Mr Ornstein, I am so sorry for your loss and grateful you chose to spotlight this issue. Unfortunately your experience is remarkably similar to millions of families in the United States, including my own with a schizophrenic family member.
Unfortunately, for many politicians, especially among republicans: .....if an issue does not directly affect them, there is little interest or empathy for the problem. I never understood why Pete Dominici was one of the few Republican advocates for mental health insurance coverage
until I found out that his daughter was schizophrenic (http://schizophrenia.com/New/Dec02b/politics.htm).
This tendency is not limited to mental health. For example, republican Texas senators are all too willing to deny Federal relief for a hurricane in New Jersey and then are first to demand Federal funds for hurricane Harvey in Texas .
Bottom line, the Republicans and their NRA sponsors who pretend to care about mental health will never properly address this issue.
1
A flaw in the article is a premature acceptance that mental illness had anything whatsoever to do with the Parkland shooting. That remains to be seen. We do know, however, that he had an assault weapon able to kill many people quickly, and, in retrospect, shouldn't have. I'm not sure we can accurately pick and choose which people outside of the military shouldn't have assault weapons to head off such massacres, while allowing lots of other individuals to own one or several. We should as a society weigh what good they serve in even the calmest and safest civilian hands -- to date I've seen no persuasive reason -- versus what harm they cause being sold at all if we don't have a perfect crystal ball to predict who will misuse them-- a harm we know all too well.
13
I am very sorry to read this story and many others readers have shared in the comments. In the USA, the tragedy of mental illness is compounded by the tragedy of inhumane, ineffective treatment or no treatment at all.
We wonder, when will this change? When will resources be devoted to providing comprehensive, humane care and support services for those who are struck by mental illness? Unfortunately, unless we can somehow do something about the ever increasing concentration of wealth into fewer and fewer hands, the answer is never, because the masters of our country see us all as surplus people. Some are useful now, until age renders them inefficient. Others, burdened by mental or physical illness, limited intelligence, an inadequate education and upbringing, or other factors, are deemed useless now. In the world of the masters of capital, humans are merely a cost, an expense to be reduced or eliminated. We are only valuable to them as long as we are productive enough to earn them profit. Fail to do that, for whatever reason, and they want us dead. Yes, that's right. Dead, the sooner the better, because supporting us would be a drain on their profits. Unless we the people can take the capital out of their hands and put it to use for the benefit of all, being discarded is the fate of us all; the mentally ill will just face it sooner.
10
Mr. Ornstein~AGREED!
The Baker Act, known in Southern California as a "5150," is a travesty which violates basic rights of liberty and doesn't help the mentally ill at all. It is a total waste of taxpayer dollars milked by unhelpful psychiatrists, cruel hospitals and Big Pharma, all for $5,000.00 per day in unlawful detention. Most individuals, unable to protest, are heavily drugged and tossed into rooms with lights blaring 24 hours. Further, nurses pass out cigarettes to "calm" those in this inhospitable environment. Later, the bill collectors come.
Agreed that the Baker Act/5150 serves no function and deeply damages those unsuspecting individuals caught in the web. In Southern California (San Gabriel Valley specifically), the police abuse 5150 to punish anyone, especially females, who make note that the cops are breaking the law. This especially occurs regularly in communities with majority Latino populations where the police take advantage of those reluctant to complain. Fighting this unlawful behavior is a long and heavy battle with fruitless outcomes.
Perhaps an NYT journalist would like to investigate San Gabriel Valley cop blotters to confirm 5150 abuses. Thank-you Mr. Ornstein for shining a light on this un-American prison and condolences for yours and your son's terrible experience.
9
Todd Zen, I could have written much the same in terms of my adult experiences with psychiatric wards/hospitals. Every time I've been in my only thought is to get out. If, due to nothing else, the sheer unending boredom. No therapy, art room, if there is one, locked constantly. Enough staff to hand out meds and do the administration mandated checks every hour or so. It is horrible.
Having been in so many times I now know exactly what to tell the psychiatrist, when I finally get to see one that is, in order to be released. Basically lying through my teeth.
Basically one is lucky to come out of such an experience no worse than when they entered the hospital, but, all too often, winding up worse.
And, yes, the bills you walk out of there with are sky high. Then comes the dance with the collections department and the insurance company if you are fortunate enough to have health insurance. Just what one needs when in such a bad place, needing to fight and work the bureaucracies of the system.
I should also mention that ones trust in their out patient personnel -- therapist, etc -- who might have pushed them into the hospital whether convincing one to go inpatient voluntarily or not -- is severely lessened in more cases than not.
14
How could you possibly fill out forms for committing your son before seeing him?
How could you imagine any other outcome than the police arresting him like a criminal, after they are told he is crazy and dangerous?
I'm really sorry this happened to your son, but it was a direct and predictable result of your very foolish actions.
10
I am so very sorry for your tragic loss. What your son and you went through is a shocking example of the state of mental health and the ignorance around it. If we had strong gun laws there would be less need for extreme responses to troubled individuals. Compassion and easy access to mental health care are essential, especially in light of the opiod epidemic. Unfortunately, money is going to the top 1% and businesses, not to Medicaid and government programs that would address the problem. Americans have to vote in every election, and vote Democratic.
2
Shame on the readers chastising the Ornsteins for invoking the Baker Act. I'm sure it was a difficult decision. I know in this case it turned out Matthew's parents were misinformed. But what if Matthew had been ready to kill himself and his parents decided to wait until they saw him to assess the situation, and in the meantime he killed himself? I am a parent who once had to decide whether to call the police or drive to pick up my child when my child phoned saying he was in a college classroom bathroom having an anxiety attack after he had tried to get to the roof and the door was locked. I went to pick him up, but what if I had been too late? Parents of children with mental illness make decisions that aren't covered in Dr. Spock. With little or no support from the rest of society. I'm sorry for the loss of your beloved Matthew, Ornstein family.
19
Mr. Ornstein, I have long admired your measured opinions on television. I have bipolar disorder, and am a bit alarmed at the blame always turned our way after these shootings. Most people who deal with mental illness are victims of crimes. There is no national outcry about that. It's easy to stigmatize us, we have no advocacy group like the NRA. That said, I take my medicine and march on, come what may. Thank you for your concern about mental health. I am sorry for your loss.
11
The several hundred comments I've read break my heart. How is what America has done to our mentally ill an improvement over the asylum used when we believed in demon possession or keeping our kin locked in the basement or attic? We know now so much more, that psychiatric conditions are brain diseases. Yet we fail to acknowledge this and make care for people with these disorders 2nd or 3rd class care, if there is care at all. We allowed health insurers avoid paying or treating and we closed public facilities never developing community based services promised with deinstitutionalization.
In America's health care creed: we are all responsible for our own health and of course financially responsible too. If you are physically or mentally sick or injured you are responsible. It was something you did, or failed to do. If you are wealthy or have (or your family has) the proper insurance plan, you may luck into care. It isn't guaranteed. It depends on your zip code.
I know there are good and caring providers across America but how did we allow ourselves to do this to ourselves. Aren't we tired of treating each other so poorly? Aren't we ashamed of how we care for each other? Not enough to seriously try to change how we do it. I think about this every time I hear that Americans have the BEST Health care in the World.
7
My condolences to Mr. Ornstein and his family. Our son has been "Baker Acted" a couple of times for trying to hurt himself. The first time he was admitted to the psychiatry ward for 72 hours. The second time he was examined in the ER for five hours and then released to us. I asked why the ER physicians didn't admit him again. We were told he was stable and the Baker Act is for up to 72 hours. He was discharged with outpatient followup.
2
My brother was ill from unrelenting schizophrenia starting in his early 20s and lasting until his death from cancer in his 60s. I know the terror and sadness and tragic waste and loss associated with serious mental illness. I am so sorry your family experienced this.
8
I see so many callous remarks from commenters who blame the Ornsteins for not visiting their son before they signed the papers. I'm sure this failure is something that haunts the Ornsteins every day of their lives, but they couldn't have known what the process was.
It's easy to be judgmental, but hard to be a parent of a mentally ill child. Until you've walked in their shoes, reserve judgment. Our system is broken. Reserve your outrage for the system.
13
There are people with diagnosed mental illnesses, anxiety and OCD, for instance, who are more self-aware and mindful of how to care for themselves than are many unpleasant, negative and profoundly miserable people who think it is always the other person who has the problem.
5
Thank you, Mr. Ornstein, for explaining, accurately, how the mental health system and laws related to it often cannot effectively help those in need. The sad truth is, though, that mental-health care is not profitable, or not prifitable enough, for hospitals and other medical-care professionals. So it gets ignored. I don't know whether the solution lies in more public findung or in some other sort of revamping of the system. But fundamental change is needed.
5
I cannot address the author's experience or Florida law; however, Texas Health and Safety Code Chapter 574 has also presented problems for family members whose loved ones face mental health issues.
I have had to defend police officers who have resorted to the use of deadly force with mentally disturbed persons.
In such scenarios, a recurring complaint was the family's inability to have their loved one committed prior to the police response resulting in death.
For those family members, they believed the probate courts and the mental health system failed them by not allowing them to commit their loved ones.
Moreover, they are upset that the police are perceived as sending deadly force to respond to a medical issue.
Unfortunately, as I have seen this debate unfold, the "failures" seem to have no solution. In some cases, I have seen families give up on seeking commitments, because the soon to be ward opposes commitment and succeeds in court. Frustrated families only recourse is to seek police protection with the only tool being weapons, not medical help.
6
When a politician says "improved mental health services" they really mean "lock the psychos up".
6
I'm not even sure they mean that. They mean spend more money on their, or a friend's pet project. Almost never is the intent to improve mental health services to serve a significantly larger number of people, particularly not the number who actually need them or would benefit from them. We fund token mental health services, nowhere near what's needed.
4
We need more beds and they need to be in better treatment centers. When the three largest mental health facilities in the nation are jails, something is seriously wrong. Every community that's big enough to have a jail should have a commensurate mental health facility. Yes it would be hard, but in America, we do hard. We just need to make sure it's done at the lowest level of government possible, not in the hands of the Federal Government because it makes easy hard and hard, impossible.
5
I'm so sorry for your tragic loss and Matthew's bad experiences. I too lost a young adult son who was almost 25 when he died.
That said, this one experience suggests not a bad law, but a bad application of the law. There is no excuse for not allowing someone to dress before carting them off. A mental patient who is not demonstrating dangerous behavior does not need to be handcuffed.
This appears to be the result of little or poor training of police officers. Every state offers Crisis Intervention Training but many police departments do not train their officers.
For some years I served on the board of a state organization that offered such training free to every police department in the state.
My own town refused the training. I never learned why, but on the face of it, what good reason could they have? Yes, they would have fewer officers in the field for a few days or pay a little overtime, but what is the saving of one life worth? Surely more than this.
Please help improve the law and its administration.
9
Consider this: There are only physical diseases; mental disorders are caused by physical deficiencies. Diabetes is caused by malfunctioning beta-cells in the pancreas; Schizophrenia results from -------. Some of our ancestors believed crazy people are possessed by satanic forces. The beliefs current medical people maintain are not all that different from those held by our ancestors.
7
Other states have different policies.
A good place to start, while waiting for a legislative overhaul, would be sensitivity training for law enforcement. Really? They can't be bothered to give someone in a crisis 5 minutes to dress?
And there's no recourse against manipulative landlords who lie?
Who came up with the nonsense that "it's not a crime to lie?"
7
For the hundreds time. It was a manager, not a landlord. The father was the landlord.
1
Mark my words...
In their zeal to appear to do something, anything, about mass shootings... anything but address the real problem of an availability of guns with high rates of fire and large ammunition capacities... politicians will convince us all that they will somehow be able to accurately predict who among us is a potential mass shooter, and when to "remove" such a person from society. For this folly, we will reward them, everyone will declare victory, and go home, pretending that the problem has been solved.
Then, after a generation of young men and women have been brutalized by a mental-health system designed not so much to "treat" them, as to make them "disappear" (and no credible evidence that this has made us any safer), we'll realize our mistake... and then spend decades talking about what a mistake we've made, before choosing to do nothing. Again.
Call me cynical... but I feel like I've seen this movie before.
3
We all know that we need improvement in the mental health system and need to improve the way the legal system deals with the mentally ill.
Yet the mental health system throughout the country has to fight hard to get and keep the poor resources that it has because everyone wants a tax cut!
So, we need to decide to pay for the system we want if we ever want to have one. Right now, increasing taxes is considered the worst disaster that can happen by huge numbers of Americans.
We need to take responsibility for the need for mental health treatment and vote to pay for it.
7
You seriously abused the process to have someone involuntarily committed. You should have met with your son and made a personal assessment prior to going to a court. This is the major issue with "red flag" laws. There are no controls to prevent serious abuse.
4
On the other hand, if he was in the middle of a full blown crisis, the terrible treatment in a mental health facility would not get to the bottom of what was causing the crisis nor would it resolve those underlying physical conditions. He would be traumatized, stigmatized and warehoused until he acted complacently enough to be left to his own devices until his metabolic brain injury worsened and his symptoms returned, as the Merck manual has described for about a hundred years, advances in so-called modern medicine doing little to change that prognosis.
Either way, this hoax of a mental health care system would have done "nothing to help him deal with his condition and only increased his sense of being stigmatized and hounded." Drugging someone long enough to enforce enough sleep to let autophagy clean up the mess in a damaged brain isn't much better than electroconvulsive therapy. Both have severe, unintended health consequences and do little to prevent continued episodes of neuroinflammation and resulting brain injuries that drive psychiatric symptoms. Trauma, stigma, and an understandable tendency to resist institutional "mental health care" are the likely lasting outcomes.
4
So much research is needed, and perhaps is being done; I'd be interested in reporting on this. That many of these illnesses seem to come out of the blue in the late teens - early twenties must be a clue as the causes. As someone who's suffered from what I guess is a low level mental illness - I call it that because I've never been psychotic - I suppose gratitude is in order. If those at the far end of the mental illness spectrum can't be seriously treated, forget about the rest of us who also suffer.
2
I am so sorry this happened to your son and your family.
6
Horrible how the authorities handled this! But you didn't check in with your son first (or have a friend/social worker/anyone do so), or check out the information you received before filing papers to have him involuntarily committed? Or find out the details - how your son would be approached, your rights, etc? No to put blame but that struck me as way extreme...
3
"In a panic, we flew to Sarasota, went to the courthouse and filled out the forms to invoke the Baker Act."
Why didn't you visit your son first or try to contact him before heading to the courthouse? That makes no sense to me.
6
I wish everyone saying this would read just a little further.
2
The lower-class version of this is being arrested for “menacing.”
2
You signed the papers before seeing and speaking with your son. That's the failure here. Not the law, not the false reporting by the landlord.
5
I will never understand why Norman Ornstein works for the odious AEI.
4
So the government wants to start paying for sex reassignment therapy at over 50k a pop but cannot even provide the basics of mental healthcare.
4
Mr. Ornstein, I am very sorry for the loss of your son. I agree with your opinion and can only state that, when it come to the treatment of mental illness in this country, there is much potential for unintended consequences tragedy.
A legal recommendation to parents:
When your child turns 18, discuss with your child the areas in the child’s life in which he or she may need your assistance and then create a Durable Power of Attorney in which you “may”, though not necessarily, act on the child’s behalf.
Each state has a statutory “form” that can be filled out accordingly, signed by your child, and notarized.
In my own case, before my daughter went to college, I was given a POA for the following transactions: real estate, banking, insurance, claims and litigation. In addition, I had the POA for “health care billing and payment matters, records, reports, and statements” (excerpt of NY short form).
This is no panacea for the current system, but it does help.
7
That is a very sad story indeed, to lose a son or daughter at any age is terrible. As to mental health for young people I have done a great deal of teaching in the UK of 'media studies, 'creative writing' feminist studies' et al. (I am not undermining them) I could go on with the array of pedagogically bewildering studies available. However one does not come across studies in regard to mental health for those students at a young age; of course psychology is available to say post 16 years of age but for many this is too late.
Apart from the heart rending article there is an Opioid crisis in the US and sleeping on the streets in cities such as London no longer shocks passers by
a great deal of the Opioid casualties and rough sleepers could have been helped to lead healthier lives if mental health issues had been part of school
curriculums at a much younger age
I appreciate your speaking out on this important issue and sharing your deeply personal situation.
However, we have to be humble enough to recognize that in many cases we lack the resources and information to make accurate judgments as to people's future action and whether or not they a danger to themselves or others.
So the real question is: how do we want to err? Would we rather be overly restrictive with respect to anyone that may exhibit signs of being dangerous and keep them locked up even if they ultimately present no danger or should the policy be to release people unless there is clear and indisputable evidence that person presents no danger. Either way you will have situations like the writer's where people are improperly retained or, conversely, you will have situations where dangerous people are let go.
Norm, I am very sorry for your loss, and more sorry that you were not able to help your son when he most needed it.
Reform of the Baker Act is clearly called for, but on its own it will do little. We need to recognize, as a society, that many mental illnesses are treatable, and that having a mental illness is not an inherent moral failing. For too long we have treated our infirm and sick as morally deficient and second-class citizens instead of people who need some help from their community to ease their struggles and help bloom their potential. I recognize the problems and agree that we need better solutions.
Do you know of any think tanks that work on mental health issues in the public interest that you could put us in touch with? If you know of none, and nobody else knows of one, perhaps its time to found one.
The National Alliance for the Mentally I’ll, among others, has state and city level branches providing resources and support for families and peers(those living with and managing severe mental illness). NAMI.org. The website offers state specific info on useful things like - health care proxies (signed by patients in an aware state to indicate who they would like to make decisions when they are unable to decide for themselves; “assisted outpatient programs” or ACT and PACT programs that include some elements of involuntary confinement and evaluation, and other resources. Sadly many of the best models are only that, even with 25 years of evidence - pilots, or underfunded small efforts. There are not enough psychiatrists, not enough facilities, too much fallback on law enforcement, etc. Truly those who cannot recognize their own illness are very hard to help, but as many commenters have said, families and communities in this country have often rotten systems for awareness or access to the help that could be available. Advocacy by NAMI , Community Access, and other groups, often working hand in hand with the American Psychiatric Association, can help. Find your local group. Join it! Send letters, support the cause. Every one of our families and communities will benefit!
2
Thank you for writing this piece. You are spot on! I commented on a piece the other day about a wonderful young woman who is homeless and mentally ill. My mother Claire was homeless, caused by her inability to manage her affairs ands a real lack of resources, compounded by her paranoia and other mental conditions. She never sought or received treatment. She avoided me because she didn't want to get treatment. Once I was able to get her to an emergency room when she was on a 7 day sleepless jag, but she didn't meet the "Imminent Harm" standard and they released her. I didn't hear from her for 4 years.Then it was only to ask for funds via Western Union.Once I tried to make the case that a sick woman in her sixties who was sleeping each night in Kennedy Airport was by definition mental ill. I got nowhere with that, Any other contracts she had with health are or police etc never made it me, obviously. We need to become a caring nation, not a nation of armed guards and bullet-proof glass. Once we lived in villages and cared for each other, we knew each other, but now we have to have a one-size fits all, and in this we are disposing of people; our mothers our fathers, our sisters and brothers, our children. It must stop.
2
My mother was schizophrenic and bipolar with psychosis growing up. The medical system was of no help and she refused taking medication due to side effects. After losing family , job, and homes she subsisted on SSI and Medicaid. Not one of her several hospitalizations were helpful.
As the eldest and main abuse target, it was difficult to spend more than a few minutes with her. I learned to early to walk on eggshells with her and similar folks. I had a broken heart too and couldn’t trust anyone.
I just want to add this though. In my attempts to heal I knew forgiveness would be essential and yet it was so elusive. I worked twelve steps, went to vippassana retreats and really only found relief with Reiki... and the approach of ,”radical forgiveness “.
After shamanic-type journeying, I clearly had love and forgiveness for her. Sent the love letter and huge weight lifted off me. Amazingly it seems she too has been healed which I can only describe as Grace.
She is happier, coherent, and a true pleasure to visit with.
9
I am sorry for what transpired for this man's son and family. I'd explore criminal and civil charges for what the landlord did.
obviously the mental health and criminal justice systems are seriously broken and need to be fixed. Most definitely family members must be able to be part of mental health treatment and be able to advocate for them and make decisions when the child/person is unable to. sort of like an automatic medical power of attorney for entering mental/emotional health facilities (maybe be limited from family members who have inflicted problems onto the child).
as the the red-flag laws, I'd suggest that school counselors also be allowed to submit information to bar a student who shows dangerous behavior and violent disruptive episodes (as opposed to kids having stupid but not in anyway violent pranks on their records). School counselors see these kids every day and I would guess have the best ability to know who the potentially dangerous ones are.
5
"Ironically, a model exists near Parkland." This model also exists in NY. My daughter was sentenced to diversion court, and voluntarily agreed to receive community-based treatment, support, and housing services. Problem is, she is mentally ill -- which means she ran away after spending only 12 hours in her new home. Unless the facilities are lockdown, they won't work. That's why so many of these mentally ill people end up in jail and prison.
4
Any time we allow bureaucrats who are not accountable to us, the public, to take over the lives of any person, we know from past experience that the outcome will not benefit anyone. Bureaucrats don't care about humanity, only about hanging on to their jobs.
1
I am surprised that nobody (or very few) has commented on the irony that the author works for the American Enterprise Institute. This is a right-wing think tank that usually advocates for the diminishment of government involvement in peoples' lives. They (AEI) often seem to insist that we dismantle government entirely.
11
We need to have a new paradigm as the old one of mental health being separate from physical health. You cannot remove your brain like a car engine to get it fixed nor can it be replaced like a knee when it becomes too broken to use. Just like nobody asks to get cancer, nobody asks to get a mental illness. They just seem to happen and there are physiological causes, just like someone who gets cancer.
Why can't we treat people as whole human beings? I see my nephew who was diagnosed as bi-polar and I see a human being in need of medical care. My friend's son who was diagnosed with schizophrenia needs medical care to deal with his condition. My own mother was diagnosed with bi-polar and manic depressive. Medication helps these people and many others with similar conditions just like chemo helps people with cancer. There is no difference.
But with that said, when any of my family is off their meds, they can and often do become violent and harm the people around them. We need to find a way to fully fund a mental health emergency team in every community just like we have EMTs. The police already have far too many duties to take on anything new. We need to have laws that direct people to health care before they commit an act of violence.
I experience more than 10 years of abuse in my mother's home because of her illness, my friend, 20 years and counting all because doctors keep claiming mentally ill people are not a danger to society, that is until someone ends up dead.
4
How tragic and unnecessary that we lost your son, Mr. Ornstein. Like many here and elsewhere, I have had experience with family and friends who have serious mental illness. In one case, I was the only person to be called on to help my friend who had no family in this country. She had her first psychotic break in what turned out to be her first manic episode.
After being in a hospital ward for a few days and "stabilized" with drugs, it was up to me to find a doctor to continue her treatment. Though she had good health insurance, every provider I called on the list was not taking new patients. Less than a week later, without treatment and without a mental-health professional, she was back in the hospital.
I'm sure this scenario is quite common. And it is a shame. She likely would have gotten better care in her home country. We should be ashamed of ourselves and do something about it instead of constantly blaming the people afflicted.
6
I recall when President Regan embraced the “empowerment” of the mentally ill. With the great new drugs available, the reasoning went, institutionalization was unnecessary: patients could simply pick up meds at new community treatment centers. Cheaper, efficient, and above all, more humane, more empowering. Mental hospitals were closed. Rah! But then the funding dried up for the promised community centers. The streets and subways in NYC filled with the mentally ill and their bags and carts and their confused attempts to survive. Mental illness is unlikely to become less of a problem. Single payer health care might make solutions more accessible. As long as that remains a dream, training for police officers must be improved. In my parents’ midwestern home town, a woman called 911 because her boyfriend was having a bad LSD trip. The police arrived and followed their training to quiet him by tasering and then, when he didn’t get calm, kicking him in the face. “There’s a spot between the upper lip and nose that if you kick right there, they go quiet pretty quick.” Several kicks were needed. The result? Broken teeth, dislocated jaw, and a jail sentence for the man seeking help, and absolution for the officers.
3
Misinformation about the Baker Act is abundant. Sometimes, people who don't understand it, use it to have an involuntary exam initiated improperly, as these poor parents did.
I served several years as a Baker Act Screener in Sarasota, advising police and doctors on the appropriateness of initiating the "BA" when they encountered people they it it might be appropriate for.
That law was never made to get people with mental illness the treatment they need. It's purpose is to prevent people with mental illness from harming themselves or others, if it is believed they might. It can only be initiated by law enforcement or certain kinds of licensed health professionals, or a judge, which was the case with this family. Family members can petition the judge, and if they convince the judge the person is mentally ill and a present danger, the judge will issue the order. The parents here must have done that.
If a BA is initiated, the person is taken into custody for a psychiatric exam. The person must be examined by a psychiatrist within 72 hours. If the doctor determines the person is a present danger, they will be held until the doctor determines they are not.
The father is right. The system is broken, and that's an understatement. We decided to kill government instead of using it to manage our society. Now businessmen who don't want government to exist are killing it. They don't want to pay taxes, and they don't want government to do the things we need it to do.
7
Mr. Ornstein: What a terrible and tragic experience. No one, patient or relative, should be subjected to this kind of treatment.
I am not hopeful that this will change soon nor do I believe that our gun laws, despite marches, protests and testimonies will change. I wish that your harrowing article and the solutions offered would change our laws but I don't believe that it will.
However, perhaps your kind of testimony will change some minds and will open up further discussions in the future. Thank you for writing such a deeply personal and painful article.
I am so very sorry for what happened to your son. Your analysis is spot on. The system serves no one.
3
My daughter suffers from bipolar with psychotic features. When her mania is out of control, we have to hospitalize her. She is now in her 20s. Once we called an ambulance, as she was trying to flee our car. The police and EMS came and were very gentle and sympathetic. They did need to restrain her, gently, in the end. I was so grateful that they were careful with her. The ER was rough, as it usually takes 24 hours to find a bed at any psych hospital, let alone a good one. If we had no insurance, she'd be back on the street. Some ideas to improve our mental health system:
1) Train police and EMS how to be caring and nonviolent when taking the mentally ill to the hospital.
2)Increase the number of beds in psychiatric hospitals so that people don't have to flounder in the ER, where there are often few psychiatrists available, especially on weekends.
3)Increase the number of psychiatrists, psychologists, and RNs in ERs and in psych hospitals. We need qualified people helping our most vulnurable patients, not just techs, though techs can be wonderful.
4) Require insurance companies to fully pay for mental health care. It is an outrage that in 2018, most people have no or 50% coverage for psychologists and psychiatry. No wonder we have a drug epidemic!
5) We need many more step-down programs, both inpatient and outpatient, for after people are no longer in the acute phase of their illness. One should not have to be super-wealthy to afford this kind of rehabilitation.
8
"Require insurance companies to fully pay for mental health care. It is an outrage that in 2018, most people have no or 50% coverage for psychologists and psychiatry. No wonder we have a drug epidemic!" AMEN!!
1
I'm sorry to hear of the loss and pain
In California, it works differently. The condo manager would have called the police. The police would then interview the individual and make a decision about a 72 hour hold. This removes the possibility of a family being duped.
The individual is then evaluated. The doctors can extend the hold by 14 days. The patient has the right to go to court (in our area, every Tuesday and Friday) to contest the hold. Patients often win this hearing and are released.
There is a 6 month hold as well, but it is rarely used.
There is a subtle difference. Apparently, in one case the police are instructed to pick someone up -- there is no decision to be made. In California, the police are required to do an assessment, without the presumption that the person will be taken in. I have seen it several times, with the police being polite and appropriate.
The 72 hour hold results in a psychiatric hospital stay. Presumably, there are three psychiatric sessions plus some related social work. There should be a medication evaluation and a discharge plan with some sort of opportunity for follow-up.
I don't have personal experience with the aftercare system for individuals without health insurance, so I'll leave it there.
5
I have quite a bit of first hand experience with the Baker Act and I don’t think it’s a bad law. I’m very grateful for it, in fact. It’s only meant to be a short term crisis intervention. We do need better mental health services but it’s a helpful option. Family members will be notified if the person admitted puts them on the notification list.
3
Thank you for writing this piece. I am very sorry about your son. I completely agree that the mental health system is broken. We can't expect the system to "fix" people. As someone who has a family member with long term mental health problems, and after working for many years with incarcerated and disadvantaged populations, and I have seen all too well that the mental health system can hurt, and even prey upon unstable but non violent people, while ignoring and dismissing dangerous ones. And mental health providers are too often ill equipped and very often follow failed treatment system models. I would add that as a society, we need to seriously examine the root causes of mental illness in this society- not just the treatment.
3
I would like to know how these situations are handled in other countries and what their facilities are like. And how they are funded.
There has to be a better way.
The parents get a call from the apartment manager, claiming to be concerned about their son's behavior and react before finding out what is going on. Had they ever witnessed any prior evidence of instability in their son. Had they had any previous interaction with the apartment manager prior to that phone call? They jump on a plane to get to the city where their son lives and the FIRST thing they do is go to court to get a Baker order? Not try to find their son and see for themselves what his condition might be? While their remaining examples of problems within the mental healthcare system are real and need to be addressed, it sounds like the first mistake made was jumping to conclusions based on something a stranger with an ulterior motive said. Do you think that may have been a contributing factor to their son wanting to distance himself from them or not seek treatment when he really did need help?
6
Easy to judge when not in the author's shoes and some details may have been omitted. Parents are too often blamed in these difficult situations.
2
"Had they ever witnessed any prior evidence of instability in their son." Yes. This is explicit in the article. Very explicit.
4
True Debby, yet in this case the details are NOT omitted. Many commenters seem to have missed them, but the article says clearly that this episode occurred "halfway through Matthew's decade-long struggle with serious mental illness," so indeed it is entirely clear there had been previous similar incidents, or at least clear reason to worry.
2
when will mental health professionals, educators & police be paid compensation commensurate with their importance to a safe and thriving country? When will education for all be realized as an expensive necessity for a well functioning populace? Will we ever have politicians who do not wear their religion as a sweater to be discarded as money comes under the table from "mission oriented" groups such as the NRA? Why are ball players & other entertainers paid so handsomely for ......what? tossing a ball, singing, dancing, acting, & other jobs of no lasting importance. Millions of dollars are spent on arenas & venues for these light weight events that distract the citizens from real problems such as mental health issues which contribute to joblessness, homelessness, the development of meaningful lives. Corporate america creates the hamster wheels for 97% of us to trod as too much money slides into their pockets. 97% of us have limited rights of self determination as government budgets are balanced by cutting funds for schools, scholarships, but darn, don't we have "the best" basketball team !!! So many lives needlessly ruined by our refusal to see the controls placed on us by the bullies of Trump's ilk, so many Matthews are lost. The Romans are still in charge, lions vs Christians in the coliseum still distracting the masses. For those of you who do not know this reference, google it.
6
My daughter too has severe mental illness--we've tried our best to help her but it is not safe for us to allow her back in our home. The story I was going to share on lack of treatment options and support has been told by many others so I will add one item.
My daughter has finally received good care in a substance abuse program. She has housing and food and participates in individual and group therapy--all of which have been extremely helpful. She has let slip to me more than once that she did not smoke or drink much but just needed a safe place to live and a break from her difficult life.
Today will be her third day as a waitress and if she makes it through it will be an employment record for her. I am cautiously optimistic but still unsure whether she will ever be capable of supporting herself through a conventional job.
She is a kind person who wants to be "normal" but cannot and maybe never will be able to control her impulsiveness and and erratic moods. How ridiculous is it that she has to fake being an addict to get food, shelter and support services she so badly needs? What is wrong with us as a society?
23
I have narcolepsy. First they told me I had depression, and put me on SSRIs. The SSRIs made me manic, twice, and I wound up (voluntarily) Baker Acted, twice, because they said I was bipolar. Of course the mentally ill self-medicate: that's all the doctors do. Drug 'em and dump 'em.
If you want a mental health system, you need a health system. The body is a holistic system, and we need holistic medicine -- an interdisciplinary approach to treat causes, not symptoms. That is true HEALTH care. All we have, at best, is "ill care". When something goes wrong: throw pills at it until it goes away. And when you run out of pills, sweep 'em under the rug.
14
The world is divided into two groups: families who have personally experienced the tragedy of serious mental illness, and everyone else.
For "everyone else," true mental illness is a vague, low-priority issue that only intrudes into consciousness when a lunatic hits the headlines, or someone is ranting on the street corner. For politicians, mental heath is a very expensive service with little-seeming payoff, with very little support from the public; an item to cut from the budget with little public outcry.
What families know is that it is a never-ending heartbreaking nightmare to try to find treatment for a seriously mentally ill loved one. What treatment professionals know is that it is essentially impossible to resolve the tension between a family's desire to protect and treat a loved one, and the mentally ill person's right and desire for autonomy and confidentiality.
9
IMHO: Problem is not mental illness. Solution is not keeping those that are mentally ill locked up. Solution is keeping guns locked away from those that are mentally ill ... and anyone else who hasn't passed a psych and gun handling test to prove they can responsibly use this tool that is specifically made for purpose of killing.
