On December 9, Rich Rifkin wrote an op-ed in the Davis Enterprise that generated a good deal of controversy. While the subject matter is not necessarily the purview of Davis it does overlap with issues that impact Davis and Yolo County. Today we have a court ruling constraining the use of Tasers particularly against those with mental disorders.
At the outset, having gotten to know Mr. Rifkin through interchange both on the Vanguard and in the community, I do believe his intentions here are intended to help, rather than intended to be malicious as some of the letters to the Enterprise in response have implied.
From that he picks his bone against the ACLU arguing that the these stories are “the product of successful lawsuits decades ago by the ACLU that “freed” the mentally ill from psychiatric hospitals.”
He then quotes Pete Earley, whose credentials are not clear other than than his son is bipolar and ended up in jail upon him stopping taking his meds and he wrote a book entitled, “Crazy.”
Says Early:
“We need to re-examine civil rights laws that require a person to become dangerous before we can help them,” Earley said. “Involuntary commitment laws that require ‘imminent danger’ ignore that a person can be very, very sick and harmless. This results in people who are psychotic roaming our streets, helpless. It also results in people becoming dangerous because they are not being treated.”
NAMI representatives were quick to write in, and probably misconstrued his point somewhat when they wrote:
“Rifkin implies that most mentally ill people are not capable of ‘running their own lives.’ We know this is not true. Many people are able to learn how to manage their chronic illness…”
Mr. Rifkin responds on his blog:
This is an unfair characterization of my column, which focused on people who are insane and therefore not capable of running their own lives. I never discussed anyone who has mild depression or any other minor disorders. I wrote, “Until those of us who are sane take full responsibility for people who are insane and accept the fact that they cannot run their own lives, we will have more and more tragedies like the one at Bellissimo Pizza.”
Many people are able to learn how to manage their chronic illness, just as diabetics or other people with chronic illnesses can.
Nothing I suggest would harm the interests of those who can manage their problems. However, many cannot manage; or think they can manage and it turns out they were wrong.
While I think the NAMI representatives eventually accuse Mr. Rifkin of something that he has not done–suggested that a most mentally ill people are not capable of running their own lives, inevitably, Mr. Rifkin’s solution presents a problem. The problem is who gets to determine who can or cannot run their own lives and how that process will play out.
The problem is briefly discussed in an interchange on another topic between Rich Rifkin and myself.
At that time, I expressed the reluctance to put away people based on what they might do, due to some notion or classification that we give them including what may indeed be a prejudicial preconception about mental illness. And I do think that Mr. Rifkin unwittingly falls into that category when he summarily dismissed this concern.
“That, David, sounds to me like the same spin as the psychotherapists who are attacking me in their letters to the Enterprise. I have much more faith in medical doctors than I have in them. Board-certified medical doctors don’t make serious decisions based on “prejudicial preconceptions about mental illness.” That is just ACLU nonsense.”
While modern psychiatric medicine has come a long ways since the days of the insane asylum, I do not share his optimism, particularly since there has to be some sort of adjudicating step to remand an individual into custody. That requires some sort of legal or quasi-legal hearing and likely and inevitably involves lawyers.
We quite simply know that when it comes to legal proceedings that one can find psychiatrists who are less professional than Mr. Rifkin implies. Returning to the days of institutionalization hearkens back to the abuses that we saw under that system exemplified by the fictional work by Ken Kesey, One Flew Over The Cuckoo’s Nest. Again, we can probably argue that our understanding has advanced since Kesey wrote his novel, but I am less optimistic that our legal system has.
Put simply, I fear that institutionalization will once again become a dumping point to put away our undesirables. We lack the resources for real treatment options both in and out of prisons that could probably avoid much of these problems, how are we going to find the resources to run institutions?
The other problem, is that many of the individuals covered here are in fact treatable and could live fairly normal lives with proper medicine and supervision by doctors.
Mr. Rifkin quote Mr. Earley in his column, but Mr. Earley’s son simple stopped taking his medicine. Mr. Earley takes issue with the imminent danger law, but changing that law becomes tricky and the question is what he proposes to do with people who show signs of mental affliction but have not actually done anything that would be considered dangerous.
