Santa Barbara County Sheriff Bill Brown speaks at a press conference regarding murder suspect Elliot Rodger in Goleta, California. Rodger, 22, went on a deadly rampage in Isla Vista near the University of California at Santa Barbara campus.

Santa Barbara County Sheriff Bill Brown speaks at a press conference regarding murder suspect Elliot Rodger in Goleta, California. Rodger, 22, went on a deadly rampage in Isla Vista near the University of California at Santa Barbara campus.

The vast majority of people with mental illness do not commit violent crimes. But the recent California shooting rampage has reignited debate over how to prevent this kind of tragedy from happening again. In the absence of any meaningful gun reform, lawmakers have proposed competing mental health measures. One bill, [House Resolution 371}, (http://beta.congress.gov/bill/113th-congress/house-bill/3717) is led by Pennsylvania Rep. Tim Murphy (R-18). It would make it easier to force people to get treatment for mental illness. Another piece of legislation, [the Strengthening Mental Health in Our Communities Act of 2014] (http://barber.house.gov/sites/barber.house.gov/files/2014.05.06%20Summary_StrengtheningMentalHealthinOurCommunitiesAct.pdf), was proposed last month by Arizona Rep. Ron Barber (D-2nd). It seeks to boost access to community-based services. Each has strong supporters and critics. Diane and her guests discuss balancing the rights of the mentally ill and public safety.

Guests

  • G.G. Burns advocate on mental health issues and the mother of a mentally ill adult son.
  • Chrisa Hickey mental health advocate and the mother of a mentally ill son.
  • Rep. Ron Barber congressman (D-Ariz., 2nd District); he was critically wounded along with Rep. Gabrielle Giffords and others in a 2011 shooting in Arizona.
  • Curtis Decker executive director, the National Disability Rights Network.
  • Rep. Tim Murphy congressman, (R-Penn., 18th District).
  • Dr. E. Fuller Torrey founder and former president, Treatment Advocacy Center.

Transcript

  • 10:06:53

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Very few mentally ill Americans commit violent crime, but the recent California shooting and the Newtown massacre 18 months ago have put pressure on Congress to do something. Lawmakers have been unable to pass stricter gun control legislation as many have called for, but they proposed measures to change how people with mental illness receive treatment.

  • 10:07:25

    MS. DIANE REHMJoining me in the studio to talk about two mental health bills under consideration, Dr. E. Fuller Torrey of The Treatment Advocacy Center and Curtis Decker of The National Disability Rights Network. But first, joining us by phone from Tucson, Ariz., is Congressman Ron Barber. He represents Arizona's second district. He was critically wounded, along with Congresswoman Gabrielle Giffords and others, in 2011 shooting in Arizona.

  • 10:08:03

    MS. DIANE REHMCongressman, thanks for joining us.

  • 10:08:06

    REP. RON BARBERThank you very much for having me on. I appreciate it very much.

  • 10:08:09

    REHMCongressman Barber, first of all, tell us how you are.

  • 10:08:14

    BARBERWell, thank you for asking. I'm doing really well, you know. I'm back -- I'm on Congress, of course. I came into Congress in 2012 when Congresswoman Giffords resigned, and I'm not in my second -- almost third year, going in my third year of Congress. My energy is strong. I still have to wear a brace on my leg where the injury was on -- they took out a vein, and they had to repair that. But I'm full of energy and really there in many ways to try to help solve of the mental health issues we have in our country.

  • 10:08:45

    REHMI'm glad to hear that. I know you just introduced a mental health bill. Briefly tell us what some of its main provisions are.

  • 10:08:57

    BARBERWell, whenever we have a tragedy like we had in California, my first thoughts are to the families of the survivors, the families of the ones who were killed. I remember so well the aftermath of the Tucson shooting and how it affected our family and all of the families around us. So before I say anything about what we're trying to do in Congress, I just want to make sure the families in California know that I'm with them, and I really understand the grief and loss. And we want to prevent that for future.

  • 10:09:30

    BARBERSo the goals of our bill are, first of all, to try to restore some of the funding that's been lost. We've cut mental health funding in this country by over $4 billion dollars, and that just is not going to help us meet the issue or meet the problem. So the bill that we have in play has to do with getting out in front of a mental health crisis before it actually takes place, and we focus a lot on making sure we have early intervention, identification, diagnosis, and treatment.

  • 10:10:02

    BARBERThe young man who shot us in Tucson was not diagnosed until, or treated, until he went to prison. I believe that had he been treated before, that that tragedy might never have happened. So we focus on working with kids, particularly school age kids and young adults. We focus on working and increasing the professional capabilities of the VA system, to deal with post-traumatic stress disorder with our veterans.

  • 10:10:31

    BARBERWe establish a registry for psychiatric beds so that when people need inpatient treatment, they can get it. We're reminded, obviously, of the tragedy up in Virginia where Sen. Gus Deeds (sic) was attacked by his son who subsequently killed himself. And he needed a psychiatric bed, and there was one available. But they couldn't find it. So we have to take care of that.

