Wednesday, September 18, 2013

We Are NSA (Not So Adept) At Noticing the Mentally Ill

You'd think that with a multi-billion dollar surveillance state monitoring our every move, somebody would have been alerted to the fact that Aaron Alexis, a guy with security clearance to work in a military installation, had been complaining about hearing voices in his head and thinking that stalkers were sending microwave signals to his body. Classic symptoms of paranoid schizophrenia.

From Reuters:
Alexis told police he believed people were following him and "sending vibrations into his body," according to a Newport police report.
He told police that he had twice moved hotels to avoid the noise he heard coming through the floor and the ceiling of his rooms, and that the people following him were using "some sort of microwave machine" to prevent him from sleeping.
"Based on the naval base implications and the claim that the involved subject, one (Aaron Alexis) was 'hearing voices,' I made contact with the on-duty Naval Station police," a Newport police officer wrote, adding that he faxed his report of the incident to Navy police.
The Newport police report said Navy police had promised to check if Alexis was in fact a naval base contractor.
 Maybe it's because the military-industrial-surveillance complex has nothing to do with keeping us safe, and everything to do with profits, control, and power for a group of doddering old fools with shiny medals for their chests and Star Trek captain chairs for their padded rumps. Maybe it's because the alleged shooter was not a Facebook fan, and didn't Tweet, or send emails to act as magnets for the NSA dragnet. He just didn't fit the mold of the mythical tribal militant internet chatterer or Occupy subversive anarchist.

He wasn't political enough for the spooks to notice. He didn't threaten the power structure. He wasn't a whistleblower. He didn't worship at a Mosque.

He was just sick. According to several published reports, he had sought help from the Veterans Administration. Whether he was rebuffed, or put on terminal hold, or just got lost in the shuffle like so many sufferers of mental illness remains to be seen.

When I read about Aaron Alexis, I was reminded of an incident in the 70s when I'd just started my first reporting job, and was assigned to the police beat.

Early each morning on my way to the newsroom, I'd stop in at the municipal cop shop in Newburgh, N.Y. to inspect the blotter for the previous night's arrests. One day as I was sitting in the lobby, scribbling my notes, a middle-aged man walked in and approached the desk sergeant.

"You gotta help me," he pleaded. "They're out to kill me."

After failing to elicit any cogent details from the complainant, the cop sent him on his way. As the man shambled out, the officer glanced in my direction, rolled his eyes and shook his head, muttering something about a full moon.

Fast forward a couple of days, and all hell had broken loose in police headquarters. There'd been a hostage situation overnight. A man had barricaded himself with his victims in an upstairs apartment. Shots were exchanged with police, and one hostage died of a bullet wound to the heart.*

Later that afternoon, as the suspect was led into court for arraignment, I recognized him as the same man who'd pleaded for help at the police station. And it turned out he'd also sought help in the local hospital emergency room, and from a Catholic church. He was rebuffed at those sanctuaries, too.

There are thousands of people with severe mental illness in this country, getting rebuffed, every single day. We rarely notice them until (and let me emphasize that this is the exception to the rule) they become violent.

Dr. E. Fuller Torrey, a psychiatrist, appeared on the PBS News Hour last night to speculate on what could have been tormenting Alexis:
Somewhere, something went wrong with his brain in his 20s, and now you're looking at symptoms of the disease, one of which is acting out, in this case killing people. And in his mind, he was doing it based on delusions.
My guess is that he was terminated by the Navy, more or less, discharged on. He probably thinks the Navy were doing all of these things that he's experiencing in his mind, and he was going to get back at them. And so this episode makes no sense to us, but to him it made perfect sense.
And, as to how he could have escaped notice both during the vetting process and on the job: 
First of all, it's important to emphasize, Judy, that most people with schizophrenia don't become violent. It's only a small been who are not being treated who become violent. In terms of -- we put everything together now, and you say this guy was potentially dangerous. He had a brain disease. He had alcohol abuse. Apparently, he had episodes of violence.
 Nobody had that information to put together, and so that -- also people with paranoid schizophrenia actually can look pretty good in an interview. And so it's difficult. This is a man who didn't know he was sick. He had what we call anosognosia, where he has no awareness of his illness. He would have been hard to treat.
It's estimated that about half of all people suffering from paranoid schizophrenia and severe bipolar disorder are going untreated at any given time. According to the National Institute of Mental Health, that amounts to about 3.5 million people.

