Bring Back the Asylums: Consequences of Deinstitutionalization

[Greg Bernhardt]

This is certainly a controversial issue, but one that begs questioning after all these mass shootings. A broader question is why are mental health services failing?

This issue hits me hard because I have a family member who suffers greatly from mental illness and as a result a drug addiction. This family member I believe should be in long term care. He is in and out of hospitals constantly. Unable to hold a job or keep friends. No ambition or motivation. Pushes family away. Skips medicine doses. And as I said, is addicted to one of the worst drugs. It's an absolute downward spiral and the mental health services can't do anything but keep his head barely above water. The family just waits for the call that he is in jail or dead. It feels hopeless and is very painful.

The only solution I can see is a long term care (months) where he gets clean, get medicine and get's life resources.

The tragic consequences of deinstitutionalization.
http://www.currentpsychiatry.com/the-publication/past-issue-single-view/bring-back-the-asylums/20064951b8caf413d494a0eb19b67cf8.html

 

[disregardthat]

Are the people performing mass shootings or similar crimes the same who are showing particular signs of psychosis or mental disturbance that would get caught up in such a net? My impression is that one of the big problems with mentally disturbed people performing atrocious criminal acts is that they are usually very isolated.

 

[Greg Bernhardt]

My impression is that one of the big problems with mentally disturbed people performing atrocious criminal acts is that they are usually very isolated.

It seems to be most of the mass shooters have been on the radar. This latest one the kid had been seeing a therapist for 11 years and the cops visited him three times.

And in the case of my family member, we've called the cops a dozen times and he is in and out of the hospital all the time.

 

[Astronuc]

Until someone acts violently, there is little that the authorities can do.

It's one thing for a child (dependent) who is mentally ill, and the parents can monitor their activity, but for an adult with mental illness, little can be done by the parents, since adults by definition are responsible for themselves.

They system is geared to protect privacy and liberty, until someone commits a crime. Unfortunately, after the fact is too late for the victims of homicide.

Apparently, once the parent(s) discovered the violent (with threats) videos, they made a call to authorities to intervene.

The question remains how Elliot Rodger was able to secure 3 handguns with a history of mental illness. Ostensibly, his treatment was deemed effective, even though he was planning violence.

Had Rodger made a threat of violence, the police could have arrested him for 'making terroristic threats'.

 

[Evo]

I think we are failing as a society to take these people in and keep them off the streets as long as they continue to show these signs. I agree with you Greg, many of the mass murderers were under previous therapy, or police had been called in. Many families have been begging for help for their loved ones to no avail.

I really am sorry for you and your family for not being able to get proper care for this person. We need to rethink things.

Now, Gold says, the pendulum has swung "too far," because the law doesn't allow patients to be protected from themselves.

"Our civil commitment laws are broken," Cornell says. "They are designed to protect individuals from being held against their will. But they have gone too far. They no longer protect society. We've had many cases where people who should have been hospitalized have been allowed to languish and they deteriorate into a violent act."

So under certain circumstances, a person who threatens to stab his mother often may not be committed against his will, even if he has stabbed her in the past, Gold says, if the most recent threats occurred more than a few days ago. "You can't commit them. You can't get them into treatment. You can't even hold them for observation; it's considered a violation of their civil liberty."

Like many other parents, Heather Tillmann of Milwaukee says she was often told her child wasn't sick or violent enough to qualify for services. At one point, a court official told her, "We can't take a serial killer to jail before they kill."

Those policies need to change, says Ron Manderscheid, executive director of the National Association of County Behavioral Health and Developmental Disability Directors. The country desperately needs to focus on prevention and early intervention, he says.

http://www.usatoday.com/story/news/nation/2013/01/07/mental-illness-civil-commitment/1814301/

 

[dlgoff]

There use to be one about 25 miles down the road from me. http://en.wikipedia.org/wiki/Menninger_Foundation

 

[Borg]

Greg, I'm sorry for what your family is going through.

The majority of people with mental illness do not commit mass murder. However, for those that do, the media provides them with abundant publicity. It bugs me to no end how the media splashes their manifestos and youtube videos all over the news. The people who perpetrate these crimes need to get as little recognition as possible for what they do - no manifestos, no videos, no Wiki page with their name listed, etc. When they see that their rants won't be publicly recognized, then they'll have to find a different outlet for their pain.

As this father now knows, it shouldn't be all about the killers.
https://www.youtube.com/watch?v=ZW_raNDQprU

 

[Greg Bernhardt]

Greg, I'm sorry for what your family is going through.

The majority of people with mental illness do not commit mass murder.

Thanks and you're right but I would like that this discussion not turn into a mass killer thread, but rather the possibility of bringing back asylums for the mentally ill that need it. My family member has no future unless there is a safe place for him to go get clean and have his bi-polar schizophrenia treated for a long term. He is addicted to heroin and doesn't take his schizophrenia meds. Social workers stop by a few times a week. Sometimes put him in hospital, but because of insurance, they kick him out after a couple days. This is a cycle that has been going on for a few years. There is only one future for this. All the family can do is wait for the call.

