Schizophrenic. Killer. My Cousin.
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But as Randall Hagar, director of government relations for the California Psychiatric Association, points out, the country will pay for it one way or another. "Taxpayers pay for nuisance issues related to the homeless," he says, especially since the total elimination of California's $55 million mentally ill homeless outreach program, which deployed teams to help with everything from housing crises to paperwork. Since the defunding of the state's mentally ill offender crime reduction program, which delivered services like training, counseling, and outpatient assistance to discharged transgressors, the incidence of violence has increased among that population, says Hagar. In Virginia between 2010 and 2011, mental-health treatment facilities turned away 200 people determined to be dangerous because there were no available beds. In Arizona, a Phoenix hospital saw a 40 percent jump in psychiatric emergency room episodes after the abolition of mental-health services to 12,000 non-Medicaid-eligible mentally ill. The moral issues of not taking care of society's sick and vulnerable aside, Hagar says, our post-deinstitutionalization transinstitutionalization is not cheap: "Two to three thousand dollars in treatment saves $50,000 in jail."
In the Tenderloin—as in Santa Rosa, as in Cleveland and Phoenix and Lynchburg—"do we have the resources to adequately treat them? No," Gyori says. Neither for those who seek it, nor for those who "don't want your help but go bonkers in the street and have to be locked away." Whatever differences they have over the patients' rights debate, Torrey and Gyori agree on one thing. "Sometimes," Gyori says, "people need to go to the hospital. The problem is, now you don't have acute beds. So people are let go too soon, and it's not as easy to get in."
"The system now is, they don't wanna see people," Torrey complains. "None of us are suggesting that we need to go back to 1930, when I as a psychiatrist could say, 'I don't like the sound of your voice, so I'm going to keep you in my facility that I also happen to own for three weeks.' You have to have a system of checks and balances."
But the pendulum has swung far past patients' rights and well into the territory of wild neglect. The dismantling of the mental-health system has left those willing to undergo treatment with no options, and rendered the laws to protect against dangerous scenarios ineffective. "Danger to self or others is defined too limitedly," Torrey says. In the eight states where that's the only triggering mechanism for treatment, "you either have to be trying to kill your psychiatrist or trying to kill yourself in front of your psychiatrist." Some states have less-strict provisions, but even there, no open beds plus the expense of keeping someone in the beds equals admission standards that are too high and discharge standards that are too low.
Regardless of what you think about commitment rules, the bottom line is you have to have facilities. If there had been a facility—not "a psych ward in a general hospital which is set up to see people with eating disorders and depression," Torrey says, but a clinic staffed with the appropriate kinds of professionals and with an open bed and antipsychotics that have proven to be extremely effective if properly administered—if my Uncle Mark could have taken Houston someplace like that—maybe crimes like Houston's could be not just predictable, but preventable.
"Hospitals are motivated to get people out as quickly as possible," says Robin Lipetzky, who deals with the fallout as chief public defender of Contra Costa County, just across San Francisco Bay. "We ignore the mentally ill until they commit a crime that ends them up in prison. Over and over again we see these situations where parents of these folks who commit these offenses—if they don't kill their parents, which is what often happens—say they've been trying and trying to get treatment for these kids and it's just not available. And it's usually young adults. There's not enough out there in terms of resources for families. The people making the budgets don't look at it as an integrated whole. It's unfortunate that that calculation isn't done at the same time." Although, she concedes, not all the pieces of calculating the cost of "treatment of the mentally ill up front" would be that easy to do. "How do you put the price," she asks, "on people losing their lives when people have a psychotic break?"