From Tragedy, New Hope

Russell Eugene Weston Jr.’s slaying of two law enforcement officers on Capitol Hill last month was dramatically, nationally public. But dozens of quieter tragedies occur every week when the delusions of paranoid schizophrenics are left untreated and allowed to escalate.

The problems typically begin when schizophrenics stop taking their medications, lose their jobs and alienate their families. Many end up on the streets and are arrested for being public nuisances or picked up in what the police call “mercy arrests.” Some turn to “survival crimes,” such as breaking into a church for food, and a few assault someone perceived as the enemy.

About 100,000 Americans with schizophrenia go without medical supervision on any given day, and too many of them eventually land in places like the Los Angeles County Jail, which houses from 1,500 to 1,700 severely mentally ill people.

A diagnosed paranoid schizophrenic, Weston was ordered committed to a Montana mental hospital in 1996 after making a threat against President Clinton but was released after 53 days without any treatment plan other than “Greyhound therapy”--a one-way bus ticket to Illinois, where his parents live.

The laws in Montana, like those in California and most other states, make it next to impossible for doctors to require treatment or institutionalization unless a patient displays clear violent or suicidal intent. Drug or alcohol dependence, which further cloud judgment, also increases the likelihood of violence.

Carla Jacobs, a board member of the National Alliance for the Mentally Ill and a mental health consultant to the Los Angeles County Board of Supervisors, captures the irony well: “My brain can tell when my leg is broken, but my leg can’t tell when my brain is broken. We would never tell a man with a broken leg, ‘We’ll give you treatment if you walk to the hospital.’ Yet we tell a person in the most severe throes of mental illness, ‘We’ll give you treatment if you first think your way there.’ ”

The laws derive from a 1960s movement to protect the civil rights of the mentally ill that was spearheaded by Thomas Szasz, a psychiatrist who saw mental illness as a myth of an oppressive society and argued that no one “should be deprived of liberty, except upon conviction of a crime.” But those laws are in need of reform, first and foremost for the sake of the severely mentally ill but also to ease the strain on the social fabric.

On Thursday, Jacobs will offer a promising solution at a public meeting called by Los Angeles County Supervisor Mike Antonovich: a proposed state bill that would allow doctors to mandate treatment, hospitalizing very ill patients involuntarily or, more often, requiring them to take medications as a condition of their freedom. The legislation, written with the aid of mental health groups, should soon be sent to the state Legislature.

To ensure that a range of treatment options is available, state legislators should also expand programs like Los Angeles County’s MET/SMART, which sends mental health workers out with police to help mentally ill street people find long-term medical care, counseling and housing. Congress can help by changing Medicaid laws so they cover long-term care for the severely mentally ill.

State law mandates that people suffering tuberculosis seek and complete treatment because TB is a communicable disease. But lawmakers need to view severe mental illnesses like paranoid schizophrenia as diseases that affect a community too, for as the tragic deaths of Officer Jacob J. Chestnut and Det. John Gibson attest, severely mentally ill people like Russell Weston Jr. often do not keep their diseases to themselves.