Psychiatric Bind

In recent months, two juries have found psychiatrists negligent because their patients committed crimes. Psychiatrists have long been required to tell law enforcement officials when patients threaten to harm people, but these verdicts, one in a state court and one in federal, extended liability much further.

In a North Carolina case, a psychiatrist was found liable for failing to ensure that his paranoid schizophrenic patient saw another doctor as he gradually discontinued his practice. The patient later killed two people. In a Connecticut case, a psychiatrist failed to report that a patient had disclosed sexual fantasies about children. The patient later allegedly abused a young man, who then sued the doctor.

Both verdicts are on appeal, but while the courts sort out responsibility lawmakers can start solving an underlying problem: the failure of local, state and federal agencies to properly care for the seriously mentally ill.

About 100,000 American schizophrenics go without medical supervision on any given day. Thousands end up in jails, arrested mostly for being public nuisances but in a few cases for serious crimes.

In California, psychiatrists who try to require severely mentally ill patients to comply with treatment face a high hurdle: the Lanterman Act, which prohibits them from forcing patients to take medications or otherwise comply with treatment against their will unless psychiatrists actually observe the patients acting in ways that pose a clear and imminent danger to self or others. The state Legislature should put California in line with other states, which allow physicians to require treatment in less urgent circumstances.

An extension of that idea is “outpatient commitment” programs, which monitor patients to make sure they take medication and go to treatment or face hospitalization. Today, seriously mentally ill people cycle in and out of prisons, jails and public hospitals, each time receiving referrals to outpatient clinics they might never visit. In Los Angeles County, for example, more than 700 seriously mentally ill people are admitted to public hospitals three or more times each year.

The federal government can help the situation by changing a law that prohibits California and other states from spending federal dollars on inpatient treatment. Congress should also support a recent call by Reps. Marcy Kaptur (D-Ohio) and Marge Roukema (R-N.J.) for an advisory committee to rethink the way the Department of Health and Human Services distributes mental health dollars to states.

In the last two years, 11 states have closed 18 psychiatric hospitals, and over the next two years states plan to close at least 10 more. County health facilities, jails and the streets in the end will receive the fallout. This shell game doesn’t save taxpayers any money. Each year, the costs of arresting, trying and imprisoning people suffering from mental illness total nearly $2 billion.

Doctors have it tough, balancing responsibility to the community with respect for the legal rights of patients: Involuntary commitments and appointed guardians should be reserved for only the most seriously ill patients. But psychiatrists need more and better options, and that’s up to state and federal leaders.