Sunday, January 9, 2011

Revise Civil Committment Laws!

Revise Civil Committment Laws!

It is true, as I taught for 36 years as a professor of psychology, that people with mental illnesses are generally no more dangerous than people without them. However, there are some exceptions. Those who are depressed are prone to suicide. Those who suffer from Bi-Polar disorder can be prone to suicide while depressed, or other dangerous behaviors when in high manic phases.

But, in instances of bizarre and senseless violence, such as the recent case of Congresswoman Gabrielle Giffords and the others who were gunned down with her, a severe mental illness (probably Paranoid Schizophrenia) was the cause. A particularly dangerous form of mental illness was allowed to wander free among us, and it was this (or another psychotic mental illness) that repeatedly pulled the trigger on our innocent and precious citizens.

Paranoid Schizophrenia is a specific and sometimes dangerous form of mental illness, especially when delusions of persecution are prominent. This should make sense to anyone. Delusions of persecution are false beliefs, often bizarre in nature, that others are “out to get me”, ”spying on me”, “taking my property”, or “trying to harm or kill me”. Of course, many normally functioning people would become very angry and tempted to “defend” themselves by attacking the “perpetrators” if they really believed that someone, or some people (perhaps the government, the next door neighbor, etc.), were trying to harm them or destroy their lives. People with this psychotic mind-set can be very dangerous and no amount of security will protect the innocent from their unpredictable psychotic behavior.

The deinstitutionalization movement culminated in 1963 when the Federal Government ordered that mental patients be freed from mental hospitals and be treated in their communities. Congress passed the Community Mental Health Act which provided funding for the construction of community-based facilities to treat mental patients on an outpatient basis. All of this happened shortly after the discovery of antipsychotic medications. In 1955 there were around 600,000 mental patients in state institutions. By the year 2001, there were only about 60,000 in state institutions. Where did the rest of the 500,400 mental patients go? These individuals with severe mental problems went back to living among us.

Following 1963, if hospitalization was necessary, patients were to be admitted on a short-term basis, medicated, stabilized and then released. This led to a “revolving door policy”, in which patients frequently were admitted, medicated, stabilized, and released, but, many then stopped taking their medication, again became actively psychotic and were rehospitalized.

Also, in the name of civil rights and humane treatment, the criteria for “civil committment” (committment to mental hospitals against one’s will) were narrowed to the point that only those who were a clear danger to themselves or the public, could be committed without their permission. This meant that even those who were actively hallucinating, ranting and raving, homeless, filthy, or in some cases starving could not be hospitalized against their will. In my view, these criteria are far too restrictive and great suffering among the mentally ill, as well as the rest of us, continues as a result.

Once again an over-reaction in the name of personal freedom and humane treatment has gone too far, predictably resulting in social chaos and tragedy, with a net loss of personal freedoms for all. Once again, I judge the true governmental motivation for a provision of more “personal freedom” ( in this case for mental patients) was largely revenue savings.

It is true that those patients who seek help at Community Mental Health Centers tend to benefit. But on a yearly basis, 40 to 60 percent of all people suffering from schizophrenia “and other severe mental disorders receive no treatment at all”. While poor coordination or shortage of services are frequently named as the cause for this shortfall, no one is willing to face the other obvious fact. Giving an active psychotic the right to refuse treatment is an absurdly self-destructive big part of our problem!

While institutions may become more effective in their treatment, there is no happy feel-good remedy for psychotics who are unable to make rational decisions in their own best interests, who do not seek treatment, or who refuse treatment when it is offered.

New Laws with more nuanced civil commitment capabilities, intensive medication and psychological treatment strategies, and mandatory close follow-up with recommittment capabilities are essential.

Wake-up America! Advocate for a Revision of our Civil Committment Rules!

V. Thomas Mawhinney, Ph.D. 1/9/11

P.S. (I) The history and statistics of the Community Mental Health Movement and its failings is based upon the college textbook Abnormal psychology, by Ronald J. Comer.

P.S. (II) Schizophrenia is a life-long mental disease with strong heritability. There is not cure for schizophrenia, though medication can imperfectly help to control its most bizarre symptoms. Since deinstitutionalization, the reproductive rates of people with schizophrenia have naturally risen and is thought to now approximate that of the normal population. The implications for the growth of the genetic basis or schizophrenic spectrum problems in our population should be clear. But, this is a topic for another time.

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