Since it appears that even the most innocuous gun control laws don't stand a chance in this country, maybe it's time for us to just concentrate on the humanitarian crisis of neglected mental illness.

After all, although the most vulnerable among us don't have a lobby, at least there is no NRA-like anti-mental health lobby skulking around Capitol Hill, threatening congress critters with primaries if they speak up for healthy minds.

Of course, I am being naïve.

* I tracked down a Google archive of my article. To read it, you have to use the "drag" technique.

16 comments:

Patricia said...

You are so right on! It's easier to get a gun than access to mental healthcare. That is the truth of the matter. The first thing Reagan did when he got into office is defund Jimmy Carter's mental healthcare legislation. (http://www.dailykos.com/story/2013/01/01/1175428/-Mental-Illness-Murder-Ronald-Reagan)and The irony? He was shot by someone with mental health issues. 2 weeks is the minimum waiting period for an appointment to see a psychiatrist at a clinic here in NJ. by then it's probably too late.

Tara Crowley said...

once again, completely inverted priorities. And thank you for qualifying your statements about mental illness. I volunteer for Stop Stigma Sacramento, and we work hard to get the message out that the mentally ill are more likely to be the victims of violence, than the perpetrators.

Your story about the fellow in the police station is compelling: this poor guy repeatedly asked for help and was rebuffed. Chilling.

James F Traynor said...

Here's some more chill. Years ago not very far north of the scene Karen described, and some ten years later, a paranoid schizophrenic with a rifle invaded a class room at SUNY, Albany. A courageous student disarmed him and was wounded by a bullet while doing so.

The attacker was deemed sane, tried, convicted and sentenced to the maximum - eight years I think. He was at that time about 25 years old. The thoughtful asked what was to be done about this man when he was released from prison. They were ignored and called do-gooders, socialists, pinkos - you know the usual suspects. These same people were among those who questioned his being ruled sane in the first place.

A few years later the student who disarmed the man graduated. Disabled from his wound, unemployed and uninsured he sued the University. And so, as they say, it goes.

Zee said...

@Karen--

Mental Illness, Part I

It is tragic that both Aaron Alexis and Jerome Banks sought help—or, at least made it clear that they needed help—but were turned away with horrific results. Even more tragic that Alexis—a veteran with an honorable discharge—could not receive treatment from the Veteran's Administration, if, in fact, he really sought help there. We definitely need to remove the stigma from mental illness and expand our mental health services. Our treatment—or, lack thereof—of our mentally ill is abominable. Yet obtaining treatment for the mentally ill is not always straightforward.

I was recently reminded that the mentally ill have rights—even when they are about to have their lives ruined through no fault of their own.

A dear friend of ours literally lost her mind about a year ago following a period of enormous personal stress and loss of a job. She became—and remains—delusional, lost in a fantasy about having recovered a “previous identity” that was “repressed” following a terrible automobile accident—which had never happened, according to friends and relatives who have known her much longer than we have.

To stay in her house and fed and clothed, she spent her life's savings and sold many of her possessions before we became aware of her personal situation. (The mentally ill can be remarkably good actors and actresses, and she kept her deteriorating situation a closely guarded secret for quite a while, even from her son, who lives locally.) After we understood what was going on, we periodically looked in on her and brought her groceries, always non-perishable stuff because she had sold her refrigerator.

We tried to get her to go to University of New Mexico Hospital (UNMH) and submit to a psychiatric evaluation, but all that did was anger our friend and alienate us from her.

In fact, we became somewhat frightened of her.

Exploring community resources, we found that the local police can and will carry out “wellness checks” if a citizen requests one for a person whom they believe to have a serious mental condition, and the Albuquerque Police Department (APD) has performed several of these checks over the past year, and removed her handgun from her home.

Yet, unless our friend threatens harm to herself or someone else, the police can do nothing more than look in on her periodically—and she doesn't have to answer her door—because our friend has a perfect “right” to “allow” her life to fall apart underneath her. No involuntary commitment for a 72-hour psych eval, no nothing, even though the “authorities” are quite aware that our friend has lost her mind.

As another friend of ours, who works in the field of mental health put it, “Only threatening to kill one's self constitutes a sufficient reason to warrant commitment. Threatening to ruin one's life in every other way just short of death does not. Strange.”