  • 10:10:54

    BARBERWe created a White House office on national health policy, on mental health policy, to coordinate all of the agencies across the federal government, put a national focus on it. We invested in increasing the behavioral health workforce, which we absolutely need and we increase the parity that's available under Medicaid and particularly the children's portion of Medicaid so we can get services to children and adults.

  • 10:11:22

    BARBERAnd we also have a provision that provides education for first responders, for educators, to understand the symptoms of mental health issues and to help get treatment for people. And we invest in resources so that we can get out in front of suicide and serious mental illness.

  • 10:11:40

    REHMAll right.

  • 10:11:41

    BARBERSo ours is -- a lot of the focus, Diane, is on trying to get out in front of these problems before they actually occur and really make sure that we have a system that works.

  • 10:11:49

    REHMAnd, Congressman Barber, there are a number of people who would say, why hasn't Congress focused on guns rather on mental health?

  • 10:12:02

    BARBERWell, you know, it's been very difficult to bet a background check bill, which I support, by the way. I think we need to expand the background check system, so we can prohibit people who shouldn't have guns. And the law requires people with serious mental illness, who are a danger to themselves or others, not to have a gun. But we don't have a system that really captures that, so we have not been able to get that through the Senate or the House.

  • 10:12:26

    BARBERBut in my background, I worked 32 years in the field of mental health and developmental disabilities. The fact that I was shot by a young man with a serious mental illness, all of that leads me to say we've got to focus on where we can get some bipartisan agreement. And I believe we can in mental health. That's my goal is to find the way to have Republican and Democrats alike work on a solution at a national level.

  • 10:12:50

    REHMAnd give me a sense of how you believe your bill would help to ensure that severely mentally ill people are treated before they possibly harm themselves or others?

  • 10:13:06

    BARBERWell, first of all, I think there are a lot of signs that, unfortunately, go undetected. And we have to make sure that first responders, teachers and family members understand what they're seeing in they see it. In the case of the guys that shot us, you know, clearly he was exhibiting serious mental illness symptoms long before the shooting. If people had known what they were seeing and could've gotten him into treatment, I believe that could've been prevented. So our bill does include a nationwide program to provide that kind of education information. But we also...

  • 10:13:37

    REHMBut, of course, it...

  • 10:13:39

    BARBER...have to get out in front of it. We have to have prevention services earlier on because we know that some of these mental health issues start very early in life. We have to get out in front of it before we reach a crisis. That's really what we're trying to do here.

  • 10:13:50

    REHMAnd, of course, in the case of the young man in California, not only had people seen that there were signs of mental illness in this young man. He had been in therapy since the age of 8. What would your bill have done to prevent him from purchasing weapons and moving forward with his horrendous attack?

  • 10:14:22

    BARBERWell, our bill does not address the issue of him being able to have a weapon. He passed, apparently, the background check three different times. He was not adjudicated a danger to himself or others. Had he been, then the background check, had it been conducted properly, would've made sure that he couldn't get a weapon. So that bill does not address that, but it does address the issue of making sure that law enforcement and others are understanding what they're seeing.

  • 10:14:50

    BARBERWhen the young man was visited on a welfare check, I believe more could've been done had the police, the sheriff's deputies, been aware of what they were seeing and what he was doing, kind of persuade him he was okay. His parents did everything right. They tried to get help, and, unfortunately, I think, overall, the systems failed him and failed his parents. And the result was that terrible tragedy.

  • 10:15:10

    REHMHow much bipartisan support does your bill have?

  • 10:15:15

    BARBERThe bill was just introduced two weeks ago, and we're still building the support. Right now, we have about 45, maybe even higher, 50, co-sponsors. I've shared it with a number of members of the Republican majority. And I'm hopeful that some of them will soon get on the bill. The most important thing we can do here is not make this into a partisan issue. It shouldn't be.

  • 10:15:36

    BARBERIn some ways, it's become one, and I think that's a real mistake because we have to go forward together. I have worked with a number of people in the Congress who are willing to find common ground, and this is an area where we can. I'm a member of a bipartisan working group, which is 10 Republicans and 10 Democrats who are often trying to find places where we can agree, and I believe this is one of those. So I'll be talking with the members of that group when I get back to make sure that they understand the bill and hopefully have some of them sponsor it.

  • 10:16:02

    REHMAnd, frankly, Congressman Barber, do you think that the kind of mass shootings we've seen in recent years could be better stopped by stricter gun ownership laws?

  • 10:16:18

    BARBERWell, I'm a co-sponsor of a bill, Diane, that would expand the background check system to make sure that people who are in prohibitive classes and people with serious mental illness, who are a danger to themselves or others, would be one of those groups. I believe that we have a big hole in the background check system, which allows people to purchase guns who shouldn't.

  • 10:16:40

    BARBERNow, the problem in the case in California and in the case of Tucson is that neither of these young men would have been stopped by a background check because neither of them were adjudicated for involuntary treatment. I believe had that happened, they could've been prevented from getting a gun when they went through the background check system. But we still have about 30 percent of guns purchased in this country that are not subject to the background check, and I think we need to close that gap.

