Wash Post: Mentally ill people and their families can't get help

Last week, the U.S. Supreme Court heard a case questioning the constitutionality of Arizona’s insanity defense. The case involves Eric Clark, a young man with untreated schizophrenia who was delusional and thought that aliens had invaded Flagstaff. Eric’s family tried desperately to get help, but could not because he was not yet dangerous. Clark was convicted for shooting and killing a police officer.

On Saturday, April 24, 2006, a Washington Post editorial, writing about the insanity case noted that:

[t]his legal question, however important, comes into play only after the system has failed. The real question should be why people like Mr. Clark's parents so often cannot get help before it's too late. The answer, unfortunately, is as glaring as it is intractable. Politicians don't like paying for care for the critically mentally ill. And the courts, in their zeal to protect the rights of the mentally ill, often neglect their welfare; the courts will generally not allow authorities to hold anyone for treatment in the absence of evidence that he poses a threat, evidence not always available before somebody gets hurt. Instead of taking responsibility for sick people -- some of whose very illnesses prevent them from making informed choices -- our system "frees" them to homelessness or delusions until they do something for which it can exact revenge.

TAC to SCOTUS: Crime, anosognosia, weak laws

The Treatment Advocacy Center filed a “friend of the court” brief filed in the Clark v. Arizona case, that said in part:

[A]nosognosia increases the likelihood that victims of severe mental illness will reject or fail to seek treatment. This problem is exacerbated by antiquated state civil commitment laws that forbid treatment interventions until individuals pose an immediate physical danger to themselves or others. Because untreated severe mental illnesses are closely correlated to an increased risk of violence, anosognosia and these commitment laws operate together to ensure that mental illness will cause some of those it afflicts to engage in criminal behavior.

Some states are reacting to the tragic ramifications of untreated mental illnesses, and consequently anosognosia, by adopting more comprehensive commitment schemes with less restrictive, more flexible standards. New York’s improved law, known as Kendra’s Law, has resulted in dramatic reductions in incarceration, arrests, homelessness and hospitalizations of the severely mentally ill. [1]

Extensive clinical research has found analogous outcomes for reformed commitment laws in numerous states. [2]

TAC respectfully submits that reforms such as these, as opposed to unduly limiting—if not completely obliterating—the insanity defense, are the proper method to balance safety concerns of States with the due process rights of the mentally ill.

The staff and board of directors of TAC thank the attorneys from the Dechert law firm who provided invaluable pro bono services on TAC’s brief:

David A. Kotler
Megan Elizabeth Zavieh
William Gibson, and
Elliot M. Gardner
Princeton, NJ 08543-5218

[1] See N.Y. Mental Hyg. Law § 9.60 (Consol. 2005). Individuals in the first five years of New York’s assisted outpatient treatment (“AOT”) program experienced fewer hospitalizations (77%), episodes of homelessness (74%), arrests (83%), and incarceration (87%), and had improved medication compliance (fifty percent) and participation in substance abuse treatment (65%). Fifty-five percent fewer recipients engaged in suicide attempts or physical harm to themselves. Three out of every four of the program participants reported that Kendra’s Law had helped them regain control of their lives; four out of five said that AOT helped them to get and stay well. See New York State Office of Mental Health, Kendra’s Law: Final Report on the Status of Assisted Outpatient Treatment (2005).

[2] See, e.g., Marvin S. Swartz et al., Can Involuntary Outpatient Commitment Reduce Hospital Recidivism?, 156 Am. J. Psychiatry 1968, 1973 (1999) (hospital admissions reduced by 57% when used for at least six months and combined with routine mental health services); Jeffrey Swanson et al., Involuntary Out-Patient Commitment and Reduction of Violent Behaviour in Persons With Severe Mental Illness, 176 Brit. J. Psychiatry 224 (2000) (assisted outpatient treatment of six months or more combined with routine outpatient services reduced the incidence of violence in half (24% versus 48%)); Jeffrey Swanson et al., Can Involuntary Outpatient Commitment Reduce Arrests Among Persons with Severe Mental Illness?, 28 Crim. Just. & Behav. 156, 182–83 (2001) (same); Virginia A. Hiday et al., Impact of Outpatient Commitment on Victimization of People with Severe Mental Illness, 159 Am. J. Psychiatry 1403 (2002); Gustavo A. Fernandez & Sylvia Nygard, Impact of Involuntary Outpatient Commitment on the Revolving-Door Syndrome in North Carolina, 41 Hosp. and Community Psychiatry 1001, 1003 (1990) (median readmissions decrease from 3.7 to 0.7 per 1,000 days); Virginia A. Hiday & Teresa L. Scheid-Cook, The North Carolina Experience with Outpatient Commitment: A Critical Appraisal, 10 Int’l J. Law & Psychiatry 215, 229 (1987) (over six months, 30% medication refusal versus 60% absent orders); Robert A. Van Putten et al., Involuntary Outpatient Commitment in Arizona: A Retrospective Study, 39 Hosp. & Community Psychiatry 953, 957 (1988) (“almost no patients” without orders voluntarily maintain treatment in mental health system versus 71% who do in group with orders); Guido Zanni & Leslie deVeau, Inpatient Stays Before and After Outpatient Commitment, 37 Hosp. & Community Psychiatry 941, 942 (1986) (hospital readmissions decrease from 1.81 to 0.95 per year).

Wrapup on Supreme Court case

SCOTUS blog on the arguments in today’s insanity defense case Clark v. Arizona …

More: NPR story TAC’s brief to the Court AP story on the Clark case

Supreme Court hears insanity defense

Tomorrow the US Supreme Court will hear a direct challenge to the insanity defense for the first time in more than 25 years, since the John Hinckley case prompted so many states to change their laws.

At issue? Eric Clark, a young man with untreated schizophrenia who killed a police officer because he thought he was an alien. He didn’t know he was ill, like about half of those with schizophrenia.

His parents just want to get him treatment – the same thing they wanted before he shot Officer Jeff Moritz.

"Lock him up for his crime," Terry Clark says, "but treat him for his mental illness, please. Eric didn't choose to be mentally ill. It chose him." – CNN (Associated Press), April 18, 2005