(The picture may be improving because only a few days ago her son informed us that he took our friend to UNMH for a voluntary psychiatric evaluation, though at last report she was refusing any medications and not being particularly cooperative.)

Continued below...

Zee said...

Mental Illness, Part II

One does not have to do very much “Googling” to link well-meaning civil libertarians with the deinstitutionalization of the mentally ill, starting in the seventies:

http://en.wikipedia.org/wiki/Deinstitutionalisation

“In general, professionals, civil rights leaders, and humanitarians [in the United States] saw the shift from institutional confinement to local care as the appropriate approach. The deinstitutionalisation movement started off slowly but gained momentum as it adopted philosophies from the Civil Rights Movement. During the 1960s, deinstitutionalisation increased dramatically, and the average length of stay within mental institutions decreased by more than half. Many patients began to be placed in community care facilities instead of long-term care institutions.” (Bold emphasis added.)

Of course, the “local care” never materialized, thanks in part to Ronald Reagan (thanks, Patricia, for the link to the Daily Kos article)though I think that the states could have done more on their own had they deigned to.

But how would “local care” have helped our friend, anyway? Whether at the federal, state or local level, our friend would still have the “right” to allow her life to fall completely apart under the influence of a mental illness as long as she's not a threat to her own, "organic" life, or the lives of others. But is not winding up on the street, in the company of many other mentally ill people, also a serious threat to her organic life in the long run?

The insidiousness of mental illness is that many of the mentally ill are not aware of their condition and are entirely resentful of anyone who tries to explain the reality to them and get them help. Witness our friend's anger and alienation. When a mentally ill person cannot recognize his/her illness and seek out help, what then?

Perhaps had we been better friends, we would have lied to the authorities, said that our friend had threatened to kill herself, and have them “commit” her.

But we weren't ready to lie to the police, and we're still not.

What else should we have done?

Cirze said...

I can't help think that the "not caring" for the mentally ill is a feature, not a bug, of the right-wing program.

After all, so many uncared-for people "loose" will always add to the fear factor in our society.

And make us very happy to have the troops come protect us.

Right?

Zee said...

Not specifically relating to mental health, but to healthcare in general. That is, more bad news for ObummerCare:

http://www.latimes.com/business/la-fi-insure-doctor-networks-20130915,0,2814725.story

“To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state's new health insurance market opening Oct. 1...

These diminished medical networks are fueling growing concerns that many patients will still struggle to get care despite the nation's biggest healthcare expansion in half a century...

To see the challenges awaiting some consumers, consider Woodland Hills-based insurer Health Net Inc.

Across Southern California the company has the lowest rates, with monthly premiums as much as $100 cheaper than the closest competitor in some cases. That will make it a popular choice among some of the 1.4 million Californians expected to purchase coverage in the state exchange next year.

But Health Net also has the fewest doctors, less than half what some other companies are offering in Southern California, according to a Times analysis of insurance data.

In Los Angeles County, for instance, Health Net customers in the state exchange would be limited to 2,316 primary-care doctors and specialists. That's less than a third of the doctors Health Net offers to workers on employer plans. In San Diego, there are only 204 primary-care doctors to serve Health Net patients.

Other major insurers have pared their list of medical providers too, but not to Health Net's degree. Statewide, Blue Shield of California says exchange customers will be restricted to about 50% of its regular physician network...

In addition to doctors, some big-name hospitals may be left out. A spokesman for Cedars-Sinai Medical Center said the hospital has received many calls from patients who were worried about keeping their access to the hospital and its affiliated doctors in the new health plans next year.

Cedars-Sinai is available only on two lower-priced Health Net plans in the state-run market, according to the hospital and insurer. Anthem Blue Cross says that it's the only insurer that includes UCLA Medical Center and other UC facilities statewide...

Newly released data show the pricing power of these tighter networks. In Los Angeles County, Health Net is consistently the lowest-cost option for a mid-level Silver plan across various age groups.

A family of four in Norwalk earning $65,000 annually would pay $384 a month for a Health Net policy, after taking into account a federal subsidy based on their income. For a policy with identical benefits, Blue Shield was next at $477 a month and Kaiser was the most expensive at $602.

The cheapest Silver plan for a couple in their mid-50s earning nearly $100,000 a year was also Health Net at $781 a month. An Anthem policy costs $897.”


The cost for the couple in their mid-50s is more than triple what I expect Mrs. Zee and I will be paying for Medicare Part B. What a ripoff!

