What’s Really Insane? Our System.

I want to call your attention to two recent events. I’d hoped to write about them sooner but traveling to give speeches, getting my new book  “put to bed” so that it can be published in January and launching a new book project caused me to fall behind.

The first is the ruling by San Diego based Judge Larry Alan Burns that Jared Lee Loughner, the twenty-two year old accused of killing six persons and wounding thirteen, including U.S. Representative Gabrielle Giffords, is so mentally disturbed that he cannot understand what is happening in a courtroom. This means he cannot be put on trial. 

Judge Burns decided to send Loughner, who has been diagnosed with schizophrenia,  to the U.S. Medical Facility for federal prisoners in Springfield, Missouri, where doctors will attempt to restore his competency. 

I’m afraid that many people mistakenly believe that the judge’s decision means that Loughner is going to be treated for his mental disorder. While he certainly may benefit from the medical attention that he will receive, it’s important to note that restoring competency and providing someone meaningful treatment are not the same.

The goal of treatment is to help an individual recover by controling the symptoms of their mental illness. The goal of restoring competenacy is to get the accused to a state where he can understand the rudimentary legal procedures that happen in a courtroom. 

Let me give you an example from my book, CRAZY. A judge decided that Alice Ann Collyer was not ”competent” to be put on trial after she was arrested for shoving an elderly woman at a bus stop. Collyer was sent to a Florida hospital where each day she was taken into a room and shown three chairs.  One chair had a sign on it that said JUDGE, another chair was marked with the words, DEFENSE ATTORNEY, and the third was labeled PROSECUTOR. When Alice Ann could correctly identify which person sat in which chair, she had passed one of the necessary standards that she had to achieve in order to be ruled competent and put on trial.

Obviously, being taught who sits in a chair in a courtroom has little, if nothing, to do with receiving help for a severe mental disorder. 

And that’s point I want to make. Restoring competency is completely different from successfully treating someone who suffers from schizophrenia.

Another misnomer is that Loughner will automatically be forced to take medication.  The  fact that he has been arrested does not mean that he automatically loses the right to refuse treatment. While I was conducting research in Miami, a prisoner stopped eating because his mentally ill mind told him that all food was poison. It was only after the jail psychiatrist went before a judge and testified that the prisoner was nearing the point of death that the inmate was forcibly medicated. In his case, the medication helped clear his mind and he began eating again. But the psychiatrist had to wait until the inmate’s hunger strike was about to kill him before the state could legally intervene.

Because of my skeptical reporter’s temperament, I’m going to presume that federal officials will find a way to forcibly medicate Loughner because of the high profile of this case. They will claim that his actions proved that he was a danger to himself and others, and then use medication to help him become stable.

And what will happen if medication helps him and he can pass the rudimentary requirements that the court requires to put someone on trial?

According to news accounts, both the federal government and Arizona could seek the death penalty. 

In short, we are currently in the process of taking the necessary steps to make him well enough  so that we can execute him for crimes that he committed when he was so sick that he didn’t know what he was doing.  

If doctor’s fail to restore Loughner’s competency, he could be held indefinitely in the federal hospital.

What’s missing from this tragedy is our legal system’s own complicity in the murders that Jared Loughner committed. There were plenty of people who recognized that Jared Loughner was not mentally stable. Students, teachers, and his own parents. But all of them were stopped from interfering because of Arizona’s involuntary commitment statute that requires a person to be dangerous before anyone can step in and provide him with help.

Arizona’s statute actually is fairly liberal. It reads:

ARIZ. REV. STAT. § 36-540 (A). “If the court finds by clear and convincing evidence that the proposed
patient, as a result of mental disorder, is a danger to self, is a danger to others, is persistently or acutely
disabled or is gravely disabled and in need of treatment, and is either unwilling or unable to accept
voluntary treatment . . . .”

Many states in recent years have realized that trying to predict when someone might become dangerous or already is dangerous is foolhardy. My friend, Clare Dickens, was bringing her son home from meeting with his psychiatrist when their car stopped in traffic on a New York bridge and, although Claire had been told her son was doing well, he opened the car door and jumped to his death.