  • 10:17:08

    REHMAnd what do you think about the idea of the involuntary treatment for those who have shown an indication toward violence and perhaps have purchased guns?

  • 10:17:25

    BARBERI believe we need to have a process. And in Arizona, we do have a process. And I think every state, slightly different processes, to bring people in front of a judge so that it can be determined whether or not they should be involuntarily treated, inpatient and sometimes outpatient. So I have no quarrel with that. I just think we have to be very careful in how we go about that. The call for broadening the number people who would be subject to that process, I think, is a bit of a slippery slope.

  • 10:17:55

    BARBERWe need to make sure that we balance the rights of all of us with this process. But I absolutely do believe that involuntary treatment is necessarily from time to time. We need to do it when it's obvious that the person needs that kind of help.

  • 10:18:08

    REHMCongressman Ron Barber, he's Democrat from Arizona. He was critically wounded, along with Congresswoman Gabrielle Giffords and others in 2011 shooting in Arizona. Thanks for joining us, sir.

  • 10:18:27

    BARBERThank you very much, Diane.

  • 10:18:28

    REHMAnd short break. We'll be right back.

  • 10:20:00

    REHMAnd joining us now by phone is Congressman Tim Murphy of Pennsylvania. The Republican lawmaker is a psychologist by training. Welcome to you, sir. Thanks for joining us.

  • 10:20:16

    REP. TIM MURPHYThank you. It's great to be with you.

  • 10:20:18

    REHMWould you talk about the key provisions in the mental health bill you introduced?

  • 10:20:26

    MURPHYYes. This is called the Helping Families in Mental Health Crisis Act. It empowers parents and families to help by clarifying confidentiality laws. It also increases the number of psychiatric beds for people in a serious mental illness crisis. It provides alternatives to institutionalization to assist with outpatient treatment laws. It applies a need for treatment standard and not just an imminent danger standard when one is looking at some sort of ability to make sure a person stays in inpatient, outpatient treatment.

  • 10:21:00

    MURPHYA key provision, it has accountability for federal grants and say they must be evidence-based. It puts more funds for serious mental illness research. It provides training for police and first responders. It coordinates (unintelligible) billion dollars in federal funds spent each year through -- for mental health through establishing an office of the Secretary of Mental Health. It provides telepsychiatry to help underserved populations around the country because there is a critical shortage of psychiatrists and psychologists to work with severely mentally ill.

  • 10:21:30

    MURPHYAnd it stops spending for the anti-psychiatry legal advocates that taxpayer dollars have been going for. We believe that people have a right to be well, and we should be working on a way for making sure people access the treatment that they need.

  • 10:21:43

    REHMNow, Congressman Murphy, some people say that assisted outpatient treatment is actually a euphemism for involuntary commitment. Are you in favor of involuntary commitment?

  • 10:22:01

    MURPHYWell, let me put it this way. We have to understand that if -- we want to pretend that those with serious mental illness are not reported, 10 times more likely to be robbed, assaulted or raped than the non-mentally ill. And too often we want to pretend that last year there were not 40,000 suicides and over a million suicide attempts. We want to pretend that there were not 1,600 murders by the seriously mentally ill, pretend that 80 percent of the homeless aren't mentally ill, and 50 percent of those in jail aren't mentally ill.

  • 10:22:27

    MURPHYWe want to pretend all of this, but the painful and tragic fact is that we can't pretend these facts away. And denial is not a treatment. These are human beings. They're sons and daughters. They're mothers and fathers. They're brothers and sisters who have a right to get better. So what happens is we want to pretend that they know that they're ill and they'll seek treatment because they want to get better. But they -- many don't know they have an illness. For example, they believe the voices are real. They believe that they're the Messiah. They believe the command that tells them their food is poisoned or that the CIA is after them is real.

  • 10:22:58

    MURPHYAnd for many who are deep into their paranoia or hallucinations or delusions for which medication and peer support and psychotherapy and occasion brief hospitalization can stop the system, (sic) isn't it more humane to have available a spectrum of services that for some to say that people who are gravely mentally ill and cycle in and out of jail and in and out of homeless shelters, but we know that with treatment they can get better.

  • 10:23:22

    MURPHYFor that 1 percent of 1 percent, I believe we need this option. And bear in mind, 45 states have assisted outpatient treatment. And the states that administer it correctly, such as New York State and Dade County in Florida and parts of Texas, they have found that they have reduced imprisonment of the mentally ill by 80 percent.

  • 10:23:42

    MURPHYThey have found they've reduced homelessness and short-term emergency hospitalization by 70 percent. So I see this, of having assisted outpatient treatment, as a way of giving people a choice for real treatment as opposed to saying they have a right to be sick, and they're going to die with their rights on. We need to change that standard.

  • 10:24:00

    REHMNow, years ago, we had institutions like St. Elizabeth's here in Washington, D.C. where individuals who did exhibit mental illness could be involuntarily confined. Are you saying that we need to fund and reopen those kinds of institutions?

