Connecticut killings reopen debate on forcibly committing the mentally ill

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Can America care for the mentally ill?

Dr. Keith Ablow weighs in

Washington – The tragedy in Connecticut has reopened a difficult debate over whether states should be allowed to involuntarily commit the mentally ill.

The trend over the decades has been to release mental health patients, with a number of court cases restricting involuntary commitment. Last week’s deadly rampage at Sandy Hook Elementary School exposed cracks and inconsistencies within the nation’s mental health system. Many say that until those problems are fixed, it’s only a matter of time before another national nightmare unfolds.

“It’s a cultural and mental health problem and it’s something we need to address soon and seriously,” former Homeland Security Secretary Tom Ridge told Fox News. “We need to balance individual rights with the needs of the community.”

Ironically, a Connecticut mental health bill calling for changes that could have taken someone like shooter Adam Lanza off the streets was defeated earlier this year in the state legislature. The bill would have allowed the state to commit someone if there was a reason to think that would prevent them from harming others.

Reports of Lanza’s mental health have varied. One source told FoxNews.com that Lanza may have snapped because his mother was trying, despite the difficulties, to commit him to a psychiatric facility.

A senior law enforcement official confirmed Lanza's anger at his mother over plans for "his future mental health treatment" is being looked at as a possible motive. Police said they had no evidence Lanza had been medicated when the killings occurred. But even if Lanza had a proven history of mental illness, having him forcibly committed would have been nearly impossible.

Connecticut is one of a handful of states in America that does not have an “assisted outpatient treatment” law. Under AOT laws, like the kind proposed and ignored earlier this year in Connecticut, states can force a mentally ill person into treatment if there is a risk of harm to others. Without them, states typically cannot institutionalize someone unless they’ve already done harm to themselves or others.

Confusion occurs because there isn’t a uniform code used for involuntary confinement.

In New Hampshire, for example, a doctor’s note is enough to trigger an initial confinement but the person requesting the lock-up must then present evidence before a district judge within three days showing probable cause or the patient walks.

It took a bloody massacre on the campus of Virginia Tech before mental health laws there were beefed up. The tragedy-driven changes included tightening procedures for mandatory outpatient treatment and increased state funding for mental health services. Prior to the 2007 shooting, Virginia had some of the loosest mental health laws in the nation.

In the days following the January 2011 Tucson, Ariz., shootings, friends, classmates and family members of Jared Loughner spoke out about how mentally disturbed he was – but state authorities were virtually powerless to stop him until he killed.

“Everybody knew he was a grenade about to go off,” Fox News contributor Charles Krauthammer said. “We have moved so radically the last 50 years to making it difficult to commit people who are dangerous. There has to be a shift in the other direction.”

After the shootings, Loughner was diagnosed with schizophrenia and underwent forcible psychotropic drug treatments. His court-appointed psychologist said he remains severely mentally ill.

Another problem plaguing the country’s ailing mental health system have been cutbacks in funding.

According to the Center for Public Policy Priorities, the national average for spending on mental health services is $109 a person. Texas spends just $36 and ranks last in the country. The Texas Department of State Health Services is asking for a $100 million increase in their budget but the likelihood of that happening is slim. In their last session, state lawmakers cut $25 million from mental health programs.

In recent years many states have also had to shut down their mental health facilities – citing budgetary concerns.

“Our mental health system has completely failed individuals with severe mental illness and their communities,” Doris Fuller, executive director at the Treatment Advocacy Center, said. “We have emptied the nation’s hospitals, gutted state and local mental health programs and turned involuntary treatment into a debate point instead of using it as a viable option to prevent tragedy involving those too ill to help themselves.”

The TAC estimates that 97 percent of the public hospital beds once set aside for mentally ill patients are no longer operational.

The Fairfield State Hospital in Newtown, Conn., located only a few miles away from Friday’s deadly shooting, closed its doors in 1995. At its peak, the hospital housed more than 4,000 patients. In 2004, the town of Newton bought the property from the state. Since then the Canaan House -- the building where patients were treated and housed – has been home to the town’s Board of Education, Planning & Zoning and Fire Marshall.

Separately, allegations of corruption and brutality have long plagued state-run hospitals. Tales of barbaric methods used to treat and sedate patients prompted a backlash by civil rights advocates. As a result, funding was slashed even more and stricter laws were put into place to prevent abuse.

“Some of those people should have never been in the hospital to begin with,” Fuller told FoxNews.com. “But as a result, we made it too hard to get into the hospitals and those people who were acutely ill or had a chronic illness couldn’t qualify to be committed.”

Even though Connecticut has been recognized as having one of the country’s best community mental health systems for adults, there have been warning signs that date back a decade that show people who needed services weren’t getting them.

In the mid 1990s, the state downsized and shuttered state mental hospitals that tended to warehouse patients rather than focus on recovery. The money saved from closures was not reinvested to create an effective community-based mental health safety net, a 2004 Connecticut Mental Health Cabinet Report found.

It’s estimated there are about 600,000 adults with mental illness in Connecticut, including 135,000 who suffer from a serious mental illness.

In 2010, the Children’s Services Working Group said the state had a child mental health crisis. The report found that 200,000 children struggle with a diagnosable mental illness but only 25 percent of them had access to services they needed.

“Our state largely depends on a wait-to-fail approach," the report found.