By Marvin Ross
If involuntary committal and treatment works when applied properly, what happens when it is not used appropriately – disaster. My friends at the Treatment Advocacy Center in the US call those instances preventable tragedies and there are many examples of those. To my mind, Vince Li is the most striking.
Mr Li was psychotic and untreated when, on a Greyhound Bus in Manitoba, he attacked his seatmate, killed him and almost decapitated him. A few years prior to this horrendous event, police in Toronto picked him up wandering along the 12 lane highway 401 that runs across the north end of the city on its route from the Detroit/Windsor border to the Ontario/Quebec border. Police, recognizing his fragile mental state, took him to the nearest hospital.
The hospital kept him for a few days and then discharged him back into the community with no follow up which, unfortunately, is not unusual. He continued to get worse until the unfortunate incident on the bus. Despite the enormous outcry from the community howling for blood, he was found not criminally responsible (NCR) and sentenced to a secure forensic psychiatric facility. The public should not have been angry about the NCR but rather about his being ignored by medicine and society until he decompensated to the point he murdered.
Over time and with proper treatment involving the drugs that the anti-psychiatry adherents vilify, he got better to the point where he could go out into the community for short supervised periods, move to a half way house and to an unconditional discharge. The part I do not agree with is the unconditional discharge which means that he does not report to anyone. Given his history, he might regress to psychosis but having him monitored would prevent that. So far, all has been well.
There are many family members killed by their psychotic children who could not get appropriate psychiatric care until after they killed, received not criminally responsible verdicts from the court and were provided with treatment in forensic facilities as a result. Over the years, I’ve written about a number of these events and once had the opportunity to meet someone who had killed both his parents. He was a very polite, quiet, sane young man.
The situation in some instances is so bad that parents live in fear of their psychotic kids, keep their bedroom doors locked at night and have a knife or some other defensive weapon handy.
One other aspect of involuntary committal is Community Treatment Orders (CTO) or Assertive Community Treatment (ACT). These order enable someone to live in the community provided they comply with their treatment. If they don’t, they get hauled back to hospital. One anecdotal bit of evidence can be found in a court challenge to CTO’s by an anti-psychiatry group in Toronto called the Empowerment Council.
Their witness as to the harms of CTO’s actually provided evidence of their effectiveness. Amy Ness had, prior to being put on a CTO, been involuntarily committed for showing violent behaviour in 2004. In 2007, while hospitalized, Ms. Ness kicked her mother in the back and hit her repeatedly. Then, in 2009, Ms. Ness grabbed a large kitchen knife and marched upstairs toward her mother after discovering a magazine about schizophrenia. In another incident, Ms. Ness kicked and punched the emergency department psychiatrist. By the time she was given a CTO in 2009, she had five hospitalizations.
Since then, while on a CTO, the judge pointed out, she takes her medication and sees her case worker on a regular basis. She has not been hospitalized, she maintains her housing and she works as a volunteer, has a job and takes courses. She does think, however, that the CTO is an attack on her personal dignity. Needless to say, they lost their court challenge.
The best one-liner on the topic (and modern society likes one-liners) was given by Cook County Sheriff Tom Dart on the 60 Minutes episode “untreated mental illness an imminent danger?”. Chicago’s Cook County jail is one of the largest institutions in North America housing the mentally ill. Sheriff Dart said “the irony is so deep, you have a society that finds it wrong to have people warehoused in state mental institutions but those very same people were OK if we warehouse them in jail. You’ve got to be kidding me!”
Is it really better to have untreated sick people in jail or homeless in place of actually treating them and helping them to get better? That is really what it comes down to.
For the final word, I’d like to quote Jude Mersereau, author of What’s So Funny? The Autobiography of a Professional Schizophrenian, Artist, Singer, and Public Speaker.
As a lifetime Schizophrenian I have learned to weigh the options of compliance/mental immaturity and their binary results, I have always been able to sign myself into Hospital. Mind you, some of those hospitalizations had been revised to an involuntary stay by my Psychiatrist within 72 hours. I have gleaned the importance of medication, also honesty with myself and the professionals. We all need to realize that it takes years to become ill, and therefore a comparable time to get well. First Hell, then Well. So I take my medication, and shut up if my day is not perfection.(most days) In Canada we have the best treatments, meds, follow-up, intervention and family support and we still can choose to live as a street-ranter with raggedy clothing and, God forbid ,jailtime for acting out instead of “going in”
the choice is yours, friends.