4
Getting out of the shower with a taser aimed at me and being screamed at to get on the ground immediately by Cape Coral FL law enforcement. Not allowing me to even put on a pair of shorts and a shirt. Tasing me twice because I wanted to put on clothes while my mother and step father looked on in horror. A very bad time of my life. I was a mess but I was not a danger to myself or to others. I did have drug issues at that time but I wasn't a dealer, just a user who kept to himself. Once I was released from the Lee County jail and back home, a few days later I was surrounded by Cape Coral police who had entered my home without any reason or my permission. They told me they would never leave me alone and my only way out was to sell my house and leave Cape Coral ASAP or they would make my life unbearable. I moved back to the Midwest shortly after and will never ever return to the State of Florida. This story brought back painful memories. It should not have to happen to anyone.
73
I’m so sorry
4
I am so sorry for your family's terrible experience. Thank you for sharing your pain in hopes of helping others.
1
Words of wisdom from someone that knows what he is talking about...as opposed to the politician ignoramuses in congress, arrogant enough to think they know it all, hence, allocating paltry resources incommensurate to the present needs (for mentally ill folks) to stop the gun mayhem in our midst. How about assigning experts in the field to define the problems and recommend the best practices to allow effective, and efficient, care. And only then, let politicians find the time and resources to put a solid plan in action. As it stands now, we have the blind leading those that do not want to see, an issue only a crazy loon would consider sound.
1
Citizens in the United States have the right to refuse treatment.
Before our children turn 18, parents have the legal right (and responsibility) to expect our kids to follow our directions. When they become an adult with constitutional rights, they no longer have to "obey" us. The majority of kids do fine and majority of parents are proud of their adult children's accomplishments. However, sometimes a child has problems making this transition to adulthood. But, we no longer have the legal right to "control" our children and keep them safe. What do we do then?
Sadly, there is a long history (in the US and many other countries) of mental health laws and treatment facilities that were complicit in the mass incarceration of vulnerable, but not mentally ill people in the name of "keeping them safe". They had no due-process, no rights.
These days, unless declared "legally incompetent", people have the right to refuse treatment. They can refuse to see visitors (even parents) and they have a right to personal privacy. There are times these civil liberties seem counter productive (especially when a person is sick or undergoing problems). Those liberties were fought for and won after countless political, military, and legal battles. I am very sorry for the loss of your son. I agree that we need to improve our mental health system, but, I am against removing or limiting our civil liberties.
2
There are times, to quote Janis Joplin, when freedom's just another word for nothing left to lose.
2
It seems to me that if you want care in today's society, you have better be able to pay for it without government assistance.
If the government doesn't spend money on it or track it then, *poof* the problem is magically gone.
2
I suppose every law needs fine tuning, but your actions were based on false information. I'm sorry for your heart break.
3
I can just imagine what you have gone through. This is a nightmare of every parent.
However, I don't think that you made a bad decision by committing your son for a 3-day evaluation. What if he stabbed a random person with a kitchen knife from his apartment? This is exactly what happened to my neighbors family.
4
I worked in a mental health facility doing what are called 5150 mental status evaluations for 20 years.There are many threats made by people to harm or kill others.Most of these threats are made by people who are angry(usually drug or domestic abuse related).They are not technically "mentally ill and cannot be held beyond the 72 hours required to evaluate them. Only the Aurora Colorado school shooter could have been classified as seriously mentally ill.Unfortunately the NRA and the Republican congress have made sure that this sort of person can remain a member in good standing of their "well regulated militia."The mental health issue is only a talking point for the NRA.School shooters can only be stopped by making sure they don't get to own assault rifles.
Having your son or daughter suddenly deteriorate into a person who is unable to think,is often paranoid and unable to find work is a tragedy.These young people go on and off their medication.They often abuse drugs,When the Republican governors of California(Deukmejian and Wilson) along with the Republican legislature, cut funding for outpatient care for the mentally ill as well as drug rehab programs,I left that field of work.Effective programs were gutted.Mentally ill patients were demonized.They now make up 70% of the homeless population.The same politicians who destroyed the mental health system in California are now trying to make it responsible for stopping school shooters.They are disgusting!
48
Two thoughts here. One, as a psychologist who worked 30 years in a state psychiatric center with patients who committed extremely heinous crimes, predicting violence is virtually impossible. Most honest mental health professionals acknowledge this, while those in the legal profession and politicians pander to the general public in offering the view that the 'answer' to this issue is mental health screening, and not proper gun control. But secondly, the view that restricting gun sales going forward will somehow markedly reduce the shootings (particularly the gang on gang killings that make up the majority of the gun deaths) is also unrealistic. There are over 300,000,000 guns in the US. Even if you put every gun manufacturer out of business, these guns will remain in the hands of gang bangers, and gun extremists, regardless of what laws are created going forward. But there is one sliver of hope here. Of the 30,000 gun deaths each year, 20,000 deaths are suicides. Many suicides are spontaneous acts, and with background checks or delays in weapons purchase, upwards of 20% of those gun suicides may be delayed, leading individuals to seek help. Others will experience eventual spontaneous remission of their symptoms also decreasing the suicide risk profiles. So there are lives to be saved with proper gun restrictions
1
Mr. Ornstein, I appreciate your story and I am so sorry for your loss.
I experienced something similar with my daughter, who had a single episode of depression in her first year of high school. She told her therapist at a session that she felt really tired and drained, which the therapist interpreted as suicidal ideation and committed her to a locked ward for teenagers. I happened to be out of town on business when this occurred, but took the first flight I could get back home to see her.
It was horrendous! She was confined to a small unit filled with very angry and disturbed kids, robbed of her autonomy, and clearly doing worse there than she would at home. And even if she was a danger to self, my wife could have stayed with her until I arrived back home, then she could be monitored constantly by people who love her--and who are both physicians. The damage to her trust in mental health professionals was enormous. And even the therapist finally, albeit reluctantly, agreed it was the wrong decision.
But I was, and still am, shocked by the ease with which people can have their freedoms taken away. I know it's occasionally necessary--I've seen it in my work in medicine--but it should be a last resort, exercised with the utmost care.
I'm happy to say that her depression never recurred, aside from the usual situational bouts of depression that happen to teens. She's a college junior and doing very well.
6
I am very sorry for your loss and for the terrible handling of you son's situation.
I will also note that the American Enterprise Institute is dedicated to shrinking government. Perhaps you can use your influence there to encourage it to understand the value of providing government services, the need for taxation, etc. Individual liberty and responsibility: in other words, social support isn't that important. it's up to free individual families to solve these problems.
9
I worked at a mental healthcare facility in Europe that worked in a very similar way to the Dade County system described by the author. Most patients were voluntary, and many had remained voluntarily at the institution after having been originally directed there by the courts. In some cases that had been the first time they had been treated for their illness and, once they got treatment, people who had been previously homeless or marginalized lived perfectly normal lives, with their symptoms 100% under control with pretty run-of-mill medication.
The system included a follow-up, transition system, in which patients who demonstrated to be able to manage their treatments were moved to shared, supervised apartments, embed in the community. These allowed patients who had been previously homeless or marginalized to learn basic social skills, acquire self-confidence and create the routines to later become completely independent.
It is not perfect. Although it has progressed immensely (more than I think most people realize), psychiatric medicine and clinical psychology are still far from 100% effective in all cases. But it gives their lives back and works for a very large portion of patients. Those systems work and are worth every single penny society decides to invest in them.
6
Thank you so much for this! Two of my loved ones were stricken by schizophrenia and I'm learning that more and more of my friends and acquaintances have children and other family members who are mentally ill and unable to care for themselves. We need another "me too" campaign to get proper funding for programs and facilities that will really help them. The 72 hour hold is a joke. It does not just rule in Florida. We also need serious studies into the causes of mental illness. I'm hoping that everyone whose life has been impacted by mental illness directly or indirectly will STAND UP NOW.
2
There’s something about this story that I cannot understand. Why didn’t Mr. Ornstein and his wife go to see their son to ask how he was, and go to see the condo manager to question him about his information, before they went to the courthouse to invoke the Baker Act?
5
Please read on. Lots of people have answered this question.
2
It's amazing that involuntary commitment is so easy when getting support for the mentally ill or handicapped is so hard. My brother lives in Massachusetts, which is known for having good services, but it's a nightmare of bureacracy to keep everything in place.
He needs to regularly recertify that he is handicapped to the feds, the state, the town, to Medicaid, the housing authority, transportation authority, for his job supports, etc, etc, etc. None of these organizations use a standard form or accept each other's assessments. The result is a heavy burden for his family and a myriad of bureaucrats repeating each other's work, all at taxpayer expense.
7
A suggestion: don't sign commitment papers without even seeing your kid or getting a police report, on the basis of a phone call from an apartment manager.
6
The snark just really isn't necessary. Of course what happened turned into a horror story. But if the person has a history of mental illness, and has experienced prior alarming episodes, when one is informed that the person either is in immediate danger or may be causing immediate danger to others, the responsible thing to do is to try to stop this as quickly as possible! One can't take the time to be sure the informer isn't lying for some bizarre reason (why would one even suspect that?), or to start calling up other people and requesting consultations. The point is they believed he was in - or might cause - IMMEDIATE DANGER.
2
It isn't "snark". It is common sense. If they had the time to fly to the city, they had the time to see their son. Imagining horrible possibilities is no excuse for irresponsible actions.
2
I'm sure everyone has a story to tell. But the real lesson to be learned is there is no cookie cutter approach to this problem. Especially when one is dealing with a problem you can't put your hands on. Unfortunately the electorate continues to believe that these kinds of problems can be legislated away.
As many have commented we need an improved, intensive, vast array of mental health services from in-home, outpatient, to group, to institutional. We need to empower Masters level therapists instead of the constant requirement to have higher degrees (Phds) and ever more certifications and credentials so that people can have access to help at the grass roots level. Commenters rightly assess things won't improve under this administration. There remains a question why, with regard to "shooters" is this mainly a problem males have. One idea, females are perhaps more nurturing and empathetic. This could be, strangely, because of "chic lit". Perhaps adolescent girls are more likely to watch dramas or read books (John Green) which depict emotionals, dysfunction, mental illness and in this way are educated more as to the nature and consequences of mental illness.
Tragically the system is broken. Mental health is tragic in itself. Parent's bad choices are involved in a child's early development which imprint that child as does his/her DNA. Do the research and you will find the statistics if you're not afraid of the truth in your own behavior as a parent and family history.
2
The author of this article is a scholar of note. His wife is a litigation attorney. How two people of supposedly high intellect could blindly commit their son to a mental institution based on the word of a condominium functionary is beyond me. You call the police on your son without even talking to him? Do your considerable intellectual skills and supposed judgement only succeed in the abstract but fail when there is a human life, your own child's, at stake?
There is more to this story than has been disclosed. The parents' judgment and actions toward their son was probably similar as he was growing up and likely at least affected the state of his mental health.
I am a parent and acutely sympathize with the pain these parents are going through and will always feel. However, from an objective point of few, there was no reasonable rationale for what they did to their son given the circumstances.
The son did the right thing in pulling away from his parents. Any rational person would have done the same.
7
It is beyond me that you presume to retrospectively
categorize the Ornstein's relationship with their son.
Your post fails to convey your acute sympathy.
6
I was sorry to read that you had your own son Baker-Acted based on bad information. But you can only blame yourself.
As for not letting you son's loved ones into see him, well that's a different story.
In many instances in the past, families used involuntary commitment to deal with behaviors they, not necessarily others, found to be reprehensible. So to a degree, the system needs to protect patients from loved ones who wish to impose their will and values on someone against their will. It's a hard balance to strike, but adult patients need to be protected from families, too.
However, we're undergoing a mental health crisis in this country. There's never enough beds and never enough funding. Until this is addressed we have little hope of dealing with the mentally ill in a compassionate and productive manner.
From personal experience I can tell you that involuntary commitment can and does save lives. It may seem harsh, but left to their own devices, some mentally ill people will place themselves or others in serious jeopardy.
In no instance should someone who suffers with mental illness be permitted to own a firearm - black powder musket or AR-15. But before that happens, we have to be sure that they are indeed truly ill and not just different from other people.
In the end we must be cognizant of the fact that the mentally ill have the same rights as everyone else and the system must have a high bar before these people can be incarcerated (Baker-Acted) against their will.
1
I was so saddened to read your story, but so glad that you wrote it. The more stories and information that become public the better the chances that people will recognize mental illness as an illness that must and can be treated...humanely. I too have experience with family mental health issues and would recommend the support groups run by the National Alliance on Mental Illness (NAMI) to help families trying to cope with mental illness.
"But what is really required is a comprehensive treatment framework and the money to pay for it."
Amen to that!!
2
I hear your pain. My brother is autistic but high functioning. He has Asperger's. But our family has experienced this same sort of incident as well although not as badly as yours has. We've had people lie about my brother because they don't like having him around. One person, an educator no less, called the police on him claiming that he threatened his wife. My brother never did any such thing and the police knew it but had to address the issue. Others have accused my brother of being a child molester or a sex offender without any reason at all but his being "different". We thought some of the cruelty and stupidity would stop once he was out of school. The truth is that it never stops because there continue to be plenty of people who firmly believe that anyone who looks or acts differently belongs in prison or as far away from society as possible.
I can imagine some of your pain over your son's death and what preceded it. Stories like yours are heartbreaking because you tried and he tried but others didn't see your son as human. What people like your son need is what our country refuses to do out of a misguided idea that no one should be dependent upon government for anything. Yet your son and you could have enjoyed a longer more productive relationship had there been a place for him to consider home. A place he could retreat to when troubled with the help he needed right there. Instead he was treated like a criminal and you like strangers.
6
We need permanent places for the mentally ill. Bright, cheerful campuses with parks and activities as well as first rate medical care. It will cost many billions of dollars. The country is obscenely rich and can afford to care for its citizens, but we prefer to spend the money on napalm and tax breaks for billionaires. That's the reality.
7
I think an unspoken aspect of this tragedy is the knock-on affects to our society of the gun lunatics and the ghastly Second Amendment. The whole country is permanently on edge, police are far more likely to shoot innocent people, common grade school disputes rapidly escalate into full blown legal crises, and a zero tolerance policy toward erratic behavior of mentally ill people is adopted because of the easy access to guns and the dire threat posed to the community. We couldn't fix everything in society by getting rid of guns but we could fix a LOT.
3
Thank you for sharing your family's story. I share your perspective that the emphasis on "locking up" people who struggle with mental illness and not involving family in the evaluation and treatment plan is not a path toward sustained recovery. Shifting public money away from Medicaid that pays for ongoing treatment and moving toward forced institutionalization and jail could not be more wrong headed. Common sense gun laws, access to care, employment and supportive housing are better strategies for communities to embrace.
1
Thia law is terrible.America is famous cruelty with their own citizens. Ir Will never change.
2
I am a psychologist in an upscale Pennsylvania region. I cannot reliably obtain emergency psychiatric care for my patients, because (1) local law enforcement has virtually no training in encounters with the mentally I'll (2) the two local crisis centers are, shall we say, unevenly staffed and cannot make necessary clinical judgements (3) there are almost no psychiatrists who accept medical insurance, and local facilities can refuse to admit patients who lack existing outpatient treatment. I know many local doctors and have relationships with area hospitals, and I am not sure I could get my kid admitted if I needed to. There is no functional "mental health system" to respond to gun violence or psychiatric crises. Policy makers need to know that before creating response systems that will fail to respond.
12
Most Republicans seem to come up with the most hare-brained solutions to major problem. Bullet proof windows costing millions when school shooters always find a way to enter schools for their shooting sprees. Just brilliant. Cutting medicaid funding and not increasing by much money for mental health treatment. Brilliant. They always go for the most punitive solution to our problems, not the best. Here's to the judge who has the intelligence and common sense to come up with a better solution. He's the brilliant one not Rick Scott and the Republicans who support such idiotic ideas.
3
I’m having trouble understanding why you believed the condo manager and Baker-acted your son without apparently attempting to contact your son to see what was going on. You flew in and went to the courthouse? Why didn’t you go right to the condo? Something is missing in how you explain what happened. Sorry your son died in a later accident but ...
7
The problem is that political leaders, law makers, judges, the police have adopted the same attitude towards mental illness, i.e., it is made up. As uneducated and foolish that stance is, policy grows out of that concept.
Criminal justice so poo-poos an insanity plea because again, the same folks and the common people buy into that belief that its a scam or a way for someone to commit a murder and get away with it. All those concepts are just plain wrong, given the science associated with mental illness. No, the devil didn't make that person act 'crazy'.
Imagine for the moment one had a cancer or some other disease or injury and you picked him/her up off of the street or from their home. No one would consider or condone not treating him/her medically and releasing that individual 72 hours or even two weeks later to a bus bench, etc.
Good medical care ought not be parsed out but rather provided to the society in substitution for the next 'atomic bomb' upgrade. We have never needed more military 'toys' or jails or police, but rather we have always needed a scientific approach to mental illnesses as well as to physical illnesses.
Common sense says if bad diet contributes to illness, then reduce profits and get rid of 'garbage' foods. If family alienation is a component, then give adults, regardless of sex, sufficient time to rear and love their children. This ain't rocket science, its merely common sense. Please pull you head out of that hole in the ground.
3
There is no such thing as mental illness. See Thomas Szaz.
2
The operative word is "care"
2
Law enforcement in our country is a joke. Despite the Constitution a person's liberty can be stripped at the whim of ignorant or malicious public officials at the local level with nary an iota of due process. The vast majority of small town or rural law enforcement are corrupt. The know they can do virtually whatever they want to whomever they want. That law in Florida extends that evil ability to civilians. I have been a victim of a similar law in another state. My mentally ill mother managed to have me detained for 24 hours. It is a sick system.
4
I would think you might find that better than the previous way of hospitalization without your consent until judged sane.
1
I am glad that you invoked the Baker Act. You acted on the knowledge that you had, to protect others.
Let us hear the condo manager's story.
3
They did not have "knowledge". They had allegation, and did not attempt
to verify it before initiating a very destructive set of actions, which were completely predictable.
The focus on mental illness as a significant source of these mass shootings is a minor fictional distraction that ignores the major significant reality of rational sane evil immoral inhumane selfish cruel human beings.
3
Many commenters here seem to completely miss that Ornstein betrayed his own son, and now seeks to shift his self-blame elsewhere... to bad law, to guns, to the "system". Ornstein misused the Baker Act, a fact that bears no relation to firearms.
Americans, apparently, suffer a deficiency in reading comprehension.
9
Good thing that your son did not freak out when he discovered strangers in his house when he came out of the shower. He might have been shot dead, as has happened to many other mentally ill individuals when those oh-so-compassionate law enforcement officer show up.
9
My goodness, how times have changed. Something rational emerges from the American Enterprise Institute.
3
But how do you improve mental healthcare or anything else in a country where the sole religion and purpose of the ruler and his party is to make the rich richer?
7
"That episode, and our 10-year journey, taught us that the entire mental health system is broken."
To me, I can't understand how it seems you listened to a total stranger and asked for your son internment without apparently trying to see him first ?
8
I'm so sorry for your loss of your son and what you and he went through.
I get the feeling that our mental health industry is quite rigid with definitions and has a terrible relationship with law enforcers and courts.
What is mental illness? On NPR the other day the experts seemed to be saying that some of these shooters were not mentally ill. What?
My feeling is that you want to shoot people you don't even know, something is not right in your head. And the -isms--racism, sexism, etc. You have an irrational anger at a group of people so much that you want to cause them harm or even kill them. Is that not a mental illness???? Maybe not by that big book the psychiatrists go by but maybe we need to re-think it.
I understand there are lots of people with diagnosed mental illness who do not want to harm anyone. That's fair and very important.
But we need to do more about the people who want to harm others. We need to broaden in some cases and sharpen in others the category to include those who want to harm others in a broad and irrational way that has more to do with their own issues. I'd like to see the Harvey Weinstein's and the bully racist police officers put in the same group with James Holmes, on a spectrum surely, but they have more in common than not.
According to your definition, 90 percent of humanity are mentally ill. Don’t they teach history in American schools anymore? Religious wars, ideological persecution’s, the Holocaust, the Great Terror, the genocide in Rwanda - all have been perpetrated by perfectly normal human beings who believed , for whatever reason, that their victims deserved death. An excellent study called “Ordinary Men” examines men who shot children point-blank during the Holocaust and comes to the conclusion that they, in fact, were ordinary men. It may make you feel smug about yourself to believe that all perpetrators of violence are mentally ill but it does not help to solve the problem.
2
Let us pause for a few seconds to muse on how much the New York Times has covered itself with glory over the years reporting on how other countries handle involuntary treatment of the seriously mentally ill -- starting with the Israeli District Psychiatrist -- a public official who can order a week of observation and evaluation and subsequent out-patent treatment or treatment in a mental hospital, if necessary within a system for treating the seriously mentally ill.
In a more coherent system, the authorities in Parkland could have referred their case to a qualified, impartial, publicly employed psychiatrist with actual power to diagnose and treat over the long term -- and who was directly responsible for doing so.
What we have, instead, is a situation where the certifiably, seriously mentally ill have the power to determine for themselves whether they can be treated. What we get out of that is, among many other things, regular sacrifice by subway train -- semi-automatic weapons not even being necessary.
4
Bravo, Mr. Ornstein!
Heart wrenching story. And to the people who are so judgemental about the lack of parental concern in communicating with their son, please understand, in serious mental illnesses there might be no time to waste. One relies on the advice of the kind stranger. In this case the evil landlord with his callous and opportunistic advice to vulnerable parents with regards to their child. Lowlife of the worst kind, he abused the premise of what constitutes humanity, compassion and a regard for another life. Such a person is akin to a murderer.
As for the deluded community of psychiatric arts. I have nothing short of anger at this presumptuous community of mind grabbers. They have used the laws to their own benefit and created Guantanamo Bays within the country for the mentally ill. Perhaps there may be a handful of serious thinkers but the few doctors I have chanced to meet scared the heck out of me. It was about hooking kids on drugs for life, ensuring a paycheque, no real emotional connect with the patient....I can go on. And these were folks from the top universities.
Next time anyone has a serious mental illness, please go to a fantastic internal medicine practitioner, it might be a simple case of adjusting deficiencies. If not prepare as a parent for the long haul and spend time, lots and lots of time, talking, cajoling and caressing your childs mind. Its amazing how much love can actually do. The last resort, a quest for the gentlest, most human, psychiatrist.
Thank Geraldo Rivera and his investigative journalism for the closing of mental health facilities.
The New Yorker magazine covered the lead-up and closure of the NY mental in a series of long articles back in the late 1970s. The series is worth digging up and rereading.
If Geraldo had anything to do with it, then his influence was one story in a wave of them. Their stories were mostly correct and portrayed modern Bedlams. For an idea of the situation, take a look at Frederick Wiseman's documentary entitled "Titicut Follies."
If I recall properly, it was recommendations by NY "advocates" for the mentally ill in combination with New York judges that led the way to our current mess, helped along by legislators who were delighted at rerouting funds for mental hospitals toward voters who would re-elect them.
1
Excellent!
i just sat in a plastic chair in an er hallway for several hours waiting for my young grandson to be evaluated after police and ambulance workers calmed him down so he could willingly go . Staff was too busy to keep us informed. after my persistent questioning of when he would be seen , at 1030pm we were told "not till the next morning. " He was asleep on a guerny. My husband and I were to spend the night in plastic chairs in an er hallway. We took him home. we were told we would get follow up services. we've been told that before. this is not treatment its torture to our most vulnerable
8
Sounds like a case similar to 'SWATting'. But I think you should have at least visited your son before having him involuntarily committed for three days on the word of someone you bearing knew. No wonder he resented you.
8
Florida just seems like the worst state. It's not, though. Most of the southern states are loaded with bad laws, Stand your ground meaning he was black, he looked at me wrong, I felt threatened so I shot him and got away with it. And oops you caught us polluting your drinking water with jet fuel, per fluorinated compounds, and we been doing it for decades, but you liked the few jobs we provided so we getting away with it and by the way, now, since we got such bad gun laws, all teachers will have to carry guns, and on and on
1
I am so sorry for your loss, but see this happening on a daily basis. As the doctor at a small, local mental health clinic, we are told to give care to people without any help. No support from the state or local governments, just more paperwork. The hospitals are no help, as they discharge people who are not stable and the state hospital system is releasing more and more people into the community with no support what so ever. There is a reason that the penal system is the largest provider of mental health care in the US.
The only way I see any changes happening is when the system completely collapses and someone with money and power get hurt. But I am not holding my breath...
4
Medical privacy laws need rethinking. They're in place as much to be a firewall between patients and for-profit motivations like mining for pre-existing conditions that an insurance company can use to void coverage and deny payments as they are to keep a patient's secrets secret. Obamacare has removed the biggest monetary motive to invade a patient's privacy, so lets rethink the system that kept a family in the dark in this case.
1
Right. These kinds of "solutions" to these terrible shooting incidents are vastly complex. My thought: abolish second amendment. Rethink the perceived need to own guns at all. If we abolish gun ownership for civilians, the argument that people need guns to protect themselves from other people with guns completely collapses. Have the courage to make a radical change to protect this country from itself.
1
Once again, single payer universal health care that would cover mental health as robustly as it does physical health would go some long way in offering a much more balanced and less stressful life for all of us.
5
An excellent example of how possibly well-intended, but poorly considered solutions to complex problems only add more layers of complexity, making solutions harder to find.
"Possibly well-intended" means to question the intent to help those with psychological problems by closing the mental hospitals that housed the mentally ill. Monies saved was to be used in ways that would trickle-down to benefit all. Ninety-plus percent stayed in the hands of those at the top and those at the bottom—many of whom being those who lost the psychiatric facilities whose ineffective-housing-and-healthcare had been better than none-at-all—got the drippings left at the bottom.
To think we help those with psychological issues best by turning them out with no reliable support net would be the epitome of human hubris, if anyone really believed such was possible. Psychologically disabled individuals are found all over the planet. They aren’t aesthetically pleasing. They don’t beautify our city squares or parks. But we can’t call ourselves civilized if we ignore them; warehousing them in poorly regulated, long-term hiding places isn’t what civilized people do. We can either work to integrate them into society recognizing their human dignity, empathizing with them (knowing that there but for the grace of the god is where we all could be), and supporting and providing for them to the best of our ability via clinics and caregivers or we must admit that we are not civilized.
To be civil is to be kind.
2
Mr Ornstein, I have been an admirer of your sensible and humane work via Cspan for maybe 30 years, and on websites for the last decade at least. If someone with all your mental and monetary resources and knowledge of "the system" is not able to solve this, what hope is there for working class folks? What is wrong with this country? I think my grandchildren should leave. Things got worse, not better since '94.
1
Treatment for symptoms of extreme emotional distress breaks all of the rules and norms of behavioral economics. Rather than the default being compassion, acceptance, tolerance and rewards for seeking and engaging in treatment, psychiatry and society condone the imprisonment of people whose behavior it deems frightening. It strips people of dignity, trust, and civil rights instead of protecting rights, preserving dignity and offering care based on honesty (full disclosure of treatment options and their likely effects - positive and negative), and autonomy.
People suffering from extreme distress are never asked what happened to them. They are never treated as credible partners in their own care, and they are never empowered to hold treaters accountable for iatrogenic harms.
As a wise old dog trainer once said, if you smack the puppy in the face when it finally comes to you after misbehaving, it will never again willingly approach you.
Well, people with extreme distress are smacked, imprisoned, coerced, assaulted and battered (forcibly medicated or restrained) as a routine experience when hospitalized. The medications they take have known risks of increased death. Treaters aren't held accountable for patient outcomes.
While the default assumption is that families are caring and concerned, more often than not, they are sources of abuse and distress to sufferers.
PS: AEI & Republican ilk are major causes of removing mental illness services from Congressional budgets.
4
Thank you for sharing your terrible tragedy. I am so sorry for what you have suffered. As have so many others. Our entire health care system is broken, and the mental health part of it much worse. Current proposals will, as you point out, only make it worse. I hope your voice will help.
1
Once your locked up in a Psych Ward all you can think about is getting out. There is nothing to do and you are surrounded by other mentally ill people. The depressives quietly plan to kill themselves and the Bi- Polar people are screaming that there is nothing wrong with them. The staff sits behind the counter calm as cucumbers, filling out paperwork and giving out meds. This is based on personal experience. The Hospital bills $2000 a day for this 'treatment'.
54
The article and personal testimonies point out a long history of stigmatizing and mistreatment and abuse of those with natal illness. If you read Phillips Pinel’s pleas for the rights of the mentally ill to be equivalent to those of other French people as summarized liberty, equality and brother or sisterhood, you will see the same story at the mental hospital , the Bicyer in Paris 1792 to 1794 and also his fight for those rights.
The wholesale confiscation of "weapons of war" throughout the United States can and probably will take years if not decades. Who or what will protect the children in the meantime? Armed guards, restricting access, stronger windows and doors, perhaps even magnetometers are common sense ways to protect children now.
If protecting children in schools is the agenda then Americans should learn from office buildings, stadiums, banks and government locations where access is restricted and enforced by armed guards. That can be done now and not in decades. Unless of course the agenda is to disarm all Americans.
Excellent essay. So very sorry for your loss.
Mr. Mrs. Ornstein so sorry for your loss. It is unfortunate that mental health issues don't receive the same funding and attention that other medical issues do. For some reason people still believe the mentally ill can just get better if they wanted to. Mental illness still carry the same stigma as it did years ago. Treatment hasn't improved much in the last hundred years. Keeping guns away from the mentally ill is the only thing we can do today. We have made great strides in the treatment of other disease. It is time the same effort goes in finding cures for mental health issues.
2
Unfortunately, the mental health field remains badly underdeveloped. In most cases, mental health professionals achieve results no better than symptom management. Symptom management often means little more than drugging patients, mitigating their symptoms but inflicting all kinds of side effects, side effects that are often so severe that patients stop taking their medications anyway. Real cures for mental illness are rare; scientifically proven mental illness prevention is non-existent.
We need a major national push for research into the causes and treatments of mental illnesses, including controlled scientific testing of outcomes, along the lines that have long prevailed in the field of physical illness. And we need health insurance that covers the most effective proven treatment options, not just insurance that covers the fastest and cheapest option.
Such a national push requires robust federal funding for research and high minimum standards for health insurance. But that will never happen with a president and a Congress who want to defund the sciences, medical research included, and who want to eliminate health insurance standards in favor of "freedom of choice."
politicsbyeccehomo.wordpress.com
2
So, the mental health industry is broken and can’t help, more laws don’t help and law enforcement is part of the problem and only makes things worse. I know, let’s ban all guns without addressing any of the myriads causes of the problem or trying to fix all the “broken” parts of the solution. Real world problems aren’t corrected by utopian solutions.
2
Seems personal responsibility is more the problem here than "bad laws" or "a failed system".
Some parents aren't up to it, so the burden becomes the neighborhood's and their lives must change?
3
Mr. Ornstein is right on target with his assessment. The 72-hour hold does nothing to help people struggling with mental illness, and treating a human being like a criminal is traumatic. I am close with someone who experienced this and then completely cut off contact with his family, who had initiated the "hospitalization." (One thing he told me is that he lied to the doctors about his symptoms in order to get himself released.)
Gun control laws, specifically making semi-automatic weapons illegal, is what will curb the mass shootings.
2
I'm sure a substantial hurdle in effective mental health treatment is encapsulated in this sentence, "That episode, and our 10-year journey, taught us that the entire mental health system is broken."
Others experiences with trying to obtain treatment for their loved ones does not seem to rise to the level that requires the American Enterprise Institute to recommend anything other than a prescription for bootstraps. Do we have to wait until every single conservative is personally affected by mental illness, sexual differences or poverty to get any form of effective action?
This is a tragic story.
There are a couple things to note. The Baker Act petition paperwork requires someone with firsthand knowledge to swear that they've seen the acts that indicate someone is a danger. Perhaps the parents here glossed over or didn't notice that part of the petition or saw it and were so worried they chose to say they had firsthand knowledge. Maybe a judge just approved it by mistake.
Second, the Baker Act doesn't require a person to be held for 3 days. If an evaluator determines they don't meet commitment criteria before 3 days, the person must be released. Of course there are problems with that, too. Not enough doctors to evaluate patients, etc.
Unfortunately, the Baker Act and Florida's Marchman Act (for people suffering from addiction) are incredibly misunderstood by families who want to help loved ones. There isn't a way to just "do something" because we've seen the terrible abuses and horrors when people can just be put away in long term mental institutions.
The author wants states to use a model of long term outpatient treatment for many people, not just those in the criminal justice system. Well, that *is* the Baker Act. If a doctor determines the person is a danger, there is a court hearing where a judge oversees that decision and commits the person to treatment as determined by the doctor's recommendation.
There is no good way to force people into treatment. Still, more help is needed, and we need to stop stigmatizing mental illness.
6
A terrible story, and I'm very sorry for your loss. Several of your ideas certainly deserve attention. As far as the Baker Act goes - your case exposes loopholes that should be closed. You were allowed to invoke the Act based on nothing but hearsay, which seems (in hindsight, at least) like a big neon invitation for people like your condo manager to take advantage. The law should be changed so only someone with first-hand knowledge of the person's recent behavior (a phone call at the very least) should be able to invoke the Act.