  • 10:24:26

    MURPHYAbsolutely, absolutely. No, that's absolutely untrue. Nobody wants that. Nobody wants to go back to those institutions, those asylums of yesteryear. But the point is, is that for some people when they're in the midst of an acute crisis -- most of the difference between my bill and the other bill -- I recognize that we have had a Jared Loughner from Arizona. We've had an Adam Lantz in Connecticut. We've had an Elliot Rodgers in California.

  • 10:24:53

    MURPHYParents were all keenly aware that their sons were in the midst of a terrible crisis. They couldn't get them help. The parents couldn't get involved in treatment because of barriers and understanding the HIPAA laws. And they couldn't get them. Their kids -- our standard now is one of imminent danger, and that literally means that someone has to witness this person with a knife or gun to their head or someone else's head before they can get them hospitalized.

  • 10:25:18

    MURPHYI believe that for people who are -- have seriously deteriorated, they need another option. We're not going to go back to those institutions. It could be short term stay in a very defined psychiatric facility, but always with the idea to get them independent, back in the workforce, living on their own, but staying in treatment so they can be better and they can be at their full potential.

  • 10:25:40

    REHMCongressman Murphy, we know that most mentally ill people are not violent. But the question becomes, how many Newtowns, how may Californias can this country endure? Aren't we also in need of changes to gun laws?

  • 10:26:01

    MURPHYWe -- what we have to do is treat the disease. To focus on guns, to me, is the same as saying the way we'll cure diabetes is to ban sugary soft drinks. We have this fellow in California, stabbed three people to death -- we forget about that -- or hit them with a hammer. We have an incident in Pittsburgh area where a student stabbed a number of other people.

  • 10:26:24

    MURPHYIt is to what is in your hand that we should be paying to. It's what is in their minds. Mental illness is a brain disease and needs to be treated that way. But this is part of what I meant when I said people want to deny the reality of this, and they want to focus on other issues. If we don't start focusing on this as a disease that should be treated, then we have opted during the crisis of the severe mental illness, we will be chasing the wrong cat and continue this way.

  • 10:26:52

    MURPHYWhat has happened in this country by closing those asylums, which we needed to close, but not providing other services and not removing the barriers of treatment, what we've done is we've housed the mentally ill in jails, homeless shelters, emergency rooms, and put them in coffins. None of that is acceptable. None of that is acceptable. And that's why, in my bill, I focus on these things to really change the way our nation is approaching serious mental illness.

  • 10:27:20

    REHMSo in line with your bill, if a parent, for example, Mr. Rodgers' parents realized that their son was seriously mentally ill, could they have intervened so that he could not purchase weapons?

  • 10:27:42

    MURPHYIn California, they couldn't intervene to get him treatment. That is the key. He was a very sick young man. These folks were desperate to get him help. And in California, parents don't have much standing. They even called the police who went to his house and didn't really look around. But these parents couldn't get him help. And would it not have been better if he and the millions of other people with serious mental illness who need help we could get them help.

  • 10:28:10

    MURPHYAbout 40 percent of those with schizophrenia, for example, are not even aware that they have a problem. And we have to make sure that they're in treatment and getting better.

  • 10:28:20

    REHMCongressman Tim Murphy of Pennsylvania, I want to thank you so much for joining us today.

  • 10:28:28

    MURPHYAll right. Thank you. Have a great day. Bye-bye.

  • 10:28:30

    REHMAnd you as well. And here in the studio, Dr. E. Fuller Torrey. He's founder and former president of the Treatment Advocacy Center. He's the author of "American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System." And Curt Decker, he's executive director of the National Disability Rights Network. I'll start with you, Curtis Decker. What was your reaction to the two proposals from members of Congress?

  • 10:29:09

    MR. CURTIS DECKERThank you, Diane. I think what's hopeful here is that we're having a national debate about an incredibly serious issue. And both bills, I think, do have components that are really important and would address the situation. Unfortunately, Congressman Murphy's bill is a pretty simplistic response to a very complex problem. As you heard, 45 states already have outpatient commitment laws, and they haven't worked.

  • 10:29:35

    MR. CURTIS DECKERAnd the reason is they do not realize the incredible amount of funding and resources that need to be in place to build a robust community mental health system, so you can identify these people, work with them, and occasionally have to intervene in their treatment. In New York, as was mentioned, they have such a bill, and it's been used. And they also funded $135 million in comprehensive mental health services to really put teeth in that program.

  • 10:30:03

    MR. CURTIS DECKERWhat we just saw in Albuquerque, N.M. was when the police went out to deal with a person who had a serious mental illness, they surrounded him, he pulled out a knife, and they shot and killed him. So we have to be -- we can't use simplistic answers. This is catnip frankly to many legislators who don't want to step up and put the resources into the mental health system.

  • 10:30:23

    REHMAnd turning to you, Fuller Torrey, what is your reaction to these two plans?

  • 10:30:31

    DR. E. FULLER TORREYWell, thank you very much, Diane. I think that the Barber Bill has some good features on it. It attempts to coordinate the federal effects. You've got to remember we're spending $130 billion federally, so anything we can do with the current efforts to coordinate it are really pathetic on it. However, the Barber bill leaves out all of the most important parts of what will really work to fix what is a terribly broken system. Mentally ill homeless, mentally ill in jail is tragedy, Santa Barbara, Washington Navy Yard, et cetera, et cetera.