Fred Drumlevitch said...

@Zee:

Good description from you of the dilemma as to how much individuals and society should intervene in cases of mental illness — or supposed mental illness — in one's family/friends/neighbors. Often, the correct decision — if a proper choice even exists — is by no means obvious, clear-cut, or timely, because, as you've said, the mentally ill are often quite adept at concealing problems.

But even with full and accurate knowledge of the situation, some observers might classify certain behavior as mental illness, while others might rate it as only eccentric. Some behavior might be considered insane due to social context or economic system — think Winston Smith in "1984", or someone who, in a cutthroat capitalist economic system, gives away most of his/her resources and lives as a near-pauper. Furthermore, some real-life totalitarian states, such as the former Soviet Union, were notorious for using psychiatric detention as a political weapon against sane dissidents.

In this country, quite widespread (and eventually, notorious) abuses of the commitment process and "treatment" were documented. Here, it was probably done in large part for the "convenience" of society, which, deep down, wanted such people out of sight and out of mind — even if such institutionalization was rationalized as being for the person's own good. But I'd bet that personal empire and economic motives of some psychiatrists, private "sanitariums", and in some cases, government-run ones too, did play a role. That should be kept in mind; with medicine having become more profit-oriented in recent decades, the potential for such psychiatric over-commitment/over-treatment abuse has become even greater. Finally, let's not forget that contemporary big pharma has an enormous profit motive for getting people labeled as in some way mentally ill and becoming prescription psychiatric medication consumers.

I think it is clear that in this country, the trend towards de-institutionalization and local treatment didn't work all that well — though as you said, it was never allotted adequate resources. But the previous commitment-treatment methods didn't work very well either, and both past practices and current treatment trends hold the potential for enormous economic and political abuse in the future.

It is a difficult problem.

Zee said...

@Fred--

Thanks for your additional comments on the thorny balancing problems of determining (1) who is actually mentally ill versus merely eccentric, and (2) obtaining compassionate, responsible, non-stigmatizing, and lawful care for those who truly are mentally ill.

I hope that I did not come across as downplaying the importance of preserving the civil rights of the mentally ill in the course of obtaining treatment for them. My dispute with the “well-meaning civil libertarians” to whom I referred above was not that they weren't dealing with real and serious civil rights abuses under the then-extant system. Rather, I think that they were simply naïve in assuming that, somehow, quality community treatment would simply “happen” upon deinstitutionalization of the mentally ill, whilst at the same time the civil rights of the mentally ill would be magically be preserved, with no “deep thinking” required.

That turned out not to be the case. As we both agree, this is a very difficult problem, and the civil libertarians got the answer less than half right. Civil liberties may have been preserved, but millions were put out on the street whilst treatment evaporated.

As you observed, the past “process” was often horribly abused, and the “treatment” following “committment” often was more akin to torture than real medical help. And with the profit motive becoming more important today in the field of health care, any new process would have to be vetted, vetted, and vetted again to ensure first, that all civil liberties are preserved, second, that treatment is compassionate (rather than merely institutional) and leaves the patient as free of stigma as possible, and third, that the treatment that is given is in accordance with current best-medical-practices.

Some “deep thinking” and “deep law-writing” will be required, neither of which our lawmakers is particularly good at.

And, of course, sufficient public funding will have to be allocated to the problem, which makes it a non-starter from the get-go.

Jay - Ottawa said...

@Zee

There seems to be agreement all around that society failed miserably with institutionalization in the past, then society failed miserably with de-institutionalization, and society continues to fail miserably in all the ways described in these comments.

The reasons for these failures are many, as has been stated by you and others; and there’s lots of blame to go around for all the interests involved.

One of the greatest problems (in my opinion, THE greatest problem) contributing to the failure of all modes of care has been poor funding. The mentally ill are yet another drain on public funds. Their lobby is weak and can be ignored, hence they are at the end of the line when taxes are redistributed.

With respect to paying taxes for knotty social problems like mental health, most well-off Americans are neither Republican nor Democrat: they’re Libertarian. Fund defense and not much else.

A new and cheaper solution has come into vogue for handling the mentally ill: re-institutionalization. Once again, the mentally ill are being swept off the streets and hidden away.

No need to build more mental institutions run by the state, sure to be underfunded into new snake pits. No need to fund more de-institutionalization schemes, which were sure to fail without proper funding. Just turn to the care and confinement infrastructure that’s already in place: jails.

