Is it Okay Not to treat the
mentally Ill?
It is well in 2012... to keep this question in mind, whenever you read about a person being suspected of being mentally ill when arrested
for a violent crime. Why? Because, contrary to myths - most mentally ill people are not violent; most do not commit crimes. The ones making the news are the ones not taking or receiving medication and/or treatment.
In fact, a recent editorial (11/27/2011) in a major newspaper (Baltimore Sun), shows just how much education remains to be done to destigmatize mental illness. First, following rare inmate on inmate deaths at a state mental hospital, Baltimore Sun editors endorsed a new CEO calling him “the right man to lead the institution on the long road to emotional recovery.” But it was stunning to learn from the editors that: “most of the extremely mentally ill patients at Clifton T. Perkins state mental hospital” had “never received treatment for their illnesses before they came to Perkins.” Excuse me? Did I miss something here? Is that true? Can the Baltimore Sun editors be really sure that patients found “not criminally responsible” for their crimes are at the correctional mental hospital because THEY DID NOT RECEIVE TREATMENT FOR A MENTAL ILLNESS before being arrested? Wow!!! How does that make you feel? Are we really being well-protected in our society?
Second, this lack of protection certainly doesn’t seem to bother some of the Sun editorial writers… even though they also pointed out that - most of the 239 patients diagnosed with schizophrenia, schizo-affective disorders, and severe mood disturbances, as major depression and bipolar disorders, DID NOT receive psychiatric treatment before they arrived there. Now that is one scary thought? Is it just me or do you find it also repugnant that the media and policy makers are not alarmed? Do they really just accept that some mentally ill people have to commit crimes to get treatment their broken brains so urgently need?
As a certified teacher for the National Alliance on Mental Illness (NAMI) in Maryland, I have taught hundreds of caregivers for the mentally ill that treatment works. They already know that stigma hurts!
NAMI’s free 12-week education program - Family2Family (F2F) - is taught throughout Maryland and the country. It is pivotal for helping parents, spouses, and other caregivers understand brain disorders (mental illness), prescribed medicines, and psychiatric rehabilitation services. We also learn how difficult it is to get coordinated services in Maryland – a state that withholds treatment unless a person is a danger to “self or others.” But the newspaper did not explore why that is the case. In other words, by not focusing on how so many untreated mentally ill adults end up at a Perkins, the Baltimore Sun might well be reinforcing the myth that the mentally ill are dangerous.
Headlines and research, however, show otherwise: it is dangerous for a society to have untreated mentally ill people. Mental health budgets continue to get cut without a whimper. And while ideally it would be well if mentally challenged people demanded better, how can they when they are already suffering from fatigue, just trying to survive without housing, jobs, and/or treatment.
Those who have graduated from Family2Family (F2F) classes continue to be appalled that we we live with or care for ”untreated” mentally ill relatives. It is not encouraging when we discover that Maryland is one of the seven worse places - Connecticut, Maryland, Massachusetts, Nevada, New Jersey, New Mexico, and Tennessee - for getting coordinated mental health care without a crime being committed. In the name of individual rights, these states allow the mentally ill people to refuse treatment even when they are in the midst of an episode. But that in itself is a strange decision since science already shows that the brain of a mentally ill person can’t be trusted early on in the disease. Denying the illness is a part of the disease itself. It is a neurologically based brain disease called – anosognosia.
According to the Treatment Advocacy Center (TAC) in Arlington, VA... anosognosia – is believed to be the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications. It is caused by damage to specific parts of the brain, especially the right hemisphere, and affects approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder. TAC says, when taking medications, awareness of brain illness tends to improves in many patients. In addition, Oliver Sacks who wrote The Man Who Mistook His Wife for a Hat, notes that it is difficult, for even the most sensitive observer… to picture the inner state of the mentally ill because the experience itself ”is almost unimaginably remote from anything” most of us know.
For Maryland and the other six states lacking court-ordered assisted or outpatient treatment means - the only way seriously mentally ill citizens can get treatment as their condition deteriorates… is to commit a crime! Remember the guy who traveled across country to fire shots at the White House late last year? Was that a mental health call for help?
It is thus hard to ignore that family caregivers lack important and much needed safety nets for helping the mentally challenged. Caregivers can’t force them to take medicine or go to outpatient treatment centers, even when these actions would make them less likely to be violent. Except for seven states, a history of not taking medicine is a condition itself for getting them to take prescribed medicine. By calling such conditions "forced treatment" or "involuntary treatment," proponents attempt to alarm the public in rhetoric about "individual rights." Rights which themselves assume that a person is of a sound mind. Those who oppose giving the mentally ill medicine or treatment against their will, therefore, cling to the narrow interpretation that requires a mentally ill person to be a danger to self or others before getting treatment. And by assumption, that usually means committing a crime.
Until Maryland and the few other states follow the example of the many... family members of the mentally ill face their untreated relatives being homeless, placed in jails, wandering the streets, and frequently released from Emergency Rooms and psychiatric facilities before they are stabilized BECAUSE they haven't hurting themselves or others, yet! So, broadening the law of “danger to self or others” is cost effective. Most states get that and have expanded laws now to include other special conditions. The result is that care is coordinated and mentally ill persons often receive court-ordered care BEFORE crimes are committed.
Those who argue that individuals should not be deprived of their rights, under any circumstances, have probably not been held hostage by a loved one with a mental illness. While it makes sense, ideally, to have mentally ill patients participate in their treatment, timing is important. Research shows that the earlier a mental illness is treated, the greater the chance for recovery. Is it really a good time to give an individual in the middle of a rage-like episode, the right to make decisions about treatment?
Without a court order to initiate treatment, caregivers are left with mentally ill relatives who insist there is nothing wrong, even though they are unable to hold jobs. So while treatment for the mentally ill remains a philosophical and political issue, what can’t wait is that the one in five suffering from a mental illness need help NOW!
It should not be forgotten that patients at correctional mental institutions are often there because they didn’t, couldn’t or wouldn't get mental health treatment BEFORE committing a crime.
So an equally pressing question for 2012 is: Is it really humane or in the COMMON GOOD for so many of our citizens with compromised minds to be denied the very interventions that would prevent them from being homeless, jobless, violent, in detention centers, prisons or state mental hospitals? If you could hear some of the hundreds of stories that we hear in F2F classes around the country, you would clearly know that the answer is a resounding “NO!”
But coordinated mental illness care is not going to happen without reform of a law based on the out-dated interpretation that a person must be “danger to self and others” before courts can order treatment. Until that happens we're still likely to hear more about "gun control laws" than updating mental health laws.
“The National Institute of Mental Illness (NIMH) in 2010 estimated that 7.7 million Americans suffer from schizophrenia and severe bipolar disorder – approximately 3.3% of the US population when combined. Of these, approximately 40% of the individuals with schizophrenia and 51% of those with bipolar are untreated in any given year.” (Source: Treatment Advocacy Center)