  • 10:30:58

    DR. E. FULLER TORREYThe Murphy Bill has four features, none of which are included in the Barber bill. One is the criteria for involuntary evaluation and commitment on it, which could've also been helpful in the case in Santa Barbara. Second is the exchange of information, the revisions of the federal HIPAA laws so that the families and the police and the mental health professionals can exchange information.

  • 10:31:20

    DR. E. FULLER TORREYThe third is the availability of beds. No, we don't need to go back to the 1950s. But we do not have enough beds now for people who are acutely mentally ill to be evaluated and stabilized. And the Murphy bill would start to fix that by fixing some of the Medicaid exclusions on that. And finally the Murphy bill targets the severely mentally ill which the Barber Bill does not. And unless we really focus on the severely mentally ill, we're not going to be able to fix what is a very broken system.

  • 10:31:46

    REHMFollowing up on that, under the Murphy plan, Fuller Torrey, how is forced treatment defined? Is it therapy? Is it medication? What is it?

  • 10:31:59

    TORREYWell, forced treatment simply means that you have to follow the orders of whoever is prescribing. We do this for people with tuberculosis. This is not something new on it. We do it for people with Alzheimer's disease who don't know that they're sick on it. What we're saying is that that small number of people who don't know they're sick but are potentially dangerous should be able to be -- live in the community as long as they take the medication that is necessary to stabilize them. That's not what we're doing.

  • 10:32:26

    REHMBut how do you know if someone is potentially dangerous?

  • 10:32:31

    TORREYWell, I think that they demonstrate -- I mean, you should not be able to use this kind of treatment until a person has demonstrated some kind of dangerousness or threatened people on it. And I think we have the ability to do that.

  • 10:32:44

    REHMDr. E. Fuller Torrey, and you're listening to "The Diane Rehm Show." What about that, Curtis Decker? How do you define the individual who may be harmful to him or herself or the community?

  • 10:33:01

    DECKERWell, that's exactly the issue, Diane. You can't. It's a continuum. People move up and down that continuum into recovery. Often they may deteriorate. And the myth that the professions can predict who is violent is just not true. And we are potentially creating a coercive system that will drive people away from treatment and not come forward. This is not tuberculosis. This is not Alzheimer's. These are people who are already stigmatized in our society and very nervous and very afraid. Families are very afraid of having their children labeled as mentally ill.

  • 10:33:34

    REHMAnd joining us now from Chicago is Chrisa Hickey. She's a mental health advocate and the mother of a mentally ill son. Thank you for joining us, Ms. Hickey.

  • 10:33:50

    MS. CHRISA HICKEYThank you.

  • 10:33:50

    REHMTalk about when your son was first diagnosed with schizophrenia.

  • 10:33:57

    HICKEYMy son was diagnosed with schizophrenia at the age of 11, his second hospitalization. My son's -- he'll be 20 years old in a few weeks, so it's been a long road for us. And children with childhood onset schizophrenia typically have very severe cases, so we've been through a lot, 14 hospitalizations, inpatient treatment, residential treatment.

  • 10:34:17

    REHMHow did he eventually get treatment?

  • 10:34:22

    HICKEYHe got treatment because I'm kind of a bulldog. We live in Chicago. And in a big city like Chicago, you'd expect there'd be lots of services, but we don't. The typical wait for a first appointment with a psychiatrist here is eight weeks. It's longer for your child. It's 10 to 12 weeks if you're a child. It's very difficult to get children diagnosed just because of the difficulty of children being diagnosed. Pediatricians don't recognize it, even though we know and NAMI tells us that first onset of symptoms for most people, or at least half, occurs before the age of 14.

  • 10:34:57

    HICKEYAnd here in Chicago, Rahm Emanuel our mayor, just two years ago closed half of our mental health clinics. So, you know, one of my issues with Dr. Torrey and Dr. Murphy's Bill is that we keep saying that community-based services have failed, but we've not really tried. You know, 40 percent less beds, lots less providers, lots less care, no supported housing, no supported employment. We're leaving the severely mentally ill without the resources they need. So...

  • 10:35:26

    REHMBut I gather that you did find a state-funded grant that does pay for residential treatment for your son.

  • 10:35:36

    HICKEYI did. We are lucky here in Illinois that we have what's called the individual care grant. It took us three applications to actually get the grant, but it does pay for residential treatment for severely mentally ill children. There are about 300 children in Illinois on this bill. Now, if you do the math and you know how many people have severe mental illness -- one in 10 children have a mental illness, that's 10 percent -- 300 kids is nowhere close to 1 percent, let alone 10 percent of the kids in Illinois.

  • 10:36:02

    REHMIs your son on medication now?

  • 10:36:06

    HICKEYYes, he is. We actually resisted medication when he was a child until he was about 13 years old. And he went through 28 different trials of medications because just prescribing medication and sending someone on their way rarely works. It takes trial and error to get the right medication. But he (unintelligible)...

  • 10:36:23

    REHMBut I gather that your main objection to Congressman Murphy's bill is in regard to forced medication.

