The debate about America’s mentally ill and how best to help them — and protect the public if they pose a threat — goes back decades to the deinstitutionalization movement that started in the 1960s with the best of intentions but led to streets and prisons filled with victims of the failed idea.
Society, literally, steps around people living on sidewalks and doesn’t have to deal with those behind bars. But when an individual decides to kill as many innocent people as possible, the debate rises to the surface again — including after the recent mass shootings in Texas and Ohio that killed 31 people.
The shooter in Dayton, who also died, had cocaine, alcohol, and anti-anxiety medication in his system, an autopsy revealed.
President Donald Trump’s reaction to those shooting helped bring the subject to the surface again, as Politico reported:
President Donald Trump on Thursday advocated the return of more mental health institutions to combat gun violence, while also throwing his support behind background checks for gun purchases.
Speaking with reporters in New Jersey before heading to a campaign rally in New Hampshire, Trump said that mental health was an under-considered factor in gun violence and that his administration would examine it “at a level that hasn’t been done before.”
“These people are mentally ill,” Trump said of mass shooters, “and nobody talks about that.”
“We have to start building institutions again because, you know, if you look at the ’60s and ’70s, so many of these institutions were closed, and the people were just allowed to go onto the streets,” Trump went on to say. “That was a terrible thing for our country.”
Politico and other leftist media have mocked Trump for his assertion about mental illness and its ties to mass shootings, including the taxpayer-funded Public Broadcasting Service (PBS), which found several experts who disagree with the president:
President Donald Trump’s call for mental hospitals as a way to fight mass shootings is alarming health professionals who consider the widespread use of the facilities outdated and the wrong tool for fighting gun violence.
Dr. Marvin Swartz, a professor in Psychiatry and Behavioral Sciences at Duke University, referenced a widely quoted paper by his colleague at Duke University, Jeffrey Swanson, which found that even if even if mental illness were eliminated completely as a risk factor, violence would only go down by about 4 percent.
“Why you would connect [gun violence] to a decline in psychiatric beds…I think makes no sense,” Swartz said.
“Characterizing this as merely or primarily a mental health issue is misleading,” Dr. Barron Lerner, a professor in the Department of Population Health at New York University’s Langone School of Health who also works at a mental health clinic, said in the PBS report.
“The vast majority of people with mental illness would never be violent,” Lerner said, making a claim that studies confirm.
Lack of Access to Treatment
But even if only a small minority of mentally ill people resort to senseless violence, that reality could lead to the deaths of innocent people.
Flashback to the Sandy Hook Elementary School shooting where a deranged young man killed 20 children and six adults. Adam Lanza also killed his mother, Nancy Lanza, who knew her son was troubled but was having a difficult time getting him “involuntarily committed” to get the help he needed.
Joshua Flashman, 25, said in a Fox News report in the wake of the killings, “From what I’ve been told, Adam was aware of her petitioning the court for conservatorship and (her) plans to have him committed.”
“Adam was apparently very upset about this,” Flashman continued. “He thought she just wanted to send him away. From what I understand, he was really, really angry. I think this could have been it, what set him off.”
The Washington Post reported that Adam’s mother had considered moving with her son to Washington State where she had found a school she thought could help him and that she was constantly distraught about her son. He was believed to have Asperger’s syndrome.
And while the PBS report addresses the events that unfolded to bring the country to where it is today in dealing with the mentally ill, it does not reveal that Trump’s sentiments reflect lessons not learned.
Start of Deinstitutionalization Movement
President John F. Kennedy signed the Community Mental Health Act in 1963. The law was meant to move mentally ill people out of state institutions into community-based clinics.
Some examining the issue have blamed Ronald Reagan for furthering the deinstitutionalization movement when as California governor he signed the Lanterman-Petris-Short Act, which ended the practice of institutionalizing patients against their will and for indefinite amounts of time. This law is regarded by some as a “patient’s bill of rights” but ultimately resulted in many mentally ill people in that state on the streets or incarcerated.
By the 1990s, the number of people in mental institutions dropped from the previous high of about half a million people in 1955 to just over 70,000 in 1994.
“Afterwards, you see a disaster,” Dr. Jeff Lieberman, a professor and chair of the psychiatry department at Columbia University, said in the PBS report. “People who had been released from state mental institutions or maybe would have been hospitalized in them no longer were.”
“And there were inadequate community-based services,” Lieberman said. “What resulted was homelessness, mental patients in nursing homes, and increasingly in jails.”
And even the people involved in launching the deinstitutionalization movement expressed regret.
Failure of Mass Release of Mentally Ill
In 1984 the New York Times ran a story entitled “How Release of Mental Patients Began,” laying out the political nature of what took place:
The policy that led to the release of most of the nation’s mentally ill patients from the hospital to the community is now widely regarded as a major failure. Sweeping critiques of the policy, notably the recent report of the American Psychiatric Association, have spread the blame everywhere, faulting politicians, civil libertarian lawyers and psychiatrists.
