Dangerousness: a foolish criteria

A front page story in The Washington Post yesterday was published under the headline: “Hinckley: Man on the mend or a danger?”

According to the story, a federal judge will decide the fate of would-be assasin John W. Hinckley Jr., this week after listening to five days of testimony.  Hinckley’s family members, as well as his doctors and case manager, claim the now 56-year old Hinckley does not present a danger either to himself or to the community. The depression and unspecified mental disorder that drove him — along with his narcissistic personality disorder — to nearly kill President Ronald Reagan in 1981 are now all under control.

That’s not so, prosecutors claim. They insist that  Hinckley, who has spent the past three decades in mental facilities,  is deceptive, lazy, and can’t be trusted. The Post quoted Assistant U.S. Attorney Sarah Chasson stating, “Mr. Hinckley has not been a good risk in the past and, therefore, is not going to be a good risk in the future.”

The judge is being asked to determine if Hinckley is “dangerous.”  If he is, the judge will not grant him more freedom than the ten day visits that he currently is allowed periodically with his mother — while being monitored by the U.S. Secret Service.

I often am asked how “dangerous”  became the criteria that is used  to decide if someone is so mentally ill that he/she can be involuntarily held and forced to undergo treatment. The question is an important one, especially for those of us who have loved ones with mental disorders.

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Why Aren’t Our Elected Leaders Listening?

Can you imagine what would happen if a newspaper reported that a hospital refused to treat someone suffering a heart attack? What would the public think if a car accident victim was turned away from an emergency room? Yet, according to a recent report by the Virginia Office of Inspector General for Behavioral Health and Developmental Services, at least 200 persons who were having a mental health crisis and met Virginia’s involuntary civil commitment standard because they were dangerous were refused treatment in the Hampton Roads area between April 2010 and March 2011. 

The practice of turning away psychiatric patients in Virginia has become so common that there is a word for it  — “Streeting.”

The IG’s report cited an example of a 66-year-old Virginia woman who needed immediate care but was turned away by 15 private hospitals. She then was driven a hundred miles away to a crisis stablization unit only to be turned away there because she did not make it through the unit’s medical clearance process due to lethargy, a medication side effect.  Forty-eight hours later she was finally admitted to a hospital emergency room.

She was lucky. At least she finally found a bed.

Where is the community outrage? Why are doctors, mental health professionals, community leaders and elected officials not alarmed?Click to continue…

A battle worth fighting!

When Rose Alberghini, the executive director of NAMI PA York, invited me to speak about barriers to good mental health care, the first obstacle that entered my mind was stigma. The way that the media, especially Hollywood, portrays persons with mental disorders is so crass, cruel and destructive that people are often afraid to acknowledge that they might need help.  

We should not separate the mind from the rest of the body when it comes to illnesses. The heart can get sick and so can the brain. Yet, we insist on viewing mental disorders separate from other physical aliments. Part of the problem, of course, is that we don’t  know the biological underpinnings that cause bipolar disorder and schizophrenia. Until we do, there are bound to be arguments. But what we do know is that persons who suffer from mental disorders are rarely portrayed sympathetically.

We would never make a person with Downs Symdrome the butt of a joke. Yet, persons with mental problems continue to be easy targets.

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Elephant In The Room

Amid all of the rhetoric, name-calling, and finger-pointing that’s going on, it’s nice that some journalists and advocates are actually speaking out thoughtfully about how difficult it is to get meaningful help for a person with a mental disorder.  Diane Rehm on NPR devoted an hour to the struggles that parents face when they have an adult child with a disorder. I was grateful to be part of that discussion. 
 Kudos to Diane and kudos to these others.

Time to speak out, not hide!

As I write this, we still don’t know if Jared Loughner had been diagnosed with a mental disorder before his weekend shooting rampage. Loughner is the 22 year-old accused of wounding U.S. Rep. Gabrielle Giffords (D.-Ariz.) and killing a federal judge along with five others in Tuscon.    

The Washington Post and New York Times both reported that officials at Pima Community College told Loughner and his parents in October that he would not be able to continue as a student until he obtained a clearance from a mental health professional  that certified he was not a danger to himself or others.

That revelation certainly implies that Loughner was exhibiting symptoms of a mental disorder, but no one should automatically assume that.

Stories such as Loughner’s are upsetting to those of us who have loved ones with mental illnesses. That’s especially true if your loved one has tangled with the police while psychotic because you know how quickly an incident can turn violent.

If it turns out that Loughner did have a diagnosed mental disorder, I hope the National Alliance on Mental Illness (NAMI), Mental Health America (MHA), and other leading advocacy groups do not run for cover.

Instead, they should follow the example that  NAMI Ohio set last week when Sheriff’s Deputy Suzanne Hopper, age 40, the mother of two children, was murdered by a man with a severe mental illness.

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Part Two – The Power of Hurtful and Helpful Words

Words.  They matter.

When I was doing research inside the U.S. Penitentiary in Leavenworth, Kansas, for my book about everyday life inside a maximum security prison, I learned to select my words very carefully.

 This is because I was in a prison where what you said or didn’t say might get you stabbed. 

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