  • 10:36:33

    HICKEYIt is in regard to forced medication, and that's because of what I said. I vehemently object to the idea that 50 percent of people with schizophrenia aren't aware that they have schizophrenia. Fifty percent aren't getting treated, but that's because treatment's not available for the vast majority of them. I would be all for looking at expanding AOT law for the 5, maybe even 10 percent of people that are severely psychotic and need the extra assistance.

  • 10:36:59

    HICKEYBut for the rest of the people that are trying to get help that can't get it because resources aren't available, shouldn't we be focusing on the Affordable Care Act which still doesn't require insurance companies to cover mental health?

  • 10:37:10

    REHMChrisa Hickey, she's a mental health advocate and the mother of a mentally ill son. Thank you for joining us, Ms. Hickey.

  • 10:37:20

    HICKEYThanks for having me.

  • 10:37:22

    REHMShort break, and we'll be right back.

  • 10:39:58

    REHMAnd welcome back. Dr. Torrey, I want to turn to you. Many people are saying we simply do not have the facilities to treat the mentally ill now. What would happen if more and more people were included in the desire to institutionalize people, even if temporarily, to prevent them from carrying out acts of harm?

  • 10:40:32

    TORREYWe've got to remember, Diane, we've closed down 95 percent of the beds that we had. We don't have enough beds. We're not going back to the 1950s, but we've got about a third of the number of beds that we have now. We're not talking about a large number of people. The people who need involuntary treatment are often people who need to be evaluated involuntary. It's about 1 percent of the total number of people with severe mental illness on it.

  • 10:40:54

    TORREYSo that -- Ms. Hickey is actually not right when she says that -- we know now that about 40 percent of people with schizophrenia are not aware of their illness. We have 20 studies showing that their brains are different. We know that treatment really can work for these people, and we know how to treat them.

  • 10:41:13

    REHMAnd what about you, Curtis Decker? How do you respond to the notion that there are simply not enough beds to treat those who do need help, without reopening all of the institutions of the '50s?

  • 10:41:32

    DECKERIt's important to note, in the Murphy Bill, there's actually now the ability, if it were to pass, have federal funds going into institutions, almost $3 billion, in reopening those old snake pits of the past. So I totally disagree with Dr. Torrey and Dr. Murphy that we would not be returning to the old ways of treating people with mental illness. In Virginia, for example, there were beds available. But the case manager did not have the resources and the techniques to be able to find those beds. We think there are many of those services available. But because we do not have a coordinated, robust community system, those services go unused and unidentified.

  • 10:42:13

    REHMI want to read to you an email from a young man, Jason, in Cleveland. He says, "Having read the manifesto released by the UC Santa Barbara shooter, I've come to find there was a time I thought along similar lines. Fellow students raised suspicions about me to school administrators. My school intervened. I was involuntarily committed for 28 days. This allowed me to get the help I needed. Involuntary commitment is a difficult choice. But at times, as with myself, it is what is necessary." How do you respond?

  • 10:43:04

    DECKERWell, the good news is it looks like that system worked quite well and that he was identified early and was given that kind of treatment. So the myth that we need to create a whole set of new laws to establish what already exists in 45 states is incorrect. But, remember, Eric Rodgers was seen by treating professionals. And they did not diagnose them as dangerous.

  • 10:43:29

    DECKERThey did not go forward with the process. The laws in California are very clear about being able to intervene in people in that situation, if they can be identified. And it's sort of after-the-fact identification that this person was violent -- and then we go back and scapegoat people because they didn't identify them.

  • 10:43:45

    REHMFuller Torrey.

  • 10:43:46

    TORREYI think Jason was lucky he found a bed and was able to get in a bed. For every person like Jason, there's several who are not picked up early because there's no bed available. Jared Loughner's a good example in Tucson. Jared Loughner probably did what he did because he was not hospitalized, and the reason, because there were no beds available in Southern Arizona at that time.

  • 10:44:06

    REHMNow, we are joined by phone by Lexington, Ky. by G.G. Burns. She's the mother of a young man with a long history of serious mental illness. She's an advocate for measures included that in Congressman Murphy's Bill. Hello, G.G., thanks for joining us.

  • 10:44:30

    MS. G.G. BURNSThank you, Diane. And, yes, I do support Congressman Murphy's Bill. And basically our son did receive, as a young child, because he was diagnosed as young as age four, and he's received many of these serious mental health diagnoses over the years. But...

  • 10:44:50

    REHMI gather he -- you tried to have him committed last month. Tell us what happened.

  • 10:44:58

    BURNSYes. This is -- it's the 20th time. He's been hospitalized 14 times as an adult, involuntarily. And six times, he has received what is considered an assisted outpatient agreed order in our state, which is only for two months, for 60 days. He does benefit. He has a history of benefitting. And with those early interventions and treatments that we're all talking about supporting and raising money and increasing funding for, he had the best there was. But now, as an adult, he had the right to refuse.

