Periodically there will be a news story about a mentally ill person attempting to kill or killing one or more people. People will shake their heads at the suffering. Liberals will use the sad event as an excuse to call for further suppression of our Second Amendment rights. Until the shootings at the Sandy Hook Elementary School in Newtown, Connecticut in December, 2012, the conservative response was muted and generally a vague reference to enforcing the laws already on the books. But after the Newtown tragedy, conservatives found their voice and began to enunciate the truth. Namely, tragedies of this sort could be prevented in many cases if our mental health system did a better job of screening and treating the seriously mentally ill.
Why does our mental health system allow these things to go on? While it would be possible to write a long book on the subject, the root of the problem is money. Legislative bodies fail to fund adequately the public’s mental health system, particularly where involuntary civil commitments are concerned.
As the administrative judge over the mental health aspect of the probate courts in Harris County, Texas, (Houston is the county seat.) Judge Olsen has heard half of the civil commitment cases in the county for over fifteen years. He has also worked with local mental health authorities to try to obtain and keep adequate funding for the public mental health system. Every budget means another battle. It seems as if mental health funding is always treated like the orphans in Oliver Twist, being given just enough resources to keep the system open for another year–in good years.
Judge Olsen also has had the opportunity to take and teach courses at the National Judicial College over the years. At these courses he has had the opportunity to compare notes with other judges from around the country. The story is almost always the same. Legislative bodies pass wise laws to treat the mentally ill properly and adequately. Unfortunately, when it comes time to allocate public money to fund the institutions that protect the public through treating the mentally ill, the funding is inadequate in good years. In lean years, the inadequate funding is further reduced to balance the budget.
The long-term results of the failure to adequately fund public mental health is certainly seen when a mentally ill person harms other people. But, the failure to fund public mental health shows up in other ways. Many of the homeless people who clog our cities are untreated mentally ill people. Many of the inmates of our penal institutions are suffering from a mental illness and would be better off being treated in a mental health facility. So would the general public.
The saddest aspect of this entire depressing process is the under-funding does not actually save the public money. It wastes money.
Most patients who are admitted to a mental health facility can be stabilized in two or three weeks. However, thanks to a phenomenon known as anosognosia many of the patients who are released after several weeks back into the community lack an awareness of their condition. Since they do not believe that they are really mentally ill, they will not keep taking their prescribed medications. They will not go to meetings with their therapist. And too often, they will go back on street drugs. In a few weeks or months, the patients will find themselves back in the mental health system. This happens way too often and is know as “the revolving door.” It would be cheaper in the long run to keep a mentally ill person in the system long enough for him or her to develop as an insight into his or her condition, rather than shaving a week or two often of the treatment time, only to have the patient being stuck in a revolving door of admission/treatment/release/decompensation and then readmission to the hospital. (E. Fuller Torrey, M.D.’s most recent book, American Psychosis, describes this phenomenon in greater detail.)
What needs to be done? Three things need to be done together to improve the situation.
The first is to fund the public mental health system adequately. Funding questions need to be approached from the standpoint of what needs to be done to keep mentally ill people off of the streets and stop them from being threats to themselves and others. The safety of the patients and the public needs to be the legislative goal, rather than saving money.
The second thing that needs to be done is for the citizens to contact their legislators to increase funding to public mental health. While there are many fine groups that lobby legislators on behalf of the mentally ill, nothing works as well at garnering legislative attention than letters and e-mails from concerned citizens who have no axe to grind, beyond wanting to live in a better and safer world.
The third thing that needs to be done is that communities around the country need to be innovative in their thinking and approaches to mental illness treatment. For instance, in May of this year, the probate courts and the Mental Health Authority of Harris County, Texas are going to launch an assisted outpatient treatment program, which it is hoped, will provide longer-term treatment to patients who have been through the revolving door of the mental health system at least three times in two years. This program will provide the benefits of longer-term in-hospital treatment at a lesser cost.
If these things are done, there will be fewer Newtown shootings, safer streets and more people with a mental illness holding down a job and being productive members of society.
Judge Rory Olsen is a Harris County, Texas Probate Court judge. Lana Shadwick is a former prosecutor and Harris County Family Court judge. Follow Lana Shadwick on Twitter @LanaShadwick2