We're all paying for a "playground for anti-psychiatric activists"

Dr. Sally Satel paints a vivid picture of how some federally funded mental health “advocates” are harming the most severely mentally ill and their families.

Take the case of William Bruce:

An appalling case of federally funded patient "advocacy" run amok was exposed just this month. On May 3, Robert Bruce of Caratunk, Maine, testified before the state legislature about his 25-year-old son, William. The young man had been a patient at Riverview Psychiatric Center from February to April 2006, where he had been committed after assaulting his father. Mr. Bruce and his wife were afraid of their son and begged the hospital to medicate him with the antipsychotic that had previously quelled his paranoia and aggression.

But William wanted to leave the hospital. Advocates from the Disability Rights Center, Maine's federally funded P&A, pushed for his release despite dire warnings from psychiatrists ("I find myself extremely concerned about this young man's potential for violence," reads one of many explicit notes in the medical record).

Nonetheless, the advocates insisted that William was "competent" for discharge and openly coached him--as a lawyer would his client--on how to placate the doctors so they'd let him go. William prevailed, and Riverview discharged him on April 20. Exactly two months later he murdered his mother with a hatchet. In his wrenching testimony before Maine legislators, Robert Bruce emphasized "the role that the patient advocates played in this tragedy."

Dr. Satel’s brilliant article makes the case that the P&A system, which Jean Isaac and Virginia Armat documented in their 1990 book Madness in the Streets as a "playground for anti-psychiatric activists" – needs to be reformed!

Horrific, but not uncommon

The story of the Bruce family is horrific – even more so because it is NOT uncommon.

William Bruce brutally killed his mother. His father describes the conversation of two worried parents the night before the murder.

"The night before it happened, my wife and I were in bed talking. I said, 'Amy, I can't believe they allow these people out on the streets. Willie should be in a padded cell, heavily sedated. What do we have to wait for? Do we have to wait for him to hurt somebody or kill somebody before they do something?' "

Unlike Cho Seung-Hui, most severely mentally ill individuals who become violent do not select their victims randomly. Multiple studies have confirmed that between 50 and 60 percent of the victims are family members; by contrast, among homicides committed by non–mentally ill individuals, only 16 percent of the victims were family members.

Joe Bruce spoke eloquently about his family’s story last night on Anderson Cooper 360 and on WCSH Channel 6 in Portland, who noted:

Throughout the family's struggle with Willie's schizophrenia, Joe Bruce said he learned a lot of things about Maine's mental health system that upset him. He learned being psychotic is not enough to get someone committed to the hospital. The patient has to be a direct threat to himself or others. He also learned how difficult it is to require someone to take medication while in the hospital. And he discovered Willie could be deemed well enough to go back into the community after just a couple of weeks in the hospital.

In the Bruce case, some of the parallels with the Cho case are eerie – one of which being the attitude of the mental health care providers charged with caring for people who are so ill.

"Recovery from mental illness is possible," wrote the director of the Maine psychiatric hospital where William Bruce was sent for treatment and released. A week later, Bruce stood accused of bludgeoning his mother to death. After Bruce was accused of killing his mother, the hospital director explained why. "In Maine, a client can choose not to be engaged in treatment ... [t]he major issue is when someone does not appear eminently [sic] dangerous and cannot be committed."

In Virginia, a spokeman for the agency that should have helped Cho after he was court-ordered into community treatment said, "The matter of the individual actually following up and going to that appointment is his or her prerogative." He also said that the court order "can't actually be enforced," despite the fact that the law says that upon failure to adhere to the treatment order, the judge can rescind it and order hospitalization.

As one Maine paper wrote after the Bruce tragedy:

We understand the concern for the civil liberties of people with mental illness, but this case shows the greater need for the patients like William Bruce is to keep ahold of them -- not necessarily in institutions -- but within a system that can treat the symptoms that lead to such tragedies.

