Friday, May 12, 2006

A Broken Mental Health System; A Dead Police Detective

The Washington DC area was rocked earlier this week by the murder of detective Vicky O. Armel and critical wounding of another officer by Michael W. Kennedy, a mentally ill youth who opened fire armed with an an assault weapon, a hunting rifle and five handguns in the parking lot of the Sully District police station in Chantilly, Virginia.

But there was more behind this tragedy than appears at first glance. Armel wasn't just the victim of a random act of violence. Kennedy may have pulled the trigger, but the real root cause of this tragedy is this society's failure to address the problems of the mentally ill in this country.

During the late 1970's and 1980's, partly as a reaction to the warehousing of the mentally ill in large public institutions, and partly as a result of the newly popular ideas of cutting taxes and limiting government, large mental health institutions were closed and all but the most severely ill people were "deinstitutionalized" -- moved to community treatment aned out-patient settings. Whatever therapeutic potential deinstitutionalization may have held was never realized, because budget cuts soon resulted in many of the mentally ill being left on the streets to be treated by underfunded, poorly staffed outpatient and community mental health service agencies. People that needed supervision to be kept on their medications and in therapy were lost to the streets, and eventually to the prisons.

My first experience with the deadly results of these changes was the brutal 1989 murder of Robin Panitch in southern California. Panitch, a social worker and AFSCME member, was stabbed 31 times by a mentally ill client. Panitch's murder eventually led to the issuance of workplace violence guidelines by CalOSHA, the first time that workplace violence was treated as an occupational hazard in this country. Among other things, the guidelines called for higher staffing levels, alarms and more security for workers who had to work with mentally ill persons.

Unfortunately, many of these lessons remained unlearned, resulting in the death of Dr. Erlinda Ursua who was beaten to death by a patient in a state mental health hospital in 2003. Ursua had been treating the patient alone in a closed room despite a recent history of violence at the hospital that included over 100 attacks on staff in the previous year. Calls for security guards to accompany doctors in interview of potentially violent patients had gone unanswered due to funding problems

But workplace violence guidelines and more security guards, however necessary, are really only bandaids on a bigger systemic problem. Writing in the Washington Post today, former Post reporter Pete Earley connects the dots, recounting his experience with Detective Armel and how she assisted him in dealing with his mentally ill son when the mental health system failed to respond appropriately. Despite a history of bipolar disorder and two hospitalizations, Fairfax Hospital had refused to admit Early's son until he posed posed "an 'imminent danger' to himself or others." But when he got to that point, the only option the system had was to try to lock him up in prison. Armel intervened to ensure that Early's son got treatment, not prison.

But that intervention by a caring police officer is the exception, not the rule, according to Early, who has writting a book on his experience called Crazy: A Father's Search Through America's Mental Health Madness

Police officers such as Detective Armel -- not doctors and therapists -- are now on the front lines when it comes to dealing with those who have mental disorders. Our mental health system is so deeply flawed that it is extremely difficult for people who are ill to get help. Instead they are being arrested for crimes they commit while they are psychotic. This is why jails and prisons have become our new asylums.

The federal Bureau of Justice Statistics has found that 300,000 inmates in jails and prisons take medications for severe mental illnesses such as bipolar disorder and schizophrenia. An additional 500,000 are on probation. Some 700,000 pass through the criminal court system each year. The largest mental facility in America is not a hospital; it is the Los Angeles County jail.

Data from the nonprofit Treatment Advocacy Center confirm this week's grisly headline. People with mental illnesses kill law enforcement officers at a rate 5.5 times greater than the rest of the population. People with severe disorders are also killed by police in justifiable homicides at a rate nearly four times higher than others.
The result of this breakdown in our ability to treat those who suffer from mental illness is not just a tragedy for them and their families, but for our society as well -- particularly for those members of our society who take on this nation's toughest and most dangerous jobs of providing us with security and providing assistance for people most in need of help -- in a system that refuses to provide the support that they need.

As Early wrote of his friend,

A good police officer, loving wife and mother of two children is dead. Her murder was preventable. Her killer should have gotten treatment. Their deaths should serve as a wake-up call. How many more police officers will be murdered; how many young men and women with untreated mental disorders must die, before we reform a disgraceful mental health system that fails to treat the sick and protect the innocent?

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