Stop Criminalizing the Mentally Ill

That's the title of this week's column by Dr. María Félix-Ortiz ("Society, and judges, should stop criminalizing the mentally ill," San Antonio Express-News, February 26, 2008). Dr. Félix-Ortiz reinforces the fact that people with mental illness are not inherently prone to violence; in reality, they are more likely to be the victims of crime. She also provides suggestions for outpatient treatment and other preventative programs.

"Recent comments made by Judge Tom Rickhoff of Probate Court 2 to KSAT evening news (Feb. 15), suggest a need for educating our criminal justice community about severe mental illness. I was not surprised by his recognition of a problem, but quite disappointed by his proposed solutions.

The judge's comments reminded me of what might happen if you ask a carpenter to fix your sink: He's likely to address the problem with the tool he uses most, his hammer. But that hammer is likely to cause bigger problems for those rusty pipes.

Bipolar disorder is not a crime; it is a disorder of the brain. Few people who are mentally ill ever commit a violent crime; the rate is similar to that found in the general population. If we did an analysis of the number of people who have diabetes who committed violent crimes, we might want to fingerprint every one of these people as soon as they're diagnosed (and close all the ice cream parlors across town).

However, people with mental illness are two and a half times more likely to be victimized (raped, mugged, etc.) than are any of us in the general population. Dr. Virginia Hiday at North Carolina State University-Raleigh also found that court-ordered involuntary outpatient treatment (OPC) for at least six months was associated with dramatically lower incidents of violence among those who were mentally ill and had a history of violence.

Other studies have found intensive case management another effective way of reducing violence and increasing adherence to the treatment plan. Case management involves old-fashioned social work where the mental health professional visits the individual at home to monitor his or her adherence to the treatment plan, help him or her make connections with other services and offer the support that can really keep people healthy.

While somewhat costly, intensive case management and OPC can reduce the more costly expenses of law enforcement, criminal justice and hospitalizations.

If Judge Rickhoff wants some real solutions, why not consult with mental health professionals and advocates, people who have the right tools in their toolbox for the job? We don't need to further criminalize mental illness; we do need more, and more diverse, mental health services and an approach that balances civil/human rights with the community's need for safety.

Contrary to popular opinion, the best mental health professionals can't reliably predict violent behavior; we can identify risk factors, but there is no test, no equation that accounts for all the variables involved in such a prediction. Lo siento, we can't read minds either.

Substance abuse is more strongly associated with violent behavior. We're in sore need of a variety of empirically validated public drug rehab programs, and I'd like to emphasize 'variety.' The programs shouldn't all be 'hammers.' Different people have different needs. Needs vary across age, gender (pregnant women need treatment, too) and sometimes culture.

If we need to find a scapegoat, let's not blame the ill for their illness. Rather, we might ask our legislators why Texas spends only $38 per person on mental health when most states spend about $80 per person, and Washington, D.C., spends more than $400 per person."