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Mental Illness and The Law: How We Got Where We Are June 29, 2010

Posted by Crazy Mermaid in History, Insanity, Involuntary Committment, Mental Hospital, mental illness, Mental Illness and Medication, Psychotic.
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If you want to change things, first you need to understand how they got the way they are.  In the case of mental illness law, politicians and lawyers had the best of intentions, but as with other ventures, the devil was in the details.  The unintended consequences of their actions continue to remain the source of frustration and even danger.

In his 1946 article “Bedlam 1946: Most Mental Hospitals Are A Shame and A Disgrace” http://www.mnddc.org/parallels2/prologue/6a-bedlam/bedlam-life1946.pdf in Life Magazine, Albert Maisel made the case that mental hospitals were terrible institutions.  The final paragraph of his article summarized his point succinctly: “Given the facts…the people of any state will rally… to put an end to concentration camps that masquerade as ( mental) hospitals and to make cure rather than incarceration the goal of their mental institutions.”

While the sentiment is perfectly understandable given the horrific conditions he found when he investigated the state of mental hospitals throughout the United States shortly after the close of World War Two, he threw out the baby with the bath water when he declared, in effect, that nobody should have to be institutionalized.  The wildly popular Life Magazine gave Maisel a platform from which to launch his idea of closing all mental hospitals, also called deinstitutionalizing the mentally ill.

Helping this idea along was the development of the first generation of antipsychotic drugs in the 1950’s. Used to treat schizophrenia and other psychoses as well as acute mania, agitation and other conditions, their discovery allowed many mentally ill people once hospitalized to return to their families, hopefully with their illness under control and able to function as productive members of society in many cases.  In many cases this was true, but not in all.

The advent of these new antipsychotics lent fuel to the fire of the deinstitutionalization movement, and, combined with the publicity of the atrocities perpetuated in the mental hospitals, served to throw the doors to the mental institutions wide open in the mid-1950’s.

From the mid-1950’s to the mid-1960’s, a small percentage of the eventually deinstitutionalized were released. But from that point forward, the trickle became a flood, culminating in the release of the majority of the mentally ill by the mid-1980’s. And as the mentally ill were released from the hospitals, rather than wait to see whether whether the experiment was going to work, those hospitals were closed down forever, shrinking from a high of around 550,000 beds in the mid-1950’s to around 40,000 today. As this experiment failed,the homeless and prison populations of every major city and State ballooned.

In the meantime, California was the first state to pass the Lanterman-Petris-Short Act in 1967, giving the mentally ill the legal right to avoid treatment for their mental illness, regardless of how damaging that mental illness became. Unless the person was in imminent (immediate) danger of severely harming or killing themselves or someone else, they had the right to be left alone, free to wander the streets, homeless and victimized, eating out of dumpsters, lost in their own world. Other States followed their example, with the former Governor of California, Ronald Reagan, leading the charge on a national level as he ascended the highest office in the land, the Presidency.

The mistakes the do-gooders made in this two-pronged approach of first deinstitutionalizing and then arming the mentally ill with the right to refuse treatment were twofold.  Their first mistake was  in perceiving all hospitalization to be bad hospitalization. Secondly they assumed that anyone who has a mental illness has the presence of mind to know when to seek treatment for that illness.

Treating mental illness like any other illness, disregarding the fact that one of the symptoms of the illness can be a failure to realize they are ill, and denigrating all mental hospitals as evil are poor choices for which we have all paid dearly, in the form of the fallout from our endless supply of suicides, the incarcerated mentally ill population, the homeless population, and mentally ill people who attack and assault others.

Until we realize that mental hospitals can also be used for good, and that mentally ill people can’t always help themselves, nothing will change.

(Note:  Part of my research for this article was done with the help of Dr. E. Fuller Torrey’s book The Insanity Offense. (2008).

Mental Illness and Murder: Maurice Clemmons November 30, 2009

Posted by Crazy Mermaid in Delusions, Mental Hospital, mental illness.
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6 comments

Here’s the real story: Mentally Ill Man Commits Murder.

Here we go again: Man with long history of Mental Illness shoots  4 police officers at point-blank range, killing all four.

Some of us diagnosed with mental illness will surely recognize some of Clemmons’ behavior- obviously not the extremes of murders or rapes- as versions of our own behavior. We can relate to some of the things that Clemmons believed.  It’s a matter of degrees. “There but for the Grace of God go I…”

Example 1:

Him: Clemmons gathered his wife and young relatives together at around at 3 or 4 in the morning on a Sunday. He told them all to undress, explaining that families need to be naked for at least 5 minutes on a Sunday. (Pierce County (WA) Police Report) Me: I took my clothes off in a hospital emergency room in the belief that I was a Mermaid.

Example 2:

Him: Clemmons believed 1) that he was Moses, 2) that he was Jesus Christ, and 3) that the world was going to end very soon. Me: I believed that I  was ordained by God to bring wisdom to the masses.

Example 3:

Him:  Clemmons believed that he could fly, and that he expected President Obama to visit to “confirm that he is Messiah in the flesh”. Me: I believed that God gave me special gifts including ESP, and that my rich and powerful friends including the Dalai Lama, Oprah Winfrey, and Bill and Melinda Gates gave me an unlimited supply of money.

Prosecutors in Pierce County were sufficiently concerned about Clemmons’ mental health that they asked to have him evaluated at Western State Hospital (WA). On Nov. 6, a psychologist concluded that Clemmons was competent to stand trial on the child-rape and other felony charges, according to court records. Twenty three days later, the mentally ill man killed four police officers.  Two days later, Clemmons was shot and killed by a police officer.

Clearly, Clemmons was mentally ill on November 6th, but his psychologist wasn’t paid to find out whether he was sufficiently mentally ill enough to require treatment for his mental illness.  The psychologist was only interested in one thing: Was Clemmons able to stand trial for rape?  The point here is that something must have triggered the request for the mental evaluation. What was it? And why wasn’t he assessed for a mental illness at the same time? Why did the assessment stop at finding out whether he was competent enough to stand trial?

What I really fail to understand is how come a man who committed several crimes and exhibited bizarre behavior and who prosecutors had evaluated for a competency hearing wasn’t committed, either voluntarily or involuntarily, to a mental hospital for treatment. How can it be that I was committed but he wasn’t?

Unfortunately, there is a distinct difference between assessing Clemmons for mental illness severe enough to require an insanity defense and assessing Clemmons for specific mental illnesses and treating said illnesses. Had the two assessments been integrated, five people would still be alive.

The murder of those four police officers was a tragedy beyond words. But there’s another tragedy here: the mess the Mental Health care system is in.

I know from personal experience how difficult it is to get mentally ill people help. I won’t be surprised to learn that his family members have been trying to get him the help he needs for years. But until he kills someone or tries to kill himself, the mental health community cannot help him. And yet even that wasn’t enough. Was it his race?

There aren’t enough psychiatrists to help all the mentally ill who need help. There aren’t enough mental health hospital beds for everyone who needs help.  The mental health care system is broken, and these things, including the senseless murder of those four officers yesterday and the murder of Officer Timothy Brenton on Halloween, are the price we pay for it. Until we fix the system, including making it much easier to seek and get help for the mentally ill, these senseless acts will continue to happen. Let’s fix the broken system and save lives.