But with that fix, I would still want something like the Baker Act available in an emergency - because that's what it is: an emergency measure, not something that should ever be mistaken for real treatment. The Baker Act (used properly) is yanking someone away from the ledge, which is very necessary. It just doesn't fix anything about the rest of that person's life.
I visited Judge Leifman's program in December 2017 and what I saw only reinforced the lessons I have learned running a mental health program for the past 38 years. Of prime importance, the true customer is the person we are trying to help and their voice and needs are central to any solution. The Miami-Dade program has achieved this by recruiting leaders from the clubhouse community, not psychiatry. They have also affirmatively hired peer staff. The have trained all officers in a crisis response system call CIT that has been "road tested" for almost 30 years in 3,000 other communities. They integrate their services across a range of providers, including shelter and outreach teams--they go where the customers are and engage people with compassion and respect. Finally, they're "learners" who operate with transparency and are willing to evolve to best assist people who have often been traumatized by the system of care, such as well-meaning, but misguided forced treatment laws.
Steve Coe
CEO
Community Access, Inc.
4
Thank you for sharing your difficult and moving story. As a clinical psychologist, I can tell you that trying to access comprehensive services for young adults experiencing first break psychosis is nearly impossible. Involuntary treatment is almost never effective or helpful. The voluntary programs almost never have openings. Or the one program that miraculously does have a spot open, your insurance will not cover. It is tragically sad and getting worse by the day. Unfortunately, unless you have a family member desperately needing emergency psychiatric services, this is an issue that most people are not aware of and ignored by our elected leaders.
5
What's more the 3 day period of confinement for mentally ill -- dangerous or not -- is not a sufficient time period for medication to take effect. So we're temporarily confining the mentally ill, medicating them, then releasing them only so they can return to their pre-medicated state. This does no service to the mentally ill or society.
5
Norman, thanks for sharing your painful story. You are not alone. Far from it.
My sister experienced postpartum psychosis. She fluctuated between a locked unit, where she could not see family or nurse her baby, and total discharge with no management of her illness. The system is insanity! In England, they MANAGE these postpartum illness with compassionate inpatient mother-baby treatment centers, and step-down programs.
My brother-in-law is mentally ill (OCD, schizophrenia, bipolar, etc), but again there is nobody to MANAGE his illness. He needs help with diet, daily living, and even the decision to seek treatment and meds (he's doing neither). He owns guns. We wring our hands helplessly.
A good friend's brother is mentally ill, and keeps making death threats to his mom. But he got more dangerous after involuntary confinement, resenting her even more. Again, there's no comprehensive mental health system that helps MANAGE these situations and provide graduated options from inpatient to living communities to daily intensive outpatient to regular medication and therapy management.
Kids with autism at least have the ability to get into programs that look at the whole person and help them manage their condition. Grown-ups are on their own. Until it's too late.
45
I was once Baker acted after a suicide attempt (rightfully so) but otherwise have voluntarily admitted myself to hospitals. In either circumstance & having met many patients w/ every serious diagnosis that exists I know there is WAY too much information missing here in this piece to a) fault the Baker Act b) mandate violating personal liberty for treatment - that's already happening, it's called prison & DOES NOT WORK!
I am soooo sorry for the loss of your son, I can't imagine what that feels like. I know what it feels like to almost die & I'm lucky I didn't. What we need is better mental health treatment & more tolerance, understanding & acceptance of mental illness!
No one would BELIEVE what I have seen or experiences in psych hospitals - outpatient or inpatient - in three different states, it doesn't matter, it's indescribably inadequate, undignified, at times dangerous for reasons that would shock you, difficult to access (did I mention dangerous?) & often the most empathetic persons were the cleaning staff. The doctors & social workers are spread thin & only make brief appearances. So much else might be built around 12 step work but if you're like me & not addicted to anything then you're stuck with nothing although 12 step is ok, but with newly sober it's very hardcore.
A final note on communication & privacy whilst on a unit: a patient is usually given the option as to whom, if anyone, they wish to allow visits or phone calls from (if there's a pay phone)
32
There are 12 step programs available and one can actually start your own. Dr Lowe’s groups and Recovery Anonymous. There are also Peer Programs in some states. There are also survivors groups online and websites who also agree the system is broken and advocate different approaches than Mr Ornstein
To Mr Ornstein
I am so very sorry for your loss. The ache never ends and it is deepened by your experiences with the system
As both a suit I or and a retired LISW I hope you read this and go to some of the survivor groups , writings, and readings. The MIA website is a great resource as was the blog oneboringoldman written by a retired psychiatrist.
Thank you for this. You just opened a window.
"No one would BELIEVE what I have seen or experiences in psych hospitals - outpatient or inpatients"
"it's indescribably inadequate, undignified, at times dangerous for reasons that would shock you, difficult to access (did I mention dangerous?) & often the most empathetic persons were the cleaning staff."
Please tell people and shock people. Nothing will change until people are forced to confront the truth of the barbaric 'treatment' of patients.
6
John, unfortunately, former patients(psychiatric survivors) are telling their stories, but no one wants to listen, because, well, "those people" are all crazy, anyway. I don't talk about my previous experiences from 20 years ago because people who know me now would probably avoid me, although I am a "normal" looking/acting person. Nothing would change except in their eyes I would "crazy" no matter how much time has passed and no matter that was a misdiagnosis in the first place.
Mental hospitals are still high-priced snake pits. Shocking people is like a drop in the bucket because people generally don't want to know the truth. They want to relax in their comfortable little hovels and shut the world of the "mentally ill" away from their nice, normal existences.
2
The country can't identify, let alone institutionalize or medicate all of the people who need help. We apparently are unable to treat all those with physical problems.
4
And how has AEI helped with the solutions your propose?
4
Thank you for sharing your grief Norman. It is not something any parent should have to go through. I think those raising children without mental health issues have no idea what it is like to have a loved one slowly or suddenly spin out of control without help available. The 72 hour commitment takes all control and contact away from parents and it is terrifying how easily all one's rights are taken away. Talk about putting parents in a horrific position. We know our kids and often know when something is wrong. But we have no real resources. No help and certainly little sympathy. America lives in the grand delusion that Mental Health issues do not exist or are so small as to be insignificant. For those of us raising children with differences, our lives and the lives of our children prove that the country is failing us.
4
Thank you, Mr. Ornstein, for sharing your painful story. I am so sorry you had to go through this. Two very close family members of mine suffered with mental illness; one died as a result of her disintegration. Demonizing the mentally ill after atrocities like the Parkland shooting is despicable and dishonest. It allows apologists for the gun industry to avoid taking responsibility for their roles in fostering mass murder.
5
My beloved daughter attempted suicide 36 hours ago and barely failed. She wanted to stop the endless depression from bipolar illness.
Dealing with her and the mental health system over the years has been simply catastrophic: poorly trained, unavailable, ineffective, understaffed, little medical oversight, intransigent insurance companies, drug companies pushing costly and dangerous medicines. And now that she's 28, our right to assist, and oh how she meeds assistance, is greatly curtailed. The HIPPA laws designed to protect will kill her. Her rights to make her own medical choices will kill her.
America seems too weak a country, too obsessed with power and its domination to acknowledge mental health is scientifically real and not a moral or character defect. A pox on this silly country and its outlandish president and Congress.
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The terror for the family lies in this. As you write, "Her rights to make her own medical choices will kill her." In fact her "choices" are being made by voices she cannot resist that command particular actions on pain of death. It is a horror for her family to realize in every moment that they cannot keep her safe from the demons no one asked for and that no one can subdue.
2
..dark ages, we all cringe at the horror of our 'ways'. The legal system in this country needs modern work. Just modern engineered English would bring us out of the dark ages. Our elders with mental problems are severly abused here (murdered) in the U.S by closed door probate courts that shun family, weither they have money or not. Lawyer/Judges with 'group speak' steal family members and farm them for 'rent'. This is due to not only the onset of some inevitable dementia but the agrivated use of anti psychotic drugs to shut the elderly up often given purposely; ignoring know medical conditions that hasten or cause death.
2
I agree it is impenetrably stupid to spend $450 million to place professional guards in schools when the chances of an attack happening are minimal. The solution is to arm a small number of teachers or administrators in each school and give them training each summer to keep them up to the task. We train young men and women with high school educations to be cops, so it's not a stretch to say a teacher could be trained to provide such a service in the rare event a school is attacked by a lunatic bent on mayhem. The teachers, of course, should be compensated for their service and have their training paid for.
But the real solution is greater vigilance on the local level by law enforcement, school employees, social service providers, psychologists, parents and students. Early intervention can prevent these tragic incidents from happening before they occur.
And how will a SWAT team be able to tell the teacher with a gun from a shooter with a gun? This is stupid. Oh Texas. Well.
2
Your "solution" is an NRA fantasy that will not work. As was recently shown, even a very-experienced policeman can freeze up and fail to engage the shooter. Why do you think an elementary school teacher will be able to do better?
4
Because they won't want to see their students murdered and they will be in place to engage.
No state wants to care for mental health care. Even getting paid to provide counseling in Texas is difficult. So there aren’t enough nurses , psychologists, counselors or Psychiatrists to work in the clinics and sub-standard rat hole psychiatric hospitals. Take care of your physical and mental health- Do Not Watch TV!
1
Richard57--Health Care, in any form, is anathema to the kind of oligarchic government we have today. We can all die in a ditch, as far as the current authorities are concerned. Their answer is to shoot or incarcerate people, rather than help them, because basically, they are "little people" who have no monetary value.
2
I do hope you took the condo manager to court and the people who hired him in the first place.
4
I'm confused.
So her son was sent to a mental institution because he was nocturnal and had long hair and the police went along?
Seriously?
Hope they sued.
I know some people have mental illnesses.
I suppose to a certain degree we all have the proclivity toward 'weirdness'.
Funny how our government declares some as mental but not others.
As for help, I fear that we as a society are trying to get rid of everything and everyone that doesn't fit our norm.
That is sad.
3
“taught us that the entire mental health system is broken.” Really, the entire culture is broken.
4
What every mentally ill person has in common is that they are suffering. To engage these people, our system needs to begin with empathy for their suffering. If we instead start by protecting ourselves from them, we will continue to fail.
4
I hope that having a big name like Norman Ornstein write about his own son will work, but it’s probably unlikely.
4
Mr. Ornstein,
My sympathies to you and your wife. My sympathies to all the parents and family members writing here. To the rest of you second guessing and remonstrating, you just don’t get it, you just don’t know.
For the last year I have been dealing with the aftermath of a psychotic break my child had, more or less out of the blue (one can see small signs that may have been precursors, but at the time we’re not red flags). The big problem: after your child is 18, you cannot make them get help. Imminent danger means they are weaponized or standing on a ledge or holding the bottle of pills in their hand. Mental health agencies, doctors, the police, even the federal resources of the NIH, etc. All tell you that they and you can do NOTHING, because your child is an adult. So you get to just watch, as the person you once birthed from your body, held in your arms, signed the perfect report cards of, clapped as they walked across the stage in cap and gown, twice, spirals into darkness and delusion. The laws, the resources, the “care” in this country is inadequate and is only available after catastrophe instead of before. We should be ashamed that we ever thought we deserved to be called “great.”
103
Thank you for your eloquent words. Brought tears to my eyes. But probably because I'm one of the many who DOES know what you're talking about.
2
Professor Ornstein, thank you for this article.
However, I can't help wondering how many of your colleagues at the AEI who haven't had these personal experiences with family members are advocating to further shred the social safety net to lower taxes on the 0.01% oligarchy they serve.
6
This essay isn’t about the organization Mr. Orenstein works for. Far from it.
2
Mr. Ornstein, Thank you for sharing your personal and very sad story involving your son. As someone who works in the field of mental health, above all it's important that we treat our patients and their family with dignity and respect. In regards to the Baker Act, I'm surprised that the police did not require first hand information from the landlord himself about dangerousness to detain your son.
In defense of the police, they were probably acting on the best information they had and they must assume that an individual is in fact imminently dangerous if they are being told so. Often emergency responders enter into life threatening situations in which a person has overdosed or is making threats, etc. Many officers receive crisis intervention training and are able to respond appropriate to their own assessment of the individual and situation once they arrive on the scene. Without more facts it's hard to indict the officers for their decision making.
In defense of the hospital staff that did not confirm whether your son was a patient and didn't inform you of discharge, they were almost certainly following the wishes of your son. Consistent with HIPAA, staff need consent to acknowledge presence of their patients even to family members. Why? Although not the case here, someone calling the hospital could be an abuser, a stalker, an employer, or someone they do not want involved. My approach is to discuss this at length with the patient so they can truly make an informed decision.
7
Has anyone had a positive experience with the Baker Act? I mean anyone who has been incarcerated?
19
That would be me. involuntary committals saved my life in the 90s, before I got treatment for PTSD.
Having said that, the parents have no one to blame but themselves. They jumped to conclusions based on second-hand information, and broke the trust of their child. Don't blame a law for your bad decision.
2
I would be dead had it not been for long term psychiatric care. When will the USofA wake up about mental illness? Don’t we know how much NOT caring for the mentally ill costs in the long run!? Are we still so blind as to think mental illness is a weakness, something shameful? Remember when having TB was considered shameful and only dirty people caught it? We grew up about that but the mentally ill are still rejected and blamed. Is that because Americans feel they need to hide their imperfections? Is that because we think you are only ok if you seem A-OK? For heaven’s sake we have mental illness all around us; every day of our lives we interact with people who take antidepressants and/or see therapists. Mental anguish is visible everywhere and not always visible. I wish all families like yours, Mr. Orenstein, would speak out more and more so we can have a massive show of hands: yes, I too have been afflicted with or lived with mental illness. My thoughts of compassion go out to you, sir, and to your family.
80
I have been treated for severe depression and anxiety, including 3 hospital stays (all voluntary 72-hour admissions) when I felt like I was a danger to myself or a family member was very concerned. I think it is absurd that I could walk down to a sporting-goods store and leave with a gun less than an hour later, since I have no criminal convictions nor involuntary mental health commitments. I know myself well enough to know that ordinarily, I pose no danger to myself, much less others...but depression is tricky. When I have been severely depressed, I am not entirely rational, and could seek to end the pain by the most expedient way possible, and if I possessed a gun, that would be all-too-easy to do. Why doesn't my country value me enough to protect me from that sort of irrational action?
7
The culprit in this tragedy isn't the law or the court system but rather the lying, scheming condo manager.
If someone is plotting to remove a vulnerable tenant, and they are savvy enough to lie convincingly, then how is a different law going to make a difference? Won't they just make up lies or fake evidence to match the different legal requirements?
7
If you see the 'Prevalence Of Mental Illness' stat (https://www.nami.org/learn-more/mental-health-by-the-numbers) you realize how wide spread this difficult problem is across the population. In numbers the very difficult to treat patients should come close to the prison inmate population, which means we need a national budget to treat the moderate-to-severe mentally ill patients which is comparable to the budget for running prisons. It is a very big national issue with federal plan that is fractured and incoherent. The government don't listen to the families with severely mentally ill loved ones, they listen instead to NRA and gun advocates about how to 'handle' the mentally ill patients.
1
I am so sorry for this family's tragic loss. How ridiculous to make families go through this, only to still lose their loved ones.
It is refreshing, though, to see pushback against the "mental health" rhetoric. To reduce gun violence, we keep must guns away from those with a history of violent behavior. To improve the mental health system, we need improve access to evidence-based mental health treatment.
This isn't hard, and I am particularly paying attention to politicians who try to distract the public with vague "mental illness" tropes that serve only to stereotype and stigmatize those who may have perfectly treatable conditions and absolutely no history of violence. The NRA and the GOP are targeting people with health issues, while doing nothing to address the real issue of aggression.
After Columbine, we focused on the negative influence of punk music and video games, while skipping over the shooters' long histories of violent behavior and rhetoric. We blamed "bullying," but focused on remaking the shooters into social outcasts, instead of looking at how aggression may breed more aggression. After Sandy Hook, again, we saw only a disturbed, detached young man. Buried beneath the headlines were his history of violence and violence ideation.
Nikolas Cruz, like millions of people, had mental health issues. But unlike most of these people, he also had a history of increasingly violence behavior. THAT is the key. Politician focusing elsewhere are part of the problem.
8
Only in America do we drive those with serious illness into the streets. Only in America do we blame the seriously ill for their sickness. Only in America do we castigate their parents. We beat the drum through language, describing the sick as people with "mental problems," or as "troubled," or as to blame for their own downward spirals. We stigmatize. We under-fund. We wring our hands. We do nothing. Our cruelty knows no bounds.
The brain is an organ of the body. When it malfunctions--the way a kidney malfunctions, or a heart, or a liver--it kicks off recognizable symptoms. Psychiatric illnesses are biological illnesses, just as cancers are. Just as any illness is. We do not throw our cancer victims into the street and watch them then be carted off to jail. We do not tell people with kidney failure that they are on their own.
I've fought to save two of my children from both their psychoses and incompetent care and I thank Norman Ornstein for writing this accurate, enraged essay. I'm enraged, too, both at the system and at the foolishness of those who would second-guess the writer or what drove his actions. Until you've been faced with the need to have your child involuntarily committed--stood in the agony that leads to that choice, the terrible panic and fear--you cannot make any assessment of what another felt he had to do.
Barbarity. Stigma. Ignorance. Fear. The things that drive policy. I long for the day when we do better. I don't think it's coming any time soon.
12
The writer should have gone to check on their son before filing paperwork to have police involved to take him to a psychiatric ward. They shouldn’t have been surprised that after filing paperwork to have their son picked up by police and taken to a psychiatric ward, that he was picked up by police and taken to a psychiatric ward.
Further, the writer should not be surprised that the hospital would not let them see their son or confirm that he was in the hospital. Their son was an adult and unless he consented to his parents visiting him or being contacted by the hospital, they should have not been given confidential health information by the hospital. The writer’s suggestion that family members should be given protected health information about a patient is particularly troubling as any patient in a psychiatric ward is free to sign consent forms that allow the hospital to do just that. If the patient doesn’t want their family involved then they should have every right to bar that from happening. Too often the general public treats mentally ill of being not worthy of the common privacy protections that ‘sane’ people enjoy.
It’s also kind of scary how the writer is suggesting that holding a psych patient against their will for SIX MONTHS is ‘far from enough time to provide any meaningful or sustained treatment’, as if outpatient treatment doesn’t exist.
This entire piece treats the mentally ill as if they have no right to due process, it’s very disturbing.
21
Bob, my guess is that you have not had a family member who was insane and had to deal with two realities at the same time:
1. You love them and want them to get help with their illness, even though they deny having an illness.
2. They have threatened you and you fear for your own life.
37
Give me a break! So you think the parents should have known better. While much of what you write is true, it is so illogical as to be spine-chilling or laughable. I trust you haven’t been on the receiving end of this sort of situation, because if you had you’d be looking at this through a different lens.
If it seems right that a hospital cannot admit your adult child is a patient being held involuntarily and receiving treatment, I think a reality check is in order. If a child is determined to be a danger to self or others, parental intervention seems generally advisable. If someone in such a state can be forcibly medicated against their will, is allowing their parents to collaborate with their healthcare team any worse? This child is more-likely-than-not going to need support at discharge. The hospital, the legal system, the patient, and society should be thankful the parents are willing to be involved.
Little in life is black or white; there's a long continuum of gray between the two poles. We have to retain enough of our imperfect humanity to understand when we're up against a rule that is illogical for the situation at hand. When I was mature enough to understand the concept, my father advised me that there are times when a lie is okay if it doesn’t hurt or disadvantage someone else and sometimes the same is true with breaking a rule. Such must be done judiciously, but to never lie or break a rule can be inhumane.
3
Carolyn, I'm sorry if that has happened to you, but Mr Ornstein gives no indication in his article that his son had threatened anyone or that anyone feared for their lives.
Unless Mr Ornstein clarifies, we won't know.
2
So sorry for your loss. Verr-rry sorry for the pain your son endured. My family (haven't we all?) has been affected by mental illness too; a sister in law committed suicide, two others diagnosed bipolar. Thankfully the family has financial resources for the never ending admissions to treatment. I can only imagine what horror other families go through without funds.
6
My grandson and I shared over 5 years of nature walks and talks, frog catching, stick-boat floating, each attentive to the other. He went to school in another state when I returned him to his mother at 7. His LD was known to his pre school kindergarten teacher was never part of his later school curriculum. He did not have EMR classes which is what LD is known to be at this time. The group home idea has proved to be a fleeting fad. So that leaves home as incarceration. This is the untalked about solution. Elderly grandparents are often society's choice. Parents are overwhelmed as well.
We talk all around the LD problem but the silent solution of home incarceration remains. We have platitudes galore, sympathetic talk, analysis until the air turs blue but the fact of home incarceration remains.
The low stress mental hospitals are sold for condos, the group homes are for the select wealthy few, the parents inherit the LD child at the grandparents death without any resources as any property is attached by the state to pay for the 'services' given. We now have thousands of 0ver 21 year olds that will be without any funds having aged out of foster care.
We will see many more of the same crisis.
What is your solution?
34
Parents aren't always the best judge of their child's mental condition, especially when the child does not live at home. No one wants to believe their child is ill. I find it hard to believe that a landlord called the police to report a dangerous person because he had long hair and a beard and took walks on the beach, although I suppose the smoking might have been an issue if he sat in his apartment and smoked all day long, as this would result in smoke permeating other persons' apartments and coat the walls and windows with smoke. Also, you cannot not have someone involuntarily committed because it might make them angry at you because by that standard no one would initiate an involuntary commitment. Mr. Ornstein isn't a mental health professional. --Anne Rettenberg LCSW
7
I am so sorry for your loss and agree with your policy ideas.
1
SINCE THE NRA TERRORIZES Those who disagree with its violence, the mental health laws do nothing to control access to guns. The late J. Everett Koop, attorney general, had said that teaching kids about the prevention of AIDS without mentioning sex is like teaching them about snakebite without mentioning the snake. The situation with violence and firearms is precisely the same. The US has the highest rate of gun ownership in the world, along with the highest rate of homicide in the world. Hence, teaching people about preventing violence without mentioning guns is, indeed, like teaching them about snakebite without mentioning snakes. However, spitting cobras can only spit (or "shoot") their venom a distance of about 2 meters or 6.6 feet.
4
Your son was not committed because he had a beard and long hair. He had to have been assessed by a psychiatrist in order to be committed, and whatever that assessment elucidated was what got this young man committed. The usual standard is either he is a danger to himself, such as suicidal, unable to care for himself in extremes, or to others either through threatened violence, or other antisocial behavior. I had a friend who was psychotic and was taking her hands off the steering wheel, convinced that the car "knew" where to go, but she was on an interstate going 70 mph while testing this theory. She was also delusional, but otherwise managing to get through her day.
In my opinion we need to beef up our ability to hospitalize dangerous mentally ill patients and give them antipsycotics in a hope to lift their symptoms. Psychoses respond reasonably well to medications, and the prognosis without them is rather grim. We also need to beef up background checks for gun purchases, and we ought to outlaw automatic military style weapons. Too many innocent people die in this country in the name of "the right to bear arms" and a "right to refuse care. " How about a right for the general public to walk their streets without fear, and the right of children to a safe childhood and an education?
6
How wrong you are with that first statement.
The assessment doesn’t happen until AFTER they are committed.
Often it takes days for the patient to finally see the doctor and get assessed.
6
Corinne is correct. There is no psychiatrist involved until AFTER the person is hospitalized.
And nobody should have the right to force anyone to take any kind of medication. Mental illness should not mean loss of civil liberties.
I also question the "danger to oneself" standard for commitment and forced medication. Logically, the right to control ones own body should extend to whether or not one decides to remain living. is is awful when someone takes their own life, but, ultimately, it is their life, not anyone else's. One could argue that people who smoke, drink heavily, don't take medication for diabetes or high blood pressure are also killing themselves, but nobody incarcerates them for doing so. I realize this is an unpopular opinion.
4
"He had to have been assessed by a psychiatrist in order to be committed...."
So untrue. Re-read this sad story and understand that his parents' declaration and a judge's agreement is all that was necessary to initiate the man's involuntary transfer to an institution.
It happened to an old friend many years ago when his brother and mother Baker-Acted him in south Florida. It turned out for the best, because the mental health specialists that attended to him correctly diagnosed his bipolar affliction, and he was put on a successful course of treatment.
5
Americans are being slaughtered by gun violence yet our brave and fearless leaders tell us it isn't a gun issue it's a mental health issue. Where is the funding for mental health if that's the case? We need solutions not finger pointing. If it's mental health, then lets fix it. As a society, we need protection from gun violence/mental health a lot more than we need a tax decrease. We need to be committed to finding legitimate solutions and not politically expedient ones.
4
While the events portrayed in the article and in many of the comments could have been familiar in Sparta on the 5th century BC, seeing them happening in the supposedly most advanced country of the 21st century defies any comprehension.
1
As the article tragically points out, mental health issues are complex - even when treatment is available, offered and wanted there are no magic solutions...
No Access to assault weapons needs to be the first priority. Countries with strict gun laws do not experience these mass shootings.
Many of these mass shooters, as profiled, seemed like very angry, violent men- some had mental health issues and in fact a few, if reported accurately, were “in therapy”...
I am not sure tying together lack of mental health services and gun access is helpful and may be the new governmental smoke screen.
Cynthia newman, msw, lcsw
2
These are common sense improvements to the mental health system in the US.
However, let’s stop pretending the GOP has any intention of improving mental healthcare as a deterrent to mass shootings.
It’s a talking point used temporarily right after every mass shooting yet immediately forgotten a few moments later.
3
Thank you for sharing your heart wrenching story about your son. We too have been down this road however, our family member was a danger to himself and others. Unfortunately he was out after 72 hours and calling us with veiled death threats for having him “locked up”. Not threatening enough to get him back to the psych ward, but just enough to terrify us.
A week later we had an ex-marine family member visit him at his apartment who did a quick sweep for hidden weapons while our mentally ill family member was in the bathroom. He found several guns duct taped under his coffee table. He was incarcerated, out a few months later and shortly after moved out of state. That was 20 years ago. We cut off communication with him after he moved.
Ten years ago we attended a family wedding in that state. An open carry state. We walked into the wedding and there he was, packin heat in a holster. We left immediately. I have told this story so many times and every time I do people look at me as if it can’t possibly be true and yet, there are so many of us who have been down this road with almost identical stories. All I can say to anyone in this predicament is to have a bag packed at all times and have a plan to escape the media when and if your family member decides to act on the advice of the voices in their head. Until we get serious about treating mental illness and regulating who gets their hands on guns, be prepared to lose more of your children.
9
My son, too, has required involuntary commitment from time to time, and I had to resort to the hypothetical to find out whether he was at a certain facility or not. "Hypothetically, if my son were with you, could he expect to be treated? "And, hypothetically, for how long?"
It's not that staff don't want to help, but one's child doesn't agree, which mine often didn't, blaming me for his incarceration, those staff are helpless. I did once discover, though, that the Palm Beach jail was the first in the country to separate criminals from mentally ill inmates who'd been arrested on a misdemeanor, rather than a crime. I decided not to bail my son out, knowing he'd get at least 30 days of treatment.
6
I grew up next to a mental hospital years ago. There were several thousand people there. There was a dairy, hospital, gardens, farms. It was quite self sufficient. The conditions seemed a lot better than what I see in, for example, the LA area. Now many years later I have a residential facility for the mentally disabled. I am always surprised that while many people are happy here and we are the SS payee and so the cash is limited, many want their freedom to drink, smoke, do drugs and have unprotected sex on the street (they can have sex in the facility with protection provided) and control over their SSI money. This is the price of unlimited freedom. If we are going to have better care of the mentally ill we are going to need more control, and we are going to have to pay more. That model was destroyed many decades ago. While residential facilities such as mine are a lot cheaper than the old state hospitals one has to think they are cheaper for a reason.....like no unions, no real benefits for employees, and low pay. Because of the small amount paid by the government our workers are paid like McDonald's workers or worse. You can't have gold plated care without paying for it and the voters seem to want to allocate funding to the military and not to those in need in our own country. This is not a medical problem.....it is a problem with the voters and their politics.
5
We warehouse the elderly the same way, in large, often substandard, poorly staffed (and underpaid) "homes." Something seriously wrong with this "Christian" country of ours.
2
While hiding behind mental health as the key problem with the country's obscene prevalence of gun violence at the same time as gutting Medicaid and other mental health treatment services is the height of hypocrisy and cruelty.
4
I am sorry for your pain, suffering and loss of your child. I worked as a Mental Health Specialist in Illinois in the days of what I call the remnants of the Kennedy era. The Kennedy's deinstitutionalized mental health treatment and promoted smaller community based centers. At Adler Zone Center we had a 92% success rate of re-integrating emotionally disturbed children back into the community. This was their last stop before permanent institutionalization. When Regan came into power (and we also had a Republican govenor), he cut mental health monies and we were closed despite our successes. This is also when we started having homeless people.
Many countries treat mental illness compassionately without making it a crime to be mentally challenged. The US is in the dark ages and going darker.
6
The words "Baker Act" send chills down my spine. My sister was "Baker acted" numerous times. Three days on lockdown, medicated to oblivion, not an apparent ounce of empathy or tenderness by the staff (it was prison) and then..out the door. She once walked home barefooted in her hospital pajamas. It was a few towns away and her feet were bleeding. Your story is so incredibly sad and yet -- here's the stunning part -- it is not unusual. I know many compassionate, competent psychiatrists and therapists; not their fault. The system is broken -- even cruel -- and mental illness is not photogenic. People who aren't intimately affected by it would prefer it would just go away. It will not.
164
Who is this Baker whose name is attached to this obscene law?
1
In addition to stigmatizing it is profoundly untenable to claim post-hoc that individuals who had been judged fit to purchase/own firearms only days before have suddenly become severely and dangerously mentally ill after a shooting.
4
Truly sorry for your loss, and your nightmare dealing with the so-called mental health system.
Any thinking person knows more than anything the root problem is republicans.
Anything good for people and the collective - they oppose or have opposed.
When SS was first proposed, they waged a bitter fight against it.
Same for Medicare, Medicaid, workers comp, the ACA, etc. etc.
We have to be discerning and vote for democrats that will support universal health care, which must include of course much expanded treatment for the whole range of needs of those with mental illness.
It is what decent people do. We know which politicians are not decent, it's self evident.
Collectively we have to do the humane and right thing by voting in those who will give us an actual chance at moving forward on this important issue.
5
It is heart breaking to read the indignity your son suffered by being hand cuffed and taken naked under the guise of helping him. Barbaric as well the institution refusing to let you see him. Until a person experiences the frustration of inept, callous, unprofessional treatment, plying the patient with drugs willy nilly, seeing your loved one drool and shuffle within days, you will never understand the raw sorrow, grief, hopelessness, frustrations you face while seeking help for them. Mental health is actually non existent unless you can afford a private facility with competent people who strive towards making their patients be productive members of society once again.. Drugging until a patient is incapacitated is the outcome in public facilities, the trauma they cause is probably worse than the illness. A constant, unbearable roller coaster ensues after after a 3 day commitment. How dare a person comment the family or parents are responsible. You look through years of photos from infancy on and revisit the moments of sheer joy, places you've been, people you were with, parties, holidays and the love documented in every picture. You cry, your chest constricts and you realize a broken heart truly exists. Mental Health is an epidemic for all ages. Hopelessness caused by corporate greed and a corrupt, failing political system
106
Private facilities can also be snake pits, no matter how posh they appear from the outside. Beautiful rolling green lawns and fancy facilities do not ensure that anyone on staff gives a damn.
4
I worked for many years as a social worker in a state psychiatric facility here in Texas. The main differences between most private and public facilities is slightly better food and decor. In private facilities, people are miraculously "stabilized" the day their insurance coverage runs out. After that, they frequently end up in my former facility. I can't tell you how many family members that I worked with were surprised and relieved that their loved ones were actually given better treatment at our old, crumbling public facility. That treatment was also woefully inadequate and the patients often discharged too soon, with insufficient aftercare and housing. However, expensive private facilities are subject to the whims of corporate greed every bit as much as public ones are at the mercy of a corrupt, failing political system. I have no answers, only questions, and a profound relief that I am now retired and no longer have to be faced on a daily basis with such a barrage of human misery.
2
Cancer... Heart Disease...
Muscular Dystrophy... Diabetes...
Severe Mental Illness...
What these all have in common is they can hit anyone, at any age, often without warning. They are all DISEASES: they are not a lifestyle choice, or a moral/character weakness. Each deserves our Understanding, Help, Support, and utmost Compassion.
Yet, mental illness is treated by society - and even the medical community - as something entirely less, and yet much more. Something darker, scary, suspect, and worthy of far less research, insurance coverage, treatment... and vastly less tolerance by society, and even family and friends. The fact that we toss those afflicted into back rooms, locked areas, prisons and jails, or the streets/homeless shelters is infinitely more a reflection on us than it is on those afflicted. Would you abandon an accident injured loved one, or toss your cancer stricken brother out on the street? Who would do such a thing? Who would condone it? No civilized society would dream of it! Yet, the mentally ill often get far less.
We can do better. We must do better!
5
It is really, really despicable for the defenders of unrestricted gun rights to shift the blame for mass carnage onto the mentally ill, taking advantage of their vulnerability and stigmatizing them further in order to keep people from seeing and acting on the obvious reality that guns are the problem. I am so sorry to hear how your well-meaning efforts to help your son got your whole family pulled into a Kafkaesque nightmare, and even sorrier to hear how the system failed to save his life.
