants to charge patients who are committed one hundred dollars, if they stay more than one day it will be two hundred dollars.

    For someone on disability this is an enormous sum, a ruinous sum. Do you really want a person who is hearing voices and in distress to have to worry that if they go to hospital that they will not be able to pay their rent.

    Similarly, Brown wants to limit the number of medications a person on MediCal can have to six. Psychiatric medications have horrible side effects. They make you gain wait, they make you disoriented, they make you very sick to your stomach, they can cause significant pain and discomfort. They can raise your blood pressure and make you have diabetes.

    If you are a doctor which symptoms do you treat with the six medications. If you are a mentally ill and the doctor will give you medicines that make you sick but not medicines to treat your nausea, if she will give you medicines that make you fat but not medicines to treat your blood pressure, if she will give you medicines that prevent you from sleeping but not medicines to help you sleep why take any medicines at all.

  • Carney

    This flinging open of the institutions and the dumping of people on the streets has been a major cause of “homelessness”. Prior to that, people sleeping in the streets were unknown as a routine phenomenon in American cities, even during the Great Depression.

  • Charles M. Kelly

    First: who’s going to pay for all this? Mental patients are not famous for being well-healed or having the funds to buy insurance. Taxpayers will scream bloody murder if they have to pay for the care of the mentally ill.

    There is, you see, a pervasive myth that people “choose” to be mentally ill. If they just “chose” to be rational, their sickness would magically go away.

    I’ve encountered this myth at point-blank range as a survivor of clinical depression and as the son of a woman diagnosed with schizophrenia. (I suspect, now that she’s dead, that she was misdiagnosed. Many mental illnesses have symptoms in common—a correct diagnosis is critical to effective treatment and yet often elusive.

    And how do you define “dangerousness?” Until someone acts, there is no evidence. Are we to embrace “preventive detention,” the notion that people be jailed indefinitely for unspecified crimes that have not occurred because we think such unspecified crimes might possible be committed at some unknown point in time in the future?

    Again, if I may cite my mother as an example: my mother feared she would harm me. Never occurred to me or to my father (who came to regret marrying her), but she feared she would harm me. So she joined Parents Anonymous, a child abuse prevention organization. Should my mother have been involuntarily committed for an indefinite period of time for joining a child abuse prevention organization? Should I have been removed from my family because my mother joined a child abuse prevention organization?

    The cure being proposed here might drive people away from seeking treatment they need, rather than making that treatment more accessible.

    And who should have paid for it? My family could have gone broke very quickly if she had been committed indefinitely. One of her psychiatric bills was a whopping, mind-numbing $20K a week for a two week stay. At those costs, neither the private nor the public sector can afford to foot the bill.

    The problem is an obvious one. The need for a solution is something no one can argue with. But the search for a simple solution will elude us until we accept that the solution, whatever it might be, isn’t going to be a simple or inexpensive.