Monday, June 9, 2008

Research on Rates of Violence Among Those with Severe Mental Illness

Here's an op-ed that appeared today in the Wall Street Journal by E. Fuller Torrey, the founder of the Treatment Advocacy Center (TAC). TAC is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. TAC promotes laws, policies, and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

Compassion, Compulsion and the Mentally Ill

"The debacle of deinstitutionalization continues to worsen with each passing year. In 1955, there were 559,000 individuals in America's state mental hospitals. By 2005, there were only 47,000 state hospital beds left in the country, a number that continues to fall. Numerous studies have documented the tragic effects of releasing hundreds of thousands of seriously mentally ill individuals from state hospitals while failing to ensure that they receive treatment.

The latest, carried out by Jason Matejkowski and colleagues at the University of Pennsylvania, found that individuals with serious mental illnesses are responsible for 10% of all homicides in Indiana. That translates into approximately 1,700 out of 17,034 total homicides in the U.S. in 2006. Over the past 20 years – during which time the public mental-health system has progressively deteriorated – that would mean 38,000 of 388,311 total homicides.

The University of Pennsylvania study examined the records of 723 individuals convicted of homicide between 1990 and 2002 in the Hoosier state. The results were published in the Journal of the American Academy of Psychiatry and the Law.

Examples of such homicides include Joseph Corcoran, diagnosed with paranoid schizophrenia, who shot four people in Fort Wayne because he thought they were talking about him. And Frank Salyers, also diagnosed with paranoid schizophrenia, who killed a policeman in Goshen after his parents tried unsuccessfully to get treatment for him at a local mental-health facility.

Although the Indiana study is the largest research of its kind in the U.S., two earlier but smaller studies reported that seriously mentally ill individuals were responsible for 10% of homicides in Contra Costa County, Calif., and 29% of homicides in Albany County, N.Y.

Most of these homicides were preventable, since the perpetrators in most cases were not being treated. Nontreatment, a past history of violent behavior and substance abuse are strong predictors of potential dangerousness in this population. We have proven options for decreasing such violence, including outpatient commitment. These programs require mentally ill individuals at high risk for violence to continue taking medication as a condition for living in the community.

Kendra's Law, passed in New York state in 1999, established one such program. A 2005 study by the New York State Office of Mental Health showed that physical acts of violence – as well as suicide attempts and arrests – by patients compelled to undergo treatment under Kendra's Law dropped dramatically in just six months; a similar reduction in violent behavior was shown in a North Carolina study.

Despite such data, assisted outpatient treatment is seldom used in the 42 states in which it is available and does not even exist in the other eight states. Even in New York, only a few counties use Kendra's Law widely. Why not? One reason is the reluctance of mental-health professionals to mandate treatment, even for patients with a history of violence and noncompliance with treatment.

Another is the misconception that such programs are expensive. In fact, it is our failure to use such laws that is expensive. Repeated hospital readmissions, incarceration costs, and the costs of homicides and other associated violence take a far greater toll on local, state and federal coffers.

The societal cost of not treating the seriously mentally ill is staggering. They constitute at least one-third of the homeless population. Unable to defend themselves because of their disabilities, they are often exploited and victimized. Approximately 5,000 commit suicide each year – one-sixth of all suicides. An estimated 230,000 are in jails and prisons, 10% of all incarcerations.

According to a 2006 study by the U.S. Justice Department, 56% of state prisoners, 45% of federal prisoners and 64% of local jail inmates suffer from mental illnesses. In fact, there are now more individuals with a serious mental illness in state prisons than in state mental hospitals.

In the end, involuntarily treating people with serious mental illnesses – who, because of their illnesses, are not aware they are sick – does not infringe on their civil rights. The fears of civil libertarians notwithstanding, the paramount civil right of someone who is severely mentally ill should be adequate treatment.

As Supreme Court Justice Anthony Kennedy wrote in 1999: 'It must be remembered that for the person with severe mental illness who has no treatment, the most dreaded of confinements can be the imprisonment inflicted by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our powers to describe.'"

Dr. Torrey is the author, most recently, of "The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens," out this month by W. W. Norton.


Anonymous said...

Far more people with mental illness are receiving a "death penalty" from forced psychiatric and voluntary without informed consent drugging than from the death penalty per se, but I guess it is more dramatic and more stigmatizing to relate murder and the death penalty than to focus on what is really killing the majority of us. Great job on promoting stigma, TAC and NAMI would be proud!

Toria said...

Great article!

To hymes: I'm not trying to be critical, but I am wondering about the basis of your opinion regarding the ongoing "death" by "drugging" of people with mental illness. Surely it could not have been formed from personal observation of someone extremely close to you (close meaning someone you actually LIVE with and see in ALL circumstances--not even a close friend would qualify, because trust me, you still won't really see what all goes on....) It's very easy to make what appears to me to be a bleeding heart-type and uninformed comment about mental illness. But unless you have been there long term to witness the often tragic and sometimes frightening things that go on in the life a loved one with a brain disorder (the current and more accurate term for conditions such as bipolar disorder [manic-depression] and schizophrenia), you have no idea how it really is, despite what you might think. You cannot imagine the magnitude of pain and trauma in their lives. The destructive things they can do both emotionally and physically to themselves and to their loved ones is heartbreaking and unending. Anyone who has lived in a circumstance like this can verify what I am saying.

Your outraged and "compassionate" comment attempting to set the record straight about how things should be handled for those with brain disorders is so far off-target. The fact is that it is no act of compassion to wish for those with brain disorders to remain untreated. And then to additionally accuse this doctor and expert in this field of promoting a stigma and an agenda of some sort is ludicrous!

Is it so difficult to consider that perhaps he might know a bit more about all this than YOU do??

Anonymous said...

I have kidney failure from psychiatric "treatment" and misdiagnosis. So hard to imagine that someone with mental illness could be commenting for themselves? I have a family member with mental illness also. So easy to assume you are the only one, eh? Dr. Torrey is an expert on how to increase stigma and manipulate statistics to meet his agenda that's for sure, but not so much on actually helping anyone with mental illness. He admits to lying to folks to get them to take meds, his sister is still actively psychotic after all these years, he took brains that were obtained illegally and never apologized for it, he writes columns making up figures on mental illness and homicides, he doesn't even care for the NIMH, he gets private donors to support his so called research. He is a zealot. It's quite possible trauma made him into what he is and I should be sympathetic to that, but somehow with all the damage he has done it's hard to be.

The information on the 25 gap in life expectancy for people in the U.S. taking psychiatric drugs is all over the place including SAMSHA, not exactly radicals. They have a ten by ten program now, trying to reduce the increased mortality by 10 years in 10 years, not enough I say.

flawedplan said...

To the blogger: I agree with the first comment and perceive you in this post at least as a tool.

Both these comments are instructive. The first one speaks to the criminalization of mental patients, the "far more" people with psychiatric disorders who are being wrongfully coerced and supervised as if we were just like the few who commit violent crimes.

The second comment is deceptive propaganda, highlighted by the continual use of the term "brain disorder". The term is MENTAL disorder (see the Diagnostic and Statistical Manual of Mental Disorders). Mental implies subjectivity, thought, emotion, will, meaning etc., the whole psychological terrain that make up what it is to be and considered a human being.

Torrey and NAMI deny all the above can co-exist in people living with "brain disorders".

If it sounds like you are in deep waters, you are. If you don't understand how you are being used as and perceived as a tool, do some critical research into who uses the term "brain disorder", how the term found its way into the discourse as a mantra, who profits by this ideology and who suffers, who promotes it and who defies it and why, for starters.