7
Incarceration under any name is a remarkably ineffective treatment for mental illness, gun fixation, criminal behavior, or slovenly lifestyle.
Sounds like the appropriate treatment for the Ornstein youngster is a haircut, shave, shower, and some counseling on manly grooming and deportment.
Universal military service would serve as treatment and preventive for many ignorances and ills of immaturity!
What???? Have you heard about any of the problems people have after military service? And during? The military is to defend the constitution and the country not cure what you see as a social ill..
2
When a person recognizes that he/she is suffering from mental illness, most can not afford treatment. Most health insurance policies cover very little of the cost. It's time to look at that as well.
3
We are all coming to truly understand the cruelty undermining almost all of the "safety net" systems in this country - from immigration to mental health to earning a living wage. Although Democrats aren't completely blameless, we can thank the Republicans. I simply do not understand how simple compassion has become something to mocked and ridiculed. When it happens to them, they suddenly see the light. No imagination, no empathy, no caring for others. It sickens me and makes me ashamed to be an American.
2
I’m old enough to remember the time before deinstitutionalization of ‘ALL’ mentally impaired. The articles & pictures about facilities in newspapers, magazines, & TV. Then bang we threw all these poor people out on the street. But, like other problems, this too has seen cycles. The old hospitals were bad. But, curing that with dumping the patients into homelessness wasn’t the answer. We are now seeing the next part of the cycle rear it’s ugly head. More ‘new’ giant hospitals. With locked wards, not rooms. In a short time even hospital pajamas would be done away with & patients, naked, sitting on the floor, either heavily medicated, or not medicated at all (whichever would be worst for them). Too few doctors, too many untrained orderlies, who look a lot like bar room bouncers. It’s the way we are headed. Though if you can wait 60 years or more, the cycle will repeat. It’s the cycle of money too. I’ve watched addiction treatment cycle. From 21 day programs 28 years ago, with many having good insurance that paid for it, to many facilities saying 3 day ‘detox’ is all they need (because it’s all insurance will pay for). In 28 years, this cycle as gone round & round a few times. When insurance pays, treatment centers teach their patients that relapse is inevitable, when insurance pays only once, they teach just say NO. When 3 day Detox is all that is available, well, they don’t really teach them anything. Many have closed. Now detoxing in jail is most all will get. Very cheap.
What does this author think happens when you call the police on someone? They show up with a warm blanket and a hug? No. Police show up with guns and handcuffs. Then they do what police are trained to do: use force to remove allegedly threatening people from society.
Some families truly have run out of options, other people just can’t cope anymore or delude themselves into believing they are helping. But pursuing involuntary commitment against a family member is like reporting him or her for child abuse or neglect—you’d better be darn sure you’re right before you make that call because once that machinery is set in motion, virtually no one can stop it.
118
Why did the parents not go to their son directly and speak to him? There is more to this story than Mr. Ornstein is willing to say.
3
"delude themselves into believing they are helping."
Yes, unfortunately.
Involuntary commitment can be worse than criminals getting jail time.
3
Does anyone besides me find that well-meaning "others" can completely eradicate someone else's constitutional civil rights? Someone who has broken no laws? This is why I and many others - despise government.
3
So what do you propose? No government? So, no traffic controls or water treatment or courts? No police or military? No sanitation or parks or subways or maintained roads? And guess what else your not so well thought out plan includes: no Constitutional Rights.
4
Based on the Patriot Act, and the lawless activities of the past (now) 3 administrations, I'll take my chances.
I feel sympathy for you and your wife for what happened to your son, and his unfortunate, early death. That’s terribly sad.
But, as I understand it, you went straight from the airport to the courtroom to have your son temporarily put in a mental institution on an emergency basis. I thought I was missing something. I would assume you would want to go see your son first, talk with him a little bit, and assess his situation before you took such drastic measures. How could you trust his landlord’s word for such an important decision to be made blindly? There must be something you left out.
14
I am generally in favor of all the steps that Mr. Ornstein advocates, but as someone who in the past was forced to undertake a painful and hard process of helping a relative experiencing a psychotic episode, I found it hard to get past the initial few paragraphs. On the strength of a single phone call from a stranger without once talking to their son they took steps to get him involuntarily committed. No, it's not surprising that he found it hard to trust you after that. I think about the number of weekends I spent -- going off and on between my parents' visits -- cajoling, coaxing my family member into seeing a doctor. I even took this person to ED after getting approval from the HMO for inpatient care, only to walk out again when this person told me that they didn't want to stay. I cried all the way home. Eventually, this person was persuaded to get help and did get better. There are no guarantees, Mr. Ornstein might never have been able to do what we did, but if you are trying to deal with a relative that you suspect has a mental illness, please, you should never act so precipitously. If his son had really presented a danger, the landlord would have called the police not his parents. If he could wait for them to fly in, there was nothing immediate about the danger.
8
I think the problem with any of these laws is the combination of the involvement of law enforcement who are inadequately trained to deal with this population, the underfunded mental health treatment system, and the woefully underfunded psychiatric science and treatment system. We're not designing mental health hospitals to be places of healing, just places of confinement; they're scary for those of us who are functionally sane, imagine how more so for someone who has psychotic delusions or paranoid ideation, etc.
The other issue: if a patient has anosognosia, by definition they are impaired and need to have supervision by kin or the state. And some studies suggest that the vast majority of people who, while in an acute state of mentally illness, commit antisocial crimes, are overwhelmingly in a state of anosognosia. That tells us that we have to focus policy on this particularly vulnerable population. Just read the NY Magazine on the tragic case of Nakesha Williams.
2
Mr. Ornstein, I am so sorry for your loss. Your story is both heartbreaking and highly illustrative. This past December, I was running in the park and was hit from behind by a car at full speed. It appeared to be on purpose. From what little we know, the driver was a young man in the throes of a psychotic breakdown. The DA told us his family was "trying to get him help", but he had recently turned 18 and could sign himself out of the hospital. I was very seriously injured and, though I am recovering, I will never run again. I told the DA that I would like to see two outcomes: this young man should never be allowed to drive, but also, I hope that, at least through the criminal justice system, he will get treatment for his mental illness.
102
Let's add that the young man should be banned from buying a gun, as well.
5
I'm so sorry to hear of your very serious injuries. Your compassion for the mentally ill young man who caused them is remarkable.
I would add one request to your short list: this young man should never be able to obtain a gun. And to truly fix that, we need a universal nationwide background check on all gun transfers, and we need every national, state, local ageny and every branch of the military to face incentives for reporting all relevant information to the national background check database in a timely fashion, and penalties for failing to do so.
3
When I was growing up, my father a psychiatrist at a major teaching hospital would lament the changes in the laws that foreclosed on involuntary hospital admissions for mentally ill patients. Like any policy, perfection does not exist and cases of patient abuse existed. However, the consequence of what was essentially a 180 degree change in policy and an group of well meaning patient activists was the creation of more than generation of street people and imprisoned criminal mentally ill patients. We have traded one problem for a far worse problem but as these mentally ill people are no longer housed but homeless or if housed and in prisons, there is no public outcry and the problem persists with horrific outcomes.
8
Releasing all these people has had another outcome: we the majority no longer own public spaces-- many are not available at all having crossed from unpleasant to dangerous. the unintended consequence of this is how we have devolved: instead of compassion we feel disgust, fear, or worse-- we feel nothing at all.
6
Mr. Ornstein, I am truly sorry for your loss and am glad that you published this article. The mental health system, if one can call it that, in this country is truly broken. As you point out, it is very difficult for individuals with mental health issues to get proper treatment, and short-term hospitalization is often extremely detrimental to the patients. Worst of all, unless the patient is supported by a family with financial means, often no treatment is available at all at a cost that even approaches affordability. This is elitism at its worst, the result of which is often "cruel and unusual punishment" of those who need help.
4
How could a country which does not share the cost of the health take care about the Mentally hill ? Libraries are full of books which explain how to develop your emotional and mental balance to be a winner but what about the treatment of mental illness : the cops and the jail ?
Pherpas could the Italian mental heath care be a model ?
My family is in similar straits--in our case perhaps its worse. An undiagnosed, seriously ill person whose condition's is basically defined by his inability to reason clearly and understand that he is ill, and deeply suspicious of all attempts (gentle, persuasive, forceful, circuitous) to get him in front of a doctor make getting him diagnosed and on the road to treatment impossible. At this point, our options are 1. continue caring for him, despite the toll it is taking on our mother, who is literally dying of stress for him. 2. kick him out of the family home, so that he can commit a crime and be forcibly evaluated. At least he can probably get a gun with ease, though, right?
5
Nothing will change until the children and grandchildren of the rich and powerful are afflicted.
The rich and powerful have the financial resources to help their own.
So, nothing will change.
Seven decades of dealing with mentally ill loved ones tells me this.
2
Nothing will change until the children or grandchildren of the rich & powerful suffer.
And since the rich & powerful have the resources to help their own,
nothing will change.
This opinion comes from observing the rich & powerful for seven decades.
1
Thank you for a great article and for expressing the issue so vividly. Nothing says dysfunction more than the Florida Governor's request for 450 million dollars to exacerbate the problem by putting more guns in schools, versus 50 million to treat mental illness. That is an example of the kind of thinking that would motivate a person to urinate into the ocean with the expectation that it will turn yellow.
2
Anyone can be harmed by fraud. To use the author's experience as evidence that the Baker Act shouldn't be part of the solution is to raise anecdotal evidence above sensible thinking. Make no mistake about it: this man's son was harmed by duplicity and greed.
1
As the mother of a teen on the spectrum, our son and our whole family have lived with the turmoil and grappled the broken system that's designed to help him. We worry that not enough can be done before he is 18 to keep him out of the prison system, despite getting the best interventions we can -- we are not wealthy and rely on what the public schools and private health insurance can do. These services are minimal, and he is shuffled up to the next grade at school each year. We all learned from Adam Lanza that even wealthy families who have the resources to care for their autistic children into adulthood cannot guarantee that they, or others, will lead healthy lives. I'm waiting for the world to wake up, and it's not waking up in time for my son. We are now looking for a residential placement where he can be stabilized, but the choices are few, and the cost is prohibitive. It's a Hail Mary play we have to make because we can no longer keep him safe. The system is set up to dump our wonderful, terrific, different kids onto the street at 18, and it appears that there is precious little any of us can do about it.
4
Surely legal standards can be changed to reflect modern realities by requiring charges and complete investigations of anyone posting or otherwise making public threats.
Investigations should canvass gun ownership, social inclusion status, mental health issues, and provide a discretion permitting law enforcement authorities to seize weapons at once.
The law needs to weight individual rights against public safety rights. Neither is exclusive.
Laws then also need to be enacted to look at later adjudication on broader standards than exist now, so that the courts can more easily prevent someone from acquiring or having guns and over longer periods.
Having one psychiatrist make one 40-min. assessment is not sufficient or appropriate in modern circumstances and this standard must be changed immediately. New methods and standards of profiling must be used instead.
Further, we need a new view of crime. More than moral turpitude, crime is also a reaction to a criticism a very dangerous crisis. Offering both psychological but also crucially important social assistance and insisting on its acceptance, also need to be on the table when dealing with loners and guns issues, and similar situations.
At the end of the day, society needs to rescue loners and prevent crimes. Everyone wins in that scenario.
2
I am so sorry for your loss, Mr Ornstein.
No matter how smart one is, when it comes one's children, it is always difficult. There is no doubt Florida has been a Florida state for quite a while but Baker Act and the building manager are unlikely the culprit of your son breaking away from his parents.
That said, there is also no doubt the sorry state of American mental institutions. There is no perfect solution but it has begun with de-institutionalization back in the last century only to be exacerbated by the relentless assault of mental health on the right.
Money is important but mental health depends on our attitude to it. Being an after thought is now coming to haunt the society with all these shootings and mayhem by deranged people. For a long time, it is a stigma. People didn't want to acknowledge it. And a way to make light of it like "I was talking to my therapist last week..." as if it were just a lifestyle. But in fact we wanted to dehumanize it. The real solution, besides money, is kindness and compassion. Money is important because it is hard for minimum wage healthcare workers to be compassionate if they have constant worry how to support their own family
2
correction: replace " Florida has been a Florida state" with " Florida has been a regressive state"
As other people in the know commenting here, I'll add my remarks. I've been a state licensed (now largely retired) psychologist and realize the utter frustration about some of the regulations regarding behavioral health treatment. One family member wrote an article a long time ago entitled "When Freedom Means Neglect." There is a continuous struggle between civil rights and certain levels of behavioral health care. Confidentiality can be devoid of common sense, especially about families, but people can be sued for breaches. Of course, I'd advocate for more funding, especially for outreach efforts by trained people--not leaving things largely to the police. Law enforcement does a valiant job in trying to help people, but I know they'd prefer to be back-up to trained behavioral health professionals. Also, of course, there should be changes in the behavioral health care coverage--Medicare for all, as Bernie Sanders and a majority of citizens want. As has been pointed out here, admission to and length of stays for inpatient treatment give priority to cases posing danger to self or others; patients otherwise don't "meet the criteria" (including for coverage!). And yes, what legislation do we get with largely Republican horrors? Shifting away from the humane to the inhuman--more money going to the rich and military. The irony is that the politicians (undeservedly) and military (deservedly) get their health care through the government.
5
I had a box seat in juvenile court for many years, first as a defender of young juveniles, then as an attorney for a child welfare agency for child abuse and neglect matters. These courts were only as effective as the supportive systems around it: the schools, social work agencies, and mental health. Since the takeover of conservatives in state and federal governments these systems have more than likely come under the austerity knives. Despite all the insightful research on prevention of crime and institutionalization, our nation's failure to adequately fund these systems is a proximate cause of many of the problems and dangers presented by people whose mental health needs have gone untreated or inadequately treated. With all the wealth created in our economic engine it is criminal what little of it goes to both these human service systems and infrastructure. We have developed a culture of avaricious people who without a sense of community and social contract are slowly but inexorably bringing us to the last days of our empire.
6
The real mental health problem in this country starts with it being called mental health. This term stems from hundreds of years ago when doctors thought they were finally learning something about physical health, but still realized they knew nothing about mental health, so "mental illness" was stigmatized. Now when doctors and other scientists are beginning to learn much more about the brain and that it functions as a physical organ subject to the laws of physics, biology and chemistry, as all other physical organs, society is still stigmatizing mental illness as something weirdly different from physical illness. They are in reality the same; the brain is just much more complex than the other physical organs. I suggest we start using "brain disease" instead of mental illness, like heart disease or kidney disease. Hopefully, gradually the stigma will lessen.
6
I fully support this and intend to adopt this term.
1
Could what Mr. Ornstein says what happened really happened? I suppose so but the story seems to have major holes in it.
If police in Florida can come and take into incarceration anyone who a landlord wants out, how come all landlords don't do that when they want to instantly evict anyone who's behind in rent or whose unit they want to rent to someone else for a higher rent. I would assume that the mental health institutions would be packed with such people. Unless, unlike in NYC, most landlords there are charitable individuals whose primary concern is the welfare of their tenants.
As to confidentiality laws not allowing the mental health institution even telling Mr. Ornstein's family whether his son was there, I know of no such laws. Could Mr. Ornstein please cite the existence of such a law? And I would assume that he is an intelligent and educated enough person that he would be willing to confront someone who cited a non-existent law.
As to 180 days of inpatient care not really being sufficient to institute proper care of the severely mentally ill, I'd like him to look into how many days of inpatient care most insurance plans, Medicare, and Medicaid will pay for.
It's lucky if they will pay for more than a week. Their attitude is that that's enough time to not only diagnose someone but to initiate and stabilize treatment.
2
HIPAA enacted in 1996 is the law that put patient privacy first and foremost; as such, many institutions practice an austere form of it, such as not disclosing to relatives of a hospitalized patient what they progress is or anything related to their condition. See https://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountab...
1
I don't know what wikipedia says but HIPAA does not prohibit healthcare providers from talking with families of patients if it is felt to be in the patient's best interest.
I would challenge you to find a case of a mentally ill patient similar to Mr. Ornstein's son where the healthcare providers were disciplined for breaking HIPAA by talking with the family. In fact, they could be disciplined and also sued by the family if those providers failed to obtain from it necessary information on the patient's past history. The ultimate responsibility is to provide the optimal care for the patient.
I'm a bit stuck on how the parents of a 24 year old, who also happen to live in another state and haven't even witnessed his transgressions, have the power to "invoke the Baker act" for that adult child, resulting in immediate incarceration.
143
I have also been trying to wrap my head around the fact that the writer flew to where his son lived and went directly to a courthouse to file without personally checking on his son or calling the police for a well-being check. It doesn't even sound like he tried to call or write his son first to assess the situation. Maybe something was left out.
7
Ten years is left out. It is not the fault of the parents or the Baker Act or the patient or the health care system. Mental illness takes its toll on patients and families. Three days of observation was not the cause of all the problems this young man had. Please.
2
The author may have been talking about the Florida marsh man Act.. (for substance abuse) It would have been up to the staff at the intake facility and/
or a licensed professional to initiate the Baker Act after the patient or client had been assessed. Law Enforcement will also support the Baker Act for a 72 hour admission period by initiating an evaluation. Law Enforcement may have to restrain a person with threatening behaviors in order to bring them to the hospital.
1
What drove your son away is a failed system and inept clinicians and police who work inside this system. Burn out and poor training lead to a poor outcomes for the mentally ill and their families. If we put money back into asylums, ones that Dr.Kirkbride and Dorthea Dix originally put forth with rehabilitation in mind and outstanding, well paid clinicians, then the mentally ill would not be on our streets or in our jails.
2
Even in states with "red-flag laws" like I believe Florida someone as obviously mentally ill as Nikolas Cruz can slip through the cracks due to negligence and failure to follow up by law enforcement and others. I believe that the NRA along with Trump are using mental health as an excuse not to do anything about guns, and it makes me furious as well as disgusted. If they cared about mental health they would be promoting education and treatment and support. But they don't and they're not. Those of us who support gun control need to focus on that issue and not get sidetracked by mental health "arguments" that are only meant to deter real change on guns.
7
This happened in December with our son. Suicide attempt, then emergency petition before the court. Leading up to that moment, police cuffed him and transported him to the locked mental unit nearby. The judge upheld our petition. During this time, we were not allowed to see, talk, or even know the unit he was in. Complete anguish... for us and for him. How is that treatment? How do we enable sound judgment to prevail when privacy laws are not serving the interest of the patient? Some research suggests that when things are "hot" an 18 year old brain can not make good judgements; on the other when things are "cool," even a 15 year old can make decisions (hence, waiting periods). Not a systematic review, but here's one article on the science of the adolescent brain: https://academic.oup.com/jmp/article/38/3/256/920018
70
Thank you for sharing your very difficult experience for the greater good. My condolences to you and your wife for your struggle and your loss.
9
These parents took a condo manager’s word — the accusations of a stranger — and flew to Sarasota, going directly to the courthouse to file papers taking away their son’s rights? They didn’t first go to assess their son themselves, or consult a doctor? And they blame the system for being “broken” and destroying their relationship with their son?
The system worked the way it was supposed to. That wasn’t what was broken in this scenario.
6
In a culture that stigmatizes mental health so horribly, those suffering are doubly hit--those aware of their illness often hide it because of that stigma. And the mental health system, based on dealing with crisis after crisis as opposed to regular, routine care, is such an awful avenue for the ill, it is no wonder they avoid it. It is our collective failure as a society.
4
I am so sorry for the terrible way your son was treated and for his loss. Your story is my story, and the stories of so many others. It is heartbreaking, maddening, and as you note, the bonds between the mentally ill person and the people who love them eventually break down - the strain is so great. Twenty years ago a psychiatrist at a major hospital admitted to me that "psychiatry in this country is third world medicine". I wish our standard was that high now.
6
The call for improved mental health is just a deflection perpetrated by a ruling class that sees no financial benefit in its realization.
5
Thank you, Mr. Ornstein. This is the first article that has made me realize that, after Parkland and in addition to gun control legislation, we must direct our collective anguish into resolve to support good mental health for all. One suggestion for articles like these - let's stop stigmatizing "mental health issues." We don't stigmatize those with other health issues - cancer, heart disease, Alzheimer's. Perhaps we stumble in properly aiding those with mental health conditions because we don't share the same compassion as we would with those of the former conditions listed. The corroded, myopic, and ignorant view that so many take in our society which looks down upon those with mental health issues is a major contributor. Until your life is touched personally with it and you realize the humanity of these members of our community, you have no reason to think otherwise. I hope in the fight for better resources for mental health support there is equally better understanding.
5
"One day the manager called us with alarming allegations about his behavior and insisted that Matthew was in immediate danger. In a panic, we flew to Sarasota, went to the courthouse and filled out the forms to invoke the Baker Act. It was surprisingly easy."
After a 40 year career in government social services as a C.P.S. worker, supervisor, and a number of other investigative positions, I find the above intervention quite odd. Why anyone would legally intervene and force incarceration of a loved one simply on the word of a condo manager is beyond me. Second, I would think most family members would first contact the relative face-to-face and make their own assessment. Decisions regarding interventions would thus come after that assessment.
We now have an epidemic of homelessness of the mentally ill throughout our country. Many of those vulnerable citizens lack aggressive case management supervision, health care coverage and services. Often, this results in a struggle/battle between the legal rights of the mentally ill and aggressive mental health interventions including pharmaceutical treatment and housing. It seems as a society we have let the rights of the mentally ill reign supreme. Although I'm a strong supporter of the ACLU and the rights of the mentally ill, I also think the primary issue is saving money. Aggressive interventions and services cost money.
If a person is found on the street unconscious with a heart attac,
2
I am very grateful for this article, as I have found the scapegoating and distortion of mental illness by the pro-gun lobby to be maddening and very close to home. I’m trying to find the right words here in an attempt to give voice to perhaps some of my silent kindred spirit readers of this article and the comments. I have survived 2 suicide attempts. I have no family. I have 2 very caring health professionals who are trying very hard to help me persevere. Suicidal ideation stalks me at every turn, and sometimes I question whether suicide is really a tragedy. But I try to keep going. I am resilient and very strong. I gave up alcohol cold turkey, though it flows freely all around me. I’ve used every cognitive behavioral skill in the book. I do the work. I’m not dumb, just ill. I’ve been in psych wards. I’ve seen broken souls. The vast majority are not out to hurt others whatsoever. But if a gun were nearby, they might hurt themselves. I know I would hurt myself, if a gun were around, so there aren’t any guns around. Lucky for me, I’m lucid enough to know better. Gun control is necessary for those who don’t know better, and that includes a whole heck of a lot of people who are not mentally ill.
Our national malaise isn’t helping my mood disorder. Health care for all, including mental health parity (Medicare doesn’t cover psychotherapy, people!) would be cheering. Not watching more gun massacres by eliminating access to weapons would be a mood booster.
10
Thank you for sharing this personally painful and publicly important story.
6
Mr. Ornstein, I am sorry for your loss. We also have a schizophrenic son; our lessons learned are similar to yours.
The "imminent risk of harm to self or others" is a meaningless standard for hospitalization/treatment for psychosis when a prominent characteristic of the psychotic state is the inability to understand that one is ill. I propose: 1. Psychotic thinking and 2. Lack of insight as to illness as standards for hospitalization and medication with or without consent for 30-60 days.
My view of civil liberties is that we have a moral duty to allow a psychotic person to make an "informed decision" about whether to accept medication and that an "informed decision" cannot occur until after the medication has been administered; the the disorganized thinking has been untangled; and a comparison between psychosis and cleared thinking can be made.
We don't ask drug addicts or alcoholics to go into treatment while they are fully impaired on their substance because we know at that point they are not capable of thinking clearly enough to make a good decision. The same is true for those with psychosis. Not all psychosis patients will accept medication, but I personally believe the numbers would skyrocket under this proposal. And the numbers are clear that the financial cost of early stabilization is low when compared to a life of revolving doors through prisons, hospitals and shelters.
4
I know someone whose wife had him involuntarily committed to get leverage in divorce and custody arrangements. He is now a licensed attorney.
One problem with involuntary commitments is that they can make a person unemployable. Also there are databases used by landlords. If you have domestic violence calls they won't rent to you, so the same is probably true with an involuntary commitment. I guess they get police records.
5
Thank you for the story. I have a son who is mildly schizophrenic and completely withdrawn from society, but not a danger, and it could easily happen to him. The country lacks a good system for dealing with mental health issues and, as a result, huge numbers of people are being left to live without the benefit of treatments that are available.
5
I am sorry about the loss of your son.
I think one of the most truthful (there were many in your article) is
"Second, a system that keeps loved ones from any involvement in the treatment of people with serious mental illness, especially those who do not know or believe they are ill, is cruel and ineffective."
No mental health is curable without the loved ones or without a relational partner, be a doctor, a therapist or a priest/etc.
As long as we think putting people in cells or empty rooms is OK, we are losing the battle of healing those in need or making their lives just a bit more manageable.
Thank you for writing this.
4
These people right fully acknowledge the serious problems with treatment of mental health, yet out of the blue, they concluded that the problem is with guns. Appears to me that they have let their guilt with the unfortunate treatment of their son influence them to try to shift blame for mentally ill people engaging in violence to the availability of one weapon over another. Too bad there is no third voice in the media and our culture recognizing that mental illness is the main issue with these shootings.
1
They must have had an inkling their son was having problems because why else not go see him first had I received a call like that about my child I would knock on her door before the Court House door. But having said that I so hope they sued the manager and the condo association.
1
Just to provide context, the "foolish Medicaid restriction" is called the IMD rule. This limits Federal money to pay for residential (inpatient) treatment in a facility larger than 16 beds. This rule was formulated in the 1970's to promote the continued, nationwide effort to dismantle the State Hospital systems and move mentally ill (and individuals with addiction) to community based services. Deinstitutionalization worked to the extent that the big mental hospitals were mostly eliminated. It also is directly and inversely related to the increase in prison populations. Prisons have replaced mental hospitals for anything other than a very short period of confinement.
3
Agree with the sad state of mental health treatment in the US. Disagree with the gun control screed. Too many of the seriously mentally ill must be coerced into taking their medication, continuing their therapy, etc. Some of them must be put in safe locations away from the stresses, temptations and risks of the urban areas in which they congregate. "Advocates" don't want to hear any of this. It will become just like Willowbrook, they rant. Yet they demand to ultimately take away the gun ownership rights of everyone, while allowing lunatics like Cruz and the others to roam free. It is not about Gun violence restraining orders. It should be about Violent Outburst restraining orders. In the only situation of which I am personally aware, an ex-husband stabbed his former wife to death. He did not need a gun. Spousal violence begins with beatings. Seems to me there should be mandatory mental health intervention, with jail consequences for failure to participate, in any situation of spousal or child abuse. Yes, a person under that sort of restraint should have to turn over any guns for safe keeping. But the guns are not the right focus. It is the violence. Then there also are the issues of the inherently sick nature of urban life and growing lack of jobs for men who used to be gainfully employed in manual labor, in factories, and on farms. Don't get me started on these issues, which may be the real elephant in the room.
I agree. Instead of scapegoating the vulnerable in moments of tragedy (and further stigmatizing the seeking of humane and self-improvement oriented profession mental health care), we ought to holistically consider the weaknesses of our society that are the root causes of anger and hopelessness among the disenfranchised.
I am sorry for your loss.
6
A brave article with common sense solutions. Another point to consider is the behavior of schools with "problem" children. Kids who misbehave or are perceived to misbehave are suspended. For blacks this starts at a very young age. They are sent home, with no guidance, no treatment plan (where needed). Then are treated as semi-pariahs when they return to school. This makes the kids feel even worse. And act out. This is another system that needs attention and change.
3
As flawed as HIPPA is, the systemic abuse of those in need of help to live with a mental affliction and their immediate relatives is rooted in an overly punitive, quasi-militarized response to such crises. We cannot police and incarcerate our way out of the needs of individuals with mental health treatment.
That is why the care and discretion of judges such as Steve Leifman, in Miami-Dade County, is crucial to a more effective, humane and reasonable approach to care and protect all members of our communities. We, as a society, remain too ignorant and therefore afraid about mental health issues and those directly afflicted by it. In the end we are all affected by these systemic failure. The Ornstein‘s ordeal is just a sad example.
1
Completely correct. Certainly, the boy who killed so many in Parkland was out of his mind, chronically. One needed only to look in his eyes: it should have been obvious that he needed extensive help.
A tiny fraction of the mentally ill commit significant crimes, and a much smaller fraction end up killing ten or twenty or more persons. But, sadly, it is usually mentally ill people who carry out such acts.
For any problem, one should go back to the beginning, and the beginning of the school and community shootings is mental illness. That's where the horror has to be treated most intensely.
Ornstein is correct about the uselessness of three or ninety day observation periods.
We had a case in my WV neighborhood where a devastatingly deranged man had terrified our hamlet for thirty years.
A few years ago, he tried to burn down the duplex in which he lived. The couple in the other half of the small structure called the police, with whom he fought and inflicted injury.
So, he was in the hospital for ten days' observation and then he was back walking around our hamlet. We said "something has to be done; sooner or later, somebody is going to be hurt."
Someone did get hurt. A couple years after the duplex incident, he killed his father.
He needed long-term inpatient care, a stronger version of Ornstein's proposal. Society was too chintzy to cover such meaningful therapy. So, It is now responsible for a death and a lifetime of warehousing him in the penitentiary.
1
I’m not sure I understand this story. The boy was living independently and the parents committed him without seeing for themselves first? And then he died later in an accident that was or was not attributable to a mental disorder of some kind?
That said, the unwritten story here is how complicated it is to be a parent, how often our judgements are wrong, no matter how much we love them, that it is easy to affix blame, and that there is nothing on earth worse than the death of a child.
I am sorry for the writer’s loss
5
Such a tragedy and thank you for trying to help other parents when you couldn’t save your own son. My daughter is alive but we are estranged because the police handled poorly a family problem.
2
Between doing nothing and involuntarily locking up people because they have mental problems there are intelligent things that can be done.
First, we need a lot more school counselors.. As we have cut funding for education, school counselors have been drastically cut, along with art, music, and gym (all of which are good for children's mental and emotional development by the way). School counselors can recognize problems and start to help children before their problems worsen.
Second, fund mental health treatment and drug counselling for everyone who wants it. Our penny wise and pound foolish society let's people go without mental healthcare, then pays far more for a law enforcement response to mental health problems, that included arresting, jailing, and sometimes, in a panic, killing the mentally ill. But for all of these weapons and weakening of civil rights, it's not stopping murders, mass or otherwise.
Third stop concentrating on mental health status, and concentrate on actual behavior. Cruz has a history of violence, that should have been a trigger to look at his other activities plus a stated desire to be a school shooter. A teen that makes an offhand remark about shooting up a school is not that uncommon. Teens like to test the limits. But when that teen has had the police called for 30 incidents of violence and buys an assault rifle, someone should notice. The violent commit violence.
And stop talking about assault rifles and talk about magazines and ammunition.
4
' until we devote the needed resources to making the mental health system work, we will continue to have unnecessary tragedies'.
Presupposing?
The mental health system does not work as is
We are not devoting the needed resources to the mental health system
There is such a knowable ingredient as 'needed resources'
We might now or some time in future be able as a society to provided that needed level
Providing that level is certainly the best possible use we can make of our resources
'Locking people up for three days is no solution'.
To the problem of having unnecessary tragedies?
Perhaps sending misbehaving children to their rooms more consistently would equally be thought 'no solution'; and would require at least the presence of an attending adult. A three day lockup does the same.
I apologize for making such a tragic story political but vote for Democrats.
Republicans politicians don't care about people.
They only care about their trickle-down tax cuts for the rich.
Those of us old enough remember the increase in homeless thanks to Reagan's mental health policies.
And the Republicans just continue cutting more and more.
http://www.povertyinsights.org/2013/10/14/did-reagans-crazy-mental-healt...
6
Neither the mentally ill nor the sea of guns around us will go away because we would wish them to do so. Over the past 100 years our country has moved from a system where we warehoused the mentally ill in large institutions to the current dystopia where we warehouse them in prisons or leave them on their own. In closing the sanataria, we offered the noble fiction of community mental health centers, but NIMBY drove the halfway houses from communities and the need for money for "good" projects (like wars which have the collateral effect of increasing the number of mentally ill), that effort is but a shell of what is needed.
At the same time, circumstance and the NRA stoked the fears of nation, driving many to the illusory security of guns, big and small, as the solution to all our problems.
Columbine, Newtown, Aurora, Isla Vista, Sutherland Springs, Charleston, Orlando, Parkland...
Could we possibly have done any worse?
4
Allow me to speak from a sons point of view.
My parents married at 20 when my mother was pregnant although lacking the judgment and stability to raise a child. Despite this they had three children and then failed to raise them with any love or attention to ensure their own emotional stability.
When I was twenty my mother decided that my girlfriend of two and a half years and I were a bad match and proceeded to sabotage our relationship.
Despite this poor parenting all three children finished college and masters degrees followed by successful careers in the helping professions.
There are millions of families with children who have survived selfish and incompetent parents like mine. The greatest emphasis on mental health services needs to be placed on children and young adults before their dysfunctional families destroys their lives.
