Sunday, July 22, 2012

James Holmes, Mental Illness, Colorado Shootings, Not Guilty By Reason of Insanity

Could James Holmes Be Seriously Mentally Ill?
It is too early to tell, but he could be. There are three reasons people do these things.
  1. Lack of maturity (ex. desire to get attention or get back at someone); 
  2. Political reasons (terrorism);
  3. Their brain was malfunctioning due to mental illness. 
I guess mental illness, and may be wrong, but here's why I think that, based on media reports:
  • James Holmes is 24, the age at which schizophrenia starts. 
  • He is delusional, i.e, believes he is the Joker. 
  • He was "normal" and then became withdrawn. Withdrawal is a common reaction to hallucinations.
  • NY Daily News reported he has lack of affect ("shows no remorse")
  • He is acting crazy spitting on everyone in jail.  
  • The owner of a shooting range reported Mr. Holmes' voice message was "bizarre"
The fact that he was highly educated, and the attack was well planned, does not rule out mental illness. The disease often starts after the education. The Unabomber was also highly educated and planned his attacks well.


If James Holmes had a mental illness that caused the shooting, what could have been done to prevent it?
Probably not much. While there are many (albeit, unused) legal procedures to help people who already have serious mental illness and a history of violence, it is much more difficult to help someone prior to a first episode without violating their rights. (Put another way: the law requires dangerous behavior rather than prevents it). One possible approach might be to make it easier to have someone undergo a 'capacity' or 'competency' hearing. These hearings determine whether someone is rational and can make their own decisions. They are frequently held for people with Alzheimer's, dementia, or developmental disabilities, but rarely for people with mental illness. If someone is found to lack capacity or competency, then someone else can be appointed to make decisions for them, which could include treatment. 


What happens if James Holmes is found Not Guilty By Reason of Insanity for the Colorado Shooting?
(Excerpted from op-ed I wrote a few years back in Wall Street Journal)
If he is found Not Guilty By Reason of Insanity (NGRI) he will be put in locked psychiatric hospital. But theoretically, when sanity is restored, he can be released. As a practical matter, few judges are willing to risk that on their watch, so even when sanity is restored—he will likely be kept committed.


To protect against the possibility of NGRI acquitees going free, some states replaced NGRI with "guilty because of mental illness." Individuals found guilty because of mental illness go to a hospital until their sanity is restored and then to jail to finish out their sentence. This forces individuals who had no culpability for their actions to go to jail at the exact time it's not needed—when they've regained their sanity. For these individuals being mentally ill is the same as being guilty: either way, they go to jail.


Our current system incarcerates people who have no culpability for their actions. It keeps sane people involuntarily committed, and gives potentially violent mentally ill individuals the right to go off violence-preventing medications. That's not justice, it's mayhem.


To correct that, we have proposed that individuals found NGRI be 'sentenced' to treatment for the maximum amount of time they would have received had they been found guilty. This treatment could be in a locked ward if needed or in the community if safe. Treatment would be monitored (much like Parole). The individual could be moved back and forth between inpatient and outpatient treatment as needed with no further court proceedings necessary. This would keep them safe, save money, and keep communities safer.


Learn more
The relationship between untreated serious mental illness and violence
Noncompliance in people with serious mental illness


For more on mental illness and violence visit http://mentalillnesspolicy.org or follow us on Facebook or Twitter.






Thursday, July 19, 2012

US Loses Psychiatric Beds for Mentally Ill




The following chart is excerpted from  “No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals 2005-2010” by the Treatment Advocacy Center (http://treatmentadvocacycenter.org)

It compares public hospital beds available for people with mental illness in 2010 vs. 2005; computes the gain or loss; tells how many beds exist per 100,000 residents; and calculates what percent of the minimum beds needed the state has on hand. Based on that percentage, the state is ranked. There is a dramatic shortage of public psychiatric beds in every state. The result is that more people with mental illnesses are being sent to jails, shelters, prisons, and morgues. 


State
Number of psychiatric   beds 2010
Number of   psychiatric beds 2005
Number of   psychiatric beds lost or gained
Percent of psychiatric beds lost or gained
2010 beds/ 100,000 total pop.
Relation to target beds per capita
State Ranking per capita (worst to  to least worst)

Arizona
260
338
-78
-23%
4.1
8%
Tied for Last
Minnesota
206
464
-258
-56%
3.9
8%
Tied for Last
Iowa
149
239
-90
-38%
4.9
10%
48
Michigan
530
1,006
-476
-47%
5.4
11%
47
Arkansas
203
184
19
+10%
7.0
14%
46
Alaska
52
74
-22
-30%
7.3
16%
45
Vermont
52
55
-3
-5%
8.3
17%
44
New Mexico
171
425
-254
-60%
8.3
18%
41
North Carolina
761
1,461
-700
-48%
8.0
18%
41
Ohio
1,058
1,210
-152
-13%
9.2
18%
41
Texas
2,129
2,730
-601
-22%
8.5
19%
40
Rhode Island
108
134
-26
-19%
10.3
20%
37
South Carolina
426
443
-17
-4%
9.2
20%
37
Wisconsin
558
716
-158
-22%
9.8
20%
37
Kentucky
446
646
-200
-31%
10.3
21%
34
Maine
137
166
-29
-17%
10.3
21%
34
Tennessee
616
1,068
-452
-42%
9.7
21%
34
Mass
696
1,015
-319
-31%
10.6
22%
33
Colorado
520
776
-256
-33%
10.3
23%
29
Idaho
155
157
-2
-1%
9.9
23%
29
Illinois
1,429
1,821
-392
-22%
11.1
23%
29
Oklahoma
401
386
15
+4%
10.7
23%
29
Nevada
302
119
183
+153%
11.2
25%
28
Utah
310
329
-19
-6%
11.2
26%
27
Georgia
1,187
1,635
-448
-27%
12.3
27%
26
California
5,283
6,285
-1,002
-16%
14.2
29%
21
Hawaii
182
171
+11
+6%
13.4
29%
21
Indiana
908
1,201
-293
-24%
14.0
29%
23
New Hampshire
189
224
-35
-16%
14.4
29%
23
West Virginia
259
258
-1
0%
14.0
29%
23
Pennsylvania
1,850
2,349
-499
-21%
14.6
30%
20
Washington
1,220
1,170
+50
+4%
18.1
34%
19
Virginia
1,407
1,659
-252
15%
17.6
37%
18
Florida
3,321
2,101
1,220
+58%
17.7
38%
15
Maryland
1,058
1,203
-145
-12%
18.3
38%
15
Nebraska
337
361
-24
-7%
18.5
38%
15
Oregon
700
691
+9
+1%
18.3
39%
14
Louisiana
903
914
-11
-1%
19.9
40%
13
Montana
194
194
0
0%
19.6
42%
12
Connecticut
741
889
-148
-17%
20.7
43%
11
New Jersey
1,922
2,820
-898
-32%
21.9
44%
10
Wyoming
115
122
-7
-6%
20.4
45%
9
Missouri
1,332
1,238
94
+8%
22.2
46%
8
North Dakota
150
164
-14
-9%
22.3
48%
7
Alabama
1,119
1,001
118
+12%
23.4
49%
6
Delaware
209
281
-72
-26%
23.3
51%
4
Kansas
705
594
111
+19%
24.7
51%
4
New York
4,958
5,269
-311
-6%
25.6
52%
3
South Dakota
238
311
-73
-23%
29.2
62%
2
Mississippi
1,156
1,442
-286
-20%
39.0
79%
1
TOTALS
43,318

50,509
-7191

14.1