By E. FULLER TORREY
The Wall Street Journal
January 12, 2011
The killing of six people in Tucson is one more sad episode in an ongoing series of tragedies that should not be happening. The alleged shooter, Jared Lee Loughner, is reported to have had symptoms associated with schizophrenia—incoherent thought processes, delusional ideas, erratic behavior—and almost certainly was seriously mentally ill and untreated. The fact that he was barred from his college until he was evaluated by a psychiatrist would appear to confirm the nature of the problem.
The truth is that these tragedies are happening every day throughout the United States. The only reason this episode has received widespread publicity is because there were multiple victims and one victim was a member of Congress. Such senseless killings have become increasingly common over the past 30 years, starting in about 1980, when Allard Lowenstein, coincidentally a former congressman, was killed by Dennis Sweeney. Sweeney was a young man with untreated schizophrenia who had been Lowenstein’s protĂ©gĂ© in the civil rights movement. Congress was also prominently involved in 1998, when Russell Weston, who also had untreated schizophrenia, killed two policemen while trying to shoot his way into the Capitol Building in Washington, D.C.
These tragedies are the inevitable outcome of five decades of failed mental-health policies. During the 1960s, we began to empty the state mental hospitals but failed to put in place programs to ensure that the released patients received treatment after they left. By the 1980s, the results were evident—increasing numbers of seriously mentally ill persons among the homeless population and in the nation’s jails and prisons.
Over the past three decades, things have only gotten worse. A 2007 study by the U.S. Justice Department found that 56% of state prisoners, 45% of federal prisoners, and 64% of local jail inmates suffer from mental illnesses.
A 2008 study out of the University of Pennsylvania that examined murders committed in Indiana between 1990 and 2002 found that approximately 10% of the murders were committed by individuals with serious mental illnesses. There are about 16,000 homicides a year in this country. Using the Indiana study as a guide, roughly 1,600 of them are likely committed by people with serious mental illnesses.
In Arizona, public mental-health services are among the worst in the nation. In a 2008 survey by the Treatment Advocacy Center, Arizona ranked next to last among all states in the number of psychiatric hospital beds per capita. If you don’t have hospital beds and outpatient clinics to treat mentally ill people, those people don’t get treated. Thus the tragedy was somewhat more likely to happen in Arizona because mentally ill individuals are less likely to receive treatment there. Although Arizona is the worst state, except for Nevada, in psychiatric-bed availability, there is no state that currently has enough beds for its mentally ill population, according to the Treatment Advocacy Center study. This tragedy occurred in Arizona, but it could easily have happened in any state.
The big picture is even scarier. Based on Arizona’s 2010 population and on estimates by the National Institute of Mental Health of the number of individuals with untreated schizophrenia at any given time, there are today in Arizona over 21,000 individuals with untreated schizophrenia. Most of them, thankfully, are not violent. But a small number of them—about 10% according to my meta-analysis of relevant studies—do become violent, usually because of their delusional thoughts and what their voices (auditory hallucinations) are telling them. This situation holds in every state. It is thus not a question of if such tragedies will occur but rather when and how often.
Mr. Loughner’s delusions fixated on Arizona Congresswoman Gabrielle Giffords, one of 12 seriously injured in the shooting. Some have speculated on the possible relationship of our acrimonious political climate to the incident. It is, however, unlikely that there is any such relationship, since similar tragedies occur in politically harmonious times as well.
The motivation for such killings is usually based on psychotic thinking, not political thinking. Dennis Sweeney killed Allard Lowenstein because he believed that Lowenstein had implanted a transmitter in his teeth that was sending messages to him. Russell Weston stormed the Capitol because he believed the government had hidden a machine there that could reverse time.
The solution to this situation is obvious—make sure individuals with serious mental illnesses are receiving treatment. The mistake was not in emptying the nation’s hospitals but rather in ignoring the treatment needs of the patients being released. Many such patients will take medication voluntarily if it is made available to them. Others are unaware they are sick and should be required by law to receive assisted outpatient treatment, including medication and counseling, as is the case in New York under Kendra’s Law. If they do not comply with the court-ordered treatment plan, they can and should be involuntarily admitted to a hospital. Arizona has such a provision in its laws, but it is almost never used.
Ultimately, it is important to hold state officials responsible for not providing sufficient resources to treat those who suffer from serious mental illnesses. For almost two centuries, it has been an accepted function of state government to protect disabled persons and to protect the public from individuals who are potentially dangerous. State governments have been very effective in emptying the hospitals in an effort to save money but remarkably ineffective in providing treatment for seriously mentally ill individuals living in the community.
Dr. Torrey is the founder of the Treatment Advocacy Center and the author of “The Insanity Offense: How America’s Failure to Treat the Seriously Mentally Ill Endangers Its Citizens” (W.W. Norton, 2008).