 

[Vanadium 50]

Greg, this is unlikely to happen. The Supreme Court ruled this unconstitutional in 1975 (O'Connor v. Donaldson) and the decision was unanimous. Even Rehnquist. It would take an Amendment to overturn this, and I can't see this happening - even writing such a thing would be tricky.

 

[Evo]

I think the issue here is if they are deemed dangerous, have already proven to be dangerous.

Here is what V50 is referring to

O'Connor v. Donaldson, 422 U.S. 563 (1975), was a landmark decision in mental health law. The United States Supreme Court ruled that a state cannot constitutionally confine a non-dangerous individual who is capable of surviving safely in freedom by themselves or with the help of willing and responsible family members or friends. Since the trial court jury found, upon ample evidence, that petitioner did so confine respondent, the Supreme Court upheld the trial court's conclusion that petitioner had violated respondent's right to liberty.

http://en.wikipedia.org/wiki/O'Connor_v._Donaldson

 

[Vanadium 50]

And there is the key - who is dangerous? Courts have generally accepted the argument that someone is dangerous if there is evidence of imminent danger, and generally not accepted the argument that this person is more probably dangerous than someone else, or that there might be dangers down the road.

 

[Greg Bernhardt]

And there is the key - who is dangerous? Courts have generally accepted the argument that someone is dangerous if there is evidence of imminent danger, and generally not accepted the argument that this person is more probably dangerous than someone else, or that there might be dangers down the road.

That is the problem. My family member attacked a person with a knife and he was let out in two weeks. That was a year ago. He's at least a complete danger to himself. Not taking meds with heroin addiction is just a ticking time bomb. I saw him a week ago and he's lost a lot of weight.

"Evidence of imminent danger" is just flat out too late. If you see the train coming at you, you do something. You don't let the train hit you or wait 2 seconds before it hits you and then do something.

I do believe insurance has a big role in this too.

 

[Evo]

And there is the key - who is dangerous? Courts have generally accepted the argument that someone is dangerous if there is evidence of imminent danger, and generally not accepted the argument that this person is more probably dangerous than someone else, or that there might be dangers down the road.

That's the issue they bring up in the article I posted, the "danger" had to have occurred within the last 48-72 hours and even if committed, they will most likely be released in a few days.

 

[russ_watters]

And there is the key - who is dangerous?

Comparing the person who was the subject of that court case to Greg's family member, I don't see their circumstances as very similar. The person in the court case had no history of violence, nor was any attempt ever made to treat him.

While the unanimity of that particular case appears warranted to me, I wonder if it had the effect of swinging the pendulum too far in the opposite direction.

 

[disregardthat]

Greg, I'm sorry for what your family is going through.

The majority of people with mental illness do not commit mass murder. However, for those that do, the media provides them with abundant publicity. It bugs me to no end how the media splashes their manifestos and youtube videos all over the news. The people who perpetrate these crimes need to get as little recognition as possible for what they do - no manifestos, no videos, no Wiki page with their name listed, etc. When they see that their rants won't be publicly recognized, then they'll have to find a different outlet for their pain.

As this father now knows, it shouldn't be all about the killers.
https://www.youtube.com/watch?v=ZW_raNDQprU

While it's a shame that they might achieve what they hoped for, I sincerely believe that allowing the government by law to actively censor and ban any message such people have for the sake of it is the wrong direction. Extrapolating, what is the line between a "freedom fighter" and a "terrorist"? Should we let the government decide that? And is it always obvious?

There are many countries which suppress parts of their population, people who see no other option than to perform terrorist attacks to express their stance to the world. There are clearly big differences to be pointed out here.. But the point is that it should never be the governments job to censor the opinion or cause of individuals no matter what the crime is. No government can be in the position to decide whether they are suppressing their population (no matter how "obvious" the situation is to the general public), therefore no government should be able to decide whether the message should be censored.

 

[mheslep]

Thanks and you're right but I would like that this discussion not turn into a mass killer thread, but rather the possibility of bringing back asylums for the mentally ill that need it. My family member has no future unless there is a safe place for him to go get clean and have his bi-polar schizophrenia treated for a long term. He is addicted to heroin and doesn't take his schizophrenia meds. Social workers stop by a few times a week. Sometimes put him in hospital, but because of insurance, they kick him out after a couple days. This is a cycle that has been going on for a few years. There is only one future for this. All the family can do is wait for the call.

Greg, this is unlikely to happen. The Supreme Court ruled this unconstitutional in 1975 (O'Connor v. Donaldson) and the decision was unanimous. Even Rehnquist. It would take an Amendment to overturn this, and I can't see this happening - even writing such a thing would be tricky.

This does not sound like an O'connor v. Donaldson case:

"A State cannot constitutionally confine, without more, a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends, ..."

I would guess that a schizophrenic addict is by definition both potentially dangerous and incapable of surviving safely.