The foolishness of the dangerous requirement is what led Arizona and other states to add “gravely disabled” or phrases such as “unable to care for self or others.”

After the Virginia Tech massacre carried out by Seung-Hui Cho, I was part of a task force that drafted new commitment language which the state legislature adopted. Virginia’s statute now reads:

VA. CODE ANN. § 37.2-817.C.  (a) the person has a mental illness and there is a substantial likelihood
that, as a result of mental illness, the person will, in the near future, 
(1) cause serious physical harm to himself or others as evidenced by recent behavior causing,
attempting, or threatening harm and other relevant information, if any, or 
(2) suffer serious harm due to his lack of capacity to protect himself from harm or to provide for
his basic human needs, and 
(b) all available less restrictive treatment alternatives to involuntary inpatient treatment, pursuant to
subsection D, that would offer an opportunity for the improvement of the person’s condition have been
investigated and determined to be inappropriate …”

Despite this more liberal language, dangerousness continues to be the threshold in nearly all of Virginia when it comes to sending someone into treatment.

I believe that our reliance and focus only on dangerousness is wrong. Obviously, we need safeguards to insure that persons are not wrongly detained and mistreated. But we must find a better way to protect people who are sick but also get them help rather than waiting for them to become dangerous.

Which brings me to the second news item that I want to highlight. 

 The U.S. Supreme Court ruled on May 23, 2011 that conditions in California’s prisons are so inadequate that the state is violating prisoners’ Eighth Amendment rights. The decision grew out of two suits that were consolidated. The first, filed in 1990, called Coleman v. Brown, argued that prisoners with serious mental illnesses were not receiving minimal, adequate care. A special master was appointed to oversee the state’s efforts to fix that problem, but after twelve years, he reported that the conditions in California’s prisons had gotten worse, not better. The main reason was overcrowding. California’s prisons are designed to house a population just under 80,000 but hold nearly double that number. In the second suit, Plata v Brown, filed in 2001, California conceded that it was not only deficient in providing care to prisoners with mental illnesses  but also was failing to provide adequate health care to the general prison population.  

The Supreme Court ordered California to reduce its prison population to 137.5 % of its designed capacity within two years.

Writing for the majority, Justice Kennedy described the overcrowding in stark terms:

“Prisoners are crammed into spaces neither designed nor intended to house inmates. As many as 200 prisoners may live in a gymnasium, monitored by as few as two or three correctional officers…As many as 54 Prisoners may share a single toilet.”

To the surprise of no one,  Justice Scalia complained in a dissenting opinion:

Today the Court affirms what is perhaps the most radical injunction issued by a court in our Nation’s history: an order requiring California to release the staggering number of 46,000 convicted criminals.

The Loughner case and U.S. Supreme Court decision reflect how foolish and cruel we have become in how we treat persons who suffer from brain disorders.

On one hand, we refuse to help someone when they first begin showing sings of becoming mentally unstable. Few communities have adequate mental health services — so even if an ill person wants help, it’s unlikely he will get it. When an untreated individual begins to become sicker and sicker, we protect his constitutional right to be crazy – until  he becomes  dangerous. At that point, we arrest him, lock him up and then give him just enough help so that we can take him to court and put him on trial for crimes that he committed when he wasn’t thinking straight. We then send him to death row to be executed or we incarcerate him in jails and prisons that are overcrowded and completely unable to meet his basic health care needs. We let persons with mental illnesses suffer in prisons where many of them get sicker and sicker and sicker.

We call this justice.

I call it insanity.

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.

  • Burroakblues

    Thanks Pete ~ I have walked this with my adult son ~

  • Nishonai

    Thank you, Pete ~ I have been trying to obtain help for my son for 10 years now, both in New York and Pennsylvania. Because he is not considered dangerous, he is left to live in squalor, wandering the streets hallucinating and cursing, unkempt and stinking.

    I hate this country. I hate the people in this country. The only reason I am here is because I am not wealthy enough to emigrate to a decent country.

    By the way, for all you imbeciles who insist the United States, a country built on genocide, is number one, you are wrong–Norway is number one.