Treatment laws that require someone to be a danger to themselves – coupled with providers who shirk their duties to those very people who have actually been found to meet those high standards – it all adds up to tragedy.

The wakeup call wasn’t Cho. It has been sounding regularly in communities across the country. It is just that nobody was listening.

SHORT BITS

• One Florida judge gives the state 60 days to figure out how it will move mentally ill inmates out of Orange and Osceola jails and get them the treatment they need, saying “"I wanted to have something done today, but years of neglect of the mental health system is nothing something that's going to be fixed overnight."
• A Maine advocate applauds Robert Bruce’s lawsuit against the state claiming state negligence played a role in his wife's death at the hands of their son. The letter-writer noted “What a shame when the difference between life and death are a few pills a day, and you can't make your loved one take them. His fight isn't just for him, but for all of us who have been there.”
• A Virginia paper comes out in support of Virginia State Supreme Court Chief Justice Leroy Hassell’s Commission on Mental Health Law Reform.
• Kaiser Permanente is charged in skid-row dumping in Los Angeles, California.

How to get into an inpatient psychiatric facility ...

Is the only way to access inpatient treatment for someone who is extremely ill an act of unfathomable violence?

William Bruce will be moved from prison to a psychiatric facilty at least long enough for evaluation - the local sheriff is relieved, noting the prison isn't a good place for inmates with serious mental health conditions. Bruce killed his mother, his family had been trying desperately to help him.

Too often such horrible events spur a call for punishment instead of compassion. Andrea Yates' fate is being decided in the deaths of her 5 children for a second time, but recall that the first time, she ended up in jail. That is where Brenda Drayton is headed as well - for the next 20-30 years, for killing her daughter.

Most often weak state laws make us wait until a crime is committed to help someone ... and then the focus is on punishment, not treatment. People with severe mental illnesses deserve to get real help from the civil treatment system before situations occur that lead them to be punished by the criminal one.

William Bruce, Andrea Yates, Brenda Drayton - if they could have been on an outpatient commitment order long before they committed murder, they might not have gotten so sick to need a hospital bed ... or land in a jail cell.

Fighting generalizations with science and truth

There is a big difference between someone who has schizophrenia, is in treatment, and is doing well vs. someone like William Bruce.

For too long, it seems the only choice in public discourse about the role of violence in schizophrenia has been to demonize EVERYONE with schizophrenia as being potentially violent, or to preach that NOBODY with schizophrenia has a greater risk of violence than anyone else. Neither is reasonable or logical.

Implying that all people are violent is simply not true and is hurtful to the majority of people with schizophrenia who are taking medication and not violent. Failing to acknowledge that under some circumstances some people with schizophrenia have an increased risk of violence is not only misleading, it can lead to dangerous situations when caregivers, police, or the mentally ill do not recognize the warning signs such as paranoid delusions.

We are grateful that the editors at the Kennebec Journal and Morning Sentinel chose a third option – clarifying who of that larger group really needs humane intervention and helping them. Educating the general public to not paint everyone with either the broad brush of violence or the broad brush of nonviolence is the best way to not only remove stigma from the majority of people with mental illnesses, but also to avert tragedies.

Waiting for danger? Here it is.

“What do we have to wait for? Do we have to wait for him to hurt somebody or
kill somebody before they do something?”

Seems like far too often, the answer is yes.

Wait until he escalates. Until you can prove he is a danger. Until danger is imminent.

The latest result of such twisted and irrational policies is making headlines in Maine this week.

Robert and Amy Bruce spent years trying to help their son deal with his mental illness, even letting him live at home despite their fears. But on Tuesday, the illness won out and authorities say William Bruce, 24, bludgeoned his mother to death. Efforts to help William Bruce through the years were stymied, first by the hope that he would grow out of it and later by confidentiality laws and civil liberties intended to protect his freedom, but at the expense of the treatment he badly needed but refused to accept.

The Bruce family, barred from having a say in many of their son's treatment decisions, were left to either turn their back on him or accommodate his illness and accept the risks.