Edit:
I see Evo and others already pointed out the danger trigger, though it appears surviving safely by himself , i.e. the ability to manage basic necessities, is also an applicable trigger here.

I agree with the general holding of O'conner v Donaldson and admit reversing it would require and amendment. On the other hand this 48-72 hour danger rule is not fundamental to that decision, and I suspect it could be, should be, revisited. For instance, perhaps the length of confinement in the psychiatric facility could be limited, not forbidden, when the conditions are ambiguous.

 

[Tobias Funke]

The question remains how Elliot Rodger was able to secure 3 handguns with a history of mental illness. Ostensibly, his treatment was deemed effective, even though he was planning violence.

The question only remains because the answer--at least the most obvious and effective one--is ignored. The Onion, as usual, sees through the usual deflections.

But I just saw your request for this not to turn into a mass killer thread, so I'll just add that I recently read Ten Days in a Mad House and human nature hasn't changed in the last 120 years, so we should keep that in mind.

 

[Greg Bernhardt]

I would guess that a schizophrenic addict is by definition both potentially dangerous and incapable of surviving safely.

Exactly. It's apparent that he needs to either be close to death or near threatening someone else for him to get more attention than a two day stay in the hospital. When the writing is on the wall. There is no future for him unless he gets long term care.

 

[AlephZero]

FWIW the UK does have some legislation to deal with this, and it is used about 50,000 times per year, but there is plenty of controversy about it. Theoretically, if a police officer sees you in a public place and thinks you are acting a bit strange, you could be hospitalized against your wishes on no more evidence than that. Or you could be hospitalized simply for refusing to let a doctor or social worker enter your house, even though they had no legal right of entry.

The unofficial description is "sectioning", since the procedure depends which section of the Mental Health Act is deemed to apply to you. http://www.rcpsych.ac.uk/expertadvice/problems/beingsectionedengland.aspx

 

[strangerep]

My family member attacked a person with a knife and he was let out in two weeks.

That's quite bizarre. I would have thought "assault with a deadly weapon" would attract more prison time than that.

 

[Astronuc]

Thanks and you're right but I would like that this discussion not turn into a mass killer thread, but rather the possibility of bringing back asylums for the mentally ill that need it. My family member has no future unless there is a safe place for him to go get clean and have his bi-polar schizophrenia treated for a long term. He is addicted to heroin and doesn't take his schizophrenia meds. Social workers stop by a few times a week. Sometimes put him in hospital, but because of insurance, they kick him out after a couple days. This is a cycle that has been going on for a few years. There is only one future for this. All the family can do is wait for the call.

Quite right, since the OP is about asylums.

There are several elements to this matter. The overarching problem is "How do we treat those with mental illness, particularly when mental illness runs a spectrum from mild (the person can function) to the severe (person is either incapable of functioning (i.e., not self-sufficient), or worse, is a danger to him/herself or others)?" In theory there is a treatment protocol that can facilitate the treatment for many who need not be institutionalized.

On the other hand, someone who is addicted to drugs and who refuses appropriate medication is clearly at risk. At what point is intervention necessary?

Then there is the present case of someone is alienated and angry at the world, and plans to do violence upon others. How can a 'free' society identify such individuals without infringing on individual liberty?

Some questions to ponder: http://www.slate.com/articles/healt...ey_and_law_enforcement_fail_to_recognize.html

A major factor in the de-institutionalization of the mentally ill in the 1980s was cost. States decided to cut costs by closing asylums. My wife was a drug and alcohol counselor then, and she had a front row seat to the crisis that followed. Mentally ill folks, many with addictions, started showing up in the community, and often in the local jails. The cost was pushed off by the states onto the local communities.

 

[Greg Bernhardt]

Some questions to ponder: http://www.slate.com/articles/healt...ey_and_law_enforcement_fail_to_recognize.html

A major factor in the de-institutionalization of the mentally ill in the 1980s was cost. States decided to cut costs by closing asylums. My wife was a drug and alcohol counselor then, and she had a front row seat to the crisis that followed. Mentally ill folks, many with addictions, started showing up in the community, and often in the local jails. The cost was pushed off by the states onto the local communities.

I think it's clear in my city as well. It takes just a 5 minute walk to find someone wondering the street who clearly needs long term care. Just last night I was grocery shopping and a mentally unstable homeless man was causing a fair amount of drama and the store security just kicked him out.

Thanks for the information, I'll be researching the "The Helping Families in Mental Health Crisis Act"

 

[dipole]

I'm not convinced that these mass shooting are necessarily primarily a mental health issue. Are the soaring number of self-immolations in Tibet a mental health issue? Are the ever increasing number of suicide bombing in the middle east a mental health issue? What motivations for the destruction of self and others count as being due to some kind of mental illness?

I think the problem is much broader and more complicated than just that crazy people have access to guns - which is a major issue - but I'm not that sure that the mental health system, asylums or not, will be able to address the main cause behind the phenomenon.