A detailed picture has emerged from a series of interviews and a review of public records, research reports and institutional recommendations. The picture is one of cost-conscious policy makers, who were quick to buy optimistic projections that were, in some instances, buttressed by misinformation and by a willingness to suspend skepticism.
Many of the psychiatrists involved as practitioners and policy makers in the 1950’s and 1960’s said in the interviews that heavy responsibility lay on a sometimes neglected aspect of the problem: the over reliance on drugs to do the work of society.
”Many of those patients who left the state hospitals never should have done so,” said Dr. Robert H. Felix, who was then director of the National Institute of Mental Health and played a major role in the shift to community health centers. “We psychiatrists saw too much of the old snake pit, saw too many people who shouldn’t have been there and we overreacted.”
“The result is not what we intended, and perhaps we didn’t ask the questions that should have been asked when developing a new concept, but psychiatrists are human, too, and we tried our damnedest,” Felix said.
”The psychiatrists involved in the policymaking at that time certainly oversold community treatment, and our credibility today is probably damaged because of it,” Dr. John A. Talbott, president of the American Psychiatric Association, said in the Times piece.
Talbott said the policies ”were based partly on wishful thinking, partly on the enormousness of the problem and the lack of a silver bullet to resolve it, then as now.”
The Times reported in 1984:
The original policy changes were backed by scores of national professional and philanthropic organizations and several hundred people prominent in medicine, academia, and politics. The belief then was widespread that the same scientific researchers who had conjured up antibiotics and vaccines during the outburst of medical discovery in the ’50s and ’60s had also developed penicillins to cure psychoses and thus revolutionize the treatment of the mentally ill.
Unintended Consequences of Shuttered Hospitals
A more recent report on the website The Balance sheds more light on the journey from having places to care for the mentally ill to a nation that virtually ignores it, which can have unintended consequences:
Between 1955 and 1994, roughly 487,000 mentally ill patients were discharged from state hospitals. That lowered the number to only 72,000 patients. States closed most of their hospitals. That permanently reduced the availability of long-term, in-patient care facilities. By 2010, there were 43,000 psychiatric beds available. This equated to about 14 beds per 100,000 people. According to the Treatment Advocacy’s Center’s report, “Deinstitutionalization: A Failed History,” this was the same ratio as in 1850.
As a result, 2.2 million of the severely mentally ill do not receive any psychiatric treatment at all. About 200,000 of those who suffer from schizophrenia or bipolar disorder are homeless. That’s one-third of the total homeless population. Ten percent are veterans who suffer from post-traumatic stress disorder or other war-related injuries.
More than 300,000 are in jails and prisons. Sixteen percent of all inmates are severely mentally ill. There were about 100,000 psychiatric beds in both public and private hospitals. There are more than three times as many seriously mentally ill people in jails and prisons than in hospitals.
The Balance report has a detailed timeline of events since JFK was president.
The Balance report also said that there were positive results of the deinstitutionalization movement, including giving more rights to people with disabilities, such as those with Down syndrome or others with high-functioning mental disorders who were unnecessarily put into hospitals indefinitely.
But the cons are numerous, including putting severely mentally ill people on the streets or with their families struggling to care for them. Even worse, many end up behind bars.
“The courts made it almost impossible to commit anyone against their will,” The Balance reported. “That’s true regardless of whether it was for the person’s own safety and welfare or for that of others.”
And J. Reid Meloy, a forensic psychologist who studies mass shootings and mental illness, including all of the on average 20 mass shootings a year since 1976, made a connection between them.
“Meloy found that mass murderers suffer mental illnesses that range from chronic psychotic disturbances and schizophrenia to paranoid disorders,” The Balance reported. “They have the paranoid, narcissistic, and schizoid traits of personality disorders.”
He said these shooters are not normal people who suddenly “snapped” but those who have suffered for years with untreated or poorly treated mental illness.
“Most planned the shooting for years,” The Balance reported, adding that Meloy believes “behavioral threat assessments” could help prevent these tragedies.
Dr. Alan Lipman, whose expertise is studying the psychology of violence at George Washington Medical Center, said mass shooters fall into one of three categories, The Balance reported: psychotic, a sociopath or psychopath, or a man between the ages of 16 and 25 who is depressed and violent.
Dr. Michael Stone, a forensic psychiatrist at Columbia University, said 20 percent of mass murderers are psychotic or delusional — compared to one percent in the general population.
“Almost half of all mass killers had depression, learning disabilities, or attention-deficit hyperactivity disorder,” The Balance reported. “Forty percent had alcohol or drug dependencies.”
The Balance report concluded that regulations to protect the rights of the mentally ill can hinder treatment, including the reality that an individual can’t be committed unless they have already proven to be a threat to themselves or others.
“Judges cannot order seriously mentally ill people to stay in treatment. People are not allowed to remove guns from mentally ill people who threaten themselves or others,” the article concluded. “Reversal of these rules would allow family members to get treatment for their mentally ill loved ones and protect society.”
“A lot of our conversation has to do with the fact that we have to open up institutions,” Trump said when discussing El Paso and Dayton. “We can’t let these people be on the streets.”
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