  • 10:45:33

    BURNSAnd that has caused such severe psychosis. It has caused severe brain damage. He now no longer believes he is ill. So as soon as the short, 60-day orders are expired -- and he does agree during that time. And first of all, he is not forced. He has an attorney that supports him. He is given the choice to either accept this agreement to live in the community with treatment or not.

  • 10:45:59

    REHMI understand that you...

  • 10:46:00

    BURNSSo, in other words, forced treatment is incorrect. It is -- you know, in other words, he has the right to refuse. And as soon as that order expires, he does refuse. He goes back to the revolving door. He doesn't believe he's ill.

  • 10:46:14

    REHMHmm.

  • 10:46:14

    BURNSHe often threatens us, his family members. He becomes extremely manic. He becomes extremely -- an extreme threat to others in the community, which leads to, you know, law-enforcement investigations, not medical help.

  • 10:46:31

    REHMNow...

  • 10:46:32

    BURNSSo there is no mechanism to help him gain help before treatment, before tragedy.

  • 10:46:37

    REHMI understand that you've said you're afraid of your son. Yet here you are publicly speaking out.

  • 10:46:47

    BURNSYes.

  • 10:46:47

    REHMTell us why.

  • 10:46:48

    BURNSAnd we have no other options. He does benefit from treatment, but we have no legal mechanism to require him to gain treatment long enough to access these services that Congressman Barber's Bill wants to increase funding for. So, in other words, we can continue to support these services that are already in place, that we've all -- you all have just discussed in your program, but the individuals like my son, who clearly do not believe they're ill -- he believes he works for the CIA and other federal law enforcement -- I mean, federal agencies.

  • 10:47:24

    BURNSHe has many gifts and many strengths. And with treatment, he could be a successful individual in the community, like he so desires and wants to do. But without the treatment, he's going to continue to spiral out of control. And families like us, our hands are tied. We have no rights to help them. And we...

  • 10:47:43

    REHMCurtis Decker, what can you say to G.G. Burns that would help her deal with this issue?

  • 10:47:52

    DECKERWell, first, let me say, I appreciate the advocacy she gives for her son, for the entire -- his life. The -- he is entitled to have representation, which he has. And he's entitled to get those services. The fact that those services are not long in duration and are not able to work with him means there needs to be a reevaluation of those kinds of medications that he needs to lead a full and sustaining life.

  • 10:48:18

    REHMAnd, Fuller Torrey, what do you say to G.G.?

  • 10:48:22

    TORREYMs. Burns actually illustrates the fact that this is how patient treatment does work. Mr. Decker said earlier it doesn't. We know that it decreases hospitalizations. It decreases jailings. And there's two studies showing it decreases violence. So this kind of thing does work. And this is the kind of thing that could be promoted by the Murphy Bill, is not being promoted by the Barber Bill. And that's why the Murphy Bill is clearly superior.

  • 10:48:45

    REHMI gather, G.G., your son has actually pulled a knife on you.

  • 10:48:51

    BURNSOn my husband.

  • 10:48:52

    REHMOn your husband.

  • 10:48:53

    BURNSAnd he -- it took the system that we have in place 14 days -- 17 days to find him. And by that time, he no longer qualified for involuntary -- even to be held even more than two hours. And so it took us two more day -- two more months of watching him deteriorate, day after day, threat after threat, till finally he had deteriorated and was desperate enough. And that's where families are forced to do -- I mean, we're forced to watch our loved ones die with their rights on. We don't know.

  • 10:49:28

    BURNSWhen they threaten an act of violence toward themselves or others, we don't know when that day will happen. And when we're crying out for help and no one will listen, and we know what helps them, but you can't access it -- so in other words, the laws require us to watch them die with their rights on. We have -- family members have no help. And without help, there is no hope. And with that, we'll continue seeing these tragedies. So, yes, Rep. Murphy's Bill does help -- help states increase their assisted outpatient treatment programs.

  • 10:50:04

    BURNSBecause right now, even -- and even in our state, if the program was amended so it was easier to obtain, there still would be no funding for that. Rep. Murphy's Bill does support that. So early interventions are wonderful. But in our son's case, he's a classic example. He had the best early interventions. The medical providers know what helps my son.

  • 10:50:26

    REHMAll right.

  • 10:50:27

    BURNSBut if he continues to deteriorate, his brain will continue to not be able to benefit from treatment. And he will become another tragedy.

  • 10:50:34

    REHMG.G. Burns...

  • 10:50:35

    BURNSAnd that's what people are not able to allow us to help our sons and our daughters.

  • 10:50:39

    REHMG.G. Burns, she's the mother of a young man with a long history of mental illness. She is an advocate for measures included in Congressman Murphy's Bill. G.G. Burns, thank you for joining us. I appreciate your candor, and I wish you all the best.

  • 10:51:04

    BURNSThank you.

  • 10:51:05

    REHMAnd we're going to go now to the phones and first to Manchester, N.H. Jeanie, you're on the air.

  • 10:51:16

    JEANIEHi, Diane. My family and I are big fans.

  • 10:51:18

    REHMThank you.

