Thursday, July 14, 2011

A few people with mental illness are very dangerous. There are better ways to keep us all safe.

Why did Jared Loughner, a dangerous mentally ill man never get treatment?  Teachers, friends, family members and others not only knew he was disturbed, his actions and words caused them to fear him.  In my experience providing crisis counseling to people with mental illness who are dangerous, most people are afraid of becoming the target of aggression.  I had become a target on a number of occasions over my twenty plus years in crisis work.  I understand why others won’t want their names attached to a complaint. The question for many becomes who to call?  In the end the police have to be involved.  Had a mental health professional been contacted, he would have had to involve the police to facilitate the evaluation.  Mr. Loughner created such fear that when the campus police went to his home to tell him he would no longer be able to attend college, they requested backup. 
The police are the primary providers of mental health services in the United States.  They deal with the mentally ill at all times of day and in both private and public settings.  At a time when the police are also being judged with regard to their actions in Tucson prior to the shootings, it is important to state that the actions taken by law enforcement regarding Jared Loughner were appropriate to the circumstances and consistent with actions taken by law enforcement agencies throughout the country.  The consequence of those actions will be that Mr. Loughner will enter the prison system, joining the approximately 320,000 other mentally ill individuals currently incarcerated.  If you add the 100,000 currently in mental hospitals, the result is almost the same number as those in state hospitals prior to deinstitutionalization.  It is also important to state that most interactions the police have with the mentally ill are ineffective because the police are not part of the mental health system and have no regular access to it.  When the call is finished and the records are written and the shift ends, nothing happens.  The only way to resolve this and to create effective interventions that can stop incidents like what happened in Tucson is to have mental health professionals attached to police departments.  One of the clients in the clinic I ran killed a police officer in 1996.  As a result, I worked with police to form a partnership that would link mental health services with local law enforcement.  Sharing information was a crucial aspect of our work within the limits of confidentiality.  I opened cases that were appropriate mental health cases and transferred primary responsibility from law enforcement to mental health, often using mandated treatment with the cooperation of local judges.  While many of our cases were driven by police reports, I would also open cases based on reports of family, friends, coworkers and landlords.  Sadly, many went nowhere, because the person was not dangerous.  The concept of dangerousness needs to be replaced by need for care.  Anosognosia, the inability of the person to recognize illness in himself, made it impossible to help many very ill people.
Crises take place on a continuum.  Mister Loughner had multiple negative contacts with police, teachers, family and friends.  At those times, if he had then been connected to mental health services, there could have been interventions.
                In this brief window between outrage and despair, there is a chance for action.  Congress can begin by appropriating funds to have police agencies throughout the nation hire mental health social workers or caseworkers to attach to departments and precincts to move people with serious psychiatric problems from the criminal justice to the mental health system.  Mental health courts could help facilitate this process.

The Story

            Mr. Jones was handsome and charming and extraordinarily dangerous.  His good looks and charm got him pretty far along.  Preppy was the term we used to describe him, which in a town with an Ivy League University is not a negative.  Wavy black hair, soft blue eyes and a 100 watt smile gave him more second looks then he deserved.  Women who should have known better suspended their judgment when they met him and would at least take the opportunity to know him better.  I never met one who did not regret it.  He never really participated in treatment, but my interactions with him, all of them in my role as crisis counselor, would lead me to believe he had schizoaffective disorder.  This diagnosis combines the elements of a mood disorder like bi-polar with elements of a thought disorder like schizophrenia.  What it produced in him was a manic mood that was like someone after 20 cups of coffee. Once started, he did not stop.  That mood was wrapped around thoughts that were very disturbing; like he was the smartest man in the United States and the government was after him, torturing and punishing him because of his genius.  Unfortunately, his actions played out these thoughts and moods in frightening and dangerous ways.

