Archaic law does harm to mentally ill

By Dr. E Fuller Torrey and John Snook

Michael Rafferty of Drexel Hill had schizophrenia. When the hospital released him, he stopped medication, as he had done many times before. A few days later, he killed his parents and a neighbor.

In Macungie, Kenneth Miller, agitated and paranoid, refused treatment for schizoaffective disorder. His mother took his car keys, fearing for his safety. A few days later, he stabbed his father to death, then plunged the knife into his own neck.

Historically, civil rights advocates passed laws protecting the absolute right to self-determination in treatment. But in their fervor to protect people's rights, they in fact trampled on them.

Pennsylvania's civil commitment law is archaic and inhumane, requiring someone to present a clear and present danger before they can be court ordered to treatment. Clearly, that is often too late.

The law ignores their right to be free from psychosis.

What is protected instead?

• The "right" to die in an encounter with law enforcement. People with severe mental illnesses are four times more likely to be killed in an encounter with law enforcement than the general population. Pennsylvania has seen tragedy after tragedy when untreated people end up confronting police.

Julio Morales died when Philadelphia police used deadly force after he injured an officer with a knife. Upper Merion police shot Lawrence Boettcher eight times after he lunged at an officer with a knife.

Both died with their right to refuse treatment fully intact.

• The "right" to be homeless. At least a third of homeless people have a severe mental illness.

Like Darryl Crosby, who checked himself out of the VA Medical Center in Highland Park in 2004. He said he wanted to be left alone. Was that the choice of a rational mind? We will never know. His frozen body was found five days later.

Protecting the right of the psychotic homeless to stay that way also affects those who encounter them. In Harrisburg, a homeless man with untreated mental illness ran up to a woman on the sidewalk and bashed her face with a pipe.

• The "right" to be imprisoned. Daniel Fisher, who wasn't taking medication for bipolar disorder, landed in prison for demanding $5,000 from an Ephrata bank teller in October 2003. Prisoners with severe mental illnesses -- conservatively 16 percent -- lose many rights once they commit a crime. But not the right to remain psychotic.
  

• The "right" to hurt someone you love. The American Psychiatric Association notes, "family members are most at risk of a violent act committed by a mentally ill person." Miller's father and both of Rafferty's parents paid the ultimate price.

Far more common are the daily incidents families suffer attempting to help a psychotic loved one whose "right" to refuse needed treatment is protected above all else. Last May in Philadelphia, Monica Randolph attacked her husband with a knife. "We have tried to get her help for years," said her brother.

In Clarion County that same month, Jeremiah Jones stabbed his father. "I called [the mental health agency] about two weeks prior to this to say we were having some problems with my son," said his father, who survived the attack, "and they did nothing."

Clearly, once we can answer "yes" to the question "is he dangerous?" it is too late. Senate Bill 226, now before legislators, would instead ask: "Does he need help?" "Is he too sick to help himself?"

This is a more reasonable and humane approach to treatment, one that would make Pennsylvania's assisted outpatient treatment law more accessible. That could make a big difference to a small number of people, because AOT keeps people out of jail and off the street.

"I tried so hard to get him help," said Kenneth Miller's mother. Miller lost his father and his freedom, but still has his state-guarded right to refuse treatment.

That is clearly wrong.