Friday, August 22, 2014

How many have to die before we act?


From page A10 | June 11, 2014 |

Every time a person with untreated schizophrenia goes on a killing spree — such as in Isla Vista on May 23 where former Santa Barbara City College student Elliot Rodger murdered six and wounded 12 others before taking his own life — some will point out that “the mentally ill are statistically no more likely to be violent than anyone else.”

The problem, of course, is that fact is entirely beside the point.

The issue is not whether all people with all sorts of diagnoses of mental illness, including those with minor maladies, pose a danger. The question is how likely it is that a person experiencing psychotic delusions, who has a history of violence or threats of violence and is not being treated, will cause mayhem.

The evidence suggests those individuals are extremely perilous — not just to others, but to themselves.

According to the Treatment Advocacy Center, “Suicide is the number one cause of premature death among people with schizophrenia, with an estimated 10 percent to 13 percent killing themselves. Suicide is even more pervasive in individuals with bipolar disorder, with 15 percent to 17 percent taking their own lives.

“The extreme depression and psychoses that can result due to lack of treatment are the usual causes of death in these sad cases. These suicide rates can be compared to the general population, which is approximately 1 percent.”

Family members of those with untreated mental illness are often at risk. According to Department of Justice statistics, when a spouse kills his mate, 12.3 percent of the time the defendant had a history of untreated mental illness. That’s 15.8 percent when a child is killed by his parent, 17.3 percent for a sibling murdered by a sibling and 25.1 percent when a parent kills his child.

In a typical year, about 5 percent of all murders in the United States are committed by individuals with a history of untreated mental illness, according to Bureau of Justice Statistics.

The National Institute of Mental Health estimated that 7.7 million Americans in 2010 had schizophrenia or bipolar disorder. The NIMH found that roughly 40 percent of people with schizophrenia and 51 percent with bipolar are not receiving treatment in a given year.

The fact that our gun control laws, compared with those in most other advanced countries, are lax adds to the societal danger of people with severe and untreated mental illness. Yet guns are not the heart of this challenge. They only compound it.

The primary problem is that we don’t require individuals with serious psychiatric disorders to receive treatment.

After each massacre, we say something needs to be done. And then we do nothing. After Virginia Tech; after the Tucson, Arizona, Safeway; after the Carson City IHOP; after the Aurora, Colorado, movie theater; after Sandy Hook Elementary School; after the Washington Navy Yard; after Isla Vista; and most recently after Seattle Pacific University; there are calls for change but nothing changes.

Seemingly no matter how many innocents die in these mad rampages, we will never adopt laws to keep guns out of the hands of the severely mentally ill.

Some gun enthusiasts point out, correctly, that a person experiencing a psychotic break can kill with a knife, too. For example, Rodger’s first three victims at UCSB were murdered with a knife. They ask, sarcastically, should we ban knives?

As much sense as it makes to forbid individuals with certain serious psychiatric ailments from owning firearms, it makes even more sense to require they get treatment, even if it must be forced on them. This needs to happen not just to protect society or family members. It must be done to protect those who have lost touch with reality and are a threat to themselves.

In California, thanks to former Assemblywoman Helen Thomson of Davis, who wrote the legislation, we have Laura’s Law. That permits a court to force treatment on a patient with a serious mental illness and a recent history of violence or threats of violence.

One reason this is necessary is because many individuals with psychiatric delusions lack the ability to understand and accept their condition. That is, they don’t realize they are sick. They think the voices they are hearing in their heads are real.

Medical doctors call this lack of awareness anosognosia.

Unfortunately, while Laura’s Law is on the books, it is almost completely unfunded. The California Department of Corrections and Rehabilitation has an annual budget of approximately $9 billion. The state, however, gives no money to provide for Laura’s Law.

The burden is on our counties. And since it passed in 2002, only Nevada County — where Laura Wilcox was murdered by a psychotic man who had refused treatment — has fully funded it. A few other counties have provided some limited dollars.

In June of last year, Yolo County adopted a pilot program, where at most, four patients can be forced by a court to receive treatment.

We likely will never stop all violent crimes by those with untreated mental illness. But all of us — especially those with severe psychiatric maladies — would be better off if people like Elliot Rodger and Adam Lanza were forced into treatment before they get ahold of weapons and tragedy ensues.

— Rich Rifkin is a Davis resident; his column is published every other week. Reach him at





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