In the end, I agree that we do not treat our mentally ill as we should. However, I do not think the problem is the ACLU, I think the problem is that we lack the resources to actually treat people in most need before they devolve to become dangerous to themselves and society. That is where I would focus efforts rather than launching attacks on the ACLU for “freeing” the mentally ill from institutionalization.
—David M. Greenwald reporting
Involuntary confinement is not and never has been an effective means of providing mental health treatment. Largely because of the growing shortage of community-based mental health programs and services, the primary providers of such “services” are now the jail and prison systems. Let’s not talk about going back to the “good old days,” before the last third of the 20th century, by curtailing hard-won civil and constitutional rights of people with psychiatric disabilities–particularly while we continue to underfund and gut voluntary mental health treatment programs.
Many interacting societal issues are at play here in the definition of “mental illness”. The concept, “unable to care for themselves” is, in itself, steeped in societal beliefs and values. Being considered egocentric vs. having an incapacitating mental illness is greatly influenced by wealth and social position ,e.g., the heir to the Dupont fortune,whose “egocentricity” came to the public’s attention when his paranoid delusions brought him to kill his house guest. A society that holds individual freedom, both physical and what goes on between ones ears, as a high priority should resist responding to the illusion that it can make itself totally “safe” and remain individually “free”.
Since I last wrote about this topic, I’ve been contacted by a number of people (in law enforcement, families of the severely ill and others who work in the mental health field) who know much more than I know about Laura’s Law ([url]http://en.wikipedia.org/wiki/Laura’s_Law[/url]), which is the “operative” law in California. It was authored by Helen Thomson, when she was in the state legislature. Helen was the chair for the Select Committee on Mental Health. Her husband, Cap Thomson, is a psychiatrist (and Helen was a nurse).
Laura’s Law “allows for court-ordered outpatient commitment of mental health clients who refuse voluntary treatment with psychoactive drugs.” (The law was named for Laura Wilcox**, who was shot and killed by Scott Harlan Thorpe, a 41-year old mental patient who resisted his family’s attempt to seek treatment for his illness.) It’s been on the books for almost 8 years. What I did not know is why it does not work. I knew for a fact that it was not functioning five years ago when my in-law could not be forced to take his medicines (which did in fact make him much better).
The reason is (essentially) money. Before our public mental hospitals were closed*** decades ago, patients could be sent to one of them. However, they no longer exist. Laura’s Law is designed so that each county has to set up what is called an Assisted Outpatient Treatment program. But 8 years after Mrs. Thomson successfully got Laura’s Law passed, no counties (other than a pilot program in L.A. county) have working AOT programs. As such, a judge could order someone into treatment, but there is nowhere left for that court-ordered treatment to take place. Nevada County, where Laura was killed, is supposedly going to have our state’s first countywide program. (I’m not sure if it is in place, yet.)
According to the Treatment Advocacy Center (mental health professionals, largely MD’s, who want the severely mentally ill to be treated) writes this about the funding flaw in Laura’s Law: “the initial bill was saddled with limitations by opponents during the legislative process. Laura’s Law now provides that it is up to each county to decide whether or not to implement the law and to establish a program for it. Among other cumbersome restrictions, the law also requires a finding at the county level that no voluntary mental health program will be reduced as a result of adopting an AOT program, that AOT can only be used in conjunction with an extremely costly and often unnecessary outpatient service program and that counties must have very high thresholds of general services, most of which are unrelated to the use of AOT.”
However, it should be noted that David Greenwald’s good friend, Sen. Leland Yee, has recently worked to remove the funding restrictions built into the original legislation. I’m not sure if Sen. Yee has succeeded in that.
