This year is on track to go down as the year of mass casualties in America associated with mental illness. With the Sandy Hook tragedy, more than 100 people have now been killed or wounded by rampaging assailants with reported mental health issues.
Horror over the inconceivable violence of these attacks has for a moment focused public awareness on the human cost of inadequate mental illness treatment. Yet - numerous and deadly as they have been - rampages such as those in Newtown and Aurora are the most rare of the consequences untreated mental illness inflicts.
Affecting millions more are the routine circumstances under which people in this country live - and die - as a result of five decades of failed mental health experiments and systematic neglect. These are the millions who live with untreated severe mental illness, behind bars or on the streets, who are arrested, hospitalized or victimized, and who die by their own hands under the influence of psychiatric symptoms.
Behind each number is a human being with a treatable disease that is not being treated. Behind every statistic is a mental health policy that elected leaders have endorsed and the public has tolerated.
It should not take the deaths of 20 small children to produce a day of reckoning for our national neglect of those who are most vulnerable. If it has, these are three public policies that offer hope for stemming both the sensational and the quieter consequences of non-treatment:
- We must stop closing public psychiatric hospitals and restore sufficient inpatient treatment facilities to provide treatment for those with acute or chronic severe psychiatric disease. Deinstitutionalization has reduced the number of such beds more than 95% from their peak numbers 50 years ago.
- We must stop viewing mental illness as a state of freedom to be protected at all costs from involuntary commitment to treatment. It is an uncivil liberty to leave people to die in the streets or lock them up behind bars because of acts they commit while experiencing psychiatric symptoms.
- We must reform our civil commitment laws - and use them. Legal standards requiring people to become dangerous before being court-ordered into treatment must be broadened. Assisted outpatient treatment (AOT) laws making it possible to commit individuals to treatment while living in the community must be enacted in the five states where they don't exist and used more widely in the 45 states where they do.
It is not only for the 20 children and eight adults dead in Newtown that this day of reckoning should not be allowed to pass without action. It is for us all.
(Adapted from an op-ed in the Milwaukee Wisconsin Journal Sentinel by Doris A. Fuller, executive director of the Treatment Advocacy Center. Click here to read the op-ed in its entirey.)