Failure in Tucson
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.

— Dr. David Gratzer, a physician, is a senior fellow at the Manhattan Institute.

D. J. Jaffe
Pundits and politicians are busy blaming Jared Loughner’s parents for not preventing him from shooting Gabrielle Giffords. It’s a common approach: blame the parents.

But as a relative of someone with mental illness, I know that under current law, families of the mentally ill are often powerless to do anything other than say, “Go to a doctor,” until after their children become “danger to self or others.” You can call the mental-health authorities or police all you want, but until your loved one is “danger to self or others,” in the name of “civil liberties” you’re powerless. That’s ludicrous. Laws should prevent violence, not enable it. Most individuals with mental illness are not violent, but there is a readily identifiable subset that is.