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Orlando Sentinel

January 25, 2004

Reprinted with permission of the author. All rights reserved.

OPED
Sensible help
Our position: Continuing treatment should be required for violent mental patients.

It is a sad irony that Florida, regarded as a pioneer in mental-health law 30 years ago, has become one of only a few states that doesn't compel mentally ill people who have a history of violence to remain in treatment after they are released from jails or hospitals.

This loophole in the law deprives them of continuing care, endangers the public and places a heavy burden on law enforcement and crisis units, which are woefully short of space. It also violates common sense.

Florida's mental-health law, the Baker Act, permits treatment facilities to hold patients against their will for up to 72 hours if doctors deem them to be a danger to themselves or others. To hold a patient longer than that requires a formal hearing, with prosecutors, public defenders and witnesses.

When the Baker Act was created, it made perfect sense. Many people suffering from mental illnesses who presented no threat were warehoused in institutions. But times change. With the introduction of new drugs for schizophrenia and other illnesses, many patients could be stabilized, leave the hospital and live a near-normal life.

Public hospitals gave way to community treatment and group homes for all but the most acutely ill. Private hospitals began releasing patients after 28 days, when their insurance expired, whether they were ready or not.

Many ended up on the streets. And even those who had places to stay didn't always continue in treatment. Schizophrenia and bipolar disorder often cause so much brain damage that patients cannot recognize they're ill.

When they stop their pills, they begin to unravel. But Florida law allows no one to intervene until there is clear evidence of danger, which is sometimes too late.

A bill returning to the Legislature would address this by permitting courts to order outpatient treatment for Baker Act repeaters who have been violent at least once or examined for commitment twice in the past three years. Authorities would monitor whether the patient stopped taking his medicine and be able to step in before anyone got hurt.

Last year, a similar bill passed the House by an overwhelming margin, but was shuffled aside in the Senate during the frenzy to enact medical-malpractice legislation. Since last May, when the bill expired without action, at least nine Floridians have died in episodes that it might have prevented.

The most recent occurred last week in Polk County, where a man with schizophrenia died in a confrontation with deputies. It is a 12-year tale of tragedy.

At 17 he killed his stepfather; he spent a year in prison, then while on parole stabbed his mother with a screwdriver multiple times. Found not guilty by reason of insanity, he was treated at a state hospital until a year and a half ago, when he was released.

Police took him to the hospital again two weeks ago, but he was released. Finally, he committed what has come to be called "suicide by police."

The outpatient treatment requirement will draw opposition from some mental-health advocates, who say the treatment community cannot handle the load without more money. It will also be opposed by some court officials, who are afraid they'll be buried in an avalanche of court hearings.

Sponsors have addressed civil-liberties concerns by limiting the court orders to those who really need the supervision. To address protests that the system can't cope with the load, they require a treatment plan that can be met with existing facilities and personnel. And they argue convincingly that early intervention will lower costs, at least over time.

Evidence in the 41 states that have tried this is mixed, but generally positive. People who are sick shouldn't have to wait for help. And police shouldn't be forced to shoot them.