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*My personal interaction with this question is limited: I have an ex-in law (who was not ex at the time) with schizoprhenia who was very ill when he was not taking his meds; and my family tried in vain to commit him so that he would be medicated and return to functioning normalcy; but after very limited lock-ups (called 5150 holds), he was released on his own and continued to spiral downward to the point he was (in my opinion) a grave danger to anyone near him. We have lost all contact with my ex in-law. The last I heard, a few years ago from one of his brothers, is that my ex in-law “lives on the streets in San Jose, drinks heavily, is deranged and probably won’t last much longer.”
**As it happens, Laura’s parents are close friends with my family in Nevada County.
***The only ones which remain open are prisons for “the criminally insane.” …. One of the great ironies of the closing of the mental hospitals in California is that Gov. Reagan helped lead the movement to shutter them. (The real leader was a far left-wing Democrat named Nicholas Petris from Oakland.) The man who almost murdered Reagan, John Hinckley, should have been locked in a mental hospital and treated for his illnesses. But because every state gave the same “freedoms” to people like Hinckley, he was able to shoot the president “in order to impress Jodie Foster.”
One Davis resident, who wrote to me after my column on this topic ran in The Enterprise, alerted me to a piece published not too long ago in the Nevada City Union newspaper by Debra Rodriguez, whose son Jonathan raped a 14 year old girl in 2008. Jonathan Rodriguez is severely mentally ill and was not taking his medications. His parents tried everything they could to help him. The missing link (it seems to me) is that her son was not forced to take his meds. If he had been, the “crime” never would have taken place.
These are Jonathan’s mother’s words about our system: [quote] Jonathan’s own struggle with mental illness began at age 15. … I am very sorry for the pain caused to the victims in this case. This event was totally out of character and beyond anything we ever thought possible. The question I ask is this: Why are the many agencies involved NOT being held accountable for their part in the failure of a broken system?
I feel the victims and the public deserve to know the whole story so that changes will be made, and this type of thing will be prevented in the future. …
Jonathan spent 10 months at Napa State Hospital being treated for severe mental illness. Upon his release in September 2007, the doctors recommended mental health court. This was denied again and again by the Nevada County district attorney, even when the judge wanted to grant it. If Jonathan had been in mental health court, safeguards would have been in place to prevent the following scenario.
Jonathan was initially being treated at Nevada County Behavioral Health Department, with family being included in his meetings with the doctor. He was doing well. He was transferred to Turning Point MIOCR (Mentally Ill Offenders Crime Reduction) program where he no longer had family involvement. No one was allowed to come to his meetings with the doctor. In fact, medications were changed without the family knowing it.
Jon’s mental status began to decline. The sheriff’s department was called to our home on numerous occasions. We asked that he be taken for evaluation. His Turning Point worker was also called to our home on numerous occasions. Jonathan was in crisis, and we were in crisis. There was no intervention other than the sheriff’s deputies and the Turning Point worker telling him to leave our home (essentially to roam the street).
Numerous calls were made to the Turning Point crisis number and his worker. Numerous and daily emails were written to his doctor and his worker at Turning Point detailing his exact behaviors. We also reported that he had numerous medications in his possession that were not being taken as prescribed. He was a disaster waiting to happen.
Many requests were made to implement the new Laura’s Law on Jon’s behalf. We were told that he qualified, but that all the details to implement Laura’s Law had not yet been worked out. On June 6, 2008, Turning Point stated that they had arranged a bed for Jonathan at a psychiatric facility in Roseville and a 5150 (72-hour hold) was ready.
A deputy sheriff and a Turning Point worker came to our home, and we convinced Jonathan to get into the patrol car with the deputy to go to Sierra Nevada Memorial Hospital. He reluctantly went with him. At Sierra Nevada Memorial Hospital, while being processed, he was apparently not being adequately supervised, and escaped. My husband found Jonathan later that night and asked Turning Point if he himself could transport Jonathan to the hospital in Roseville. Turning Point refused, saying it was against protocol.[/quote]
[quote]Turning Point told my husband that if he brought Jonathan to the emergency room at Sierra Nevada Memorial Hospital, Jonathan’s worker and the paperwork for his hospitalization would be there. His exact words were, “Mr. Rodriguez, I promise you. Your son will be in the hospital TODAY!”