                He lived in a rooming house downtown occupied by students and recent graduates.  It was a building where there were shared spaces like kitchen and bathroom.  He ate people’s food, he banged on the bathroom door, and he entered other people’s rooms and sat on their beds while they were sleeping, then waking them to tell them something.  It was at that point that the winning smile became the frightening grin.  If they disagreed with him, he would yell at them and curse them.  I got a call from the police department one morning asking me to come see him.  He was in a holding cell at the back of the station.  “They locked up the wrong person!  They screwed up!  Get me out of here!”  When I tried to ask what happened, he was out of control.  “She’s the criminal, not me!”   The overnight shift had gone home, so I read the report.  At about 4 in the morning he had arrived at the police station with a young woman.  Her hands were tied behind her back and she had packing tape over her mouth.  He pushed her against the bullet proof window and shouted, “This is a citizen’s arrest.”  The desk officer responded by putting him in cuffs and taking him to a holding cell.
               
                The woman reported he’d come in after the bars had closed and had been crashing around the kitchen and bathroom.  He then had gone from door to door asking if anyone had cigarettes.  She had been sleeping for a while before he came home and since it was a weekday she had school in the morning.  She’d begun to yell at him and when she'd had enough of his antics she got very personal in her language.   He grabbed her and put her face down on the bed and yanked out the phone line to bind her hands.  When she’d screamed he pushed her face in the pillow, yelling at her to “Shut up!” The packing tape was put on before he pulled her down the hall.  In her nightgown and bare feet he pushed, pulled and dragged her the four blocks to the police station.  He wanted her charged with aggravated harassment for cursing at him and calling him names.

                I tried to speak with him, to calm him down.  He had no idea what he had done to be treated this way and as he stated to me many times, “I’m not crazy.”  A few hours later when he got in front of the female judge, he was calm and charming, but the judge would have none of it.  Before his arraignment the court officer had run his “sheet”, a list of previous charges and crimes.  At the time, the computer paper was on a roll.  His sheet was 14 feet long.  I was in the court and the judge asked me if he would get mental health treatment in jail.  “We’ll try,” I replied.  “If I send him to the hospital there’s no guarantee they’ll keep him, is there? “  she asked, already knowing the answer.  He went to jail and the student got an order of protection.

                A few months later I got a call from an officer I knew quite well. “Terry, I’m in my car on Green Street and Mr. Jones is walking down the street pushing a shopping cart with a rifle in it.  Is there any reason he should have a rifle?”  A chill went through me, “No, absolutely not!”  I did a short hand of mental hygiene law in my head.  “Take him into custody, I’ll sign the papers.  And please be careful.”
                Minutes later I met her at the police station with him in an interview room.  I sat across from him at a desk and asked what the gun was for.  He smiled smugly and said, “None of your business.  I’m not crazy and I don’t have to talk to you.”  An investigator went to the K-Mart where Mr. Jones had bought the rifle and nearly 1000 rounds of ammunition.  There was no background check at that time and if there had been it would not have included psychiatric hospitalizations.  On the form where it asked if the person purchasing the weapon had ever been committed to a mental hospital against their will, Mr. Jones had checked “No”.  When asked about this, Mr. Jones had replied, “All of those hospitalizations were illegal, I don’t recognize them.”`
                Hours on the phone trying to get the Feds through the ATF (Alcohol, Tobacco and Firearms) to file felony charges for lying on their form were wasted.  The local District Attorney’s office finally came up with the misdemeanor charge of filing a false instrument.  We noted that Mr. Jones at the time was heading in the direction of the colleges.  He never told anyone what the gun was for.  He left town shortly after that, telling me and my police partner Beau Saul, “I can’t do anything here, I’m leaving.”  Months later I got a call from a Sergeant in a police force in a nearby city.  “I picked up this crazy guy with a shotgun.  What can you tell me about him?”  I replied, “Look at his sheet.”

2 comments:

  1. When will this end? These are the people that give mental illness a bad name. Isn't this what mandated outpatient treatment was supposed to take care of? Kendra's law? Don't they have something like it in Arizona? Why isn't Mr. Jones forced to have treatment?

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  2. The truth is that, as a group, mentally ill humans are no added intense than any added group. In fact, they are far added acceptable to be the victims of abandon than to be agitated themselves.

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