If the Left heeds President Obama’s admonition last night to put aside the childish political finger-pointing over the Tucson murders, perhaps we can have a constructive conversation about the lessons of the tragedy. Specifically, about how our society handles the mentally ill who do not appear obviously homicidal or suicidal but nevertheless require serious psychiatric care.
According to the Treatment Advocacy Center (TAC), roughly half of all U.S. states allow involuntary commitment under a “need for treatment” (NFT) standard. Individuals can meet this standard without posing an immediate physical threat to themselves or others, and without suffering from “grave disability.” If it can be demonstrated that a person will experience severe mental deterioration in the absence of treatment, he or she can forcibly be evaluated and then hospitalized. Meanwhile, the vast majority of states have laws authorizing “assisted outpatient treatment” (AOT). Under AOT, recipients may continue to live in their own home, but they are compelled to accept medical care for their sickness. This is “an exceedingly effective intervention,” says TAC policy director Brian Stettin. Indeed, the available evidence suggests that AOT can dramatically curb the risk of homelessness, psychiatric hospitalization, arrest, and imprisonment among the mentally ill.
The tragic irony is that Arizona boasts some of the strongest AOT and NFT laws in America. Had Jared Lee Loughner been referred to mental-health professionals, there is a chance that his bloody rampage could have been prevented. Think of all the people and institutions — his parents, his neighbors, his fellow Pima Community College (PCC) students, PCC administrators, the campus police, the Pima County Sheriff’s Office — who witnessed signs of his psychosis but apparently failed to notify the relevant officials. A simple court petition could have saved six lives.
On the other hand, as TAC founder Dr. Fuller Torrey has noted, Arizona’s public mental-health services are actually quite poor. The system is woefully — indeed, frighteningly — ill-equipped to manage the state’s psychiatric population. So even if Loughner had been referred to the proper channels, he might not have received treatment in time to stop his deadly outburst. Like many other states, Arizona rarely puts its AOT and NFT standards to use.
Will that change, post-Tucson? We certainly hope so. According to a 2007 Justice Department study cited by Torrey, the mentally ill represent 45 percent of all federal prisoners, 56 percent of state prisoners, and 64 percent of local prisoners. Clearing out state mental hospitals was sold as a compassionate policy during the 1960s and 1970s. Yet the “reforms” of that era left behind a grisly trail of human wreckage.
The case for adopting — and vigorously applying — muscular AOT and NFT laws is overwhelming. Of course, tough standards mean very little if the mental-health system is inadequately funded. At a time when state budgets are under enormous strain from burgeoning Medicaid rolls, steep levels of education spending, and bloated public-sector pensions, directing more money toward psychiatric care may seem a low priority. But the consequences of neglecting mental health are all around us: on our street corners, in our hospitals, and throughout our jails. Moreover, the price of AOT and similar policies must be weighed against the price of inaction. Only a small fraction of schizophrenics commit violent crimes; but even the nonviolent ones are at great risk of being hospitalized. All told, the public cost of untreated mental illness is substantial.
While this is primarily a state issue, Washington can help — by getting out of the way. Since the mid-1980s, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) has operated a program known as “Protection and Advocacy for Individuals with Mental Illness” (PAIMI). Despite its worthy aims, PAIMI has long functioned as a de facto arm of the ACLU, bitterly resisting compulsory treatment for the mentally ill. As psychiatrist Sally Satel observed in a 2007 Weekly Standard article, “a lot of the financial and ideological firepower obstructing common sense reforms” has come from SAMHSA in general and PAIMI in particular. In the aftermath of Tucson, such obstructionism is no longer tolerable. If SAMHSA and PAIMI continue to hinder life-saving policy changes, they should be shuttered.
Revamping mental-health systems should become a genuine bipartisan cause that unites Republicans and Democrats across the country. Critics of compulsory treatment denounce it as an assault on personal freedom. But schizophrenics cannot truly exercise their God-given freedom — or enjoy any real dignity — without medical assistance. Blocking efforts to get them such assistance is not “humane.” It is disgraceful.