Treatment Is What Will Set Free the Mentally Ill

It would be simple to frame our state’s current debate over mental health laws with portraits from its two extremes: A locked ward of drugged and drooling mental patients, strapped helplessly to hospital beds. Or a horde of disheveled, delusional, homeless former patients, aimlessly wandering the streets.

But listen to Janet Hoover and you realize that the tragedy of our current system lies not in its extremes, but in the vast area in between, in the unremitting anguish of the mentally ill and the fear and frustration of their families.

Last fall, I wrote about a woman who ran down a man in a parking lot. Should she be prosecuted for murder, I asked, if she was psychotic when she committed the crime? Her family called her a victim of mental illness--a bipolar disorder she’d struggled with for 20 years. The dead man’s family blamed irresponsibility, not insanity.

Hoover, whose brother has bipolar disorder, responded with a five-page letter that relayed the horrors faced by the mentally ill and the desperation of families like hers.

“It is easy for you to say it was her responsibility to get help,” the Orange County woman wrote. “People have no idea what it is like.”

In the 22 years since his diagnosis, her 42-year-old brother’s life has been a series of hospitalizations, mental breakdowns, suicide attempts, arrests . . . in between episodes of living normally.

Her family’s attempts to force him to get help when they sense he is about to “go off” are thwarted by laws that allow involuntary treatment only for those who pose an immediate danger to themselves or others.

“It is unfortunate that the law allows unstable people to sign themselves out of a hospital,” Hoover wrote. “Many times we had to take my brother home in an unbalanced state because he thought he was fine and wouldn’t sign the papers to stay. By no means was he capable of making this decision, but the law hands the responsibility to him, then holds him responsible if he goes out and hurts someone. Who is the insane one in this?”

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We were considered champions of human dignity 34 years ago, when California approved a landmark reform of laws that had made it easy to keep people locked up in mental hospitals. The advent of better medication and treatment options was supposed to make it possible for the mentally ill to live productively at home. Institutions shut down, as the number of patients committed dropped from 30,000 to fewer than 1,000 today.

But community mental health centers were never adequately funded, and those most in need often refused to go. After all, it is a hallmark of mental disease that many people in the throes of illness don’t realize they are sick; don’t recognize their hallucinations, delusions and paranoia as signs they need help.

Today, thousands remain untreated, spiraling between madness and sanity. It is estimated that 50,000 of the state’s homeless are mentally ill. Our jails hold another 20,000. A few commit such atrocities they force us to consider the notion that our mental health system has failed.

In New York, it was the tragic death of Kendra Webdale that spurred legislative change. Two years ago, the young woman was shoved beneath the wheels of a train by a schizophrenic man who had refused to take his medication. New laws there now make it easier for courts to mandate outpatient treatment.

In fact, California is one of only 10 states that has no provision to require treatment of mentally ill people who are living outside locked institutions.

But, despite a string of tragedies here--including the death of two children in 1999, when a mentally ill man drove his car onto a Costa Mesa playground--our lawmakers have not been inspired to approve voluntary treatment reforms.

That may be about to change. This week, the Assembly’s Judiciary Committee is set to consider legislation by Assemblywoman Helen Thomson (D-Davis) that would allow judges to compel those being released from mental health facilities to accept monitoring and care, or risk being confined for treatment.

The proposal is an emotional one. When Thomson, a former psychiatric nurse, first proposed similar legislation two years ago, demonstrators torpedoed it with protests, claiming it would abridge the rights of the mentally ill.

This time, proponents have ammunition of their own--research that shows that so-called assisted outpatient treatment increases compliance with treatment regimens, reduces violence among the long-term mentally ill and cuts costs associated with crisis care.

For many, that may make mandated treatment a fair exchange for some small loss of civil liberties.

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Janet Hoover knows that psychiatric hospitals are unpleasant places. During her brother’s first commitment, “they tied him down to the bed. They drugged him and he went into a catatonic state for several days. It took weeks to bring him out of his stupor.”

She understands why some former patients find it hard to stick with treatment. Even the most effective medications can have side effects as unpleasant as the symptoms they treat.

She also believes that the mentally ill need our help to build constructive lives.

“My brother lives each day trying to stay away from the edge that he so easily slips over,” she says. “Our family lives in fear that one day . . . he will hurt or kill someone as he tries to escape his demons.

“We don’t want to see him locked up, but when he needs help, we need to be able to make him get it. Without that power, our hands are tied.”

Sandy Banks can be reached at sandy.banks@latimes.com.