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Policy Madness

Serious mental illness is not “enriching.” October 7, 2016
Politics and law

The New York Times recently ran an op-ed declaring that being psychotic is “enriching,” and arguing against involuntary treatment of the psychotic. “The assumption that someone else’s reality is invalid can foster distrust; it sends the message that we don’t respect this person’s experience of his or her own life,” wrote Irene Hurford, an assistant professor of psychiatry at the University of Pennsylvania. This romantic, Pollyannaish, and false view of psychosis is rampant in the mental-health system, regularly parroted by the media, and dangerous to both patients and public.

Examples abound. When Mary Barksdale’s son was psychotic and untreated, he killed two police officers because he thought they were aliens from outer space. Mark Becker was also psychotic and untreated. He thought his football coach was Satan so he killed him. Russell Weston Jr. wasn’t forced into treatment. He killed two U.S. Capitol Police officers in Washington, D.C., in order to get at a time machine he “knew” was hidden in the Capitol basement.

These individuals weren’t exercising free will; they had serious mental illnesses that kept them from doing so. The organ charged with regulating their behavior was damaged. The mental-health system should have stepped in to help them before they hurt themselves and others. If necessary, that help should have been given over the patient’s objections. But a system that should offer treatment before tragedy has instead made tragedy a prerequisite for treatment. There are now 140,000 seriously mentally ill Americans living on the streets, 365,000 in jails and prisons, and 770,000 on probation or parole. More than 5,000 seriously mentally-ill people kill themselves every year. Common sense dictates that we should provide a path to treatment, but there isn’t much common sense in the $147 billion mental-health system. 

Hurford, like many in the mental-health industry, minimizes an association between mental illness and violence. That’s ridiculous. If there is no association, then why do hospital psychiatric units have doors that lock while cardiac units don’t? Why do nurses in psychiatric units have to wear panic buttons, while those in cancer units don’t? Why are police called to restrain people with untreated, serious mental illness, but not those with untreated psoriasis? Pretending there is no association between untreated serious mental illness and violence is delusional, dangerous, and cruel to those who could benefit from treatment. While the mentally ill and the seriously mentally ill are no more violent than others, research clearly shows the untreated seriously ill are more violent than others. Political correctness may require denial of the association, but reality doth protest.

The purpose of Hurford’s op-ed was to argue against the Assisted Outpatient Treatment (AOT) provisions of the Helping Families in Mental Health Crisis Act. AOT—called Kendra’s Law in New York and Laura’s Law in California—is a revolutionary approach to treating serious mental illness designed to minimize homelessness, arrest, violence, and hospitalization. Before the 1990s, practitioners generally had only two options for people who were psychotic and on their way to mayhem. Do nothing, or remove all their rights by involuntarily committing the patient to a hospital or jail. AOT provides a middle ground by allowing judges to order six months of mandated treatment for the mentally ill, even as they continue to live in the community. It is tightly monitored and exclusively for those who have already accumulated multiple episodes of homelessness, arrest, violence, needless hospitalization, or incarceration due to their failure to comply with voluntary treatment. AOT is not an alternative to voluntary care––it is only used after that approach fails, and before incarceration or involuntary hospitalization becomes necessary.

Research from multiple states, especially New York, has shown that AOT dramatically lowers rates of homelessness, hospitalization, arrest, violence, incarceration, victimization, and suicide. By reducing the use of inpatient commitment and incarceration, it cuts costs to taxpayers in half. AOT has been recognized as effective by the International Association of Chiefs of Police, the National Sheriffs Association, the U.S. Department of Justice, the Agency for Health Research and Quality, the National Alliance on Mental Illness, and the U.S. Conference of Catholic Bishops. Only the mental-health industry opposes AOT. They fear that admitting the connection between severe, untreated mental illness and violence will cause “stigma.” The industry’s political power is so strong that when New York City allocated $800 million to the ThriveNYC mental-health plan, virtually none of it went to expanding AOT.

Compelling people to take treatment they don’t want sounds icky, and seems to mock our most precious concept of civil liberty. But doing so carefully, correctly, and judicially can save lives.

Photo by stevanovicigor/iStock

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