The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens by E. Fuller Torrey
More than 50% of “rampage killers,” men (they are almost always men) like the one who killed more than 30 people at Virginia Tech a few years ago and the one who recently killed five people and grievously wounded Representative Gabrielle Giffords and several others in Arizona, are seriously mentally ill and untreated. More than 60% of men who kill their own children and 75% - that’s three out of four – women who kill their children are seriously mentally ill and untreated. More than 10% of the prisoners in American jails and a larger percentage of people arrested for non-family violence are seriously mentally ill and untreated. Between a third and half of the people who are homeless and living on the streets and eating out of garbage cans, as best can be determined, are mentally ill and untreated.
We have stringent state laws in the US that prevent involuntary hospitalization and involuntary treatment of people even with extremely serious paranoid schizophrenia and bipolar disorder, even if they are delusional and violent. A few such people who have been treated against their will have been awarded millions of dollars when represented by civil liberties lawyers to make certain they continue to go untreated – and in all too many cases remain on the street, eating garbage, threatening and attacking their families, sometimes murdering others. The laws require a person to be threatening “imminent” violence – which means with a knife in hand and moving forward, and so also means years of increasingly frequent and threatening incidents and a history of assault, even with a baseball bat, knife, gun, or other weapon, is not enough to allow a judge to force the mentally ill person to remain in treatment and to continue to take medication.
In The Insanity Offense, E Fuller Torrey, makes a plea for more sensible and humane treatment of these people who are, by the nature of their illness, unable to make a sane decision whether to be treated or not. Before the middle of the 19th century people who were insane were kept imprisoned and chained. Today we are doing much the same thing, because leaving such people untreated leads to staggering numbers of the mentally ill residing in our jails and prisons. In the more than 3,000 counties in the United States there is not one with a hospital housing more mentally ill people than the county jail. The jails are our new mental hospitals. The costs, and not just the costs in money, are staggering.
Torrey’s case for sensible laws that allow involuntary hospitalization and treatment of the most seriously ill is convincing. Sick people who are released from hospitals without further treatment are alarmingly vulnerable – they are attacked, raped, murdered in much higher percentages than the general population. They fill our jails and take up the time and resources of our police system. They are now a large percentage of the people who attack police and are killed by them. And the very seriously mentally ill are found in disconcertingly high percentages among those who attack and murder their families, neighbors, and complete strangers.
We used to have mental asylums, places where, ideally, the sick and vulnerable were given asylum, and could be protected from themselves and others. But deinstitutionalization from the late 1960s through the late 1990s has put most of these people at the mercy of themselves and others.
We cannot call ourselves a civilized nation and continue to treat the most vulnerable among us in this way.