Help Schizophrenics Lead Secure, Productive Lives

Joseph Parker will be remembered as the man police shot after he slashed two co-workers to death and injured four others at an Albertsons supermarket June 29 in Irvine.

Acquaintances said he believed he had been hearing instructions from the devil. But family and friends in his hometown of Ford, Va., remember Parker as a happy-go-lucky kid nicknamed “Smiley” who became a volunteer firefighter and who wanted to dedicate his life to saving others. Said a neighbor quoted in a news article: “If I was to show my boys a model of a good, wholesome child, it would be Joe Parker.”

What transformed “Smiley” into the Albertsons killer?

The answer: a neurobiological brain disorder called schizophrenia. Its victims experience hallucinations, paranoia and delusions. Without treatment, those symptoms can lead people to kill -- either themselves or others. Individuals with untreated severe mental illnesses are 10 to 15 times more likely to either take their own life or die accidentally.

They are three times more likely to be a victim of violent crime. And each year in the United States, more than 1,000 homicides are committed by people who are psychotic; of those, 120 occur in California.

In contrast, a person with schizophrenia who takes prescribed medication is no more likely to be violent than anyone else. So, considering the consequences, why wouldn’t anyone with the disease beg for treatment and stay on it? Why didn’t Parker take his medication? And why aren’t Parker and co-workers John Nutting and Judy Fleming alive today?

The answer is simple. Schizophrenia is a brain disease, not unlike Alzheimer’s. Its symptoms can change the very essence of the victim’s being. Half the people with schizophrenia have dysfunction in the area of the brain that, if it weren’t diseased, would allow them to recognize that they are ill and in need of continual treatment.

Parker eschewed medication because he was too ill to realize he needed it. A psychotic state became Parker’s reality. His delusions would occasionally accelerate until police picked him up because of his dangerous actions. On those occasions, he was placed on an involuntary hold at a psychiatric hospital.

California’s involuntary inpatient law does not consider the severity of the person’s symptoms or the fact that their brain precludes them from recognizing that they are ill and might stop treatment when released. The law considers only their immediate behavior, if it is suitably dangerous. Thus, once Parker was medicated and became calm again, he would be released.

The average length of stay in California psychiatric hospitals is about one week. It can take weeks for a specific drug to take effect and months for a doctor to find the right combination of medication to control the symptoms of schizophrenia. The time Parker spent in his revolving-door hospitalizations did little more than put his symptoms at temporary abeyance. There was no time for him to get well.

On Jan. 1, a state law took effect that could have given Parker the time and supervision he needed to recover sufficiently. Known as Assisted Outpatient Treatment (AOT), the law allows preventive intervention for those who might not meet the criteria for inpatient commitment but who need treatment to prevent relapses or deteriorations that would predictably and rapidly lead to their needing repeated hospitalization.

If the program were available in Orange County, Parker would have been committed to a multidisciplinary community treatment team that would have been responsible for making sure he stayed on his medication and did not return to the point of danger.

Other states with similar programs have found that they reduce homelessness, hospitalizations and violence while increasing medication compliance and quality of life for the individual. Unfortunately, the state’s fiscal woes resulted in AOT legislation being modified so counties had the option of adopting it. No new money was attached to encourage counties to implement the law.

Orange County is in dire fiscal straits. Few new programs will be implemented, and many old programs are being lost. Impending cuts to the mental health agency will affect the county’s already strapped inpatient system.

Revolving-door hospitalizations and medication noncompliance are perhaps the most costly elements of the mental health system. Noncompliance is costing about $350 million in return hospitalizations nationwide a year.

AOT can cut that cost by reducing hospitalizations and increasing medication compliance. A study in Iowa showed that that state saved $16,000 per year per patient using a similar program.

During times of fiscal austerity, creativity and political will can make more effective use of existing resources. The L.A. County Board of Supervisors has implemented an AOT program on a pilot basis.

The Orange County Board of Supervisors should do the same. Once AOT is provided in Orange County, people like Parker might be remembered as “Smiley.” Waiting for danger before moving to help people with severe mental illness is just plain too late.

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Orange County resident Carla Jacobs is a founding board member of the Treatment Advocacy Center (www.psychlaws.org) in Arlington, Va., a nonprofit group working to eliminate barriers to treatment of severe mental illness.