Keep, and expand, treatment options

“About 95% of the nation’s public psychiatric beds have been eliminated.”

Doris Fuller is the executive director of the Treatment Advocacy Center, which is urging the government to make mental illness treatment available to more individuals at risk for committing violent acts.

Nobody wants to see guns in the hands of individuals who are mentally unstable. But merely reforming America’s gun laws or purging film and videogames of all murder and mayhem is not going to prevent mass killings like the one that took 26 lives in Newtown last month.

For one thing, even a complete gun ban would leave many weapons available to individuals intent on harming others. Since March 2010, for example, men in China exhibiting psychiatric symptoms have used knives, an axe, a machete and a box cutter in mass assaults that left school children dead or wounded. In the past three months alone, nearly 40 Chinese children have been wounded or killed by assailants without guns.

Meanwhile, in California, automobiles were the weapon of choice for three mass killings that have left seven dead and nine injured since 1999.

Making entertainment less violent likewise would do nothing to liberate psychotic individuals from the dangerous commands of voices and actors who exist solely in their brains. These are far more real to them than anything Hollywood can create for the screen.

To reduce mass tragedy, there needs to be mass recognition that a small number of individuals with untreated severe mental illness will continue inflicting harm on themselves and significant numbers of others as long as legal and other barriers prevent them from getting the treatment they need to begin recovery.

The National Advisory Mental Health Council recognizes seven serious mental illnesses. Of these, three — schizophrenia, severe bipolar disorder and severe depression — account for the vast majority of violent acts associated with untreated psychiatric disease, which include suicide. Approximately 7.7 million people suffer from these three diseases, and about half of them are receiving no treatment at any given point in time.

There is no evidence that individuals who receive treatment for severe mental illness are more dangerous than the general population. But an estimated 1% of the 7.7 million have been found to pose a danger to themselves or others when untreated, and that’s 77,000 people at risk to harm someone while experiencing symptoms from a treatable illness.

If America wants to get serious about stemming headline massacres that have produced more than 100 casualties in 2012 — and the countless everyday tragedies that unfold with little or no publicity — three public policies must change.

First, we must stop closing public psychiatric beds, and restore a sufficient number of lost beds to treat individuals with acute or chronic mental illness. Over the past half-century, about 95% of the nation’s public psychiatric beds have been eliminated, leaving 14.1 beds per 100,000 people, according to a 2012 Treatment Advocacy Center study. The last time so few beds per capita were available to treat the most disabled and vulnerable mentally ill was when Zachary Taylor was president (in 1850). The study also found that when states cut funding for their state hospitals, they experienced increased violence.

Secondly, we must reform state civil commitment laws that require people to be dangerous before they qualify for court-ordered treatment — and use those laws. State laws and policies in some states essentially make bloodshed a necessity before courts can order an individual into treatment. Bureaucratic foot-dragging and other obstacles that limit the use of more progressive laws need to be eliminated.

Thirdly, we must pass and use court-ordered outpatient treatment laws that require people who are at risk for arrest, violence, re-hospitalization and similar setbacks to stay in treatment as a condition of living in the community. These assisted outpatient treatment laws have been shown to reduce a host of consequences of non-treatment including homelessness, incarceration, suicide and other violence, among others.

One half of mass killings are associated with untreated brain diseases that affect less than 1% of the U.S. population. To change the math, we have to add treatment to the equation.

The Treatment Advocacy Center is a nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illness. The organization promotes laws, policies and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses.