Revise Civil Commitment Laws!


Revise Civil Commitment Laws!

The following is a republication of a blog that I did on 1/9/11. My reference to a recent mass shooting, at that time, will certainly date this blog. However, nothing has changed with the many mass shootings in America since then. These are almost to painful for us to bear. The school shootings are even, somehow, more gut-wrenching.

Nothing has changed and so neither have the contents of this post.

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It is true, as I taught for 36 years as a professor of psychology, and as I validated during 40 years as a psychotherapist; people with mental illnesses are generally no more dangerous than people without these afflictions. However, there are some exceptions. 

Those who are severely depressed are prone to suicide and in rare cases, also homocide. Those who suffer from Bi-Polar disorder can be prone to suicide while severely depressed, or other dangerous behaviors when in high manic phases.

Instances of bizarre and senseless violence, such as the recent case of Congresswoman Gabrielle Giffords and the others who were gunned down with her, a severe mental illness (probably Paranoid Schizophrenia) was the cause. A person suffering from paranoid schizophrenia, a more dangerous form of mental illness, was allowed to wander free among us, and it was this (or possibly another psychotic mental illness) that repeatedly pulled the trigger on our innocent and precious citizens.

Paranoid Schizophrenia is a specific and sometimes dangerous form of mental illness, especially when delusions of persecution are prominent. This should make sense to anyone. Delusions of persecution are false beliefs, often bizarre in nature, that others are “out to get me”, “spying on me”, “taking my property”, or “trying to harm or kill me”.

Of course, many “normally functioning” people would become very angry and tempted to “defend” themselves by attacking the “perpetrators” if they really believed that someone, or some people (perhaps the government, the next door neighbor, etc.), were trying to harm them or destroy their lives. But those in a paranoid psychotic state with with this psychotic mind-set can be very dangerous and no amount of security will protect the innocent from their unpredictable violent psychotic aggression.

The deinstitutionalization movement culminated in 1963 when the Federal Government ordered that mental patients be freed from mental hospitals and be treated within their communities. Congress passed the Community Mental Health Act which provided funding for the construction of community-based facilities to treat mental patients on an outpatient basis. With cases of acute mental states, patients could be admitted for short terms, evaluated, medicated, stabilized and released back into the community. They were oftentimes referred to out-patient therapists within their community for continuing therapy and support. 

All of this happened shortly after the discovery of anti-psychotic medications. In 1955 there were around 600,000 mental patients in state institutions. By the year 2001, there were only about 60,000 in state institutions. Where did the rest of the 500,400 mental patients go? These individuals with severe and sometimes dangerous mental problems went back to living free withing all of our comminities.

Following 1963, if hospitalization was necessary, patients were to be admitted on a short-term basis, medicated, stabilized and then released. This led to a “revolving door policy”, in which patients frequently were admitted, medicated, stabilized, and released, but, then stopped taking their medication and again became actively psychotic and were likely to be re-hospitalized for the same course of treatment.

Also, in the name of  civil rights and humane treatment, the criteria for “civil commitment” (commitment to mental hospitals against one’s will) were narrowed to the point that only those who were a clear and present danger to themselves or the public, could be committed without their permission. This meant that even those who were actively hallucinating, ranting and raving, homeless, filthy, or in some cases starving could not be hospitalized against their will. 

These criteria are far too restrictive and great suffering among the mentally ill,  as well as the rest of us, continues as a result.

It is pure stupidity to insist that an actively psychotic individual make a rational decision about what is best for themselves to do about their psychotic condition.

Once again an over-reaction in the name of personal freedom and humane treatment has gone too far. In doing so it predictably has resulted in more social chaos and tragedy, with a net loss of personal freedoms for all.

Once again, I must judge that the true governmental motivation for extending the definition of “personal freedom” ( in this case for mental patients) was largely revenue savings.

It is true that those patients who seek help at Community Mental Health Centers tend to benefit. But on a yearly basis, 40 to 60 percent of all people suffering from schizophrenia “and other severe mental disorders receive no treatment at all”. While poor coordination, or a shortage of available services, are frequently named as the cause for this shortfall, no one is willing to face the other obvious fact.  Giving an active psychotic and potentially dangerous the right to refuse treatment is an absurdly self-destructive big part of our problem!

While institutions may become more effective in their treatment, there is no happy feel-good remedy for psychotics who are unable to make rational decisions in their own best interests, who do not seek treatment, or who refuse treatment when it is offered.

New Laws with  more nuanced civil commitment capabilities,  intensive medication and psychological treatment strategies are essential.  Mandatory close follow-up with streamlined recommitment capabilities are essential.

Also glaringly clear, and most costly, is the need to increase America’s mental hospitals, once shut-down, in order to provide long-term care for those who simply cannot be stabilized and returned to open society.

Wake-up America!  Advocate for a Revision of our Civil Commitment Rules!

V. Thomas Mawhinney, Ph.D.   1/9/11,  2/18/18

P.S. (I).  The history and statistics of the Community Mental Health Movement and its failings are based upon the college textbook Abnormal psychology, by Ronald J. Comer.

P.S. (II).  Schizophrenia is a life-long mental disease with strong heritability. There is no cure for schizophrenia, though medication can imperfectly help to control its most bizarre and incapacitating symptoms.

P.S. (III). A factor in our social decline is that since deinstitutionalization, the reproductive rates of people with schizophrenia and other severe mental illnesses have naturally increased and are thought to now approximate that of the “normal” population. I believe this has led to a growth of a variety of genetically-based schizophrenic spectrum and other serious mental problems within our population. 

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