1
Politicians' priorities have always been and likely always will be about kneeling down to those who pay to help keep them in office. It's a cushy job. Why would they want to have to work for a living?
My oldest sibling has A mental Illness and she has self medicated with alcohol her entire adult life. She’s progressively descended into severe alcoholism to the point of repeateded police involvement, numerous hospital stays, and eventual foreclosure and loss of her home. Smart, funny, and totally ensnared by her illness. No way to help, the vicious cycle is you can’t help a gravely I’ll adult who doesn’t, or can’t, acknowledge her illness.
5
I completely agree with you and am so sorry this happened to your son. Wonderful op-ed.
I got stuck on the early mention that the first action you and your wife took after arriving in Sarasota was to go to the courthouse and file Baker Act papers.
I cannot help but ask why you didn't go first to your son...assess for yourself his condition and what to do. Do you think if you had done that first, your assessment would have been what what you concluded after the debacle of his treatment: The manager wanted him out of the condo and off the premises.
I have to ask this sticky question; otherwise, how can we really assess what is wrong and what to do about it? Apologies if you are offended by this question. However, I believe it a reasonable and fair question.
6
As a lawyer representing families of children with disabilities, the transition to adulthood, particularly in the area of emotional disturbance, presents a vast legal gulf between those who qualify for guardianship and everyone else. Either an adult is legally incapacitated -and can be stripped of self-determination, an extremely serious infringement on an adult's rights- or is not. The law errs on the side of individual liberty. Unfortunately, in the gun debate, there seems to be no end to the amount of national fortune- tax money, privacy, individual liberty, the right to bodily integrity - citizens are forced to sacrifice in support of the tiny minority of citizens who demand private ownership of assault weapons. I disagree that individuals who society labels "seriously mentally ill" should have no right to own guns, unless that is defined based on known violence, such as abusers. This is a political statement, not a disabilities-relevant one. It deflects from the truth that everyone, mentally ill or otherwise, should have the right to live in a community free of privately owned assault weapons.
2
There is a presumption expressed in this opinion and many comments that if we had effective mental health system a lot of this would end. I do not - why? The meds in many many instances simply do not work except to give folks enormous side effects. "Treatment resistant" is the phrase used by the medical commentary for patients for whom the meds don't work - meaning the disease is resistant not the patient.
I have watched in horror as my siblings have swallowed fists full of pills for years and got nothing but more ill and enormously obese with medically induced metabolic disorder. The episodes kept happening and their mental health did not improve they just became physically as well as mentally ill.
109
Yeah, I know psychotropic medications are worthless and only prescribed by corrupt psychiatrists in the pocket of big pharma.
Except that they do work. You may not have noticed it but the Lancet, one of the top medical journals in the world, just published a study establishing the efficacy of the antidepressant medications.
4
Hardly any responsible health practitioner would throw pills at someone and say that's it. Virtually everyone recognizes the need for comprehensive mental health care, which includes talk therapies, social services, family involvement, and more. Expensive--but less so than the alternative.
3
I do not know that a "lot of this" would end, but we can't do nothing. I hear what you are saying and from the other comments, it's obvious that the pharmaceutical companies have a huge role to play here, too.
2
It is discouraging to read the comments and the hand wringing. So many of the comments claim that all that is needed is adequate funding, by someone else. While it is great that we recognizes that adequate funding can solve just about any challenge, somehow we fail to adequately fund every challenge. Why is that? Limited resources ?
Clearly, no. The recently passed tax bill displays that we do have the money, but do not have our priorities in the right places. That must change.
2
One small solution to this multifaceted problem is to have your child sign the proper paperwork, PRIOR to leaving home for college, that will allow the parents to be notified and involved in your child's medical care. States may vary on the required information but do the research and be proactive with your teenager's mental health issues. Universities have their own layers of student privacy rights and combined with medical privacy rights, it is impossible for parents to be involved without their child's documented authorization. Parents and other loved ones do need to be involved during this "mandatory hold" period. Keeping the family at arms length limits the dialogue and I believe can make things worse. I know some will say they are 18, an adult, and can make their own decisions but most teens and young adults do want their families involved. Parents keep a copy of it, file it with the university and the student health center--whatever it takes. We did go through this as a family without the documentation and it made a difficult situation even more difficult. As I said, this is only one small piece of the conversation but hopefully it will prompt other families to discuss these issues before their student leaves home.
2
One thing that many may misunderstand is that there are two processes in mental health commitments. One involves an initial emergency detention to have the individual help and evaluated for a brief period to determine if the individual poses an imminent risk of harm to self or others. If the initial evaluation determines that the individual does present an imminent risk of harm, then the case ends there even if the individual has a mental health condition that would benefit from mental health/behavioral health treatment. As so many of the comments mention, many individuals with serious mental health conditions end up not receiving mental health services. Your article about Nakesha that was published over the weekend is a classic example of an individual who needed such care and refused it. While she was not judged to be at imminent risk or harm to self or others, the choices she made led to harm to her health and early death. These stories are repeated in so many families. Your next story is in the outpouring of frustration and concern about the lack of outpatient mental health services and mechanisms to help people get this care. And it needs to be added how hard it is to get the care even if you have money--in our own situation when the need arose and there was agreement to get care, it was very hard to get an appointment with a psychiatrist even when we were paying cash. Those with less have it much harder.
6
There just was a study published citing the severe shortage of psychiatrists in this country. This is due to the low reimbursement for psychiatric services. Most medical students in the U.S. wonder why they should enter a low paying specialty which also has to face the public view that its practitioners don't benefit patients when they could enter higher paying and more celebrate fields like surgery.
In fact, we would have very few new physicians entering psychiatry if it wasn't for foreign medical school graduates who have no interest in psychiatry but take training positions here because they are the only such positions they can get.
1
Someone has to mention that a few decades ago the U.S. made the decision to turn mentally ill people out on the streets instead of in mental hospitals. There was a promise to provide out-of-hospital treatment and support, but virtually nothing was done. (Look at all the money we saved!) The mental hospitals were often pretty bad but the "solution" of abdicating responsibility was despicable.
As for the people who bring up guns: Why? How is this column related to guns?
9
Actually, I worked in the "Community Mental Health Centers" (CMHC) system in the early 1970s that continued from the 1960s. It was designed to help people transition from the institutions to communities. It spoiled me about access to behavioral health care from then on because of the eventual changes in the system, going from adequate government funding to an insurance system. There was, eventually, the change to inadequate care (that you mean) for very many people unless they could pay out of pocket or afford insurance. And qualifying for disability has become even more difficult. The CMHC system wasn't perfect but was the glory days of adequate behavioral health care, now long gone! (And how related to guns? Easy access by anybody through opposition to checks in a country with an ocean of firearms might make it related.)
3
The money saved from closing mental hospitals was supposed to go to funding outpatient mental health facilities. Never happened thanks to many people including that liberal hero Mario Cuomo who, as governor of New York, took the money received from selling off the valuable real estate of those closed mental hospitals to pay for other state programs and not for the care of they mentally ill.
1
It isn’t easy to get help even when you want it. I live with bipolar disorder and just relocated to a new state. The first thing that I did was to try and find a new psychiatrist. The first available appointment is five months from now. Five months? The wheels on my bus will fall off if I cannot get my medication for five months. In addition to the changes mentioned by Prof. Orstein, we need more physicians. Sorry for your loss.
12
I moved to California and was told I could not see a psychiatrist for one year because I was over 65 and needed to see a geriatric psychiatrist. My new MD provided me with medication for the year. When I finally saw the specialist, she informed me that I had been misdiagnosed years previously. I found a great therapist and no longer take any medication. Good luck and have an open mind. Find someone who has been trained at a top facility. Diagnostic and medication practices have changed over the years.
4
We have plenty of physicians. You can get elective surgery as soon as you want because there are so many physicians doing it and they get paid so well.
We have a shortage of psychiatrists because we have decided their services are of little value and deserve not to be paid very much for them.
1
Years ago when I moved to a new state, a new set of shrink/therapist (together in the same session) screamed and berated me for not getting a "referral" ahead of time before I left the previous state. I could not even get a dentist referral and these clowns wanted me to obtain a referral for new psychiatric practitioners. Delusional--and I mean them, not me.
I wouldn't take the word of a stranger for something like this; I would want to see for myself. Involuntary commitment, for whatever period of time, it such a serious step that it should only be invoked with full knowledge of the possible results. I'm very sorry this happened to the writer and the so, but this was a case of leaping without adequate looking. Also, the greater society is not particularly caring about what becomes of an individual caught up in its meshes.
3
Mr. Ornstein, I am truly sorry for your loss and the entire sequence of events. I don’t have any answers or even useful thoughts on this topic, but I do believe we must listen to those who do. Thank you for sharing yours.
14
One sentence says it all:
"the entire Mental Health System is broken"
We don't have a system; Republicans in government will NOT spend adequate amounts of government money, and our County Jails and Prisons have become the default "First Line" resource.
Adequate numbers of (Federal and State) dollars would be a good place to start. Let's create the community mental health resources that were supposed to replace the State Mental Hospitals. That means a LOT more than practitioners asking if you are taking your prescribed medications every couple of months (Once every three months at the VA).
It's all about the Benjamins.
7
That's a big part of it, but that will not solve the problem either. I think we need to question whether someone who is mentally ill, but not an imminent danger to themselves or others, should be allowed to live homeless on the street. The article about Nakeesha was so heartbreaking. I think we will have to rethink how we deliver patient care to many mentally ill patients also. For many people having an appointment and taking their meds will help, but there will be others that will need more intensive care. It is a difficult problem, but I don't think it is beyond our ability to take care of these individuals, although it will require many different areas of the government to cooperate.
Yes. I made a plea for more funding for trained outreach services and some training of common sense about confidentiality. Regarding the latter, I've advocated for some families (in my role as a psychologist) at least to ask hospital personnel to talk carefully with patients about allowing family access, even supervised if necessary. Part of the persuasion is through emphasizing screening (some families are unfortunately toxic) and mentioning that family involvement would ease the hospital stay and discharge plan.
1
I wish it were just the Republicans but cutting mental health services funding is one of the few things conservative Republicans and liberal Democrats agree on.
Among the latter are Governor Brown of California and both governors Cuomo of NY.
2
Very sorry for your tragic loss.
I can tell you without hesitation, and with intimate, personal knowledge of the subject that getting armed policemen involved with your mentally ill relatives is a recipe for unbearable tragedy. I share your pain.
I lost someone I cared for deeply because an untrained policeman gunned them down while they stood unarmed in their own living room.
There needs to be a better first option. A way to send a supportive, well-trained professional to safely check on the situation before bringing out the guns and the handcuffs.
But there's no money for that, right? Plenty, though for airplanes the military doesn't want, and for wars that never end.
27
A much needed, well written article, sharing a human-created tragedy with a series of caveats meant,I believe, to create a safer and more menschlich life for all of us.Unfortunately words, whatever their factual underpinnings,
may not be sufficient.All too often, influential individual and systemic stakeholders,whatever their agendas, ideologies,and principles of faith,do not seem to consider the dimensions of reality-both temporary and more permanent implications and consequences- in their words and deeds.
These include ever present uncertainties as mantrafied certainty is transmitted daily!Unpredictabilities, and randomness, in every area of our daily life as one copes,adapts and functions in a toxic WE-THEY culture enabling the violating of selected stigmatized,often marginalized, disempowered and excluded,"the other." And as facts, fictions and fantasies are "goulashed,"spiced with alt-facts, and the oppressive energy depletion from dealing with unstoppable media intrusions, is the myth of total control...if one only tries hard enough.Often enough!Your shared pain documents minimization of necessary mutual caring. Lack of mutual respect. Absent mutual trust and compassion between all peoples; including with strangers.Mutual help when needed to enable safe daily living for all of us.Whatever the intent of any law, when, how, and why it is implemented,or not, is critical. Your son was violated by a series of people and systems, whatever their state of innocence.
2
Biggest problem, with the whole thing, our misunderstanding of "mental illness" and those who suffer from it. Part of the population lives in fear of those adjudicated mentally ill, the other half makes excuses and/or ignores the obvious. In my career I dealt with loads of schizophrenics, none were killers, not even close. Lost souls who were cast out by family, unable to take care of themselves, and unable to navigate daily tasks, YES. Murderers, NO. In some areas people with mental disturbances are treated as an embarrassment, one to keep away from. "Oh, they are just different". None of that is true or applicable to the problems faced by these human beings who have a fragile connection to reality and other humans. Until we as a population face our discrimination of those with mental problems(most treatable), get treatment for them and support them while in treatment we will continue to deal with all the associated problems. The couple who had to deal with Matthew's dilemma, my heart goes out to them. They thought they were doing the right thing only to find Matthew had been railroaded by the property manager. I hope they sued the guy. Our treatment of psychiatric cases is deplorable, but some of it is, like with Matthew, just some one that some one else wants to be rid of. There is no justice here and won't be with the way Washington, especially the current regime, does business. They would give them all guns, maybe hoping that they would do away with themselves.
5
I have a friend who purchased a condo for investment and rented it out to a nice African American couple. This all happened in Canada in an area where few African Americans live. The Building management or the Strata started to pressure him to get rid of them because especially the guy "scares" the tenants or the other owners. At the beginning he resisted, then he pondered if he could make it public by turning to a newspaper and finally decided against it. He felt this racism is too much for him to handle alone and was not prepared to embark on a crusade. Very sad, he did not renew their lease when it expired. We all felt sad, especially since this happened in Canada in a large city of all places. Shame.
4
I am a doctor and I can tell you that the American Health Care system can be awful. Maybe we need a meetoo movement to demand decent and compassionate health care for all.
21
Even if we had universal care, with the current laws someone who wanted to refuse treatment could do so and become homeless. We could not force them to get the care they need even if we had it. Universal care is not a panacea. I say this as someone who has lived in countries that have such care and have friends that are still there. Please, it's not so simple.
In a compassionate system, the right to get treatment would be stronger than the right to refuse treatment. It is so easy to say the “patient refuses”
Here in our community we have a 30 year old man who exhibits obvious paranoid schizophrenic behavior. He is highly intelligent and articulate, from a prominent family. He has been arrested 4 times in 3 months for violating a protective order. His parents have done what they can to intervene, but the law prevents them from having him committed for sufficient time to diagnose and treat. All who know him have backed away from him because he targets people with great rage, and we fear him. This cannot end well; we anticipate a tragic ending.
10
Yep. My dad was diagnosed, and obviously, manic-depressive, a true Jekyll-Hyde, with episodes of violence toward our family. After he choked my mother to death at age 52 (insanity is an absolute defense), he was put on lithium which allowed him to be his normal Dr. Jekyll self, and he lived a full live into his 80s. But he missed his "highs" and would get off his lithium, and there we'd go again on the manic-depressive roller coaster.
1
No amount of money or good will can fix the "mental health" or "behavioral health" system failures until we recognize that the mind and behaviors are dependent upon the brain, and the brain is part of the body. Mental health is not separate from physical health, yet we continue to ignore the mountain of evidence tying chronic inflammation, nutritional disorders, genetic abnormalities, endocrine, imbalances, and chronic infections and environmental disorders to the metabolic brain injuries that produce psychiatric symptoms. Instead, we categorize the symptoms and describe the resulting syndromes as psychiatric diagnoses, as if they have no known underlying causes that can be treated, so we treat the symptoms.
The thing is, we know a lot about the underlying causes of the brain injuries that cause psychiatric symptoms, but the people responsible for psychiatric care and diagnoses remain largely ignorant of that information.
Cytokines IL-10 and IL-6 often drive depression, and we know many substances that offset those effects, but psychiatry ignores that. IL-1, IL-6, MMP-1, MMP-9, and TNF-alpha drive conditions that drive psychosis and mania, but mysterious neuroleptic drugs that miss those marks are used instead.
Infections drive the inflammation. Why not test for them and treat them when found?
MTHFR, COMT, CBS, and MAO genetic abnormalities can lead to psychiatric symptoms, and can make some treatments a source of trouble. We should investigate before treating.
3
If you know what causes most mental illness, I would start planning how you're going to use that Nobel Prize money you're going to get.
Mental illness is usually the result of mult-systemic dysfunctions that compound one another, which is why the drug company quests for one cause and one cure generally fail.
I gained my insight when my partner was rapid cycling through bipolar mania with psychosis and depression coupled with severe energy depletion that is characteristic of chronic fatigue. The meds the psychiatrists were handing out had terrible side effects and made the chronic fatigue worse.
I researched what could cause each of her dozens of symptoms and, after a painstaking process, narrowed down the choices to a few key mechanisms in which the immune system drives chronic inflammation in the brain. At the core of the well documented and thoroughly researched problem was the tendency for excess glutamate to cause excitotoxicity in neurons, which then die and release more glutamate, setting off a chain reaction. Doctors and researchers have shown that this harm can be halted by introducing the precursors to GABA, so we did that and the mania subsided. Repeated applications confirmed the effect, as established literature predicted. Then, we traced several known cytokines to neural and psychiatric symptoms and used documented remedies to remodulate them until all psychiatric symptoms subsided, never to return -- something the psychiatrists said was unlikely, even with the drugs they admitted they did not understand.
I did no original research, I just used freely available scientific information.
2
In these days of bluster and fear-mongering, thank you so much Mr Orenstein for pointing out these crucial needs for so many underserved mentally ill people and their families. I wish we heard more direct discussion of the actual policies that don’t work and solutions that might help.
And thank you for putting the terrible pain of your family struggle to this good purpose. My heart goes out for your loss.
6
I am so sorry you lost your son.
My experience comes from the other side of the story. When my paranoid, bipolar, and suicidal father began wandering the woods at night, naked except for his boots, and built a homemade cannon aimed at the front door to foil "the kooks," my mother and I researched what it would take to have him committed. Because he was not "an imminent danger to himself or others"--a standard defined in ways we could not meet--we were unable to intervene. He continued to deny he was mentally ill, right up to the day he shot himself in the head, after lining up a row of pistols on a table so he could choose the "best" one.
Would he have been helped by involuntary confinement? We don't know. Certainly not if he'd undergone the experience Mr. Ornstein's son did. And under current law, he would have continued to be able to own and purchase more firearms.
11
I am all for reforming gun laws and fully funding mental health care, but the idea that the Baker Act is a bad idea is ludicrous. While you might have misused the Baker act on your own child (acting without first observing), I assure you, I am aware of many incidents where its judicious use has clearly saved lives. For instance, when a family member in the midst of a manic episode, after refusing to take her medication, was actually hallucinating that demons were circling her head.
6
Perhaps the parents made a bad decision Mr. Jasonmiami, but they made it based on what they thoughtthe Baker Act was meant to do, not how it was actually applied. Furthermore, they made the decision because it was the only available option to them at the time. The parents were intentionally misled by the property manager. The parents were denied access to their son which would have provided them the opportunity to "observe" as you so clinically put it. The parents were not told he had been released. How, in this horrid sequence of events, can one justify the Baker Act? At a minimum it needs to be completely re-written.
To be clear, the act absolutely doesn't need to be reformed. You are speaking out of ignorance. The Baker act is there for a very specific purpose. Namely, it gives families an option when someone they care about obviously poses a danger to himself or others and there are no other available means for you to stop them before it is too late. If the person you care about is behaving reasonably or rationally, take them to a normal psychiatrist... If they are not, that's why we have the Baker act. It isn't there for long-term mental care. It is there for a crisis.
A huge percentage of the time the act is used when someone stops using medication that they were previously taking voluntarily, whether it be anti-depressants or anti-psychotics. Anyone who knows anything about mental health realizes that that can be an extremely dangerous time. Not being able to see the patient for 72 hours is a feature to protect that person's privacy and to determine whether or not the reporting family member was right to do so without their undue influence on the process. Guess what, when you Baker act someone (right or wrong) they are going to be furious at you. They aren't going to want to see you or talk to you. You do so inspite of the consequences.
Why? Because crazy people don't realize they are crazy. Sometimes, even after they've returned to a semblance of sanity.
2
I am bipolar (Bipolar 2) and know what a horrible thing it is not to be able to get help - effective help.
The drugs now used to address bipolar are ineffective.
Bipolar depression is a horrible thing to experience. Your brain tortures you. It's like living in a deep, dark, dank, scary well, down at the bottom, with the sounds of weird animals around you that you can't see, but terrify you.
When you are in the dank, dark depths of a bipolar depression, unable to get off the couch, unable to shower or change clothes, unable to imagine a real life, it does not help to have a doctor give you a prescription which "might" help in 6 weeks or so. 6 weeks. Of terrible pain. And fear. And darkness, And aloneness. And if that doesn't help, we'll change the dose or "try" something else - another 6 weeks.
If you had a bad headache and the aspirin you took for it said it would help in 6 weeks would you take it?
Or would you, as many of us do, resort to other drugs or alcohol to get immediate relief from the pain and anxiety and darkness?
More money must be allocated to find ways to treat the pain of mental illness. And it must work better and faster. People like me need hope. And people like me are your sons and daughters and mothers and fathers and sisters and brothers and colleagues and friends and neighbors..
9
On what basis is your claim that medications for bipolar disorder don't work? It certainly isn't based on the research we have establishing their efficacy which was required for the FDA to approve them.
If you're saying that they don't work for you, fine. But that's like saying that cancer drugs are ineffective because they don't cure everyone of cancer.
2
You should not make such a blanket statement about medications for bipolar disorder. My daughter had a friend who was diagnosed after a manic episode and a suicide attempt. The medications and therapy have helped her regain her life. Many medications take a long time to take effect, thyroid meds are one, not everything is instantaneous. I hope you are in therapy now, please don't give up!
2
People make a common mistake, equating the Florida school shooter with the population being treated in medical facilities. In fact, a Florida shooter shares and more in common with the recent story of the parents will imprisoned and tortured their children. These parents and the Florida school shooter both have personality disorders, which is an area of psychiatric/psychological practice that is little understood even by trained professionals. No wonder the population in general mistakes violent psychopaths with individuals who truly need mental health treatment.
I make this observation based on 45 years of working with individuals in need of psychological treatment. I have worked in to lock psychiatric facilities. I cannot think of one individual who was involved in heinous acts such as those like the Florida school shooter and the parents tortured their children.
6
The author of the story and his wife committed their son without even talking to him or assessing the situation and then blame bad laws for the result? Take responsibility for your own actions. The state is not responsible for what you did to your own child.
3
Tragic story and result, so sad. A wise man once said, believe none of what you hear and half of what you see.
2
I couldn't help wondering, based on as written, why mr. ornstein and his wife went first to the court instead of to matthew's apartment.
3
Prisons make lousy mental health facilities, and end up costing way more than proper health care.
Yet we have no problems building more cells, and not a functional health care system in this country.
Who is crazy? All of us for allowing this to happen.
Universal health care is the only correct answer.
3
Universal care will not solve this problem. It is multifaceted and will require changes to our laws and cooperation among many different government agencies.
Respectfully, Moria, universal health care will make a huge difference. I'm POA for a mentally ill veteran who has bounced from ER to ER for 20 years. I've started the process of getting the VA to do their job, but keep running into problems- because he can't make appointments- while he's incarcerated/Not Guilty by reason of insanity in a state mental health facility.
If he had access to proper psychiatric care and case management- we wouldn't be in this situation.
38
Imagine if instead of spending $18 billion on an unnecessary wall on the Mexican border, an additional $18 billion was spent on mental health treatment?
8
It's quite concerning how many people are willing to throw HIPPA out the window considering it's one of the main safeguards that allows mentally ill people to get treatment without having to throw away their lives/
4
The Parkland shooting was tragically predictable, and was in fact predicted. Multiple people, on multiple occasions, went to the authorities at the school, at the local level, and at the federal level even, and nothing was done.
Even when evidence of a crime, like making death threats, was presented, the authorities did nothing. Had criminal charges been brought against Cruz for the fights he got into, for the death threats he made, he wouldn’t have been able to even buy those weapons. Thus, not only was the Parkland shooting predictable and predicted, it was also entirely preventable.
Until progressives accept enforcing the laws that we have, the additional laws they lobby for and sometimes get will continue to be little more than therapy.
Yes, enforcing the laws that we have means hurting the people that progressives often want to protect; illegal immigrants, the mentally ill, minorities who tend to act out more in school settings, people who commit crime, past felons, college students who turn violent when confronted with opinions they don’t like, and imams and Muslim activists who critique Western life to an extent that it borders on aiding and abetting acts of terrorism. All are worthy progressive pets.
But until progressives are willing to sacrifice and even hurt these loved ones to keep the rest of us safe, they’re going to continue to be ineffectual and we’re going to keep tuning them out.
1
I am so sorry you feel this way. It is preferable to love the other as our neighbor and part of our human family.
1
I am so sorry for the loss of your son. My adult son also has repeatedly become a threat to himself and others, and with no means for treatment. He’s now in his early 30’s. As a caring parent with financial means to provide for treatment, watching his life erratically unfold is even more difficult when laws make it impossible to be involved. Tragedy upon tragedy. Once again, my condolences for your loss. Thank you for your article.
5
So they made the massive error of not first visiting their son before taking a very serious action. I might be suing that condo person or worse if he lied to me about that. Now the law surely should allow relatives to be informed and in the process.
4
I’m so terribly sorry for what you’ve been through. It must be nearly unbearable.
In 2015 the 28 year old son of very dear friends of mine went on a shooting spree. He killed his mother and two others, and wounded a fourth person.
This young man was schizophrenic and delusional (and in a great deal of pain himself). Police had been called to the house to intervene when he became aggressive, and once he was taken to the emergency room at the local hospital.
In our small town - and given the limitations on treatment options for the mentally ill when they do not consent but family wants to intervene - there was no recourse. In the meantime, he was assembling an arsenal... Our worst fears came to pass.
He is now is prison for life. He will never receive adequate treatment, and the victims can never be restored to us. The grief and trauma continue to reverberate through the community and beyond.
There are failures at so many levels that can be blamed... Inadequate treatment for mental illness, failure to involve functional family, overwhelmed and undertrained police officers... and the lack of gun laws to intersect with mentally ill folks that would never pass a background check.
Consequently, as a person still in treatment for trauma, I would so readily give up my right ever to own a firearm of any kind to stop this madness.
I know that your son was not violent, and I would never fault you for any of the steps you took to help him. Th system is not “broken”
8
Perhaps the most important sentence in this very good essay: "Health professionals should be able to petition a court to order someone to accept a comprehensive treatment plan if that person has gone untreated and is unaware that he or she has a serious mental illness and would otherwise be homeless, cycling in and out of jail or worse." I have a family member who has gone without the possibility of a productive life, since his mental disease has completely taken away his understanding of how ill he is.
13
I had the same thing happen with my mentally ill brother when he visited me here in Florida a few years ago.
The problem was not the Baker Act, though, it was the second issue you raised: the limitation of resources, lack of competence/ability of the mental health care at the local hospital. Even if they could admit my brother, they didn’t have the skills to stabilize him back on his medicine.
After 4 months and 3 separate times Baker acting him here, I finally drove him up to New York where he was admitted, effectively treated, and has been stable on his meds since.
What is ultimately going to cost society more for someone like him? Effective treatment or repeated ineffective re-admission to hospitals (where he receives Medicaid, requires police officers to bring him in and judges to hear the Baker Act request), possible crime, perhaps jail?
Even as a conservative, financially conservative individual looking it a purely from a cost & efficiency standpoint, effectively and competently treating these individuals is the most cost effective thing to do.
37
Who should bear the financial burden? The individual (through purchase of insurance or direct payment for services), the immediate family. donors, providers (volunteers), the local community (community health care services funded by local taxes), the tax payer (federal income taxes), ... ?
If the answer is "tax payer" , then expect the funding to be politicized and subject to the whims of the latest election.
1
Silmilsr insights (amounting to socializing healhcare) often occur to conservatives only when one of their own poorly-insured family members becomes ill.
2
Hopefully, this moving and sensible article will spur our suffering nation to insist on a Congressional and White House task force that invites NAMI, the National Association for the Mentally Ill, and leading thinkers and doctors to brainstorm about how America can build a better mental health system. Let's face it, the lives of our students and children depend on how we as a nation treat those least able to be practical. Empty our prisons of the mentally ill but be sure to first fund proper community support. Empower families and Amend the Baker Act. Permit those who are kept "on hold" at least supervised contact with their immediate family members. Such immediate changes help those who suffer from mental illness and their families, and are a meaningful tribute to those beautiful children murdered at Parkland and other schools whom we deeply mourn.
9
Mental illness is, well, an illness. It has never been treated as such. Imagine having heart disease and never receiving any treatment until you are too disabled to benefit from treatment. Imagine if, once diagnosed with chronic heart disease, only Medicaid would pay for the treatment. Imagine if there were few Cardiologists who would accept Medicaid for treating your heart disease. Then imagine what it would be like if during your physical exam every year, you received a mental health evaluation much like you get an EKG or blood work and be sent to a mental health professional early in the disease process. Most people would balk at such a thing because they feel they are not "crazy". Well everyone has "some" mental illness. It can be looked at as a spectrum. You fit along the line somewhere. Few are totally free of mental illness. Few are so far gone as to be unreachable. Many, however, fall in the middle and, untreated, most will have periods where they move along the spectrum into demonstrating more symptoms. Most "get better" with time, less stress, and support. Others do not. To make any significant difference, mental health needs to be incorporated into the medical treatment of everyone. The notion that we can fix the problem by giving a pill or flicking a switch is pure fantasy. We can no longer "hide" our mentally ill. To treat them, we need to stop worrying about making sure the wealthy have enough disposable income.
22
You are on the right track with your analogy, only the problem is even worse. Imagine if you received emergency treatment for a newly discovered serious heart condition, and were told you definitely need medication and care. However, you are discharged with no follow up care arranged, and there is no way to get an appointment for the care you need any sooner than 3-6 months in the future. Many providers you call have closed their wait lists because they are so long. If you are lucky enough to find a doctor who can see you, they will most likely refuse to accept or even bill your insurance company for you, not matter how good it is. You are given a prescription for 30 days of the medication you need when you are discharged. When you ask what to do if it runs out before you can see a doctor, you are given information about a "clinic" the hospital holds a couple of evenings a month where you can go and hopefully get a prescription for more. When your family asks what to do if the condition gets worse while you are waiting 3- 6 months for an appointment to open up, they are told to take you to an emergency room. True story, only substitute bipolar disorder for heart condition. Would society stand for such a system if this is what people with heart disease or cancer had to go through?
3
Sir, I am sorry for your loss, but I wish we had a similar law where I live.
We received a note from my son's out of state college saying he was on probation, but because of privacy laws, we could not be told why. Apparently he verbalized suicidal ideations.
He is 28 now, living at home, working the graveyard shift at a mall while working on his AA by day. But on his off days, he paces our house, loudly muttering to himself--sometimes arguing with himself. When called on it, he claims he didn't say anything and we are making it up. There is more than one night I have locked my bedroom door and slept with one eye open.
I would love to get him in-patient psychiatric observation and care. But he is an adult who doesn't think he has anything wrong with him. I am willing to risk the familial break to get him the mental health care he needs. But without a Baker Act, we must wait until the unthinkable happens and act after the fact.
18
"Second, a system that keeps loved ones from any involvement in the treatment of people with serious mental illness, especially those who do not know or believe they are ill, is cruel and ineffective."
Too painful and long to tell our story but my sister eventually died at 36. She was murdered in NYC. She had no sense of danger she was causing herself by her own actions or the danger she was in from others taking advantage of her. She had schizophrenia, onset in late teens. As she passed 21,for years we were kept from being involved in her treatment, unable to do anything but watch her risky behavior and worry. She had her "privacy". Additionally, as time went on, her two children were traumatized for life. The whole story is too painful and long for here. My heart goes out to Norm Ornstein and the many others who have similar stories. I am convinced we know very little about how to deal with serious mental illness in this country. Nor do we seem interested apparently other than putting many in prison. In our case my sister was not a murderer, but she was very vulnerable to being murdered.
29
I sympathize with your pain, as my family went through a similar experience with my brother, who was also schizophrenic. We were unable to get help for him unless he was declared an imminent danger to himself or others, even when he was insane. Well, he did try to kill himself - in my parent's home- and put my father, who was trying to help him, in the hospital. After years of too many scary situations to mention, he died. Family members, who are often the only ones who care about an individual, should be able to get help dealing with the mentally ill. Even though mental institutions are depressing places (I have visited inside a few), at least the patients have a warm place to live, a bed and food to eat.
3
Our family had a similar experience. I'm so sorry for your loss and thank you for sharing.
2
Thank you for sharing. I wish everyone in Congress and especially our president would read what you have written here. It's heartbreaking but very enlightening!
8
I, too, am deeply sorry for Professor Ornstein's loss. The last time our son was hospitalized for schizophrenia, we begged, on multiple occasions, to talk to the attending psychiatrist to share with him important symptoms we had seen at home. We were silenced. Two months after our son's release, he took his life. This tragedy should not have happened. The system that should treat and protect those with severe mental illnesses is, indeed, broken at every level.
25
A sad story to be sure. As a nation we are struggling mightily in dealing with complex issues - or even discussing complex issues. Mental illness and guns combine to be a witches brew of complexity. Claiming guns aren't the problem, mental illness is, seems to be the end of the story. It's as if we've thrown up our hands and say I give before even beginning a dialogue. Of course health care and something as nebulous as mental illness (in the eyes of many) is beyond our scope. It takes too much money to deal with mental illness and too much courage to deal with guns. Consequently we are in a permanent stalemate.
