Forcing mentally ill patients into treatment

Dr. Fuller Torrey is not a gun-rights advocate. But he shares one view with those who fought and turned back federal gun control legislation in the aftermath of the Newtown massacre of schoolchildren:

Gun control would not do much to prevent another horror such as Newtown, Conn. - or Aurora, Colo., or Tucson, Ariz. Assertive mental health treatment would.

It's likely, Torrey argues, that those recent mass shootings, like that of six years ago at Virginia Tech, occurred because people with severe mental illnesses did not get the treatment they needed. And they did not because a failed federal policy over the last 50 years closed too many state hospital beds in favor of community-centered treatment.

Torrey is a founder of the Treatment Advocacy Center in Arlington and author of the soon-to-be-released book "American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System." He will speak Tuesday evening before a NAMI Roanoke Valley audience of supporters and skeptics when the local chapter of the National Alliance on Mental Illness gathers for its annual dinner meeting.

Torrey is a passionate proponent of assisted outpatient treatment laws.

These, he explained in a phone interview last week, allow court-ordered involuntary treatment for a small subset of severely mentally ill people "who have already demonstrated their dangerousness and demonstrated they won't take their medication voluntarily."

In short: "Taking medications needs to be a condition of living in communities. And if people refuse, they should be hospitalized."

This sounds eminently sensible as a matter of public safety. And vastly more compassionate to families of severely mentally ill adults who, at worst, are dangerous to themselves or others and, at best, are not always competent to make rational choices. They are vulnerable, and many times more likely to be the victims than the perpetrators of crime.

Civil libertarians object to involuntary treatment, and some mental health professionals are skeptical that mandatory outpatient treatment is a practical solution to a real problem.

Virginia has a weak mandatory outpatient law, passed in the wake of the Tech shootings. Gail Burruss, director of adult clinical services for Blue Ridge Behavioral Health Care, said last week, "It's seldom used by the court here, which looks at it as criminalizing mental illness."

Yet family members who at times plead for mandatory treatment for people they love would say they are trying to keep them from becoming criminals - committing a crime that would land them in prison. What Torrey would call the mental institutions of our time.

"I truly can appreciate both sides of it," Burruss said.

Intervening "when someone has shown a propensity for violence and is clearly in need of psychotropic drugs; I certainly don't disagree with that." And she agreed "we missed something in the whole deinstitutionalization process."

But she reminded, "only a very small subpopulation of people who are mentally ill are violent. And not all people who are violent are mentally ill."

Torrey cites statistics that people with severe mental illnesses like schizophrenia or bipolar disorders are responsible for 10 percent of the homicides in the country and about 50 percent of the mass killings.

In their right minds, these are regular people, not monsters. If they were forced to take medicine for their illness, those violent deaths almost certainly would not occur.

That still leaves 90 percent of the homicides and half the mass killings to go on as usual, Burruss pointed out. Mandatory outpatient treatment "is not going to provide an adequate answer to violence in our society."

True. But Torrey isn't arguing to undermine gun control. He wants to mandate treatment for those few people whose sickness makes them dangerous to others. We've done so with tuberculosis, he pointed out.

"It seems like it might be easy to think that mental health professionals have predictive abilities," Burruss demurred. "The simple truth is, we don't."

Torrey might suggest asking the local police, the de facto front-line mental health workers in communities all over the country. "If I walk into the Roanoke Police Department, and I ask, 'Could you identify for me the 20 people who are severely mentally ill who are potentially the most dangerous?' they'll say, 'Oh, yes.' "

Even if that were enough to convince a court, Burruss reasoned, "If somebody is determined to commit a major violent crime, I don't think an outpatient treatment order is going to be a deterrent. The only thing that is going to be is confinement."

And the vast majority of mentally ill people do not get long-term care in a state hospital. They're in community hospitals.

"There's not adequate means to provide adequate care."

Here, Torrey could not agree more.

If the gun-control debate accomplishes nothing more than to create public urgency for fixing a broken mental health system, it will have achieved some purpose. So long as we make haste prudently.

Even skeptics are looking forward keenly to Torrey's appearance.

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