From the Wiki article you cited:
“In summer 2009, author and columnist Heather Mac Donald stated in City Journal, ‘jails have become society's primary mental institutions, though few have the funding or expertise to carry out that role properly…. at Rikers, 28 percent of the inmates require mental health services, a number that rises each year.’"

Your criticism of civil libertarian and civil rights advocates as naïve actors in the mental health picture strikes me as highly selective and revealing. I wasn’t aware these two groups in particular paid no attention to funding issues, instead preferring magical thinking, thus earning them your low esteem. How come you didn't bold Ronald Reagan's name as well?

We here at Sardonicky thought you were coming along so well as we weaned you away from hoary conservatism. Now this lapse. It may take longer than we estimated before you willingly become a proud card-carrying member of the ACLU.

Assisted Living for Mentally Ill said...

Thank you for your nice article. Its really awesome.

Zee said...

Hoary Conservatism, Part I

@Jay--

Sorry to disappoint you again, this time with my lack of steady progress towards “willingly becom[ing] a proud card-carrying member of the A[merican] C[ivil] L[iberties] U[nion].” And, sorry also that you consider this most recent “lapse” to be proof-positive that I remain a stunted, “hoary conservative.”

First, let me say I don't believe that I have suffered any “lapse.”

I am a willing, card-carrying member of the ACLU, just as I am a willing, card-carrying member of the National Rifle Association. I'm sure that I've mentioned the former before, and I'm certainly not ashamed of my support for either organization. But neither will I ever be a blindly loyal, steadfastly proud, member of either organization, if that's what you're suggesting I should be.

Both of these organizations do—or have done—many good things, IMHO. But they both can also be inconsistent, stupid, blindly fanatical, or just plain wrong—again, just MHO. And when either of them acts in any of these latter four ways, well, I'm going to be critical of them.

Thus, I was critical of the civil libertarians who—among others—led the charge to “deinstitutionalize” the mentally ill starting in the late '60s or early '70s, something which, I think, may have done as much harm as good for the mentally ill over the past 40 years or so.

Now, perhaps I was wrong to single out civil libertarians for this mistake (for so I see it to be) by using bold-faced type. As noted in the Wikipedia article to which I provided a link, there was plenty of blame to go around, right up to Ronald Reagan. (Although, as evidenced by his defunding of the Mental Health Systems Act, Reagan may actually have thought through the consequences, and, callously, found them to his liking. )

So why did I almost instinctively single out “civil libertarians” for bold emphasis and particular ire?

Well, perhaps because I expect better of lawyers who pompously claim so much “intellectual rigor” for their analyses, “analyses” that are, ultimately, only “judicial opinions.” The civil libertarians exercised legal rigor—perhaps—in obtaining their short-term goals of deinstitutionalization and expanded civil rights for the mentally ill, but they exercised no rigor whatsoever in worrying about the “far-field” effects.

Zee said...

Hoary Conservatism, Part II

Hoary conservative that I am, I believe strongly in Colin Powell's “If you break it, you own it” philosophy. Now, I have no direct knowledge that the aforementioned “professionals, civil rights leaders, and humanitarians” paid NO attention to funding issues once they succeeded in “liberating” the mentally ill. But whether they did or did not have a planned “next step,” in the end, they failed the mentally ill badly. They “broke” the system intentionally and then—for whatever reason—failed to make it right or better.

In fact, they may not even have seen any need to do anything further. And I'm not the only one to see it that way.
I haven't read his book, Taking Liberties: Four Decades in the Struggle for Rights, by Aryeh Neier (a former president of the ACLU) but here is a quote from it regarding deinstitutionalization, taken from a book review by the conservative Claremont Institute:

“ "Unhappily," [Neier] says, "I concede that deinstitutionalization of the mentally ill was a civil liberties success but, for many of those released and for their urban neighbors, a social policy failure."” (Again, my daring, bold emphasis.)

To claim that deinstitutionalization was a “social policy failure” implies to me that Neier really thought that deinstitutionalization was a legitimate, social-policy end in and of itself, with, perhaps, no concern for future fallout even needed.