  • Vermont

    I am saddened by the fact that every time something like this happens, the media continue’s to miss an opportunity to have a real conversation about mental illness in this country. The transinstitutional shift from massive psychiatric institutions to prisons for one of our most vulnerable populations is outrageous. I understand the pain that others have suffered when life is lost or harmed, but when are we as a society going to understand that by putting support and funding into our system of mental health care will ultimately stop these tragedies.

    I am grateful for your comments and continued advocacy Pete.
    Thank you.

  • RhondaB

    Hi Pete,

    Love your post, but it is way over generalized.  i work on a forensic mental health unit.  There is no way to return someone to competency without treating their mental illness.  Competency is far more complex a construct than you are making it out to be.  It is not only knowing the roles of people in the court, understanding the charges against you, understanding the potential consequences.  It also involves being able to work effectively with your attorney in your own defense, which acutely psychotic people cannot do.

    The dilemma, once people suffering from mental illness have been charges with a very serious crime, is what to do with them on a longer term basis.  Once they are psychiatrically stable, which can take months to years, should they remain hospitalized due to the nature of their crime, thus making the hospital a deFacto prison?  Should we release individuals who are psychiatrically stable from the hospital even when it may be 6 months to one year out from a heinous crime?  It is not so simple as you suggest.

    Concerningly, increasing numbers of public mental health beds are being taken up with criminally involved patients, leaving other patients who are not criminally involved with little to no access to public mental health beds.  When I say criminally, I am not talking about trespass and disturbing the peace charges.  i am referring to sexual crimes,  other violent crimes, drug charges,murder, assault etc.

  • JUDY

    Pete,
      And it seems as though also our prisons are becoming the new mental health facility, but more than anything, getting the help before a crime is committed I think is very important.  And so much of what  you are saying is correct. Sadly enough there are some who wait also to obtain a sentence to their freedom or lack of and then must wait.  If they need help they must wait until they are sick enough to commit the crime before anyone will do anything, seems unjust.  This is when we have an overpopulation in institutions, and where help could be obtained earlier.  It is a needless problem.  Judy

  • Desireedugas

    Pete, do I have a story for you.  Like you, I wrote a book, but the difference between you and I, I’m not a writer and my book is self-published.  I am Bi Polar, my mother was also Bi Polar and was sent to Louisiana’s State Mental Institution in 1973 at the age of 34.  She never got better and lived in a nursing home from the age of 46 to 66 (her death). I  starting having “issues” at the age of 23.  I was diagnosed Bi Polar after my thyroid was removed (because of thyroid cancer) during good ole’ Hurricane Katrina in the summer of 2005. Please help me tell my story.  You can follow my “snarky” blogs on facebook> Desiree Cart Dugas…. You can also watch my silly dances on You Tube>  desireedugas… after all, that’s what Bi Polar people do.

  • Bernied

    What’s really sad is some of the very people who are supposed to help the mentally ill will then fight any legislation that mandates treatment. In Pennsylvania these groups are making it excruciating to pass pending legislation that will improve the existing clear and present danger, a needed change to the current law. these groups include some  NAMI affiliates among others. It’s time pass SB115- HB58

  • Susan Inman

    As a longtime Pete Earley fan, I’m happy to have discovered this blog site.
    I’m hoping, Pete, that you’ll consider investigating a related problem: the kind of education about mental illnesses that future mental health professionals receive (and don’t receive) about severe mental illnesses.  I believe that in the US, as in Canada where I live, there are not requirements in many programs training a variety of mental health professionals to include science based curriculum about these disorders. And social policy programs seem very attached to theories about the social construction of ‘so-called mental illness.’ This ignorance contributes to the practices and policies that doom the untreated mentally ill to prison.
    Susan Inman
    author, After Her Brain Broke, Helping My Daughter Recover Her Sanity

  • Heathergm

    What I find amazing is what happens when someone is found incompetent and cannot be made competent even after months of hospitalization.  Frequently, the mentally ill person is released back to the street.  It is very rare for someone to be ordered to a long-term structured environment.  With the deinstitutionalization of state hospitals, these folks wind up in locked dementia units which is not where they belong.

    Heather Miller, LCSW
    Warminster, PA