My husband again convinced our son to go to the hospital for help. When they arrived at the hospital, there was no worker and no paperwork. He was told to see his doctor at his regular appointment later that day. My husband took our son to his doctor at Turning Point that afternoon, where he was, as usual, not allowed to go in with Jonathan.
Our son came out with packages of medicine. The dosage of the medication had again been increased. This was done even though the doctor and Turning Point had been informed on numerous occasions that Jonathan was not taking the medicines as prescribed. When communicating our concerns with Jonathan’s worker at Turning Point, all he could say was that if he was noncompliant, maybe he needed to be terminated from the Turning Point program.
We could not understand what happened to the needed hospitalization or the implementation of Laura’s Law. It seems that all Jon’s worker was concerned about was whether he picked up his medication. There was no follow-up from that point on.
Our son was mostly in the street with nothing more done to ensure his own or the public’s safety. Less than two weeks later, June 18, he was arrested. Again, a mentally ill person had to commit a crime before anyone would do something. Once again, a mentally ill person was not served adequately in Nevada County. Though many agencies and departments were involved, neither the public nor Jonathan were safe because he was not hospitalized as needed and as promised.
When will things change in this county, and when will these things that happened to us NOT be swept under the carpet? How many Scott Thorpes or Jonathan Rodriguezes will it take?
After Jonathan’s arrest I sent a four-page letter asking the directors of Turning Point and Behavioral Health to investigate the chain of events and failures that contributed to our son’s declining mental health. Their only response to my letter was to make excuses for their failures, and as to my knowledge, no changes have been made. The public should know that the system is still broken, and steps should be taken to make the changes needed. [/quote]
[i]”Involuntary confinement is not and never has been an effective means of providing mental health treatment.”[/i]
Said by someone who clearly has never had any personal experience with this topic.
Rich: Eric Gelber probably has more personal and first hand knowledge on this subject than any of us.
Well, let me just say that Mr. Rifkin’s making a statement like “Said by someone who clearly has never had any personal experience with this topic” without having a clue as to what my experience is reflects on his credibility, not mine. I will not get into any prolonged debate, but will make a few points:
E. Fuller Torrey, founder of the Treatment Advocacy Center, is the most prominent advocate of forced psychiatric treatment in the United States. His views are extreme and not mainstream.
Nicholos Petris was a powerful advocate for the rights of people with psychiatric disabilities. The major legislation he authored–the Lanterman Petris Short (LPS) Act–is a landmark in the history of disability rights and served as a model for similar civil rights enactments around the country–much to the ongoing chagrin of E. Fuller Torrey and his followers.
Psychiatry lacks the ability to identify the Hinckleys of the world in a manner that would not also result in the involuntary commitment of others with serious psychiatric disabilities, the vast majority of whom pose no danger to anyone. The LPS Act, which Mr. Rifkin impliedly denigrates, requires due process safeguards to minimize such unwarranted curtailment of individual liberty.
Opposition to Helen Thomson’s well-intentioned outpatient commitment legislation by mental health consumers and advocates was widespread and, again, largely based on the ineffectiveness of involuntary treatment.
As for my own personal and first-hand knowledge, I will note only the following: Ph.D. in psychology; J.D.; and 26 years practicing disability rights law.
[quote]As for my own personal and first-hand knowledge, I will note only the following: Ph.D. in psychology; J.D.; and 26 years practicing disability rights law. [/quote] That’s what I meant by not having [i]personal[/i] experience.
You would do well to read Dr. Torrey’s book, The Insanity Offense, on what happened to patients in California, after LPS passed. It was a disaster and led to our huge homeless surge and many tragic crimes, including mass murders.
