Shielding Society and the Ill Too

The U.S. Justice Department estimates that every year 170,000 people with severe mental illnesses cycle in and out of the criminal justice system. Typically they are ignored until they harm themselves or someone else, or try to; then they are jailed, released and remain without oversight until they are arrested again.

Buford O. Furrow Jr., the man accused in the racist shootings at a Granada Hills Jewish center and the murder of a postal worker, had been jailed for assault, had sought psychiatric help and had warned others of his violent urges. But there are better-documented examples in the last few months in California. Steven Allen Abrams, who had failed to take medications prescribed to control paranoid delusions, is accused of killing two children and injuring four by crashing his car into a Costa Mesa preschool. Joshua Rudiger is in custody, charged with slashing the throat of a woman in San Francisco after he failed to comply with court-ordered treatment for schizophrenic delusions that he was a vampire. More often, severely mentally ill people are themselves harmed, as when a police officer shot to death Margaret Laverne Mitchell, a homeless woman in Los Angeles, after she brandished a screwdriver. Mitchell’s family had tried to get her committed to a treatment or medication regimen but were blocked by state laws against compulsory treatment.

Two bills pending in the state Legislature offer promising ways to protect patients and the public’s interest.

* The state’s present jail and mental health systems release seriously mentally ill inmates, even those believed to pose a serious danger, with virtually no supervision; AB 1028, by Assemblywoman Helen Thomson (D-Davis), would change this. Psychiatrists, with the approval of a severely mentally ill person’s family and a judge, could compel a treatment regimen, such as taking medications on a regular, supervised basis, under a program called Assertive Community Treatment that has been successful in other states. ACT programs send mental health workers to patients’ homes, if they miss appointments, to counsel them, monitor treatment and beef up communication between mental health or social service workers and police.

* Intervention in the lives of the mentally ill before they end up in prison would be provided under AB 34, by Assemblyman Darrell Steinberg (D-Sacramento). This measure would provide grants to counties to track and treat seriously mentally ill homeless people whom mental health workers and law enforcement officials see as heading toward jail because they abuse drugs or act threateningly. Such a program statewide would need more funding than the $53 million currently called for in the bill, but it’s a start. In a Baltimore study of individuals with severe psychiatric disorders, those treated under Steinberg’s “Adult Systems of Care” model doubled their medication compliance and cut by half their time in the hospital, living on the streets or in jail.

Assertive community treatment is sometimes denounced by liberals as a civil rights violation and by conservatives as a way of letting criminals evade punishment. But the people being treated would once have been hospitalized, perhaps for life. As U.S. mental hospitals emptied over the last three decades, the promised network of effective follow-up care never materialized. Systems to monitor, evaluate and track seriously mentally ill people keep an unfulfilled promise to improve their lives and protect public safety.