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National Review Online


Failure in Tucson

January 13, 2011

By David Gratzer

A bloody look at rights, responsibilities, and brokenness.

Should there be involuntary-commitment laws for the mentally ill? National Review Online asked some mental-health and other health-policy experts.

David Gratzer

Robin is a patient I’ve seen many times before. He suffers from severe mental illness. Despite my efforts to help him, his treatment pattern stays relatively the same: He gets ill because of treatment refusal, is admitted to hospital where he is medicated against his will, then leaves, and, soon after, goes off his meds again, so that the frustrating and expensive pattern of psychosis and institutional care repeats itself.

With Robin, there is modestly good news for society: Like the vast majority of schizophrenic patients, he doesn’t have a violent bone in his body.

But some do. About 1 percent of the seriously mentally ill are violent. They account for about half the rampage murders in the United States.

It’s difficult to tell exactly what happened in Arizona, but this much is already clear: Jared Lee Loughner was under the influence of a chemical imbalance, plunging him into a distorted world of delusions and psychosis. Despite the early media portrayals and Democratic whispers, this had nothing to do with talk radio or tea parties, and everything to do with an illness.

Signs were missed; action wasn’t taken. Now, like tens of thousands of other mentally ill people, he seems destined to enter the prison system. (And, for the record, even that isn’t a prescription for care: A University of Michigan study recently found that two thirds of prisoners with severe mental illness receive no treatment.)

Before the 1960s, psychiatry was largely unrestricted by patient rights. In the past four decades, the pendulum has swung to the other extreme. People like my patient Robin “choose” to spend their years in and out of hospitals. Sometimes the results are catastrophic.

It’s true that many states have adopted laws that allow society to demand treatment of certain high-risk outpatients. California has such a law, inspired a decade ago when — ten years ago almost to the week of the Arizona tragedy — college student Laura Wilcox was shot dead by a paranoid man who had refused treatment for his mental illness. Yet, because of lobbying and lawsuits by patients and civil libertarians — some of which has been done with taxpayer dollars — these laws are often weak or not enforced. Consider: A majority of counties in California don’t enforce Laura’s Law.

Arizona is a tragedy. But perhaps it will inspire us to reconsider the rights of the severely mentally ill, and our responsibility to them.

Original Source:



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