I don’t question Dr. Gelber’s expertise or experience, but the idea that society has no right to protect itself nor to help those who are criminally insane is absurd. Jon’s parents’ story above is not uncommon and highlights the failure of our mental health system. It is hard to fathom Dr. Gelber’s statement, “Psychiatry lacks the ability to identify the Hinckleys of the world in a manner that would not also result in the involuntary commitment of others with serious psychiatric disabilities, the vast majority of whom pose no danger to anyone.” Not even when there is a clear history of violent acts against others while suffering from delusions? I find it odd in our society that we have no hesitation in providing medical assistance to those who are unable to act in their own behalf because of a heart attack, a stroke, an automobile accident, etc, but if the inability to care for oneself is caused by a failure of the central nervous system rather than the cardiovascular system, we assume they have a “right” to refuse treatment. It doesn’t make sense to me. It is inhumane to those who are mentally ill and to those who are the victims of their delusional acts.
One of those LPS tragedies — actually 13 murders — is documented here ([url]http://books.google.com/books?id=p31kH0F4HmkC&pg=PA25&lpg=PA25&dq=herb+mullin+had+been+arrested+for+the+perez+killing&source=bl&ots=DvTjhffGV1&sig=yCyhfYxckQnh0cMKOmiZoWkSyJU&hl=en&ei=hXQ6S8H9NoyCswO5lrmKBA&sa=X&oi=book_result&ct=result&resnum=4&ved=0CBcQ6AEwAw#v=onepage&q=herb mullin had been arrested for the perez killing&f=false[/url]) in this passage from Dr. Torrey’s gripping book.
Observer:
“the idea that society has no right to protect itself nor to help those who are criminally insane is absurd.” “highlights the failure of our mental health system”
I don’t think anyone disagrees about the failure of our mental health system. I don’t think anyone argues that society has not right or DUTY to protect itself. The area of dispute is the proper course of action one must take to both fix the current system and protect society.
From my perspective Rich Rifkin’s solution paints far too broad a brush and would end up putting into confinement of some sort of a whole host of people that really represent no threat to society but also who could lead productive lives if the proper care and treatment options were more readily available with support for individuals and families.
[quote]Rich Rifkin’s solution paints far too broad a brush and would end up putting into confinement of some sort of a whole host of people that really represent no threat to society but also who could lead productive lives if the proper care and treatment options were more readily available with support for individuals and families. [/quote] You MUST misunderstand what I think needs to be done to reach such a wrong-headed conclusion.
My understanding (from speaking with psychiatrists) is that the vast majority of people with severe mental illness can be treated with psychotropic medications and live in society. It is only a very small minority of the severely ill who don’t improve with drugs. They need to be locked up for their own safety and society’s, as well.
But just because someone with severe psychosis can live in society does not mean that person has the cognitive function to make reasonable decisions about his own medical care. He (almost certainly) needs help. All I would like to see for help is to assign him a guardian. (That should normally be a member of his family.) The guardian should be responsible to make sure the patient is getting proper medical care and taking his anti-psychotic medications. If, however, the patient goes off his meds — everyone who knows someone with severe mental illness knows “going off meds” is a real problem — then the guardian needs to be able to turn to the law for help. That is, take the patient into a locked facility, get him back on his medications; stabilize him; and when he is well enough, release him back to the custody of his guardian. Such patients can live perfectly well (most of the time) in society. They don’t have to be locked up for the long-term.
The first step in the process of getting the severely mentally ill who are going untreated into treatment is to fully implement Laura’s Law at the county and state level.
As long as we care more about civil libertarian nonsense, we will continue to have huge numbers of homeless and imprisoned mentally ill and some very tragic crimes. Before we had nonsense laws like LPS, we did not have one quarter to half of our prisons filled with mental patients. Our massive surge in the homeless in the late 1970s was a direct result of that terrible law.
This discussion roughly parallels the current debate concerning what level of safety can be achieved by attempting to preemptively remove those profiled as potential “terrorists” from our midst and at what potential cost to the nature of our society. Anecdotal tragedies are moving but should not be the basis for thoughtful public policy.
“….All I would like to see for help is to assign him a guardian. (That should normally be a member of his family”
…another personal anecdote,for what it’s worth, albeit dated(late 60s). A young man I got to know in S. California described being involuntarily hospitalized in a mental hospital by his parents, in Wisconsin as I remember it, because his reality with regard to personal goals, work ethic motivation and other 1950s “thinking” were not normal. He described his “thinking” as having been markedly altered by what he experienced when drafted and sent to fight in Vietnam.