9
When large psychiatric hospitals closed with inadequate alternatives, the lack of long terms treatment for mentally ill persons became a real problem. We walk around, or help with a meal, homeless men and women on our streets, most of whom suffer from some type of mental illness. I thoroughly agree with the writer of this article that short-term treatment of those suffering from severe debilitating mental disease is not effective. No other chronic disease is treated with such short term "fixes." In my humble opinion, given the difficulty and inefficient delivery of services in small community-based mental health facilities of which there are not enough, the only viable alternative lies in reopening mental health hospitals/institutions. We hear of cancer treatment centers and hospitals all the time. Let's treat the disease of mental illness the same way; mental health treatment centers - centers that take insurance like all hospitals, medicaid and medicare rules that don't limit stays. It's time to stop viewing people who are challenged by mental illness as less than worthy of medical care. Equal protection demands this treatment. Why is this so hard??
22
I totally agree but who is going to pay and what objective standards are going to be applied to adults who might not have your values but not be really mentally ill?
2
We have serious mentally ill people (schizophrenia) in my immediate family and my extended family. We have had the same experiences as the author with the medical system.
As I nurse I know that most families are touched by mental illness. It is a common problem.
I also know that many mentally ill people are loath to recognize it. They fear being stigmatized and don't want to be mentally sick. Families cannot force treatment of adult children when illness is denied.
Those who have been diagnosed and treated often decide that when they are feeling better they don't need to take their medications. Then they deteriorate.
The outpatient plan for housing non functional mental health patients is to put them in a low rent apartment where they live alone. This is the worst possible situation for people that cannot take care of themselves or reach out to others. There is little money in the system for high quality permanent residential homes that would so benefit the mentally ill.
Money is the biggest factor in our broken mental health system. Treating mental illness is not a money maker. Therefore the system does not want to invest in it.
Having a mentally ill family member is one of the most difficult situations any family has to face. Except for the wealthy there are few community resources, and support from the medical system is almost nil. This is why so many of the mentally ill end up on the street or in prison.
23
We are all caught in this mystery of humans which speaks of deeply-rooted genetics persisting despite efforts to dull down, now made interminably more severe by a complex pharma-society of licit and illicit drugs. First, I would convene a national conference to rewrite all diagnoses with the vast number of of drug interactions; secondly, I would rewrite HIPAA law in light of public safety; thirdly I would pray that everyone, sick or well, be loved and when that doesn't seem like enough, to support a loving, harm reduction environment. We refuse to see how we are complicit in the intersection of these forces.
6
There is something wrong in the system when a family or close friend is not allowed to know if a person is admitted to a hospital let alone know about their status.
This is a bad law that needs to be fixed.
Usually such laws are enacted by a bureaucracy when an incident happens that shows the flaws in the system.
Rather than use common sense to analyze the situation, bureaucrats come up with another law which covers their backs but does nothing to solve the problem.
Just the way health is overmedicalized in US, ordinary human interactions are overlegalized.
We want 100% certainty in every situation and for that we add ever greater layers of rules and regulations and come up short all the same.
8
"Bureaucrats" do not make laws. Legislatures do.
1
We must stop generalizing people with mental illnesses. Many are a danger to themselves or others in varying degrees. My mother was diagnosed as manic depressive and bi-polar. Even when she was on medication, which was rare, I was in danger. I will dare to say most mentally ill people do not have the intent to harm others, but they still may hurt themselves or those around them. Every person must be considered unique and not stereotyped.
More importantly, sending the police is the wrong way to handle a situation where a 72 hour commit might be needed. Parents and other family members need help from mental health professionals before their loved one spirals out of control and most certainly before things become violent. Communities should have teams of professionals available to go on calls as in the case of the authors son. They could go in with an open mind and make a better threat assessment than a police officer.
I agree that the mental health care system is broken and must be fixed. But these generalizations must stop as well. I spent 10 years in physical danger until I could move out of her house at 15. Parents are being physically and emotionally harmed by their kids who cannot or will not get help. The worst thing you can do is to treat the the mentally ill person before you "just like all the other mentally ill people".
11
Norm Ornstein suggests sensible approaches to treating mental illness, not one of which will gain any attention in an era where the party of small government (for the little people only, if you please) is in charge.
8
A very sad story...and I give kudos to this father in sharing his story to bring the issue to discussion, which might be the first element in change. Another aspect, though, is this: a close family member is bipolar and an alcoholic. Frequent blackouts put them and their child at serious risk. The spouse came home to find their infant child, having fallen off the bed with objects down their throat from crawling around on the floor. The spouse called 911 as they couldn't arouse the other parent. Police came, and used the Baker Act to hospitalize the parent. Although the psychological threat was identified, medication prescribed, and counseling for the alcohol abuse recommended, once the patient was released, there was no followup. The incidents have continued to happen with the parent in denial and not taking medication and the drinking has increased.
I believe the Baker Act can have a positive outcome, but not until we have a sustainable health care that treats mental illness with the gravity it deserves, and ALL patients have equal access to care. One of the many reasons I support socialized (omigod, I used that word) medical coverage that offers all people needing medical attention the care they need.
13
This argument is predicated on the belief that the mental health system, if available, is successful in turning potential killers into law-abiding citizens. And yet... although I haven't a "scientific study" of mental health professionals to see if they share this belief, I am guessing that few of them, being hones, do share this belief. The problem stems from a deeper place, I don't think we have a name for this place, let alone a method of counteracting it.
2
The situation here in New York is very different. It is much more difficult to involuntarily commit someone. A family member must go to court to obtain a mental health warrant, which only provides for removal to a psychiatric emergency room. There, two different psychiatrists must agree that the patient is an imminent danger to self or others before they are committed.
Ironically, while it is harder to involuntarily admit someone to a psychiatric hospital in New York, there are many more resources available for treatment and rehabilitation. In Florida, however, it is a very different story. The aspect of the Parkland disaster that was most neglected was the complete and utter failure of the social service sector to effectively deal with Nikolas Cruz. Rather than blaming the local police and the FBI, who can only address actual criminal behavior, we should turn our attention to the fact that Florida's Office of Child and Family Services (or whatever they call it down there) utterly failed to address the serious problems facing this young man and his family, which were years in the making. Undoubtedly, this is a result of Florida's pathetically weak safety net, which comes as a "benefit" of living in a low tax state. (Florida has no state income tax.) Well, you get what you pay for.
Thank you, Mr. Ornstein, for sharing you and your wife's tragic story. My heart goes out to all parents and relatives who are dealing with a mentally ill family member.
12
"the entire mental health system is broken."
This sums it up.
As a sister, daughter and aunt of persons with mental illness, I can attest to this.
I also believe that the way we perceive mental illness in this country needs improved. Stigma, expectations for the person w mental illness to have insight and thus consent to or seek treatment, poorly paid community mental health workers, an uninformed law enforcement and sentencing system that puts the mentally ill in prisons, etc, etc, etc...are just some indicators of our broken system. Research, awareness, funding and support for evidence based practices in the field are needed.
9
Sadly, it often takes personal tragedy for scholars at a conservative think tank to call for more spending on mental health, including community health centers, wrap around services so people don't fall through the cracks, and longer and more expensive inpatient services for those in crisis. We have somehow placed the mental health system into criminal justice and jails rather than a comprehensive community mental health system. Arming teachers for $450 million is so misdirected when it could be used for the kind of services Judge Leifman has called for.
The real tragedy after 50 years of universal condemnation of a broken mental health system, we still criminalize the mentally ill and we make no investment in a public health approach to mental health. Why is it so hard to fix this?
8
I am a retired clinical Social Worker with 40 years experience as a therapist, supervisor and administrator in the public mental health system. Mr. Ornstein, I am very sorry for the pain that your family went through but believe that the answer is not providing more hospital beds; instead, federal and local funding should support a comprehensive system of community care for people like your son who suffer from serious mental illnesses.
There are a number of evidence-based, science based models that have proven effective in helping adults in recovery from mental illnesses to effectively manage their symptoms and live a full and meaningful life. They include Supported Housing, Assisted Community Care (ACT), Case Management and Supported Employment. Clubhouse programs such as Fountain House and Venture House in NYC offer a range of vocational, educational , cultural and peer supported activities that address the loneliness and sense of isolation that is often experienced by individuals with mental illnesses. Programs operated by individuals in recovery from mental illnesses who have been recipients of mental health services have proven effective in reaching out and connecting to people who are fearful of engaging with the mental health system.
I find it very sad that we only talk about the need for better mental health care when there is a tragedy like the recent mass shooting in Florida. Blaming people with mental illnesses and locking more of them up is not the answer.
14
I think if we follow the money as it applies to the mentally ill, we will find that MOST of our mental health funds are spent support and treat addictive disorders, followed by the prison system, with in-patient and community mental health services a distant third and fourth.
We need to refocus our priorities to get funding to where we can get the "most bang for the buck" and that is in "community mental health" at the lowest levels.
5
This is a very important, life-or-death issue that too often gets swept under the rug. I have also tried to help two sons struggling with mental health issues, and agree that the current system is broken. Once a youngster reaches 18, the parents have very little ability to participate in decisions regarding treatment, unless the patient agrees to sign a release. Almost by definition, young people with mental health problems cannot easily make good decisions about treatment, medication, etc. While I understand that civil liberties must be respected, and we can't go back to the days where oddballs of various sorts were hidden away in asylums, there must be a middle ground where parents and loved ones can participate in these critical decisions about treatment.
18
There is a long list of things that we as a nation would not do if we really valued families — instead of just giving lip service to that idea. Among them, we would not apply the concept of rugged individualism to those in obvious need of help, like the mentally ill. My heart breaks to hear the story of Mr Ornstein’s son. But then, I have a liberal bleeding heart and believe in community rather than tax cuts and am willing to put my money where my mouth is to solve the problems we face. A large segment of the American people prefers the tax cuts.
30
mr ornstein thanks for speaking the real truth of the situation i am so sorry your son never received the help he needed finally the REAL truth of the situation we find ourselves in again i have been waiting for this article and sorry for the loss of your son
25
Norman, thank you for sharing your story and helping to move this debate along. You mention a program in Parkland that is helping in some ways. I am sure that there are other examples that can provide our lawmakers information that will help them to act. We do need lawmakers who really are listening to their communities. But we need communities to provide a voice that is stronger and more committed to change the current laws that do not help us deal with these issues and problems. This article helps us to understand what needs to be done although much more has to be said. There are a lot of issues a lawmaker has to take a position on but in the end we should support them only if we are sure they have the community in mind and not their corporate backers. Are we ready to hold them to account in this way?
26
My sincere sympathy in the loss of your child. Thank you for helping to contribute to the public's knowledge of mental illness. Society as a whole doesn't understand what can't be seen, and then make up stories to tell themselves to generate fear of the unknown. These individuals live in various states of intense inner struggle every day and little compassion or understanding from others only adds to what they need to carry. Insurance companies, some medical professionals and some law enforcement individuals need education to allow them to better understand and help those that need support more than most. The forgotten. These individuals are 'individuals' meaning they carry the same traits the rest of society carries, but with added weight, the weight most of us could not bare.
24
Your story sounds very familiar. Our grandson has suffered a similar fate except that he has not been killed. He rejects help from family feeling they have only done him harm. He has often been incarcerated because there is no mental health treatment available. He then is released without notifying any family member. His whereabouts are a puzzle to us most of the time. Prayer seems to be the only action we can take.
A federal mental health law needs to be passed since the ill often travel across state boundaries.
34
A cautionary tale.
My sympathies to the Ornsteins. No parent should have to experience the mental decline of their child.
However, if I read the article right, after hearing from the Condo manager, instead of going to their son to assess his condition they went directly to the courthouse and triggered a legal process which premised on an imminent danger to one's self or the community had to be implemented on an emergency basis.
The author notes that his son already had serious mental problems that continued until his death, but offers no information connecting the arrest with the subsequent course of his illness or death.
As it must, in order to be effective The Baker Act is reactive. After receiving credible information regarding a potential danger the authorities must act and act fast to protect the public leaving the details to be sorted out later.
As to the act's potential, limited as it may be, in light of the ease with the Ornsteins were able to trigger the Act in their son's case, had a credible source informed the authorities of Cruz's issues the massacre at Parkland might have been forestalled.
In any event, they were faced with a Hobson's choice, and I commend them for taking the action they thought necessary to protect him and the community.
21
I agree with Sam. The Baker Act is effective. The objective in these instances is to protect others from possible harm, not soothe family relationships. All things considered, I'd rather error on the side of public safety than having layer upon layer of bureaucracy that impedes a few days of controlled professional observation. When it comes to dangerous anti-social behavior, public safety precedes individual rights - including 2nd amendment rights. Our right for safety precedes the individuals right to have weapons of mass destruction.
15
Incarceration is not necessary to alleviate fears of mentally ill people with guns. Several states have enacted Red Flag Laws which allow authorities to take guns from people determined to be at risk to themselves or others. Some of these people may be admitted to care facilities. Many are not. What matters is they do not have the means to easily hurt themselves or others.
2
Apparently you missed the purpose of this chilling story. There for the grace go us all, this is not about mending family fences, it is about society's inability to think and address these issues. Who know that the people protecting their families aren't as disturbed as the rage which engages the shooters at these schools, hospitals, domestic violence, racist police veterans the list goes on and on. So please forgive me for not accepting your simple statements about safety for all, without thinking about what people like you are doing to others under the name of safety. Each day we encounter people who have some type of mental illness that is just life. Put your them vs me and, think about real humane solutions vs just shooting people. Society remembers when lynching was an acceptable act by society, when children were bombed in a church by God fearing people or were they mentally disturbed?
Mr. Ornstein we feel your pain and thank you for also highlighting proven solutions, we all need to get in the ring to address the needs of society and DEMO.CRACY
Mr. Ornstein, thank you for sharing your tragic story. Please accept my heartfelt condolences for the loss of your son. "First do no harm" has rarely been the guiding principle in mental health care. No parent should have to endure the treatment you received from medical institutions.
70
Providers need more training in HIPPA. Though my husband and I are our daughter's legal guardians, her therapist refused to take phone calls from us, citing HIPAA!
A few weeks later, when her team met to discuss why she wasn't following through on things she promised she'd do during therapy sessions, I explained the reasons to the therapist... who was astonished to learn that our daughter has severe problems with memory.
I also explained HIPAA to her in detail. Therapists can passively *receive* information about clients (especially guardians!). They just can't share it (with non-guardians.)
79
Actually providers are terrorized during training.
1
I live in Florida. In a well recognized upper middle class community. In my community our town spends more money on our dog park than on child care, after-school programs or any form of community out-reach for at-risk individuals. Until such time as our residents see this as an issue, nothing will change. We, you and I, are all responsible. You and I should attend our town or city governance meetings and ask why our elected leaders spend our money on dog parks rather than the needs of at risk members of our communities: our children, our neighbors, ourselves?
178
Dogs can be euthanized; that’s the difference.
1
Because in the US, pets are people but the poor and mentally ill are not people. How else would you explain the insensitivity to their suffering?
2
Your post reads as follows:
"Renaud - California USA
I live in Florida..."
Okay, which one is it?
Thank you for sharing your experience. I'm so sorry for your loss. Your courage to share what you went through helps us all to understand these issues better.
97
HIPPA needs to be reformed and more education about the law’s provisions is needed. The Act never envisioned providers refusing to give information to family members, certainly not in emergency situations.
One physicians’ office told me I had to sign a form giving them the authority to release my own medical records to myself! To no avail I told them the law requires providers to give individuals their own medical records.
74
Over the past 50 years, I have seen mental health facilities shrink drastically. Prescription drugs have become the overwhelming treatment of choice, despite their limited efficacy for vast numbers of patients. Prescriptions, written quickly by psychiatrists who are often only allowed a few minutes with each patient satisfies the need to "treat" a patient. These drugs have their role, but it is limited. Drugs are being used as substitutes for inpatient treatment. Now, very troubled people are send out of inpatient programs in a handful of days while they are still lost, bewildered, and sometimes enraged. Many forms of person to person treatment have developed over the years and have become quite effective, but public institutions eschew such treatment. It is too expensive (and the person to person therapies don't have the powerful lobbying of big pharm to help them out.) Thus, the helpful but limited effect of psychotropic drugs, have become the main and often only treatment offered. Only the well-to-do can get a comprehensive treatment program.
We used to do much better than this. What went wrong? States are saving money be not offering inpatient hospitalization. Insurance companies only offer a pittance for psychotherapy. This is easy to get away with. The mentally ill are not a large voting constituency; they don't organize. The real juice for change has to come from a concerned citizenry.
53
Excellent summary. Change can come from a concerned and informed citizenry. But those citizens must demand that much more money be spent on sound mental health treatment and high quality facilities.
1
What about NAMI? It is an organization supporting people and families living with mental illnesses. It does push for better laws and insurance programs.
Yes, indeed. NAMI is an organization which does push for better laws and better insurance coverage. However, It always seemed to me that it has been rather careful in its advocacy. It seems to tip toe around. It might have a greater impact if it depended less on money from pharmaceutical companies and if it got more assertive in criticizing the establishment.
My heartfelt condolences for the loss of your son. Unfortunately in America there has always been a disregard for those suffering mental illnesses, yet at some point during each of our lives, I would surmise that we all suffer at one point from some form of the disease. Enough of the taboos surrounding mental illness. As a people, we need far more compassion for those suffering mental illnesses and we need a healthcare system that provides quality treatment for anyone afflicted. Healthcare in this country generally is substandard compared with the rest of the developed world and care for mental illness probably ranks at the bottom. We have a huge shortage of psychiatrists and psychologists and an over-reliance on psychopharmacology. Psychiatric treatment today too often relies on infrequent and brief visits with physicians, the topic of conversation being primarily, "how is your medication working?" Yes, drugs are critical to care and treatment and lifesaving in many instances, but we desperately need a better support network of compassionate human beings who are there to provide care, understanding and love for those who are suffering.
83
Rich, psychiatrists are the problem in terms of over-reliance on psychopharmacology. They know no other way.
1
It seems that we live in a society that is loathe to "take away" freedoms.
I perceive the left as historically advocating for increased freedoms for mentally ill folks and advocating against policies supportive of longer term hospitalizations, involuntary treatment, etc.
On the right, there seems to be some overblown paranoia and defensiveness about the second amendment. The folks on the right want to "do something" about mental illness, but they don't want anything "to be done" about gun ownership freedoms...
It is not an either/or issue. To avoid excessive regulation and rights-infringement on either issue, I believe we need to make some reasonable and moderate reforms on both issues. Gun Violence Restraining Orders seem to be reasonably well accepted by folks on the right and left, why isn't this federal law yet? Between Columbine and Parkland, we have seen many instances of troubled & mostly young men demonstrate many warning signs to many people before engaging in mass shootings. We need to make it a bit easier for concerned family members, treatment providers and emergency responders to initiate appropriate care referrals, even is someone is initially resistant.
I highly recommend a recent New Yorker article that profiled the father of the Newtown shooter. I think that a longer-term psychiatric hospitalization would likely have been the only thing to prevent the Newtown shooting.
18
My heart ached at what your son endured and what you and your wife endured. I'm so, so sorry.
When a person is a danger to himself or others, the first thing you do is remove weapons and drugs from his reach. Then, you get the person the medicine and therapy to treat his symptoms as best as possible. The same goes for access to guns - we need to ensure such an individual cannot access firearms while we develop better mental health care. And as Mr. Ornstein says, no civilians should be able to buy weapons that enable the shooter to kill many people at once. Why is this so hard to understand here?
14
My 38 year old son was diagnosed with schizophrenia 10 years ago. He is unmedicated and believes that everyone around him is a body that is being operated by AI. It feels like schizophrenia is a terminal illness, with bouts of crisis dominating short term stability. There really is no one that can help. I miss my son so much.
87
I really feel for you - and your son, as both your suffering must be extreme.
I really wonder if forrcing medications is the right thing in certain circumstances.of course I understand the terrible pitfalls - on the other hand, how can we let someone in such extreme distress suffer interminably? (To be clear, I do not mean you, Annette- I mean the laws, the system.)
2
I am so sorry, Annette. My mother had two schizophrenic brothers and it was so difficult for them and the family.
2
You are not alone. Many of us are in the same situation. Take care.
1
I agree that accepting a landlord's sight unseen statements is a curious basis alone on which to commit your son.
But I am incredulous that the landlord is not facing criminal, or at least civil, liability for his actions. Again, this story omits crucial details.
45
Involuntary commitment is traumatic and disruptive and should be considered only when there is imminent danger and the patient refuses treatment. Sending police officers without mental health professional is not the best way to initiate treatment.
I think it's safe to assume it was not just a landlord's phone call, but terrible prior experiences as well.
3
Yes. The landlord needs to be brought to justice, if that has not already happened.
1
There's got to be some way to get help for people who don't know how ill they are. The involuntary psych hold is awful; the lack of ongoing treatment, ditto; the lack of adequate funding for ANY kind of health care is a disgrace. Obviously this is completely aside from the gun issue - conflating the need for health care and a nurturing system with the gun problem is frankly infuriating. The sheer number and availability of guns in this country, including assault weapons that belong ONLY on the battlefield, just about guarantees endless violence and loss of life.
So let's leave that aside for a moment. Without the involuntary psych hold, which is a horrifying thing to do to somebody, there are nevertheless practically NO tools to help people who can't or won't help themselves. My beautiful sister spiraled out of control a few years ago, wouldn't care for herself, insisted on self-medicating, ignored her doctors - she apparently was seeing a therapist but wouldn't listen to her drug and treatment recommendations.
She hung herself in the basement. My beautiful sister is gone and I'm utterly at a loss to figure out why.
24
I would say that most mentally ill are unable to see that they are ill. "Normal" to them is what they experience every day. They seldom can be reasoned with. Bottom line: this is mainly genetic. There is seldom someone to blame. Endemic of the human species. A good read along these lines: The Roots of the Self - Unraveling the Mystery of Who We Are by Dr. Robert Ornstein. I'd say the biggest help is to at least have a basic understanding of this phenomenon.
I’m very sorry for your loss. I too have a son who was diagnosed, at the age of 21, with schizophrenia. He’s been hospitalized several times for brief periods since refusing to take antipsychotic meds. It seems these drugs either no longer work or they have such severe side effects that the alternative is preferable. Lots of people try to give advice. I try to explain that my son is like one afflicted with dimentia—he’s lucid for very brief periods of time. He’s being supported by me and his father but, when the money runs out, I imagine he’ll wind up on the street like so many others. The system is indeed broken and a sense of hopelessness now engulfs me. Why can’t we garner the power and political clout that the NRA now possesses? We have to organize and demand greater resources if anything is going to change.
46
Q: Why can’t we garner the power and political clout that the NRA now possesses?
A: Money and the influence it buys.
1
My son had 72 hour hold and arrest during his high school years. Huge money goes to local crisis group called the Aspen Hope Center. So called professionals failed me completely. Said my son was off the charts and another said that my single parenting skills were not strict enough. I call them the Hopeless Crisis Center. Thank you for this article
17
Yes, that's too often the case, unfortunately. So-called mental health professionals too often have no idea and often make the patients problems far worse.
1
Thank you for this thoughtful piece. There are other sources that have pointed out that the requirements to have someone in trouble held and treated for a long enough period have swung too far toward "civil liberties" during the last big mental health reform. Yours is the first I've read that was willing to consider this after having suffered from too few civil rights. There is somewhere we can find that will truly help those who need it when and how they need it.
6
The laws vary by state. In New York, for example, it is very hard to forcibly commit someone. It is such a complicated issue.
1
My first wife suffered from serious mental illness and I agree with everything you have written. I live in a different country where the laws and the care is better but its still not close to good enough. All of the police in my country are trained to deal with mentally ill people (after 2 technically justified shootings which led to coroners' courts criticizing the police for backing psychotic people into a corner where a violent response was more or less inevitable). And, of course, we dont have the problem of firearms in my country. I wish you all the best.
17
Good to know learning from experience is possible somewhere.
I'll add that cornering anyone is unlikely to invite a positive response from anyone, really. Expecting a mentally ill to somehow respond as desired to this doesn't make much sense.
2
Mr. Ornstein, a favorite commentator on public opinion and polls, hits the nail on the head when he discusses how easy it is to trigger commitment under these laws. There is often no probative value in the original complaints, nor even reasonable tests of fact.
The way in which custody is accomplished and then administered is typically farcical, a sham. Usually what happens is nothing other than confinement and testy exchanges with the house expert at such facilities while they claim to test the danger of the confined.
There is usually also little in the way of conversation that supports thought or analysis in the system. The house expert typically is thinking in terms of supporting an evidentiary claim at a commitment hearing, yet even that process is typically avoided by misleading the patient into agreeing away key rights and permissions.
The whole system is a farce, a Mickey Mouse procedure run to minimize cost and guarantee commitment judgments to force the confined person to accept forced medication, often poorly chosen by the house expert who usually has so many people to see that names, cases and situations are seldom remembered.
In Nebraska, the law has a reputation of being abused by sons trying to force an elderly parent off the farm and out of the way so that they can take over the family business. Armed sheriffs deputies can make surprise ambushes of individuals; then, without oversight, resulting unchallenged detention can last weeks.
17
When Kennedy signed his last bill, the Community Mental Health Act, it freed tens of thousands of involuntarily committed who had been imprisoned in mental hospitals for decades in draconian conditions. The anticipation was to replace the institutions with outpatient, community based centers, But the use of taxpayers dollars on the "undeserving" was frowned on by Reagan and his ilk. So now, no hospitals, no facilities, nothing. Except prisons, jails, and more law enforcement.
We are the greatest nation on earth. We can do better.
37
When it comes to health care, we need to stop with the cliche that we are the greatest nation of earth and examine why we cannot provide compassionate health care for all Americans.
1
Thank you for mentioning the "genial" Reagan who was the one who closed the facilities and kicked the mentally ill out in the streets.
1
We are NOT the greatest nation on earth. There is such thing and if there was, we would not be it. In your assumption expressed in your last line lies already the root of the problem and the obstacle to change.
2
In 1968 I began my first job as a clinical psychologist at a community mental health center in Ohio. I had just completed two years of a graduate internship at the same facility leading to a master's degree.
That same year began the dismantling of the nationwide mental health system in the United States under the guise of closing state mental hospitals that were necessarily but wrongly accused of being inhumane. These same state mental hospitals provided a desperately needed safety net for the mentally ill.
Those former mentally ill patients are now homeless throughout America or incarcerated in county jails and state prisons.
Misguided legislators shut down the only functional mental health system for America!
50
Michael, please read about the history of state mental hospitals. They were torture facilties. Dr. Cotton in Trenton State Hospital removed patient's teeth or other common practices such as placing patents in freezing bath water, electric shock, lobotomies, strait jackets, ankle and wrist constraints, and most importantly, a view that people who are suffering are "diseased, and were highly stigmatized by the majority of nurses and MD's in their charge. There are plenty of excellent healthy treatment models for people who have been labeled by the $ industry (heath insurance, psychiatry and pharma, drug rehab industry). Soteria, Hearing Voices Movement, CBT, Mindfulness CT, trauma therapy, conflict resolution/effective communication work, learning healthy coping skills. When a country or community is suffering (due to being overworked, poverty, fear, exploitation, or some kind of childhood trauma), much easier to find scape goats....the "mentally ill," the Mexicans, the Jews, the Irish, than to be empathic. The irony is current research in the fields of neurobiology, (epigenetics, neuroplasticity) tells us no one has to suffer from psychological problems (check out the following MD's who are working in major university systems - Norman Doidges, Dan Siegel, Ronald Siegel and https://www.madinamerica.com/category/in-the-news/ .
Completely agree. And yet,. the ones that remain are often hell holes - in some cases, posh helll holes, but still horrible places.
Let me get this straight.
Landlord calls parents.
Parents go to courthouse.
I assume the parents reported the behavior of their son as second hand information, as the article suggests.
On this basis the son was committed in a scenario resembling kidnap.
Maybe this is not what happened. The account given leaves many questions unanswered as to what really happened and I suspect sequence and facts have been altered in order to make it appear that the young Mr. Ornstein was mistreated by the authorities under the authority of a bad law and that the parents are blameless.
I also don't understand the reference to Nikolas Cruz. The article says that there would have been difficulty in committing Cruz based on the difficulty of deploying the Baker Act, yet it seems it couldn't have been easier to deploy the act to commit the writer's son.
Their son wasn't just a long haired bearded guy who walked on the beach in the middle of the night. By the parents' own account, at that point he was known to them to have been suffering for five years from a mental illness, although they say nothing of the nature of this illness, as if all mental illness is the same, with the same degree of severity.
I suspect the Ornsteins made this difficult decision and regret having done.
It must be a very difficult thing to do. It's the proverbial space between a rock and a hard place.
However wrong the landlord was, they easily believed his account.
I'm sure for good reason.
17
Their son had long hair and a beard. He smoked and walked on the beach at 3AM. That's it? The author says his son died in an accident at age 34. He does not mention that his son somehow asphyxiated himself. If a person is insane they must receive treatment. If they refuse treatment force must be used.
Thank you, Mr. Ornstein, and the other commenters here, for shedding some real life repercussions on the Baker Law. This infuriating, clumsy tool is both too much and not enough, and emblematic of the paucity of interventions in mental health care. When will we get a wider variety of treatments and legal protections that will really expand options for the ill and their caregivers? I sense the tide is turning and there is now more space to have these conversations about mental health. Let’s take this to the next level and engage with funders, providers, law enforcement, and our elected officials. And each other.
8
I am sorry for your loss and you clearly identify many necessary improvements to the Baker Act, and more importantly to our support of the mentally ill. However, I do believe that when mentally ill people have the potential to harm others we should always err on the side of protecting others who may be harmed. That should be our moral duty as a society. The mentally ill should have the right to effective treatment and should be treated with dignity and respect whenever possible. That is also our moral duty as is implementing real gun control. But let's not muddy the issues. If a mentally ill person seem dangerous, given that they are mentally ill and not likely to be in full control of their behavior, the state should have the obligation to take action. As painful as that may be for a parent, I would hope they would prefer that to be innocent people being harmed.
4
I could tell you stories from here to the moon about the abuses of the mental "health" system, but I think it would fall on deaf ears with most of the "lock up the mentally ill and throw away the key" crowd.
I spent a good portion of (wasted) time in mental facilities as a result of a serious medical misdiagnosis. I almost died as a result. I have skin in the game. It's unequivocally about the money. There's lots of greed, graft, abuse, and all around criminal behavior in these institutions, and I'm not talking about the patients. Out of the ones I was incarcerated in, three went out of business due to Medicare fraud by the owner,(first one) patient abuse in the second (in that case, it was a big scandal, covered by major newspapers for the good part of two years), and money laundering in the third.
In this tragic case, I don't blame the parents. I am very sad for their loss, and I completely understand why they are inconsolate about their son. They were duped and it happens a lot. That's the problem with the Baker Law. It's not about the guns or the criminally insane (most so-called mentally ill are not violent or criminals, most are victims of crime, in fact). It's not about the "right" to override privacy laws, either. The "mentally ill" have so little privacy/rights as it is, and all it takes is one evil (or even misguided) person to call law enforcement on a whim and there's a tragedy in the making. It happens all the time and the Baker Law contributes to this.
12
Yet people with mentally ill minor children often cannot get any help until AFTER said child has committed a crime. They have a slightly easier time with adult children because of laws like the Baker Act. Then there are children that have a mentally ill parent. These kids have no legal recourse and are at the mercy of their parents and other family members.
The criminal/penal system is not they way to deal.with the mentally ill. I would prefer to treat the mentally ill like people who get cancer or some other serious disease, because that is what mental illness really is, a serious physiological disease. We do not stigmatize and shun people who get chemo and we should not stigmatize and shun people getting psychiatric treatment.
2
Mr. and Mrs. Ornstein: I am so sorry for your loss.
5
Wait a second - so your son was living life just fine, completely independent and self supporting, you have him committed based on rumor, he doesn't appreciate it, and doesn't speak to you, and dies in an accident.
How is this a tale of mental illness or an issue of insufficient time committed?
Mental illness is unpredictable, not always curable even with perfect care, and people with no record, no criminal record, no record of mental illness can choose mass murder, and a rapid fire weapon will cause massive quantities of people to die. It's not mental illness that is the issue here, nor red flags - most of the mass murderers did not have those red flags. But they did have guns.
10
He wasn't completely fine (nor does it say he was self-supporting), it says he was halfway through a decade-long struggle with mental illness.
3
Mr. Ornstein, thank you so much for sharing your painful experience with your son. I totally agree with you that our mental health system is broken. In fact, our political and health care systems are broken and incapable of dealing with our complex problems of gun deaths.
First of all, I don't think it's entirely clear how to distinguish between mental illness and a confused, angry world view. For example, in the aftermath of Parkland shooting, there were multiple cases of teenagers as young as 12 posting on social media "hoaxes" of shooting and killing people. These children were arrested and charged. Were they "mentally ill" or just immature? If they were just "joking," what kind of society have young people who think killing and death joking matter?
Even when counselling services are available, in that kind of mental states, would they be open to talk therapy? How do we counsel people who do not want to be counselled?
Furthermore, denying family members access for "privacy" reason actually cut off help these people can tab into beyond what mental health professionals can provide. I find this practice rather rigid, counterproductive, and foolish.
