How freedom punishes the severely mentally ill

By E. Fuller Torrey and Mary T. Zdanowicz

USA Today

June 7, 1999

Reprinted with permission. Copyright 1999 USA Today. All rights reserved.

May 21: Margaret Laverne Mitchell shot dead by police in Los Angeles.
May 23: Robert F. Silver Jr. dies in police custody in Clinton, Md.
May 25: Rodney Mason shot dead by police in Queens, N.Y.

Mitchell, Silver and Mason have more in common than tragic deaths. All suffered fromsevere mental illness, none was taking his or her medication, and each of their familieshad tried unsuccessfully to get them treatment.

This is what can happen when the severest forms of mental illness — schizophrenia andmanic-depressive illness — go untreated.

Mitchell, a college-educated homeless person with untreated schizophrenia, was shotafter allegedly lunging at a police officer with a screwdriver. Her son said he had triedto get her help, but was told she first had to either hurt herself or someone else.

That same day, Silver’s parents were in court trying to get him treatment. A judge senthim home.

Two days later, Silver died of an apparent heart attack after five police officersstruggled to subdue him after he attacked the side of a church van.

Less than 36 hours later, police officers shot Mason after he stabbed an officer.Discharged from a state mental hospital six months earlier, he was not taking hismedication. State law prevented officials from forcing him to take it, even though heearlier had attacked another police officer.

These are not isolated incidents. As the White House convenes a mental healthconference today, one of the issues it will address is inadequate treatment laws, whichresult in the mentally ill more often facing a police officer’s gun than the caring armsof a well-trained psychiatric team.

Oblivious to illness

The reasons are twofold.

First, nearly half of those with schizophrenia or manic-depressive illness don’trecognize the symptoms of their illness (delusions, hallucinations, paranoia, withdrawal),and they don’t believe that they are sick, so they do not voluntarily take theirmedication.

Secondly, most state laws say an individual must pose “an immediate danger to selfor others” before medical intervention can occur. Civil libertarians have made italmost impossible to treat psychotic individuals who refuse care. These misguidedactivists have created a morass of legal obstacles that prevents us from helping manypsychotic individuals until they have a finger on a trigger or have attempted suicide.

“Death by cop” is not the only dire result of our present system.

Americans with untreated severe mental illnesses represent less than 1% of the U.S.population, yet commit nearly 1,000 homicides each year, or 4%-5% of the total annualmurders.

At least a third of the estimated 600,000 homeless individuals have schizophrenia ormanic-depressive illness. At least 10% of prisoners suffer from these illnesses, costingtaxpayers $8.5 billion a year.

A better way exists

It’s time to reverse course. Mandatory treatment for those too ill to recognize theyneed help is far more humane than our present mandatory nontreatment.

The legal standard for assisted treatment should be the need for medical care, notdangerousness. Society should save people from degradation, not just death. States shouldenact strong treatment laws that say individuals such as Margaret, Robert and Rodney canlive in the community only if they consistently take their medications. If they do not,they could be involuntarily rehospitalized.

We will not have to reopen all of the psychiatric hospitals that closed afterdeinstitutionalization, which began in the mid-’50s. With proper medications, properlytaken, most with severe mental illnesses can live in the community.

But we must help those incapable of making informed medical decisions. Our lawenforcement officials should not be the frontline caregivers for those Americans trappedby psychoses