Center Urges State Legislators to Protect Its Most Vulnerable Citizens from Ravages of Psychosis and Reduce Rates of Violence, Homelessness, Incarceration and Suicide

In the intervening 30 years, our understanding of severe mental illnesses has changed dramatically, making the LPS Act badly out of date. It is now known that schizophrenia and manic-depressive illness, the most common forms of severe mental illness, are diseases of the brain, just as multiple sclerosis, Parkinson's disease, and Alzheimer's disease are diseases of the brain.  A brief summary of some of the evidence that proves this point follows:

1. Individuals with schizophrenia and manic-depressive illness, including those who have never been treated, have enlarged ventricles in the brain, as demonstrated in over 100 studies to date.¹
2. Individuals with schizophrenia and manic-depressive illness, including those who have never been treated, have a reduced volume of gray matter in the brain, especially in the temporal and frontal lobes.²
3. Individuals with schizophrenia and manic-depressive illness, including those who have never been treated, have more neurological abnormalities, as shown in over 25 studies.^3,4
4. Individuals with schizophrenia and manic-depressive illness, including those who have never been treated, have more neuropsychological abnormalities that impair their cognitive function, including such things as information processing and verbal memory.⁵
5. Individuals with schizophrenia and manic-depressive illness, including those who have never been treated, show decreased function of the prefrontal area, an area of the brain which we use for planning and thinking about ourselves.^6,7
6. Approximately 50 percent of individuals with schizophrenia and manic-depressive illness, including those who have never been treated, have impaired insight into their own illness. This has been shown in at least 10 different studies.⁸ Such individuals do not realize that they are sick and they will, therefore, usually not accept treatment voluntarily. Studies suggest that this impaired awareness of illness is probably related to the decreased function of the prefrontal area.

Given these findings, the assumptions on which the LPS Act was passed are incorrect:

a) Such individuals are truly sick; they have a disorder which affects their brain.
b) Approximately half of them are not capable of making fully rational decisions regarding their own treatment.

The fact that under LPS individuals with severe mental illnesses can be treated involuntarily only under the most extreme circumstances has had, and continues to have, dire consequences for Californians:

• At least one-third of homeless individuals are severely mentally ill and not being treated. In California, their total number has been estimated to be 49,500, approximately the same as the total population of Davis or San Rafael.  This is an urban disaster, especially in cities such as San Francisco and Santa Monica.
• Approximately 10 percent of inmates of California jails and prisons are severely mentally ill.  Many of them were arrested for minor crimes that were the direct consequence of their untreated illness.
• A California study reported that police now spend more time responding to "mental health crises" than to robbery calls.⁹  When police confront severely mentally ill individuals who are out of control, the encounter sometimes turns deadly.   This happened in 1998, for example, when the police killed Tom Neville in Fresno, Brian Burgos in Los Angeles, Han Huynh in Ventura, and Martin Arias and Doeon Lifton in San Francisco.
• Suicide and accidental deaths are increased 10 to 15 times in individuals with severe mental illnesses who are not being treated.
• Individuals with severe mental illnesses who were not being treated were 2.7 times more likely to be a victim of a violent crime in one study¹⁰; in another study, severely mentally ill women were 2 to 3 times more likely to have been raped.¹¹
• Nationally, it has been reported that approximately 1,000 homicides each year are committed by individuals with severe mental illnesses, almost all of whom were not being treated.^12,13  Since California has 12 percent of the nation's population, that suggests that there are approximately 120 homicides each year in California committed by individuals with severe mental illnesses who are not being treated.   The Appendix lists some examples of such cases from 1998.

The most tragic aspect of the failure of the LPS Act is that it deprives many citizens of the opportunity to be treated for their illness.  Many individuals with severe mental illnesses can lead productive lives if they receive treatment.  For example, Dr. Fred Frese, who was diagnosed with paranoid schizophrenia and involuntarily treated, became a psychologist and is on the Board of the Treatment Advocacy Center.   And Jonathan Stanley, who was diagnosed with manic-depressive illness and was involuntarily treated, became a lawyer and is on the staff of the Treatment Advocacy Center.  How many mentally ill Californians have been denied similar opportunities to lead productive lives because of the continuing failure of the LPS Act?