In any case, whether the problem is mental illness or troubled world view, why do we expect them to be "cured" in 3 days or 90 days? We don't expect to treat hypertension, or diabetes, or lupus, or any of the chronic physical illnesses in 90 days, why do we expect a mentally ill person to be okay after 90 days?
8
A heartbreaking story but largely anecdotal.
I handle involuntary commitments in Oregon as a lawyer for the state. In order to deprive someone of their liberty for any significant period of time the “Person Alleged to be Mentally I’ll” is entitled to a court appointed attorney, evidence by clear and convincing proof that they are both mentally ill (a legit diagnosis, no just what police think) and proof they are an imminent danger to themselves or others or unable to provide for basic needs. Threat means they are JUST about to actually hurt or kill someone or themselves.
Mostly families plead with me to seek committment of seriously mentally ill family members. It’s never a snap decision borne out of misguided concern and even if a judge commits them, it can only be for a maximum of 180 days. Is that enough to treat them comprehensively?
No, but that’s not the goal. Many conditions, like bi-polar schizo-affective disorder, can be greatly mitigated by medication.
But unless the patient complied with treatment they spiral into conduct that too often results in their own death.
Confidentiality laws may seem unfair but the alternative is worse and everyone is entitled to due process.
We deinstitutionalized tens of thousands of patients in the 70s but then never constructed the “community based mental treatment” that was supposed to follow.
13
Unfortunately, inpatient mental health care in emergency situations sometimes does more harm than good--if it is poorly handled, the person who needs help leaves the facility traumatized by the experience and determined to avoid repeating it at any cost.
6
Dear Mr. Orenstein, what an unutterably tragic story; heartfelt thanks for sharing its pain for what it can tell us about our mental health system. Surely this is an area where thoughtful people could come together and ponder and develop improvements in a bi-partisan spirit. The human misery engendered by our dysfunctional legal and medical structures for mental health demand such an intervention.
24
Parkland as tragic and horrific as it was will likely provide a significant number of learnings and opportunities for policy improvement simply because so many layered systems did not stop the attack. That is cold comfort for the families but must be noted by policy makers.
I do not say these layers failed in isolation or assign blame to any one component because because the failure was systemic. The moment we declare the deputy failed or the Sheriff failed, the FBI, or the school, we assign culpability to a single actor. And that's an attractive option because it's simple.
Most security procedures at the institutional level are layered. You have cameras, access cards, preparedness drills, and so on because something will inevitably go wrong when the chips are down. Hopefully, though, not all the systems collapse in a single instance.
In this case, more by accident than design, despite warnings to multiple law enforcement agencies, an unstable individual was able to gain access to a weapon, breach the physical security of building, through violence of action threw the law enforcement response into disarray. As a result of these disruptions many innocent people died.
It's not just guns or mental illness or metal detectors.
The response to this tragedy requires us to design interlocking systems that actually work together and are put in place as part of a unified strategic vision to stop this violence.
I hope we are up to the hard work that must be done.
5
"But until we devote the needed resources to making the mental health system work, we will continue to have unnecessary tragedies. Locking people up for three days is no solution."
But until we are honest about the priorities of our culture and society we will continue to waste time hoping for change that won't come. We lock people up because it is ultimately the "easiest" thing to do. Everything in our society is gauged on how quick and easy it is for those who have other priorities (like making more than their neighbor). Sorry it's the oldest story: the vulnerable are neglected even if they are not abused; money is made off of them somehow.
14
Thank you, Mr. Ornstein. Our own experiences resemble those of your family, and I am sorry for your loss.
I greatly appreciate the analytic clarity you bring to this discussion. The Community Mental Health Act (of 1963) has never been meaningfully funded, and with insurance companies allowed for so many years to deny payment for extended treatment, it is no wonder hospital beds have disappeared even while state institutions for long-term care were being closed.
The solution is funding, but we have not as a society been able to make such a humane commitment. Until we do, people with long-standing, severe mental illnesses that, like so many, do not readily and simply respond to medication will be abandoned, and they along with their families will suffer.
57
Medicine alone is never the answer. Every single psychiatric medicine we have comes with significant side effects, and limited results. It is a first line, but should be used with a minimum necessary standard, and shouldn't be prescribed without a comprehensive treatment program. Cog/behavioral therapy is better for society and the individual in the long run. Using medication as a mainline of action is simply pacifying a suffering person so society doesn't have to put any work into dealing with people. It is lazy, cruel, and mostly ineffective
4
So sorry for the pain you have.
20
Frankly, Stephen Dale, your sympathy is misplaced. The author betrayed his son to a lying landlord. His pain is self inflicted.
Norman, I am so sorry for the loss of your beloved son. I’m also sorry for some of the comments from others that , as parents of these children, judge us when they have not walked in our shoes.
My sweet, loving, witty son struggled with schizophrenia for 15 horrifying years until 3 years ago he chose not to live this way anymore.
We had Jake all over for treatments, inpatient hospital stays and countless meds that had terrible side effects.
Our country still has enormous stigma attached to mental health and does not make research a priority. Bipolar, schizophrenia is a neurological disease and money needs to be allocated for brain research the same as cancer, diabetes, Alzheimer’s, and so on.
Society let both of our son’s down.
Sending prayers to you and your family.
250
TB Wetzman- it is the "iron triangle" economic concept -
psychiatric lobbyists/pharma lobbyists/politicians - created a billion $ industry and led to a current broken mental health situation (e.g. current opioid epidemic is a perfect example of a pharmaceutical company fueling the epidemic). Psychiatry needed to reinvent itself after they went out of the business of doing psychoanalysis and started providing medications only and developed the appropriate "diseases."
There is research and biographies of people managing their schizophrenia, bipolar, depression, but they usually have some kind of meaningful work (passion) that gave them a reason to live, a great deal of intellectual curiosity, healthy support, luck, and very often money (eg. just to name a few famous- John Nash, Ellyn Saks, William Jiang ). There are no quick fixes (in a world run by quickness - eg popping a pill), because the violence, mental health (and addiction) issues are connected to our being well read, support from our community and financial resources. Large WHO study, years ago, indicated that 3rd world countries have better outcomes with people suffering from schizophrenia than the US!
Parents of adult children with mental illness want an alternative to calling the police when the illness creates a desperate situation. I hope the model proposed in this article can withstand a Supreme Court challenge and generate change of mental health laws in a way that truly protects mentally ill persons and their privacy but does not leave the parents and living relatives as bystanders.
The NRA is focusing on mental health in the case of mass shootings to deflect from legitimate efforts for gun control. Still, it is a singularly powerful and wealthy lobby that might be useful in promoting this model. Let’s see if it is willing to put its money where its mouth is.
24
The NRA are indeed a terrible organization, but their focus on mental health is not misguided, regardless of motivation.
It can't be stated too often. We need universal background checks with full access to medical records. Half of the gun deaths in the USA are actually suicides.
Unfortunately medical records are closed to background checks. And many well-intentioned, "progressive" people demand that we keep it that way because of a misguided fear that opening the records will "stigmatize" the mentally ill. As a result, the background check for a pistol permit is deeply and irredeemably flawed because it cannot uncover an applicant's suicidal tendencies, need for psychotropic medications, history of mental illness, prior institutionalizations, neurological impairment, or any other mental health issue that should make it impossible for an individual to carry or buy a gun.
4
To be meaningful, any "alternative to calling the police when the illness creates a desperate situation" needs to be available around the clock. Sad truth is that at 3:00 AM Saturday, the police are your only option for this and a lot of other things.
4
i also have a family member with mental illness, and one of the consequences of being locked up for 3 days at a time, many times, is that my person distrusts his own room. he hates being within four walls, so he sleeps outside, in all weather. thus, this brilliant but seriously ill person is made even more vulnerable to disease and assault.
101
Our son pulled us into the mess and difficulty of mental illness, and our broken system. There are layers of dysfunction, each more abysmal than the last.
Psychiatrists whose sole function is to dispense medication. Labelers who test and come up with bizarre diagnoses like schizo affective disorder, even admitting that it's not clear what that is. The two year struggle after his diagnosis to realize that he can manage his anxiety and lead a good life.
But it's his work and perseverance that did it, and the fact that we stood by him as best we could.
I am so grateful our son is working hard against the stereotype, and I fear the labels that strip people of their rights.
Tom feeds the homeless on street corners, he would not harm anyone.
We need common sense gun control, to ban AR 15s and assault weapons. It may take years to get these weapons designed to kill and maim humans en masse out of our country, but that is the answer, not trying to take guns just from a select few.
53
Mr. Ornstein, I am sorry for your loss. I've long believed the term "mental illness" is a misnomer and is used in misleading and harmful ways. Further, more often than not, it is not visibly apparent when a person is a "danger to themselves or others." It's human nature to want easy answers (or if not easy, then at least structured enough to offer a possible explanation for the things we can't control), BUT adjudicating "mental illness" and coming up with laws that isolate a hurt person even more than they already feel is only going to make matters worse.
12
While your concerns about the Baker Act are no doubt relevant, I have to say that my reaction to the way you handled the situation is incredulity, at best.
On the basis of a phone call with a property manager, you flew to Sarasota, went immediately to the courthouse, and filled out forms invoking the Baker Act? Did you maybe think of calling your son, or stopping to see him before the trip to the courthouse? You state that he was released after three days, and sent home in a taxi, but you weren't informed. Where were you? Did you wait to find-out what happened, and have a conversation about it, or had you left town?
The situation you describe is definitely tragic, but unless something is missing from the article, there were definitely problems beside the Baker Act. I'm sorry for your loss...
45
The loss of their child is tragic. But I agree, something is missing here. Taking the word of the condo manager, and heading straight to sign the paperwork just doesn't ring true of any parent. I can think of quite a few other possible steps in between. If there had been a signed HIPAA form, things might have gone differently. Privacy laws and civil rights claims are what empties the mental hospitals; perhaps it's time to claw some of that back.
13
Yes, I was wondering that too. Who would jump on a plane and go straight to the police based on a random phone call from a stranger who gave no details? Unless the author is skipping over all the details of his son’s mental illness, there was no mention of any mental health issues affecting their son. He walks on the beach at 3 am? That in itself is indicative of nothing. Did they press charges against the apartment manager for filing a false police report?
2
Totally guessing here but judging from my own experience with a beloved family member sometimes they won't talk to their parents or siblings or children or others who love them and care for them. Mentally ill people can be difficult if not impossible to communicate with and sometimes those of us who care for them the most are also the people who upset them. So they shut us out.
It's a terribly painful situation - sometimes one simply cannot pick up the phone and talk to their child, sister, parent. So there's no choice but to rely upon the words of others.
Sometimes too the ill person lashes out with great rage at the people who love them; they become unapproachable.
It's terrible. It's impossible to convey the sense of helplessness and loss.
12
My prayers and thoughts are with you. And you are correct... "That episode, and our 10-year journey, taught us that the entire mental health system is broken."
But, our country is not unique. Every country in the world has trouble young people trying to cope with a difficult world, and sometimes losing the battle. The problem with our country is that we allow these troubled individuals to have access to military grade killing machines.
Your American Enterprise Institute, if I'm not mistaken, is a champion of conservative principles, including strongly supporting the NRA's interpretation of the 2nd Amendment. Perhaps you can use your own experience to effect change in that thinking.
We need to ban military grade killing machines to the military, the police, and shooting ranges where hobbyists can have fun shooting these machines of war.
Again, sorry for your loss.
17
Why are the laws so very different for the elderly with dementia and the young who have serious mental illness? I'm ignorant and curious. My mother has Alzheimer's and with a POA I'm able to house her in an assisted living facility and eventual memory care unit, even though she doesn't want to be there (though she needs to be there). NYT - this merits a story.
30
Jen- because there is no stigma against dementia which is considered a "legitimate illness." There is still stigma with people suffering from poor attachment to one or both parents which starts in the womb, people who do not have healthy role models in their family or nearby that they can emulate, and a culture that stresses wealth and power over empathy and kindness.
The most frustrating aspect of our mental health system is the failure to implement evidence based methods of care. The NIMH funded RAISE (recovery after initial schizophrenia episode) study showed that early intervention using coordinated specialty care had a positive effect on long term outcome. Yet this type of care is virtually unknown throughout the US. I am hopeful that the growing frustration with the status quo will lead to better treatment options in the future. I fantasize about affordable housing in communities targeted to helping the seriously mentally ill integrate as best as possible into society with just enough oversight and guidance to keep them safe. I suspect that every parent of a mentally ill child has a similar fantasy.
12
Mental illness is tricky. Society is afraid of those who suffer from mental illness yet at the same time unwilling to invest in the changes needed to make sure that those who need help get it in a caring, compassionate manner. There's such stigma attached to a mental illness diagnosis that many people who need help don't seek it. Those of us who need help but can hide it suffer silently hoping no one will find out.
I'm sorry for your lost. The condo managers behavior is a sad example of how many people with mental illness are treated. Thank you for using your story to highlight a better way of getting people the help they need in a way that allows them to lead a fairly normal life.
14
A great article that raises a lot of good issues for discussion. The sad part is, the members of Congress who blame mental illness every time there's a mass shooting (and give assault weapons a pass) are the same ones who never vote funds for more and better mental health services. For them it's just a way to cower to the Gun Lobby and blame everything but the guns for a very complex problem. So sorry about your son, Norm, but thanks so much for writing this.
36
Wisconsin does not allow individuals to file mental commitments; only the county corporation counsel can. This is an important safeguard. Allowing individuals to file commitment petitions, which many states do, invites unscrupulous abuses by people who at best do not understand mental illness and at worst, are simply trying to lock someone up for personal motives. This is one of the scariest aspects of the gun debate. In the irrational zeal to preserve gun rights, some are advocating making it easier to commit people. The Soviet Union was notorious in its use of psychiatry to lock up dissidents. It's a dangerous road to go down.
40
I am so sorry you had to lose your son that way. What a horrible outcome. We fret about our son on the autism spectrum, and how he will be received as he moves into adulthood as well.
14
Most perpetrators of mass shootings are not mentally ill. Since mental illness is difficult to diagnose and treat in any case - there is no blood test for paranoia - do we really want to hospitalize everybody whose behavior is deemed “unconventional”? Back to the USSR where involuntary confinement was used to put away dissidents and artists. No, the only way to stop American carnage is to take away guns. Nobody needs an assault rifle and if you need a handgun for self-defense, it is possible to obtain lawfully even in countries with strict regulations. The staggering statistics of gun deaths in the US compared to the rest of the world speak for themselves. Either the guns are to blame, or Americans have a sixfold rate of mental disease compared to everybody else. I guess if you qualify the desire to own weapons of mass destruction as a mental illness, the second option makes sense.
21
We confuse the issue when we classify every gang-related group murder where more than two people die as a "mass shooting." When the criterion for mass shooting is defined simply as more than two dead it draws no distinction between gang and drug related shootings, and school shootings. The perpetrators of gang vendettas probably aren't mentally ill. That doesn't mean that the Sandy Hook and Columbine shooters were not. In fact, given that so many of the massacre shooters end up killing themselves and leave behind lunatic rants I think it's wrong to write off the possibility that many are indeed mentally ill.
Nicholas Cruz survived his own massacre. We're missing a golden opportunity to learn how to prevent future massacres if we don't allow this murderer to be studied extensively.
Give Norm Ornstein a break. It's easy to read the story and think, "I would have done xyz first" but unless you're in the situation, you don't know what you'd do. Yes, losing your dignity, your rights, your agency is horrible and scarring, but if the possible alternative is death, what choice does a parent have? If your loved one is suffering from mental illness, that's always the terrible fear in the background--not of their losing their rights but their life.
41
I so agree with your comment: I was dismayed at the attacks on the parents, totally missing the point of his comments. The positive comments came from parents who had gone through similar experiences, not some judgmental yahoos.
2
Norm is just fine, with or without a break. The problem is a system which is biased to accept without question allegations which trigger significant consequences without oversight or the provision for self-correction. Malice, in particular, has always been a significant driving force which perverts this process.
In a more perverse form, this abuse of process has presented recently in the form of "swatting".
So, just because one or more persons may be carrying guns and wearing badges, this does not mean that either assumed facts or legitimacy of complaints are true. An exaggerated sense of emergency and heroism, or even simple irritation, often does lead to regretful consequences.
Unfortunately, the governance process in this country feels that it cannot afford to either deal with such problems, improve obviously flawed procedures or even provide care rather than pills to those who actually are mentally ill.
My guess is that Norman Ornstein knows all of this all too well.
1
Sad.
1
I've tried to post two comments and the NY Times' censors have deleted them both. As a social worker I've seen first-hand that it's nearly impossible to coordinate with a client's family members or other loved ones without requisite ROI's (which people suffering from delusions, paranoia, or depression usually refuse to sign off on), let alone get somebody committed to a mental health facility due to laws (such as HIPAA) that the ACLU has promoted. Blaming Regan or the Republicans won't get us anywhere on this issue. The bigger issue, if we're not permitted to have a dialogue, how can we ever solve our problems together?
22
America is the country that throws $billions at the military every year so we can develop new and better ways to kill people. America passes on $billions to the rich so they can have even MORE wealth to play with. Yet poor Americans, especially the mentally ill, are not even given enough in basic resources to survive. It's time for us to admit the obvious - America stinks!
29
FOLLOW THE MONEY
20
As a member of a NAMI support group, and as a parent of an adult with serious mental illness this story resonates to my soul. I have been fortunate enough that my son did not have something terrible happen to him, and did not completely cut himself off from me, even though he experienced forced hospitalizations. That was because he responded to medication, and now has continued to stay on medicine. However the journey to get there was extremely difficult, much of that difficulty was due to the system itself, and it could be fixed. I also work in the system, as a faculty member in a department of psychiatry in a midwestern medical school. We have the ability to develop systems that use strong persuasion and coordination with families to improve the possibility that the mentally ill person gets adequate care. The Twenty First Century cares act, signed by President Obama in the last days of his presidency, actually contained important mental health legislation including A HIPPA reform process the HHS is supposed to initiate. While our treatments for these disorders is far from ideal, the current system doesn’t really give them a chance.
64
My son cannot handle alcohol and instead of being arrested he was taken to the county mental health facility for 72 hours. I prefer that to an arrest and potential record. He got help and doesn’t drink now. This turned out to be a stepping stone in getting him the proper care. But if a adult child doesn’t want help, this won’t do much, but again it’s better then being arrested. My son was 27 nice looking blond white male, I tend to think they would have arrested him if he fit into a different profile.
28
Dear Mr. Ornstein,
I'm so very sorry for your loss.
35
My heart goes out to this father, but action needs to be taken much earlier.
In the state of CT applicants for a pistol permit are required to take a class in gun handling and safety, pass a written and hands-on test, be fingerprinted, and undergo a background check. To purchase a gun an individual must show their permit. (These are requirements which should be adopted by every other state.)
Unfortunately medical records are closed to background checks. And many well-intentioned, "progressive" people demand that we keep it that way because of a misguided fear that opening the records will "stigmatize" the mentally ill. As a result, the background check for a pistol permit is deeply and irredeemably flawed because it cannot uncover an applicant's suicidal tendencies, need for psychotropic medications, history of mental illness, prior institutionalizations, neurological impairment, or any other mental health issue that should make it impossible for an individual to carry or buy a gun.
Opening mental health records and school records to the background check could probably prevent more tragedies than a three day hold for observation when people are reported as a danger to themselves. The Florida shooter showed a clear tendency towards violence for years before acting on his demented impulses. Yet he was able to buy a gun legally because Florida's gun laws are so lax. If a FULL background check had been required that man would have never been allowed to own or carry a gun.
14
No, no, no! Medical records are not open because of fear of being stigmatized by the population at large but because of the fear that insurance companies will penalize them by way of increased health insurance cost. Eliminate that fear and no one will care what your medical background is.
6
Todd
If they don’t use medical records to evaluate one’s mental stability to own a gun , then what do they use ? Nothing ?
The whole thing seems ridiculous. For instance , if someone has prior mental hospital stays and is a diagnosed schizophrenic , they should not be allowed to own a gun . As I missing something here ?
1
I am sorry but the background check is conducted by a federal agency, not Florida.
Mr Norm Ornstein, I'm sure most of us know you from your appearances at the PBS. I wonder how a country which can boast of being the most affluent in the world can't get its act together. There are definitely no dearth of wise counsel and funds for the young Americans who suffer in shadows with their mental illness. But the American social-political and religious leadership doesn't come forward to generously invest in areas where their youth, the American future generation, could be sheltered, nourished and developed. I wonder what will happen to this country with its rate of incarceration, use of opioid and failing standard in Math and Science among teachers and students. It has already seized to be the beacon of democracy for the world !
11
This doesn't even get into how bad the facilities for involuntary, or even voluntary, treatment are. I have a relative who just endured four weeks at one of the "highest rated" in the nation. It was not only a dump, but there was zero (ZERO!) psychotherapeutic activity or attention. The only goal was to "stabilize" on medications, and then release to outpatient treatment - wherever that might be found. Literally no psychotherapy. Zero. (I can't stop saying it, because it's so absurd. There. Was. None.)
159
I had a similar experience with a close relative at a nationally known teaching hospital. For him, it was ECT treatments and medications. No counseling or psychotherapy. The facility released him pretty quickly after I had expressed some concern that insurance might only cover a fraction of his treatment. Outpatient treatment wasn't even an afterthought, and only organized by his regular psychiatrist after he came home with little obvious improvement.
44
We've been there and we know. It still never ceases to amaze me, either.
2
The article raises a number of questions about due process and the mentally ill: how could parents who are non-witnesses to an event be able to obtain any court relief and how could the court grant such a relief based on hearsay, especially where the obvious possibility of landlord collusion existed? A lot of thought has to be given to revisions to mental health for both procedurally and substantively, or we will return to the era of “snake pits.”
14
The parents need to recognize that it wasn't just the Baker Act, it was how they used it. Instead of going straight to the condo and talking to their son, they went straight to the courthouse. They also did not ask enough questions or study what happens when the Baker Act is invoked. While I sympathize with their loss, and while I agree the Baker Act has many flaws, the parents most serious error was to fail to go see their son FIRST, before invoking the Baker Act.
27
This country needs to evolve into a better society. We need evidenced based solutions to these huge societal problems not stop gap measures. Serious mental illness is very prevalent yet rarely seen or discussed. If you asked many of your friends and acquaintances about it you would find that almost everyone has a friend or relative with bipolar disorder or schizophrenia. Our country cannot seem to realize that healthcare for all makes everyone safer and it's cheaper that leaving people untreated on many levels. The GOP has actually made it illegal to study gun violence.This is not the behavior of a civilized society. Psychiatry also needs to come out of the dark ages. Train people to systematically take care of the seriously mental ill; far too many psychiatrist want boutique practices treating soccer mom anxiety. Other countries have systems that actually work. American exceptionalism should not preclude us from looking to see who actually has solved this problem. Wouldn't we all like to stop seeing people sleeping on sidewalks or under overpasses? Times up for 18 th century responses to the mentally ill. The last major "reform" was when Reagan closed all of the large mental health facilities. No one bothered to follow up to see what should have come next and whether it was working.
23
No they haven't made it illegal to study gun violence. What they did was pass a law that threatened to strip funding from the Centers for Disease Control and Prevention unless it stopped funding research into firearm injuries and deaths. The effect was to bring research on gun violence to a pretty much complete halt for a period of years, but it was not illegal to study it. There is a difference.
1
The NRA are intractable on any kind of common sense measures. And as they own most conservative politicians an quite a few liberals as well nothing is going to get done until they accept that there need to be some common sense agreements. But they will agree to no solution and prevents anybody from buying any kind of weapon. They oppose everything that has been suggested. No progress can be made under these circumstances and they know it.
5
Thank you for this. It illustrates so well that, of all the things we could do about this problem of shootings in schools (and elsewhere), the idea that we should focus on more deeply involving the courts and police in the care of those experiencing psychic pain is, well, just plain nuts. Who, exactly, in that scenario is mentally ill?!
4
True moral of this story: don't trust landlords. Only a landlord would be capable of doing something like this...
13
It is disappointing that, at the end of an article decrying a stigmatizing and traumatic system that treats the mentally ill as potential criminals, you feel the need to plug a different form of stigmatization that treats us as potential criminals. We need a system that encourages everyone to seek the help they need as early as possible; adding the threat of the loss of rights to the already steep emotional barriers that keep people out of treatment is precisely the wrong approach.
8
Mental health is an area that our states continue to struggle with. I am truly sorry to see what happened to Matthew.
You'd think that local governments could contract with counselors & psychiatrists to deal on the instant with con artists like the property manager mis-using the law against someone they are simple uncomfortable with.
4
Dear Mr. Ornstein,
My deepest sympathy to you and your wife. I've been spared the family trauma that you have experienced and have no idea how our family would have handled such a situation. A few general observations though.
Our society is punitive, judgmental, and short on empathy. It seeks to solve deep problems with simple solutions some of which can make things worse.
"If you see something, say something". Easy, isn't it? It may or may not have prevented the Parkland shooter from getting a weapon, but a ban on the sale, distribution & private ownership of war weapons would have been more effective. Do we really want to become a nation of snitches, like servants of the Stasi, maybe turning in people just because we don't like them? Then what? The Soviets used to class people as insane if they were seen as a politcal threat.
Instead of the politically difficult but common-sensical steps of restricting types of weapon and size of clips and insisting on mandatory training, licensing and insurance, we think, wrongly, that we can cherry-pick people who can be restricted and leave the rest to be classed as "responsible". I would remind 2nd amendment absolutists that the Supreme court, even as it asserted in Heller vs. DC the personal right to own weapons, it also stressed that, like any right, this is not unconditional.
Conflating mental health problems with firearms problems makes it more difficult to deal with either.
42
Having spent 7 years working to effect change in the mental health field through the use of technology, I heartily agree with Mr. Ornstein that - in the words of Bob Dylan, “Everything is broken”. There are not enough healthcare professionals working in mental health, leading to average wait times for a psychiatrist appointment of 12 or more weeks. Social workers and psychologists are woefully underpaid due to limited insurance payments and Medicare/Medicaid rates that pay hourly rates more in line with fast food workers rather than healthcare professionals. Mental health organizations are funded by charity and block grants that do not come close to covering operational costs. Medicaid is under attack across the country, further aggravating the challenges for people with mental health disorders, who disproportionally rely on government services for health and housing. Resources are thin, and technology, if installed at all, is antiquated; Wi-Fi is hard to find.
Another thing that is hard to find are heroes in government and the private sector who will champion a reimagining of our mental healthcare system, integrating primary care with mental health and social services. Someone who will address the challenges head on, helping to overcome the persistent and damaging stigma attached to someone who’s brain isn’t working correctly. Someone who will promote the use of technology AND reimbursement policies to expand access to services for long term health and stability. Help...
31
Sorry for your suffering.
Society has the money to help people but doesn't have the compassion. Mental illness is an invisible disease. Even people who should understand do not want to help.
By the way, this only supports that Florida is a state for scammers. The condo manager should be in jail.
33
Thank you for sharing your personal story. Your analysis is spot on both about our mental health "system" and the chances that involuntary commitment will prevent mass shootings.
As and ER doctor, I must answer the question of if a patient is "a denger to self or others" every day. I can assure you that it is imperfect at protecting society and for protecting the patients. This is true whether done be a psychiatrist, ER doc, or family member. The involuntary commitment laws are needed, but do not by themselves make for a true system of care.
25
And prone to EXTREME abuse at the whim, or for the profit, or for the perverse pleasure, of health professionals.
4
The privacy laws are torture for families and loved ones. Yes, there are exceptions, but for most people, their families are their best friends and best chance to re-orient in a loving and nurturing environment. They often have knowledge and perspective about patients that health care providers need to care for their patients. Don't lock us out!
57
For your consideration:
https://www.nami.org/Learn-More/Mental-Health-Public-Policy/Psychiatric-...
I share your thoughts and empathize with your tragedy. There should be facilities in every state that offer care to the mentally ill, giving them treatment and stabilizing their condition, and helping them re-enter the world. These would be unlike the old hospitals, which were ineffective at best.
Jail is not the answer. The mentally ill should not be treated like criminals. Most of them, as mentioned in this article, are not violent.
National Alliance on Mental Illness (NAMI) is a national grassroots organization that works for the mentally ill and their families.
26
While civil commitment is sometimes necessary, it cannot be denied that the mental institution is the civil law counterpart of the criminal law prison, and in some ways mental inmates have even fewer rights or dignity than prisoners. It is not necessarily more “humane” to put someone in a mental institution over a prison.
Once institutionalized, one has few rights and is, typically, isolated from the outside world, including loved ones. It is no accident that these--stripping of rights and isolation--occur in tandem. What takes place inside of facilities for those who've been involuntarily committed is, often, nothing short of horrific.
Further, forcing "treatment" onto those who do not present a danger to others--those whose conduct is disruptive, embarrassing, or inexplicable to others--is not compassionate; it's arrogant.
The number of categories in the DSM is growing as our definitions of sanity are narrowing. Fear of difference is pushing us toward laws that will deprive whole groups of autonomy and dignity.
59
A hundred recommends,
4
Your description of why facilities and DSM demonstrate your extremely limited understanding in all areas of mental health care. This is sad because I believe you're advocating for those individuals who deserve and would benefit from adequate mental health care.
2
You are so right. Reagan closed the state hospitals, leaving people with serious & persistent mental illness to languish, untreated, on the streets and in and out of psy hospital units. Disgraceful! We had a seriously ill Pt on an acute unit for 3 years because there was no long term tx facility available. We need safe, secure “towns” where these people can live with the supports they need.
34
Regan takes far too much blame for issues regarding mental health and associated problems such as homelessness, etc. Take a look at the actions of the ACLU, a far greater culprit in this battle.
4
Marti,
Would you please clarify what you mean by "these people"? Do you mean those who talk to themselves? Whose definitions of reality do not match yours? Who hold ideas outside the mainstream? Who dress in ways deemed inappropriate for the weather, the occasion...? Those who wear white after Labor Day? Where are these lines to be drawn? And, what parties will draw them? People presume they'll never be on the wrong side of those lines, that they'll be the ones with the pencils.
2
President Kennedy signed the Community Mental Health Act in 1964, which freed tens of thousands from permanent warehousing in mental institutions behind locked doors in Draconian imprisonment. It envisioned community mental health facilities instead of a life in prison. But then Reagan thought tax cuts for the rich was a better societal investment. Reaganomics deserves all the blame and then some.
7
Dear Prof. Ornstein, I am so sad to read this terrible suffering that befell your family. I want to personally thank you for sharing your story. I grew up with a mentally ill sibling and saw her suffering and that of my parents. She is, thankfully, still alive. I can only imagine the pain you must feel and I send you my condolences. I will do my part to fight for a better system for people suffering from mental illnesses.
170
I am a PhD but I have been institutionalized for mental illness as well. The mentally ill are fully capable of being "high functioning" contributors to the economy and to American society. Stigmatism and stereotyping does make talking about and dealing with mental illness very difficult. I think the media, academia, and others need to fully grapple with the misunderstandings between the general pubic and the mentally ill.
279
Politicians and too many citizens are willing to accept inadequate, underfunded but important programs. As our population has increased, so have the numbers of mentally troubled children, men and women. We lock people up at considerable cost and then forget about them. We neglect many of our public schools, our mental health facilities, our towns and cities -- and in all of them are The People.
We could much more effectively address, if not solve, so many of the nation's problems with compassionate leadership and determination.
Most Americans alive today do not know about this country as it sacrificed and pitched in during World War Two.
For many, only when the tragedies and needs hit home, as with the Ornsteins,
the families in Sandy Hook, Parkland, Orlando, Las Vegas (just a few examples) are people motivated enough to act.
We must never stop asking others, "If it was your child or grandchild, what would you do?" Whether it's over mental illness, mass murder, homelessness, inadequate facilities -- issues that are truly about a "strong" America.
We're addicted to phones and to ignoring what's going on beyond our limited vision. As a Fool demanded of a king: See better!
Doug Giebel, Big Sandy, Montana
17
Yes, there are solutions to these problems. AS demonstrated in other countries. It is not rocket science, as they say. We know what to do, we just have to be willing to pay for it.
21
"we just have to be willing to pay for it"
you mean tax the rich for it.
2
No. I don't mean "tax the rich." My reference to World War Two (which I remember having lived through) means the entire nation must pitch in to solve our major At Home problems. Of course the wealthy must pay more, having been given enormous benefits,
but real solutions require national effort. Self-interest is not the same as The National Interest. It will take education, awareness, genuine leadership -- and probably many more massacres and other disasters before Americans realize, accept and work to end the serious internal problems we face. Today just about everything is "politicalized." Mental health, massacres, neglected education systems, crumbling infrastructure, drug epidemics -- those issues affect all who live here.
Doug Giebel, Big Sandy, Montana
5
Thanks for this informative and deeply personal analysis of our mental health system and the difficulties your family experienced first hand. It must have been a frustratingly painful ordeal. I believe this will lead to deeper and more meaningful conversation about how we can better serve our loved ones with mental illness. This is a bipartisan issue - and one we must act more strongly on together. Thank you for strengthening this dialogue.
12
So sad. I'm sorry for your tragic loss. I wish this society would learn from these awful events but I'm not hopeful.
