Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Heed the Warning Signs We Must Make It Easier to Ensure Needed Mental Health Care

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Heed the Warning Signs We Must Make It Easier to Ensure Needed Mental Health Care

Article excerpt

When should society intervene if a person shows signs of mental illness?

As with the shooters at Virginia Tech, in Tucson, Ariz. and in Aurora, Colo., there were ample warnings that Aaron Alexis was experiencing mental distress before he killed 12 people at Washington's Navy Yard.

Police in Newport, R.I., did nothing to help Alexis when he complained about hearing voices and being zapped by skin-vibrating microwaves.

They were not legally obligated to.

In 1975, the Supreme Court ruled in O'Connor v. Donaldson that the state "cannot constitutionally confine ... a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends."

That decision established our legal threshold of posing a danger to one's self or others.

The next year, a federal court ruled in Lessard v. Schmidt that involuntary commitment is permissible only when "there is an extreme likelihood that if the person is not confined he will do immediate harm to himself or others." The court required that in civil commitment proceedings people with mental illness receive all the protections accorded to criminal suspects -- including the right to counsel, the right to remain silent, exclusion of hearsay evidence and a standard of proof beyond a reasonable doubt.

In 1979, the Supreme Court decision in Addington v. Texas raised the burden of proof for involuntary commitment from a "preponderance of the evidence," the usual standard in civil cases, to "clear and convincing" evidence.

These decades-old rulings have had a chilling impact.

In 2002, a Fairfax County, Va., emergency room turned me away because my college-age son, who was delusional and had been hospitalized twice for treatment of bipolar disorder, was deemed not sick enough to hospitalize. Police advised me to claim he was dangerous to get him admitted. Three years later, I called the county's Mobile Crisis Unit for help but was again told that I had to wait until my son became dangerous. When he did, that unit refused to come because the dispatcher decided, based on my call, that my son was too dangerous. Instead, the police came and shot my son twice with a stun gun.

Our societal fear of involuntary commitment is rooted in our "One Flew Over the Cuckoo's Nest" past, when innocents were warehoused in state asylums without legal protections and with little hope of release. But times and circumstances have changed.

Other nations have progressed to a "need for treatment" standard, which considers the potential for danger but does not require it.

Under the 1983 Mental Health Act in England and Wales, individuals can be forced into treatment if they have a mental disorder. Patients are examined by a licensed psychiatrist and a doctor, including one who has known the patient previously. …

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