Our insane mental health system

Faith-based finalists | The poorest among us are those who've lost their minds, according to psychiatrist E. Fuller Torrey

Issue: "The audacity of real change," Aug. 23, 2008

I first heard E. Fuller Torrey critique America's mental health non-system nearly two decades ago-and the evidence of breakdown has only increased since then. The mentally ill now form probably half of the homeless and prison populations. Exploited and victimized by others, and often terrorized by their own phobias, they are a threat to themselves and to others, causing one-tenth of the homicides in the United States.

Torrey, a psychiatrist who specializes in helping schizophrenic and bipolar patients, founded the Treatment Advocacy Center (www.treatmentadvocacycenter.org), a national nonprofit trying to improve treatment of those with severe mental illnesses. He has persevered in helping men and women who are truly the poorest among us in that they don't even own their own brains any more.

WORLD: How many seriously mentally ill individuals are homeless or incarcerated in the United States at any given time?

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TORREY: Conservatively it is estimated that there are about 175,000 seriously mentally ill persons who are homeless and another 220,000 who are in jails and prisons. By "seriously mentally ill" I mean individuals with schizophrenia, bipolar disorder, and severe depression with psychosis. This definition does not include individuals who only have alcohol and drug abuse problems. Thus, individuals with serious mental illnesses make up at least one-third of the homeless population and at least 10 percent of the jail and prison population. Both numbers have been, and still are, increasing.

WORLD: What was the trendsetting California legislation during the Reagan years, and who were the strange bedfellows pushing it?

TORREY: In the late 1960s California set the standard for emptying its state mental hospitals and other states then followed its lead. In 1969 it implemented a law, widely known as the Lanterman-Petris-Short (LPS) Act after its sponsors, which made it exceptionally difficult to involuntarily hospitalize psychiatric patients. Once in the hospital, patients could only be held for 17 days unless they met very strict criteria for dangerousness. The new law resulted in a major exodus of patients from the hospitals, a movement known as deinstitutionalization.

WORLD: Which strange bedfellows pushed for that law?

TORREY: A very odd coalition: politically left-leaning civil libertarians, who believed that nobody should ever be involuntarily hospitalized, and politically right-leaning fiscal conservatives who saw closing the hospitals as a way to reduce state expenditures and thus reduce taxes.

WORLD: Who was Herb Mullin and why did you write about him?

TORREY: Herb Mullin was a young man with untreated schizophrenia who, because of his delusions, killed 13 people in Santa Cruz, Calif., in 1972 and 1973. As is typical for schizophrenia, Herb had been a promising young man until his disease began after he completed high school. I used Herb as a case example because he is typical of the individuals with untreated schizophrenia and bipolar disorder who account for about 10 percent of all homicides in the United States. Most of those homicides could be prevented if the people were being treated.

I also used Herb because his untreated illness was at least partially a product of the new LPS legislation which had just been implemented in California. In 2005 I visited Herb, who is serving a life sentence in a California state prison. He still has schizophrenia. So far his incarceration has cost California taxpayers over $1 million. The cost of the antipsychotic medication needed to treat his illness in 1972, and thus prevent the homicides, would have been a few dollars.

WORLD: What effect did Wisconsin's mental health reforms have?

TORREY: Wisconsin, like California, passed legislation in 1972 that made it very difficult to treat people with serious mental illnesses. Following the passage of the new legislation Wisconsin witnessed an immediate increase in mentally ill persons who were homeless, in jails and prisons, and committing violent acts, including homicides.

WORLD: With mental hospitals closed, which public officials are now the front-line screeners of mentally ill individuals?

TORREY: In the past, psychiatrists, psychologists, and social workers were the screeners; now, it's police and sheriffs. They are the ones called when mentally ill persons become disturbed. For example, in New York City in 1976 the police responded to approximately 1,000 mental illness calls each year. By 1998 this had increased to over 25,000 such calls each year. Police and sheriffs are not recruited or trained to be mental health screening officials and it of course takes time from other law enforcement duties that they should be performing.

WORLD: What is "dying with one's rights on"?

TORREY: Dr. Darold Treffert, a psychiatrist in Wisconsin, originally used the term. He kept track of the increasing number of deaths of individuals with serious mental illnesses who died from accidents, suicides, starvation, etc., because of the new laws making it difficult to treat them. Dr. Treffert wanted to emphasize the fact that the new laws were effective in protecting the person's civil liberties and their right to refuse treatment, but in doing so the laws put the person in danger. Dr. Treffert is one of only a few American psychiatrists who have spoken out forcefully regarding the abysmal job we are doing in providing appropriate care for individuals with severe mental illnesses.


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