13
"Confidentiality" as it is used by many mental institutions is imposed, not agreed upon.
Upon entering an institution in Naples Florida, I took with me a notarized statement that anyone calling was to be told I was there and even minimal information about my progress. It was my choice that friends know. I now recommend every one do precisely that. Take with you a notarized form saying exactly who can be notified, and then see that it is followed.
The institution violated that order, was forced to apologize and instructed its receptionist to do as I had legally requested.
136
Yes. It seems like the confidentiality clauses are more of a technique for staff too keep away annoying family and friends than a protection for patients.
If someone comes to see a patient, the patient should be asked if they want to see that person. If that does not happen, it is an abuse not a protection of Rights.
1
Your son was 24. You no longer had parental rights to his medical records.
I am sorry that your son ended up as he did, and the landlord/rental agent was deeply wrong in what he did, perhaps even criminally.
But if you wanted to remain engaged with your son, it was incumbent upon you to do so, and if he did NOT want you engaged, than that, too, was his right.
You don't "own" an adult son.
20
You are missing the point. There are mentally ill adults who are a harm to themselves. Someone has to take care of them.
15
Your son is always your son.
15
There are. The son wasn't one of them - he was living on his own, no problem, with little enough contact that his parents were willing to believe a crazy story with no questions.
2
The police are the last people i would call for anything.
Insensitive parents, or maybe just mean spirited.
15
Don't judge until you've been there. If you fear your loved one hurting themselves and/or injuring you, often the police are the only recourse to stop either from happening. It's at the core of what's wrong with our mental health system - inadequate services for the last hidden illness in modern America.
9
Biggest mistake I ever made was calling 911 for a fight within my family. When they got there we had all calmed down, and their response was ‘we’re arresting someone here tonight’. They can cause a bigger problem then the original reason you called them, as far as they are concerned you have no rights.
5
I have nothing but praise for the local police dealing with a family member in trouble.
2
Dear Prof. Ornstein, I am so sorry for your loss. I am writing this as I sit in the hospital next to the bed of my 25-year-old daughter, who suffers from mental illness. They are kicking her out (sending her home) after an emergency psych evaluation. You are correct the system is broken. In just a few months she will no longer have my health insurance. The job she has doesn’t provide anything like what she needs. And I am terrified for her. You are correct, 90 days isn’t enough time. She’s only had a week of intensive inpatient care. Once. She managed to flit from one provider to another, none of whom has had her long enough to find out who she is let alone what her problems are. None of them ever asked her family about her history. This time it’s just an evaluation and home we go. Take your meds. Make a safety plan. We need comprehensive care, not nickels and dimes. And it sure won’t happen under this administration. Best wishes for your own healing.
1120
I am so very sorry.
18
You described the current system in a nutshell. Hodge podge and inadequate. NAMI is a great organization but it cannot do what society at large needs to demand: Fully covered, comprehensive, continuous mental health care for the seriously mentally ill. It's not like this problem will go away if ignored. It just festers. and Medicaid is inadequate. Especially since it's on the chopping block every single time a budget is proposed. Everyday a young person develops a serious mental illness. A country of intelligent compassionate people would take this into consideration and provide a system that actually works. America can do so much better.
15
The best resource for your daughter is you and your family. Buy insurance with the coverage needed and make arrangements directly with providers that can deliver the needed care. Participate directly with the provider, as a volunteer or any other role they need filled. Have you daughter authorize you with a power of attorney so that you can assist the provider and elevate the level of care and information shared.
Fight!
17
Without judging anything anyone has said, two fundamental problems:
1. Mostly, we (i.e. medical science) doesn't know how to treat (the many different forms) of mental illness. Outcomes are often terrible even with treatment.
2. The contradiction of compliance obtains: to be treated, mentally ill people must be compliant: take their meds properly, attend therapy sessions, etc. By definition, they tend not to do this.
Until real progress is made on these fronts, guilt, failure, abuse, and, too often, tragedy, will be common, no matter what the "system" does.
27
I worked in the mental health system for years, first as a nurse, then as a legal services attorney representing patients who were in and wanted out or vice versa. Its a lot harder these days to get a seriously psychotic person into a hospital than to get them out. The problem is not just a lack of public money to pay for services (altho a LOT more money would make things easier and provide some sense of security for a lot of the mentally ill who are homeless, or close to it), but its also a paucity of proven, reliable ways to help the seriously mentally ill. For many, the meds produce terrible, irreversible side effects, or don't work at all. ECT is still controversial and can have horrible side effects, too. There is no residential care available except to the 1% who can afford to pay for it privately. "Community Care" is put onto family, who lack the time, and ability, to provide the supervision and support necessary, even if they are well intentioned. Prisons and jails are now the largest providers of mental health services in the country. The last resort for the mentally ill in our society today is a crowded jail cell, even if they haven't committed a crime that warrants arrest. The reformer Dorothea Dix could could back today and start her work all over again.
11
We have a health insurance system that will pay for hip replacements for obese 75 year-olds who smoke two packs of cigarettes a day. But just try getting effective mental health treatment for a 22 year-old child suffering from anxiety and depression. I dare you.
618
Sorry, but I don't believe in merit-based health care. I am an MD. I try to be fit and don't smoke. But I stand up for my obese smokers. They don't have to earn a hip replacement. Just being a human being, I want them to walk rather than be in a wheelchair.
56
I have seen the most amazing care in the Netherlands, for adults who stopped functioning for a couple of years, and were so well taken care of that both returned to responsible jobs. Their rent was paid by the government, they were able to stay in their own house with their child and recover. Humane treatment just for being citizens. It is possible.
75
I think the complaint wasn't with the care given to the person needing a hip replacement, but to the lack of any sensible treatment being available for the depressed 22 year old.
10
Everyone who reads this should also read the previous op-ed by the mother who owns a gun. There are lots of anecdotes that can be used to discredit one policy or another and no policy will prevent all violence (gun or otherwise) even if they are implemented perfectly. But we need to evaluate policies based on what small improvements they may make, recognizing that errors will always be made as long as humans are implementing the policies.
7
And the former neighbor of a friend could have written an op-ed on a situation opposite to the one of that mother. Hearing a noise in the hallway and groggy with sleep, this guy grabbed the gun he kept in his night table drawer and fired through his bedroom door--narrowly missing his daughter returning unusually late from a date. The woman writing the op-ed claims the self-defense her mother practiced never gets reported to the police, but neither do near misses in what could have been a tragedy. I found her op-ed unconvincing. My parents never protected me with a gun, nor did my husband's parents, nor the parents of anyone I know. And none of us feel it necessary to "protect" our kids with guns. And, yet, somehow we all survived, while SO FAR in 2018 at least 44 children have been killed or wounded in unintentional shootings where there are guns in a home.
The June 19, 2017, issue of Newsweek states that: "...child gun injuries and deaths may be even more prevalent in the United States than we realized. A study published Monday in the journal Pediatrics showed that an average of 5,790 children in the United States receive emergency room treatment for gun-related injuries each year,.... The study also found that an average of 1,297 children die annually from gun-related injuries, making guns the third-leading cause of death for children in America.... The number is based on data taken from 2012 to 2014 for children up to the age of 17."
Heartbreaking to have your “adult” child hospitalized and not be allowed to be involved in their treatment plan . For once they are discharged you are the ones available to assist with follow up care. This hippa law has created so much harm and was really never intended to be so overly “protective” of privacy, common sense has gone by the wayside.
28
When Mr. Ornstein's son turned 18 and moved out on his own, the Ornstein's no longer had a proprietary relationship other than that which their son, himself, was willing to grant.
It is a sad take that Mr. Ornstein tells, but it is the price that we pay for raising children and having them grow into adults.
7
Owl, I don't perceive anything in the author's tone that suggests a desire to own his child. I hear an anguished father who wants to help his son and protect him. Humans require the help and support of others throughout the life span, particularly when they are ill due to a mental health problem. Of course we want our children to mature into adults, but some mental illnesses prevent people from exercising reasonable judgment, and leave them vulnerable in the absence loving help.
35
In a healthy society parents wouldn’t be shut out of their children’s life because of a policy created by overzealous civil libertarians. People with mental health issues who suffer from paranoia or depression often reject the very people who want to help them the most.
13
This sounds like a selectively edited recounting of a very sad story that should not be blamed on Baker Act.
16
Why do you assume it's not accurate? Are you familiar with hiipa and involuntary commitment? Sadly, this sounds entirely plausible. And it's heartbreaking for all involved.
24
Because Anne - the Baker Act has demonstrably saved lives and prevented disastrous situations over many years. A single example of parent's making bad choices does nothing to counter those successes. Selectively edited because there is clear evidence that there is a surfeit of blame to go around. The Baker Act is far from perfect - but it works in its own fashion every day - unlike the fantasy world that the author suggests might happen some day.
3
Why to assume it's not accurate - selectively edited?
There's the fact that the parents had little enough contact that they didn't know the tale was a lie.
There's the fact the son was living on his own, paying his bills - nothing indicating there was extreme mental illness.
There's the fact they didn't contact him at all - not a simple phone call - which indicates the relationship was already broken.
There's the fact that the son doesn't die due to mental illness - it's an "accident" - no hint of mental illness as a cause, and it no doubt would have been mentioned.
Then the tale of his son's loss is used as a means to say there is a problem with laws about gun control.
1
First I'll say that I'm sorry for your loss. As someone in the mental health field, I'd like to make a few observations.
1. HIPPA laws protect privacy, but there are exceptions when it comes to emergency treatment, including safety assessment for mental illness. This may be a new exception since your experience.
2. Many states do allow commitment under grave disability, which is similar to what you describe.
3. That said, we cannot be to paternalistic about this as we are removing people's rights.
4. There really is no way to force people into prolonged treatment. All the orders under the sun can be issued, but it is up to an individual to follow it.
5. The level of malice and, frankly, sociopathy that a mass shooter has is most often not due to a treatable mental illness. The answer is prevention through reduced access to lethal means, not mental health treatment.
6. This focus on the type of weapon is a losing battle. We need to focus on laws that will minimize criminal access. The vast majority of Americans support that. Also, as headline grabbing as these shootings are, the number of suicides and homicides not due to mass shootings is many, many times higher.
103
some states are funding mental health counselors to ride along on 911 calls so the outcome is something other than death by cop
31
The phrase is "suicide by cop." Big difference.
2
Yes there is a difference. If the person is acting irrationally due to mental illness and is shot because the officer(s) interpret the actions as a threat, then it's not suicide.
3
"$450 million to station guards in every school, with more funding for bulletproof windows, steel doors and so on, while adding a paltry $50 million for metal health " This is a travesty. Republicans just care about their Damon guns, and not about mental health at all.
109
Ironically, Tim Murphy, the Republican Representative who was forced to resign because of his hypocritical urging that his pregnant mistress get an abortion was a strong stand for funding for better mental health services.
Thank you, thank you, thank you. So much more we can and should do for the mentally ill, who are generally only a potential threat to themselves
33
The Republican’s hero, Reagan started this mess when he was governor in California and brought it to the whole country when he was president.Until we as a nation treat people with more respect than money,it will never change. We have turned are jails into mental institutions. It is really hard to understand how the most advanced country in the world can be so backwards with our most vulnerable citizens.Now we are demonizing all mentally ill people as an excuse to keep our guns and the gun money flowing. America please wake up! It’s not a choice for them.
74
It didn't start with President Reagan though I've heard many people say to. I worked for a state Psychiatric Hospital in 1965, my first adult job. We were trying to move our patients out then. I remember well one woman who was told that it was o.k that she heard voices, she just needed to be sure not to tell other people, especially her employers about them. Now was she dangerous? I doubt it. But was she likely to be able to hold down a job and were their supportive services to be sue she had a home, check on whether she was taking her meds, taking care of herself. Not so much.
9
She might have been okay. It's now widely accepted that many "normal" people hear voices. If she had enough self-awareness to know she shouldn't talk about it at work, she sounds pretty high functioning.
3
What DID start with Reagan was the defunding of the supportive services mentally ill people need. After all supportive services provided by the government are the problem. Homelessness is apparently the solution.
1
Dehumanizing anyone suffering from mental illness does nothing to help them. In fact, it can permanently damage the relationship between the person and other important people in their lives, which is distressing enough to make a so-called sane person feel unrooted. Sending police into an adult's home unannounced, to invade their privacy and forceably take them into custody, would be a terrifying experience for just about anyone. Imagine how much worse that would be if you were already feeling confused and frightened. Instead of demonizing the young men who have committed shooting atrocities, we should focus instead on what it is that makes so many young men feel so powerless that they think using an assault rifle on civilians is a reasonable solution. I would start with the narrow, oppressive version of what it is to "be a man" in a country led by someone who is possibly the worst male role model of all time.
504
Yes and when a mentally ill person is put in prison then does weird things they are often put in solitary confinement!
Solitary confinement has been proven to do long lasting mental health damage even to a healthy mind. It is a form of mental torture.
Taking the mentally ill and subjecting them to mental torture helps no one.
4
Very true. If they have a gun though, it should be confiscated. When a person has a serious mental health issue and is felt with good reason to be a danger to him or herself, and possibly others the issue becomes more than invasion of privacy. This does not mean that this should be done without the utmost of care and consideration, by uniformed police yet.
Your suggestions, though good, is for the long run and for the relatively well and for all of us. It does not help with the immediate situation with diagnosed or undiagnosed but obvious severe mental illness.
3
Thank you for this thoughtful policy analysis; thank you for your time becoming informed on this issue. One point in your story stood out: using police officers to contain those who might be mentally ill is stigmatizing, and traumatizing to the person who is being sent to treatment. The assumed criminalization of the situation, the lack of common decency (not allowing him to dress or bring his cell phone), the terrifying confrontation with a system oriented to dealing with criminals: this could easily send someone over the edge: there must be a better way. Even using plainclothes officers with training and approaching someone like this with dignity.
62
In Pinellas County,FL the police, in conjunction with mental health associations have created a new, specialized position (CIT officer) within the force to intervene in family mental health crisis'. It has worked very well along with family counselling services to aid in addressing complex issues surrounding adult mental health problems. It's a wonderful start.
6
Even without cops, the experience of institutionalization can be traumatizing in itself.
7
I'm sorry for your loss. However, please consider sometimes the parents are the problem. I had a brother who died at 28 under similar circumstances. He had suffered a childhood full of abuse by my parents, as did I. The thought of those two horrible people having any power over me in adulthood terrifies me.
42
It is such a complicated and contradictory system. The points made in this article are necessary in this time where anytime a shooting or violent crime occurs the blame is quickly shifted to mental illness or immigration. The system is obviously flawed when we are unable to have a civil dialogue about gun control in the wake of a mass shooting but suggesting that we build more mental institutions to lock people up in is perfectly fine. We can't violate a persons right to bear arms even if they are a danger to themselves but to suggest that they be institutionalised is perfectly ok. It is never mentioned that there are numerous rulings that have found involuntary treatment to be a violation of civil rights.
The vast majority of people with mental illness are not violent. Anyone who decides to go into a school, or a concert, or a movie theatre, a post office, lottery headquarters etc more than likely has some type of mental health issue--but these shooters are the minority of people with mental illness. The common denominator is not the illness, but the access to guns. Yes, the mental health system needs overhaul. We do no one any favours by treating people in the short term without involving natural supports or building their capacity to live independently.
We cannot go on with this flawed view that the 2nd amendment prohibits us from reforming gun law. How is it ok to lock a person up to prevent shootings but unconstitutional to limit their access to a gun?
61
I don't believe that the 2nd Amendment prohibits reforming gun law. The problem is that the loudest voices for reforming gun law are against the 2nd Amendment and thus against the basic rights of person to be able to adequatly defend their own lives and their loved ones. When these voices for unreasonable gun reform are removed from the conversation, progress will begin.
7
I would never agree that people be institutionalized on some simple basis, but the very idea that no one be hospitalized without their consent disallows the fact that the disease they suffer from eliminates their ability to recognize that they are in fact very ill.
While most of the sick are not dangerous per-se, they are often homeless, sickly, addicted etcetera.
Is it really better for these our fellow man to have the 'freedom' to live in a cardboard box, or sleep on a subway grate, than to be fed, cared for, and have the medical care they need?
10
That’s simply not true. The loudest voices belong to the overwhelming majority of Americans who want common sense gun laws, similar to those in place in civilized countries around the globe.
16
I’m so sorry to hear of how your son suffered. And how much you and your wife must have suffered. My son is a teen and is battling depression, and there is a history of that terrible disease in the family, which makes the situation all the more serious. Your piece resonated with me and made me ask myself a lot of questions. For the life of me, I simply cannot imagine in my most horrible nightmare committing my son to an institution based on a call from a Florida condo manager. Why not speak with your son first? Why not have a friend in the area visit him? Why go to a court house before seeing your son? Why not call his therapist? Why not call the police just to investigate? If you did not want to communicate with your son, and you didn’t want a friend to reach out to him, why go to a court house and sign commitment papers before getting all the relevant information from a lawyer? How could a parent not foresee the damage that your actions would do? Why am I the only person with these questions? Is this what all other parents would do? I’m not being judgmental. I’m sure you had good reasons for your actions. I am honestly curious. I want to be prepared for bad scenarios.
85
Exactly my questions. And it might well be that those things have not been shared here with detail. That was my question. The notion in the US that when you are 18, you are of the life of your parents (and this might as well NOT be the case) is terrifying. The recent recommendations from the National Institute of Medicine plus all the neurocognitive development show how our young adults need stronger connections with their parents, and today, more than ever. This family might not be the case, but parents, remember: your child needs you far more during that transition to adulthood. And there might be other ways. In this extremely more so now individualistic country, we need to make sure we have connections and a net around ourselves and our loved one. Always learning! Hugs!
8
I wondered those same things, but suspected the story was edited poorly, and some pieces got left out. Such as, this must not have been the first time the son had had a similar incident, so the condo manager's story made sense to them and they truly believed urgent action was imperative.
8
As long as we're playing the "why" game of questions, why not put the blame squarely on the criminal (in every sense of the word) actions of the selfish, piggish manager who started the whole ball of wax. He was the problem. Let his actions have serious consequences and next time maybe he'll refrain from making a false report and jeopardizing someone else's life.
2
In Japan, the justice system and mental health systems cooperate, fully training and certifying psychiatrist MDs in the laws pertaining to mental health, and they then hold the power to adjudicate mental health cases rather then ordinary judges who can't possible diagnosis or determine what a patient needs. There is some hope for justice and treatment at once, and the facilities to care for people who need it, though of course it is not perfect.
Japan also requires extensive training for those who want to own and use guns.
Why we continue to do both these things badly is beyond me.
271
One of the greatest weaknesses I see in our American society is our unwillingness to embrace the best practices of other countries. No matter what the topic or what societal challenge we address, highlighting an effective solution from a foreign country seems to spur an immediate negative response. If we were not so convinced that the American way is the only way, I think we could solve many of the problems that are hampering this country's progress.
5
We won WW2. When the USA occupied Japan, a very conservative man, Douglas MacArthur, imposed all the best of the "New Deal" upon Japan. Features and benefits that Japanese take for granted from their government were never extended to US citizens because Republicans in the USA refused to extend and improve the New Deal after the war. They did not actively fight the New Deal though because Ike thought that foolish.
The New Deal was finally extended and improved by LBJ when there were Democratic majorities in both the House and Senate. Nixon, like Ike, did not fight liberal programs of his predecessor. He funded them.
Reagan led the fight against the New Deal and the Great Society that Republicans have continued to fight for 40+ years. Since 1980, Republicans in DC have over and over done all they could for the "undeserving Rich" while punishing the "deserving Poor", notably, the mentally ill, the weak, and the infirm..
3
Big guy.....I would not insinuate that this humane way of dealing with and treating the mentally ill is because of what Douglas MacArthur imposed. Certainly after more than half a century, the Japanese deserve some credit if not most of it.
Dear Norman Ornstein,
My thoughts go out to you and your wife. The pain of losing a wonderful son never goes away.
Alongside your good proposals, I offer my own, which might complement them:
First, abolish the Second Amendment. It was tolerable when people lived ten miles from one another but not when they live cheek by jowl. It is antiquated, more so than our electoral laws.
Second, establish a system of community mental health centers, where people can be interviewed by a psychiatric professional and admitted voluntarily for treatment they deem helpful.
Most people who have a serious mental illness, a bipolar illness or schizophrenia, are not violent. The small number who express or exhibit paranoid or suicidal behavior should be interviewed by a psychiatrist who can order them to be confined temporarily until a court decides whether they can be released or should be confined to a hospital ward for treatment.
Third, as Dr Allen Francis writes, we should avoid over-diagnosing and over medicalizing normal behavior. A lot can be done by social workers and counselors to help people,, who are not mentally ill, restrain their anger. Anyone who sees the gripping film, Three Billboards outside of Ebbing Missouri, will know what I am referring to.
18
Much blame is due the "privacy" laws that keep family from being informed about their relatives' illnesses (not just mental, but also physical and even dentistry). Our society's obsessive and nearly paranoid concern for "privacy" does great harm.
Much of what is described here is the fault of the privacy laws, not of an inadequate system of mental health care (which often does no good anyway).
12
Every patient is given a form which allows them to designate which (if any) relative or other person can have access to information and in what capacity. The mental health system is no different.
The privacy laws are there for a good reason. They prevent unauthorized people from gaining access (and that includes parents, etc. if the patient does not want them to have access). It allows the patient to be in control and safe from unwarranted invasions of privacy.
There are bad actors--including family members--who would mishandle such information, and jeopardize the patient's health care/autonomy. Privacy laws are very important and need to stay intact.
15
Norton,
If a person is being constrained by the Baker Act, there is an implied lack of personal responsibility. When something like the Baker Act is imposed it seems reasonable that a family member or other responsible person is empowered by the authority to have full access as an advocate for the person.
11
It doesn’t matter if you sign a form allowing the dr to talk to parents or other relatives. The drs, at least some, still often won’t talk to anyone but the patient. My parents have first hand experience with two of my siblings who developed mental illness in their late teens. Even with signed papers drs will not speak with them or return calls. I guess a ten minute appt every six or eight weeks, or longer period, is enough for diagnosis versus the experience of those living with the patient. Mental healthcare in the USA is 100 percent broken.
13
Norman Ornstein, you did not make a mistake. I believe that choices should be judged (if at all) on the basis of the information available at the time of the decision. They should not be judged on the outcome. I have been a climber (rock mostly, some alpine; a climber of only modest ambition and talent), and I know well that externalities (spelled L-U-C-K) have as much chance to affect the outcome as do decisions. There are many climbers who are acclaimed when (in addition to their talent and work ethic) were very lucky. And others (many others) who died despite those attributes.
I contend that most caring and aware parents in the situation you found yourself with your son would have made the same choice. IT WAS THE RIGHT CHOICE. That there were things you could not know, and twists you could not anticipate, does not change my view of that. Bless you, hugs (if I may), and I thank you for your courage in sharing your very articulate and caring story.
49
Agreed, we parents do the best we can. God bless you
8
and what is to prevent someone from fraudulently using a "red flag" like the manager used the Baker Act ?
how many people have to die from a lack of adequate self defense? who is going to keep an upset ex from using a "red flag" to disarm their target?
11
SSS seems to be saying that if the Ornsteins' son had had a gun he would have been able to defend himself from this absurd arrest (by shooting the police) as he stepped out of the shower. Gun fanatics like SSS are the very people whose judgement is so dubious that they should not be allowed to have guns.
4
It seems ironic, Norman Ornstein, that you think it cruel when the "system that keeps loved ones from any involvement in the treatment of people with serious mental illness, especially those who do not know or believe they are ill"
Was it "love" that caused you to accept the word of a lying apartment manager over a direct conversation with your own son, before you dashed to Florida and empowered a court to have him arrested?
I was going to let your apparent hypocrisy pass, insofar as you clearly believed your son was capable of living unsupervised in your condo, until you blame shifted your self guilt to law abiding Americans with this (utterly misinformed) statement : "no civilians should be able to buy weapons of war like AR-15s".
As a matter of FACT: rifles (any kind) are involved in less than 1% of all firearms fatalities in the US annually. As a matter of FACT: the AR-15 has never been used as a weapon of war by ANY country. As a matter of FACT: the US M1 Garand, an actual weapon of war for the United States, is commonly available to civilians through the Civilian Marksmanship Program. As a matter of FACT: the NICS background check prevents thousands of unauthorized gun purchases every year.
You misused the Baker Act, a valuable tool that enables law enforcement to intervene in dangerous situations. You'll need to find some other way to ease your guilt than to deprive law abiding Americans of their constitutional rights.
15
Well, at least we know what concerns you most. May you and your automatic weapons be peaceful and safe!
25
Please Joey, take a deep breath. Some people who are mentally ill are dangerous to others and some are not. Who’s to say? In New York any two doctors can hold an individual in a mental hospital for 72 hours and then again for months.
I was once a that the dirty end of the stick. I was held against my will for five days. When I was finally released I was fighting mad. I’ve been a lawyer for 30 years and I was going to show these bozos a thing or two. After a week of research I discovered that I had no rights in this situation.
13
Why are you blaming the parents? It was the lying, sleazy manager who was entirely to blame, end of story. Why are you giving that person a pass. He should be ashamed and if it were me, I would have made sure that manager faced legal consequences, if possible
20
Dear Professor Ornstein.
You rightly demand the system to serve the people of this country. That's what true Millsian liberalism is about. The people running our country are money hungry bigots, who lack even a shred of human decency. They do not care about the needy wherever they come from, whether form the good ole USA or foreign shores. They worship Mammon not any human God, and feed their fans (read:reality TV show fans) with spectacle and vicarious power rush. The system is broken because the silent majority is too dumb to realize or even care a whit.
I applaud your valiant efforts as I have mentally ill family, but the whole ship is rotten and the passengers nauseated. We need to wash the Republican rot out of Washington,
23
My heart is so full after reading this. Norman Ornstein, please keep up the fight for sensible legislation that will help save lives. You and your family are in my prayers.
24
This article -- though I feel compassion for the Ornstein family on their loss -- was nothing but hype to attack guns. Their son did not use a gun. He did not kill anyone. He was not violent at all. He died accidentally.
This sad story had literally NOTHING WHATSOEVER to do with gun control.
2
Yes, CC, it does. The NRA and various politicians who do not support gun control are proposing that it be made easier to use the Baker Act to stop people who are deemed "an imminent danger to themselves or others." Read that again: "an imminent danger to themselves or others." The point of this article is that a 72-hour commitment under the Baker Act, no matter how easily invoked, would do nothing to actually get help for the people who need it. The Ornsteins' son did nothing violent--but he also did not get any treatment that helped with the problems he did have. Would Nicholas Cruz, had he been committed under the Baker Act, actually gotten treatment or would he have gone to jail or simply been released after 72 hours? The gun lobby keeps proposing useless remedies while ignoring the one remedy that has a hope of making the biggest difference--sensible gun control regulations.
1
What a profoundly moving story. I am so sorry for your loss and hope your piece opens eyes.
This demonizing of the mentally ill and targeting them rather than guns has bothered me for years. It's a sickness the way the NRA deploys its obfuscation tactics. The plain truth is this: a mentally ill person without a gun is a mentality ill person, one who poses as little or less threat, according to statistics, as anyone else. A mentally person with a gun is dangerous, not because of the mental illness, per se, but because of the gun.
The NRA is incapable of engaging in honest debate; it's why it bullied the CDC and the National Association for Pediatrics into burying studies and statistics about how deadly guns are to children's health. You want to talk insane? Think of the families madly putting child locks on everything, buying baby gates, etc. and then putting a loaded pistol in the freezer. Because, hey, no kid has every opened the freezer to look for treats, right?
We need better and much more affordable mental health care; that issue is independent of gun care. Only profoundly corrupt and self-serving people try to conflate the two. The NRA wants us to talk about anything and everything under the sun rather than its deadly, sleazy guns. We don't have to comply. It does a profound disservice to those suffering from mental illness to engage in the kind of mindless baiting the NRA keeps being allowed to get away with.
789
This misguided fear of "demonizing" the mentally ill is what has prevented us from demanding effective background checks which can keep guns out of the hands with suicidal and/or homicidal ideation. Health records are closed to the background checks. They should be open.
5
In my experience, the mentally ill are usually quite vulnerable, and need family involvement as well as community resources. Allowing someone to buy a gun, who cannot take care of themselves adequately, is insanity! And letting anyone outside of the military possess an AR-15 is so unnecessary. We need better, more comprehensive treatment and supportive accommodation for the mentally ill AND laws prohibiting automatic weapons.
9
The IRAs politicking is called free speech. Governments formed by true electoral majorities can overpower even malicious political speech.
2
Thank you for your very painful, thoughtful, and accurate analysis.
We have no hope of preventing these tragedies through the mental health system.
Unfortunately, mental health professionals can only identify dangerous people after the fact.
Gun control laws are necessary. There is no reasonable excuse for average citizens to have access to weapons clearly designed to kill people in mass quantities.
I am hoping to live long enough to see it.
706
The problem here is not that mental health professionals cannot help. The problem is that the mental health services that are effective are much more time consuming and expensive than a 72 hour hold.
24
Unfortunately, mental health professionals can only identify dangerous people after the fact."
That's not true. Mental health professionals could probably identify dangerous people, but there is no way in a democratic political system to actually employ mental health professionals in this way. Again, you are mixing up inherently aggressive and violent people with those who actually need mental health services.
Mental health professionals cannot identify people who will commit mass murder. Most of the mass murderers we read about were not observably mentally ill.
Blaming mental illness and demanding background checks for it is a diversionary ploy by the gun lobby to avert the only rational action, which is to ban semi-automatic weapons. Gun owners, if quick to anger, please read this: If your gun is not semi-automatic, I am not proposing it be banned. If it is semi-automatic and your only reason is that you love it, well, I love my classic V-2, also, but I had to give it up.
7
To avoid a calamity judging by the looks of things like beyond the scope or innocent bystander. Florida isn't renown for professionalism nor it's standards of excellence. Every state in the future should adopt a code for precaution and noticed ble through the course of business.
Thank you for writing this. I too am a parent in a similar situation. I am so sad my son never found the mental health care he needed before it was too late. As a family member NAMI was helpful to me. But when your child is an adult it's next to impossible to be a part of the solution if he or she rejects the help.
31
72hrs is up, person goes to store, they're over 21, they buy rifle and then go shoot up a public place. The law is near-worthless, just delaying the inevitable. Want to actually make a dent in the shootings and increase public safety drastically? Outlaw the sale and possession of semi-automatic weapons.
125
Except I have not read of one single example of that -- where someone left a 72 hour hold in a mental hospital, then went out to by a gun and murdered people.
In fact, the vast majority of mentally ill people are sad, lost and confused -- most mental illness is DEPRESSION, with its accompanying lack of ability to act on ANYTHING.
There is a huge difference between someone depressed, or confused -- and the rage & violence & sociopathy of a Nikolas Cruz, who was KNOWN as violent (rather than classically "mentally ill") by his family, schoolmates, neighbors -- who tortured animals and made clear threats about his plans on social media!
Despite the gun control pitch here....Mr.Ornstein's son was not violent, nor involved with any shootings.
1
So, CC, exactly what is your point? That people who are "only" depressed or confused should be allowed to purchase guns? A leading cause of gun deaths is actually suicide, and suicide by gun happens more frequently in homes that have guns. In more than a few instances, suicide victims have been known to buy a gun immediately prior to shooting themselves, one of the problems of a system where there is no waiting period between an attempt to buy a gun and actually obtaining the weapon. Confused people might not purchase AR-15s and then proceed to attack a school or public venue, but they have been known to purchase handguns and kill family members within a short space of time. So, again, what is your point?
Norman, I am so sorry that your family had to go through that experience, and I'm sorry for the loss of your son. We had a similar experience with our son at roughly the same age, when we were also stymied from participating in his recovery, which, after fits and starts, ended in his brain damage from an overdose of prescribed medication. Our society's ability to engage and help those who are struggling with mental illness is a tragic mess. The most surprising issue is that those in serving professions, who are supposedly the most informed, carry unfathomable stigma and prejudice against those they serve. I do not apologize for that opinion.
There is plenty of middle ground between the most punitive and the most lax approaches, and we have the science and intelligence to create a system that works.
Thank you for sharing your story -
202
I'm so sorry for your family's loss. Judge Leifman's program is indeed a model, combining justice, charity, and mercy. It seems to me that Florida and other states have a long way to go to resolve how they address the most vulnerable residents, given how the Baker Act and court-ordered guardianships have been abused without benefit to those brought under them. At the end of the day, while we MUST deal with these issues of adequate mental health treatment, mass shootings will only end when shooters cannot obtain these high-velocity, rapid-fire weapons.
42
Thank you for telling us of your experience. Anyone who has interacted with the mental health system knows how flawed it is. You provide some suggestions to help make both the patient and the public safer.
41
The first part of your story -- being prevented from obtaining information about your loved one while undergoing care -- is fairly common and terribly frustrating.
Troubles of that nature can be addressed with a Healthcare Power of Attorney. Everybody should have one, especially since healthcare privacy laws such as HIPAA have caused providers to be unduly cautious (IMHO).
Of course an HPOA will not solve the myriad other problems that you have correctly identified.
37
A health care power of attorney is a good idea, but it won't help when someone who is mentally or emotionally unstable refuses to sign one.