Mental illness, gun control, and murder

Writing at the Wall Street Journal today, Dr. E. Fuller Torrey provides a brief summary of the themes explored in his forthcoming book, American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System:

On Feb. 5, 1963, 50 years ago this week, President John F. Kennedy addressed Congress on “Mental Illness and Mental Retardation.” He proposed a new program under which the federal government would fund community mental-health centers, or CMHCs, to take the place of state mental hospitals. As Kennedy envisioned it, “reliance on the cold mercy of custodial isolations will be supplanted by the open warmth of community concern and capability.”

President Kennedy’s proposal was historic because the public care of mentally ill individuals had been exclusively a state responsibility for more than a century. The federal initiative encouraged the closing of state hospitals and aborted the development of state-funded outpatient clinics in process at that time.

Over the following 17 years, the feds funded 789 CMHCs with a total of $2.7 billion ($20.3 billion in today’s dollars). During those same years, the number of patients in state mental hospitals fell by three quarters???to 132,164 from 504,604???and those beds were closed down.

As this process continued, it became clear that “the open warmth of community concern and capability” meant “release the mentally ill into the wild, and hope for the best.”  The end result was “the federal takeover of the mental-illness system,” which got roughly the same treatment the rest of us will be getting for other health problems once ObamaCare is fully implemented.  Some people do well under the new regime of de-institutionalization, especially if they have strong family support.  (Oddly enough, “the open warmth of community concern” doesn’t seem to count for much compared to family support – a truth we’re not supposed to dwell upon, in many other areas of social concern.)

As for those who don’t do well…

According to multiple studies summarized by the Treatment Advocacy Center, these untreated mentally ill are responsible for 10% of all homicides (and a higher percentage of the mass killings), constitute 20% of jail and prison inmates and at least 30% of the homeless. Severely mentally ill individuals now inundate hospital emergency rooms and have colonized libraries, parks, train stations and other public spaces. The quality of the lives of these individuals mocks the lofty intentions of the founders of the CMHC program.

Like so many other big federal initiatives, it doesn’t work, but it’s shockingly expensive.  Torrey figures “the annual total public funds for the support and treatment of mentally ill individuals is now more than $140 billion,” which is fully ten times as much as the expense of the evidently more effective pre-Kennedy system, in adjusted dollars.  Accountability for this breakdown in mental health has almost completely evaporated; when disturbed people go on violent rampages, The System responds by cracking down on law-abiding gun owners.

The government isn’t even doing a very good job at addressing the mental health issue of returning soldiers suffering from post-traumatic stress disorder, which is why tireless volunteers like slain “American Sniper” Chris Kyle are stepping forward to take up the slack.  He was reportedly engaged in such activity when the man he was trying to help killed him.

An ABC News report on Kyle’s death includes a statement from Dr. Jeffrey Lieberman, recently elected president of the American Psychiatric Association, that would appear to conflict with Torrey’s thesis, until Lieberman’s comments are fully unpacked:

The shooting is the latest in a string of tragedies stirring debates around gun control and mental health. But Lieberman said the mentally ill “do not contribute substantially to the overall rates of gun violence in this country.”

“People with mental illness tend to be over-represented in these sorts of tragedies largely because their symptoms have gone untreated — they lack access to care or they lack insight to the fact they need care,” he said.

Lieberman said discriminating against people with mental illness is “not the solution to violence in our country,” but added that improving access to care for the mentally ill “would reduce these extremely rare but nevertheless tragic, senseless events.”

All right, which is it?  Either the mentally ill “do not contribute substantially to the overall rates of gun violence in this country,” or they “tend to be over-represented in these sorts of tragedies largely because their symptoms have gone untreated.”  One suspects Lieberman is obliquely referring to the far larger amount of gun crime perpetrated by relatively mentally stable criminals.  We focus on the small number of mass shootings and bizarre crimes, like the recent Alabama child-hostage standoff, because they’re sensational and intriguing.  That small body of high-profile cases also becomes the prime mover of public policy.  No one in the media is terribly concerned about the body count steadily accumulating due to street crime in the gun-free paradise of Chicago.

Where do we draw the line between “discriminating against people with mental illness” and identifying those who need “improved access to care?”  Why can’t a system whose costs have swelled 1,400 percent over the past 50 years provide that care?  The public is fascinated by questions about why a deranged individual like the Newtown killer or Alabama kidnapper perpetrated their crimes… as if the sane could ever find comfort by deconstructing the logic of the mad.  The gun control debate proceeds as if a great portion of the mentally stable population trembles on the edge of murderous insanity.  An earlier generation might have looked at mass murderers and settled for the explanation “because they’re insane,” on the relatively rare occasions when people with such disorders were left to roam the streets unsupervised.


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