[quote]This discussion roughly parallels the current debate concerning what level of safety can be achieved by attempting to preemptively remove those profiled as potential “terrorists” …[/quote] I don’t think that is the right analogy. The better analogy is with a small child with a serious illness who does not want to take the medication which his doctors believe will cure his illness. The child does not understand the salutary effects of the medications because he is not fully capable of deciding what is right or wrong for him. Whenever a child decides not to take his medicines, we force him to do so. However, when an adult who is [i]non compos mentis[/i] (and thus unable to understand the salutary effects of his medications), we (post-1969, post-Petris-Lanterman) let the patient wither away and die for his “choice”. Everyone who is sane understands that the patient did not freely make this “choice”. It is only extreme civil libertarians who think someone who is severely mentally ill ought to decide his own fate.
It is rarely the case that the victims of these “decisions” are society, as is the case with the terrorist. The primary victim is the patient. Chances are very high he will end up homeless, on drugs or alcohol, malnourished, a victim of violent crime and incarcerated. That is the “freedom” civil libertarians are achieving with their position. (It is also the position of right-wing conservatives, like Mr. Lanterman, who think they are saving money by not funding public mental hospitals and not requiring lock-ups for people with severe mental illness who are going untreated.)
The next most likely victim is the person’s family members. Dr. Torrey has the numbers in his book. I don’t recall the exact percentage, but it’s something like 80% of the time an untreated mental patient commits a violent crime, he does so against a member of his own family.
Another category of victims — albeit a small group of society — is public figures. Rebecca Schaeffer was unusual in that her stalker (who had untreated psychosis) actually murdered her. Same with John Lennon. But literally hundreds of famous people have stalkers, some of whom are dangerous. (I know a person who used to be on local TV in Santa Barbara whose home was broken into by a stalker who had been writing “crazy” letters to her because she was “driving him crazy, talking to him through his radio and TV set.”)
The least likely people to be harmed by our policies of not treating people with severe psychoses are random strangers like Laura Wilcox or Andrzej Leonik ([url]http://www.nytimes.com/2009/12/08/nyregion/08neediest.html[/url]). Yet just because these crimes won’t happen to most of us does not mean they are not very serious and tragic. I expect even Gene and David and Eric Gelber are sympathetic to Mr. Leonik. These crimes not only destroy the lives of the people who are attacked directly, they devastate the families of the mental patients, as in the case described above by Debra Rodriguez.
Rich Rifkin.. your not infrequent complaint that your initial postings are being “misunderstood” has much to do with their shape and TONE. When this is addressed, your response is usually more thoughtful, measured and easily “understood”.
I doubt that you will find an argument on this blog to the observation that the system can be improved to deliver better care to the severely mentally ill. What I gleaned from your initial postings(and other supportive responses) was a “political” tone that is quite disturbingly similar to the perceived “terrorist” security challenge which is allowing severe abridgement of citizen freedoms.
[quote]What I gleaned from your initial postings(and other supportive responses) was a “political” tone that is quite disturbingly similar to the perceived “terrorist” security challenge which is allowing severe abridgement of citizen freedoms.[/quote] I have no idea what you are talking about.
I’m sure I’m only talking to myself at this point, but before this thread falls off the list, I’d like to voice my agreement with Davisite2, “I doubt that you will find an argument on this blog to the observation that the system can be improved to deliver better care to the severely mentally ill.” This has been an interesting discussion, and I suspect that all those contributing would like to see more services for the mentally ill. Although we disagree on where to draw the line for involuntary commitment, there is more we do agree on rather than disagree. Given the economic and political reality of the day where we, as a society, are not willing to serve those who are desperately seeking mental-health care, it is not very likely that society is currently willing to tax itself further to assist those who are not able to recognize that they also need help. For me, I will continue to support Right and Relevant and vote for political candidates who express compassion for the most vulnerable of our society. I hope other posters will join me.