By John Ballard
Mass murder is nothing new. Starting with Wikipedia, the interested reader can drill into a string of links detailing the stories of George Hassell, Howard Unruh, Richard Hickock, Perry Smith, Richard Speck and Charles Whitman. Not mentioned in that list is Andrew Kehoe, perpetrator of the Bath Township (MI) School disaster, 1927, which took the lives of 45 people, mostly children.
What is new it the frequency and speed with which mass killings occur. What happened in Tucson was a predictable event. One would think that by now Americans would be reaching a consensus about how best to reverse this trend but one would be wrong.
We have instead evolved a formula now applied to each repetition of the same phenomenon: shock and dismay, calls for justice for the perpetrator, sympathy for the victims, public expressions of piety and patriotism, followed by closing the file until the next event comes along. And there is always a spate of suggested remedies aimed at changing the politics, habits, faith or attitudes of those other than the ones advancing the suggestions.
No blog post can do more than point readers to what may be unexplored territory. This post is aimed at three such targets. deinstitutionalization, civil commitment and a 45 minute video from a C-SPAN call-in program which aired yesterday.
?Deinstitutionalization was a noble idea which has thus far led to dismal results, including an escalating number of mass killings. Most readers will not recognize the word but those of us of a certain age will have memories of when and how it started. Sometime in the Sixties the size and conditions of state mental hospitals came into the national spotlight. In many cases these places were neither mental nor hospitals but repositories of human cast-offs where unwanted children and adults could be made wards of the state until they "got better" or eventually died.
As an undergraduate in 1963 I was among a group of students on a day trip to Georgia's Central State Hospital in Milledgeville which had been considered among the largest and worst of the lot. I recall the guide telling us that the inpatient daily census at the time was in excess of thirty thousand patients. The campus was vast, including many buildings and a farm which produced enough eggs and chidkens for use in the hospital's food service and employed a large number of those able to work. There was also a cemetery where unclaimed patients were buried. Impressive new dormitory-type buildings were being constructed faster than they could be utilized thanks to the fund-raising efforts of Sybil Vandiver, former first lady of Georgia. The experience was overwhelming and we were told by the head of the music therapy department that if we graduated with a degree in Music Therapy he could offer all of us, two car loads, a job!
Soon after that was when a national trend began with the best of intentions, to outsource the treatment of as many patients as possible to local mental health facilities where they might receive more individualized attention and have the support of their families and local communities. Unfortunately the vision rarely got past the dream stage and the last forty years have resulted in an uneven, underfunded, politically volatile and largely undiscussed mixture of results. Many communities have excellent public resources for people with mental illness but those are few and far between. The national picture of mental health is as messy as the rest of health care, except more so.
I personally know of several individuals whose lives have been destroyed by the shortcomings of what passes for mental health treatment in Georgia and other states. One of my employees was a woman in her late thirties who grew up in Central State Hospital, having been placed there as a child as being "retarded." Fortunately, someone in her family intervened and after two decades she was re-evaluated and released since they found nothing wrong with her. By then her teeth were irreversibly damaged by years of medication and her social skills were damaged to the point that serving in a cafeteria line was the best job she could do.
I could go on, but my guess is that most readers already know of equally tragic personal examples, either in their own families or someone close to them, of an individual afflicted by some form of mental illness, substance abuse or both (typically they go together) but these cases are rarely, if ever, discussed except in the most anonymous way.
?Civil Commitment is the term used when an individual is involuntarily removed from society for the purpose of mental evaluation. Laws vary widely among states and communities, and the notion of taking away the freedom of an individual is contrary to all we have been taught to hold dear as Americans. This is a topic deserving a national conversation as well as better leadership from elected representatives, but the idea of involuntary commitment, a favorite tool of tyrannical political systems, may be more radioactive than the subject of abortion.
Nevertheless, the country is not excused from looking at civil commitment and gathering the courage required to address the subject with intelligence and sensitivity. Again, I have had personal knowledge of more than one instance of civil commitment. This is a sensitive subject but one that needs to be addressed now more than ever. Eventually we as citizens will be forced to make a decision about who is more fit to initiate civil commitments: responsible private citizens or authorized representatives of government. Given the option, I believe courageous individual citizens are the better choice.
This is part of a statement from Michael J. Fitzpatrick, National Director of NAMI (National Alliance on Mental Illness):
When tragedies involving mental illness occur, it is essential to understand the nature of mental illness�and to find out what went wrong.The U.S. Surgeon General has reported that the likelihood of violence from people with mental illness is low. In fact, �the overall contribution of mental disorders to the total level of violence in society is exceptionally small.� Acts of violence are exceptional. They are a sign that something has gone terribly wrong, usually in the mental healthcare system.
Nationwide, the mental health care system is broken. Arizona, like other states, has deeply cut mental health services. Arizona has a broad civil commitment law to require treatment if it is needed; however, the law cannot work if an evaluation is never conducted or mental health services are not available.
In specific cases such as this, authorities and the news media should seek to objectively determine every factor that may have contributed to the tragedy�so that we can act on lessons learned.
* Was there a diagnosis?
* What is the full medical history?
* When were symptoms first noticed?
* Did family members receive education about mental illness and support?
* Did the person or family ever seek treatment�only to have it delayed or denied?
* Was the person seen by mental health professionals? By whom? How often?
* Was treatment coordinated among different professionals?
* Was the person prescribed medication? Was it being taken? If not, why not?
* Was substance abuse involved?
* What may have triggered the psychiatric crisis?
This is not an indictment of Arizona or its mental health system. The only reason the state of Arizona is mentioned here is that the statement was issued in response to the Tucson tragedy. The fact is that Arizona is one of a small number of states which allows a verdict of "guilty but insane" with the proviso that the perpetrator can be sent to a mental health facility for treatment, but upon recovery from mental condition will serve the remainder of a sentence in jail.
I'm not as interested in arguing the merits of the law as discovering a way to (a) improve how mental illness is treated and (b) raising the awareness of the reader to his or her individual responsibility regarding civil commitment of family or others clearly needing evaluation.
?This forty-five minute program yesterday on C-SPAN is a valuable contribution to the national conversation. Hopefully the small clip will stimulate interest in watching the whole program.
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