It’s Mental Illness Awareness Week. But what we really need to be aware of are the discriminatory laws that harm people with mental illness and prevent treatment for the most seriously ill.
The recent death of Daniel Prude and other disturbing incidents have focused national attention on how police respond to mental health crises. But few people are investigating the failures of the mental health system that lead to these police encounters in the first place—failures that cut across all races and incomes.
The mental health system is hamstrung by a series of discriminatory laws that limit the number of crisis beds, prevent people from receiving treatment until they have deteriorated to the point of dangerousness and block families from participating in their care. The result is a disastrous and inadequate system of care for people with brain illnesses like schizophrenia and bipolar disorder.
In the case of Daniel Prude, he was taken to the emergency room for psychiatric care but released without treatment or medication hours before his fatal encounter with police. Why he was released so soon has not been fully answered, but if a person seeking treatment appears calm and rational during observation, most state laws allow them to leave whether they are in crisis or not.
A spokesperson for the University of Rochester Medical System said in a statement that they are bound by a New York state law that prohibits hospitals from keeping a person involuntarily for more than 24 hours unless they are likely to cause serious harm to themselves or others and that requires immediate observation, care and hospital treatment. Doctors apparently determined that Prude didn’t meet this standard.
The statement also called Prude’s care “medically appropriate and compassionate.” It was neither.
When we talk about mental illness awareness, we need to truly understand the nature of mental illness. Psychotic disorders like schizophrenia are brain illnesses that cause disordered thinking, delusions and altered perceptions of reality. The longer left untreated, the more damage occurs to the brain and the less likely they are to recover.
Most people with untreated schizophrenia lack insight—they are so sick they don’t know they are ill. Known clinically as anosognosia, it is a symptom of the disease itself. If the organ responsible for thinking is impaired, rational decision-making may be impossible.
In the quest to protect a person’s civil rights, we end up taking away a person’s right to medically necessary treatment, leading to tragedy, jail or both. People with untreated serious mental illness cycle from hospital to the streets to jail and back again, and no one is held accountable. It’s a game of hot potato and everyone loses.
In Maryland, where I live, despite excellent hospitals and mobile community-based treatment programs such as assertive community treatment, the state laws governing mental health treatment are the worst in the nation, according to a recent report by the Treatment Advocacy Center.
Maryland’s commitment laws do not consider a person’s history of psychiatric deterioration in the decision to admit and instead rely on an ambiguous standard of “danger to self or others” that is open to interpretation.
And Maryland is one of only three states without assisted outpatient treatment—court-ordered treatment that can prevent people from ending up homeless, in jail or dead and restore meaningful lives.
Until we remove the barriers to treatment, not only will we continue to see fatal encounters with police, but people with serious mental illness, their families and our communities will continue to suffer the consequences.