  • 10:51:19

    JEANIEI wanted you to know. And I am an example of someone who did not benefit from forced treatment. And I know a lot of people who did not benefit from forced treatment, and we're examples of the slippery slope that Rep. Barber spoke about. And I had worked full-time for years until I became very depressed. I also have anxiety, border-line personality disorder, and obsessive-compulsive disorder. And I was told that if I -- I either had to have shock treatments, or I would be involuntarily committed to the state hospital, in which case they could do the shock treatments anyways.

  • 10:52:03

    JEANIEI had over 20 shock treatments -- this was seven years ago. Since then, I have not been able to maintain a part-time job for even six months, and I am permanently on disability, which happens to so many folks. And the cost of that disability is unbelievable. And this is a societal problem, not -- you know, we need to focus on our society and the lack of compassion and the lack of community.

  • 10:52:39

    REHMAll right, Jeanie. Thanks for your call. Fuller Torrey.

  • 10:52:43

    TORREYWell, obviously, psychiatric treatment doesn't work for everybody. Involuntary treatment has been very, very helpful for many people -- has restored them to a living wage, able to live in the community. And I think that it's important to realize it's only needed for a very small number of people and that it does work.

  • 10:53:03

    REHMAnd you're listening to "The Diane Rehm Show." Curtis Decker.

  • 10:53:08

    DECKERWell, I believe again, we are working on creating a system of coercion and force that is going to scare people away from coming forward. I really have to object to using Newtown as an example of how the Murphy Bill would assist. Remember, Adam Lanza was not known to anyone in the mental health system. And his mother had a gun collection. They were not coming forward asking for help. There's nothing in the Murphy Bill that would assist the Newtown situation, as tragic as it was.

  • 10:53:36

    REHMYou're shaking your head, Fuller.

  • 10:53:38

    TORREYYes. This young man had been seen by a psychiatrist at Yale. He was evaluated. He was known by the mental health system, and they did not act on it.

  • 10:53:44

    REHMAnd isn't that the concern that many people have, that somehow mental health professionals are restricted in what they can say and the actions they can take?

  • 10:53:58

    DECKERAbsolutely not. As we said, 45 states have outpatient treatment laws that allow professionals to come forward, but they don't. The treating physicians do not identify these people as being dangerous. It's difficult to predict. And as a result, they don't come forward. Just increasing the laws or lowering the standards, I don't believe will make it any easier to predict who will be violent and who will not.

  • 10:54:23

    REHMAll right. Let's go to Debbie in Alexandria, Va. You're on the air, Debbie.

  • 10:54:28

    DEBBIEThank you, Diane. I'm very concerned about the proponents who are speaking about how strengthening commitment laws by invoking the names of people who have done very dramatic and public events, like Loughner and the young man, Elliot Rodgers and Adam Lanza and so forth, because what is being put forth as in the Murphy Bill, they would not have met the criterion. They're not like Ms. Burns' son that had a long history of cycling in and out of the hospital. They were, indeed, acutely ill, but not severely ill. And I'm concerned that a system that is so underfunded and disjointed, as been mentioned, that compelling people to treatment in it won't help them.

  • 10:55:10

    REHMFuller Torrey.

  • 10:55:12

    TORREYSurely, we need more money. But people like Loughner, people like Holmes, were severely mentally ill, were identifiable, could have been stopped. These things are preventable if we had an adequate treatment system.

  • 10:55:23

    DECKERWell, I agree. If we had an adequate treatment system, we might be able to prevent these kinds of tragedies. However, they do not have the continuum of services where people can be identified early, worked with through the system, and then, if they do deteriorate, have the proper intervention. Right now, we have to rely on the police -- totally ill equipped and inadequate -- to deal with this population. And again, these simplistic answers to a very complex problem is distressing.

  • 10:55:47

    DECKERI agree with the last caller. To use these individual, horrific cases as the -- to build a mental system on these anecdotal situations -- Congressman Murphy talks about evidence-based practice, and yet all of his rationale for his bill are individual anecdotal cases.

  • 10:56:05

    REHMCurtis Decker, there are a great many people who believe that Congress is turning its attention to these mental health initiatives because they don't want to deal with guns, because of the NRA. Wouldn't the country be better off if the Congress focused on guns?

  • 10:56:29

    DECKERWell, I think they have to focus on both. I, certainly as a mental health advocate, want to see a robust mental health system. I also think the gun issue needs to be addressed. And it is very disconcerting when we move past the gun discussion immediately to stigmatize people with mental illness.

  • 10:56:46

    REHMFuller Torrey.

  • 10:56:47

    TORREYObviously we need to help on the guns. But the guns is not going to solve the problem we're looking at, Diane. This is a -- these people are mentally ill. Until we treat their mental illness, they will kill with cars. They'll kill with knives. They'll kill other ways as well.

  • 10:56:59

    REHMDr. E. Fuller Torrey, founder and former president of the Treatment Advocacy Center, Curtis Decker, executive director of the National Disability Rights Network, thank you so much.

  • 10:57:16

    TORREYThank you, Diane.

  • 10:57:16

    DECKERThank you, Diane.

  • 10:57:17

    REHMAnd thanks to all of you for listening. I'm Diane Rehm.

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