Who won the Olympics: Lesson for Mental Illness Advocates

As of now, measuring medals,  NBC gives Olympic rankings as follows

1. USA 42 Medals
2. China 42 Medals
3. Russia 23 Medals
4. Great Britain 22
5. Japan 21 Medals
6. France 19 Medals
7. Germany 19 Medals
8. South Korea 16 Medals
9. Australia 14 Medals
10. Italy 7 Medals

And most Americans believe those rankings. USA is number one. Feels Good. American exceptionalism and all that. But if you measure the number of Olympic medals per capita, the US, China and Russia come out near the bottom.

1. Australia 1620
2. UK 2830
3. S. Korea 3036
4. France 3439
5. Germany 4308
6. Japan 6072
7. Russia 6505
8. US 7477
9. Italy 8687
10. China 32,079

And even this is not an accurate representation, because it only performs the calculation for the top 10 medal winners. Qatar, with one Medal and a small population actually beats the USA and almost every other country in per capita medals. 

What does this have to do with mental illness? 

There is a lot of bad information out there because advocates and media are measuring the wrong thing. For example, many advocates say people with mental illness are not more violent than others. This is true. But that is only because the advocates who create that statistic assume that 40% of the population or so is mentally ill. But when people ask, "Are people with mental illness more violent than others?" they are usually asking about the homeless, psychotic with schizophrenia, not "all mentally ill."  As Sally Satel and I wrote years ago in National Review measuring the wrong thing is a common way to  to underestimate the incidence of violence among people with serious mental illness. 

Measuring the wrong thing is preventing us from adopting the policies that can help the most seriously ill. It is  preventing us from understanding who is really doing well at the Olympics.

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.

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