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Waiting for Danger Can Prove Deadly to the Mentally Ill

November 13, 2000|E. FULLER TORREY and MARY T. ZDANOWICZ | E. Fuller Torrey is president of the Treatment Advocacy Center. Mary T. Zdanowicz is executive director of the center. Web site:

Sept. 1: Marie Elise West is charged with running down and killing 65-year-old Jesus Plascencia in Van Nuys.

Sept. 30: Jonathan Baker is shot and killed by police after he slashed three people with a penknife in the waiting room of a Ventura hospital.

Oct. 15: Gabriel Estrada is charged with brutally stabbing Ignacio Pillado Ortega to death in Santa Ana.

Three tragic incidents that made Los Angeles headlines recently share a common legacy: untreated severe mental illness.

According to news reports, the West and Estrada families repeatedly tried to get help for their loved ones but were met with bureaucratic red tape from state health and law enforcement officials who said nothing could be done unless there was evidence of immediate danger or inability to access even the most basic and immediate physical needs.

Each of these incidents illustrate the vulnerability and volatility that sometimes accompanies untreated schizophrenia and manic-depressive illness, the two most severe forms of mental illness. Each also illustrates California's need for stronger and more humane mental illness treatment laws.

What makes these cases even more heartbreaking is that the state Senate had the opportunity in August to reform the treatment-prohibitive Lanterman-Petris-Short Act, which governs when Californians who are unable to make rational decisions because of mental illness can be treated. A bill by Assemblywoman Helen Thomson (D-Davis) that would have de-emphasized the "right to be psychotic" guaranteed by the LPS act had passed the Assembly but was mired in a Senate committee.

West, Baker and Estrada are but the most recent examples of the grim outcomes that can occur with untreated mental illness and weak state treatment laws. Waiting for danger before intervention, however, has had dire and expensive consequences for California:

* Nearly 50,000 Californians with untreated mental illness are homeless.

* About 16% of state inmates are severely mentally ill.

* California police spend more time responding to mental health crises than to robbery calls.

* Ten to 15 times more suicides occur among those with untreated severe mental illness.

* People with untreated severe mental illness are nearly three times more likely to be victims of violent crime.

These statistics can be attributed to the insidious nature of these illnesses. Half of those who suffer from schizophrenia and bipolar disorder don't realize they are sick. They don't recognize that their hallucinations, delusions, paranoia and withdrawal are symptoms. Since they don't know they are sick, they refuse treatment.

California's legal standard for assisted treatment should be the need for medical care, not dangerousness. Society should save mentally ill people from degradation, not just death.

Under California law, an individual must be taking lives by driving wildly down city streets or about to jump off the Golden Gate Bridge before medical intervention will be permitted.

Many states recognize that waiting until the mentally ill are dangerous or incapacitated is just too little, too late. These states consider factors such as mental deterioration, being unaware of the need for treatment and having a history of violence or refusal to take medication. Conversely, these states understand that individuals with untreated mental illness have a greater chance of committing an act of violence. The failure to pass meaningful mental illness treatment legislation is bearing bitter fruit in California. Perhaps next year, policymakers will come to understand that being psychotic can be deadly.

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