The reviewer goes on to say:

“... it is preposterous to say that a junkie who defecates in the streets and sleeps in parks is liberated. As for the right of a community to maintain a decent quality of life, that's not his problem. What matters is that someone who previously had few rights now has an abundance.”

http://www.claremont.org/publications/crb/id.794/article_detail.asp

I judge Neier and his civil libertarian colleagues similarly to the Claremont Institute book reviewer. If you break the mental health care system, especially with good intentions, it behooves you to own it and make it right. And if you fail to make it right, guess what? “Good intentions” are no excuse: you own the dismal failure just as much as you would have owned the glorious success.

If you think it's harsh or unfair of me—and others—to judge them thus, well, so be it.

I guess that's just “hoary conservatism.”

Jay - Ottawa said...

@Zee
Welcome back from the wild. And good to hear you're looking in on The Claremont Institute, dedicated to "a reinvigorated conservatism." Maybe Sardonicky will soon add it to the blog roll.

You say that Aryeh Neier and his ilk "broke" the mental health care system, so now they "own" it and must fix it.

Did the mental health establishment itself (psychiatrists, psychologists, other mental health workers and the NIH) see big problems with institutional care in the 50s and ‘60s? Did they have any hand in creating the Community Mental Health Act (1963) and the Mental Health Systems Act (1980)?

Isn’t there a long history in the US of broken mental institutions predating Neier’s service with the ACLU?

Can community-based alternatives ever be adequate if funded properly? Or is the best and only and least naive policy answer the forced re-institutionalization of the mentally ill into large state asylums?

Isn’t it a tiny bit unfair to say advocates fighting for the civil rights of the mentally ill should also be held responsible, in full, for the subsequent failure by several state legislatures to adequately fund community-based care?

Since deinstitutionalization, which political group consistently voted for –– and lobbied for –– cutbacks in public funding for mental health: conservatives or progressives? Red states or blue states?

Might we ever suspect that hoary conservatives –– and even re-invigorated ones –– might now like to shift the entire blame for the failure of de-institutionalization upon civil libertarians, despite the relentless de-funding of the system mainly by hoary conservatives?

Some answers might be found here:

http://www.motherjones.com/mojo/2013/04/map-states-cut-treatment-for-mentally-ill

http://www.presidency.ucsb.edu/ws/?pid=32339#axzz2fgVCVYmK

http://www.motherjones.com/politics/2013/04/timeline-mental-health-america

http://en.wikipedia.org/wiki/Community_Mental_Health_Act

Fred Drumlevitch said...

The points raised by @Zee and @Jay deserve further comment. Unfortunately, I haven't fully thought them through — and in any event, right now I don't have the time — so I won't attempt a detailed answer.

Briefly, though, I would say that while I understand the abstract validity of @Zee's point about "you break it, you own it" with regard to a situation, I'm not sure of the applicability of that point to de-institutionalization, since, as we all pretty much agreed earlier in the discussion, the institutionalized system was itself in many ways already broken.

Having said that, I do want to definitely avoid the facile conclusion that since there is plenty of blame to go around, we should take the easy route and not blame anyone, let's just "look forward". That kumbaya route is essentially the one Obama took on so many matters — and it (just like its polar opposite, dogmatic opposition) avoids any rational, evidence-based sharp critique of ideologies and their implementations, and the ways in which they can fail. That, in turn, helps contribute to the current situation with regard to so many matters — rather than the past effecting what amounts to "natural selection" on methods and ideologies, properly eliminating those that don't work well, we instead find ourselves beset by faulty ones that seem, zombie-like, to refuse to stay buried. Not only do we not properly solve problems, we keep returning to not-much-different variants of what should be known to be thoroughly discredited methods and rationales.

I do think that it's fairly obvious that Republicans are stuck in an ever-lower-taxes-and-we're-definitely-not-our-brothers'-keeper mode — even in the face of some truly serious problems that require planning and large-scale action. Meanwhile, the Democratic Party never was much in demanding high enough efficacy and efficiency of social programs, and nowadays has largely abandoned any real commitment to genuine social and economic justice, and adequate funding thereof — which may explain @Zee's point about civil libertarians too often seeming overly dedicated to the pro-forma elements of liberty, which don't require much funding. (In fact, pure liberty often results in savings — if one counts only money).

One point about state government shirking its funding of services for the mentally ill (which we at this forum probably all agree is a major problem): It's even worse than just that. As an article in the NYT details, states are not just inadequately caring for those most in need, they are literally shipping them off to other states so as to avoid even the most minimal costs and responsibilities. At the very least, that suggests the need for primarily national funding of social and medical services. Unfortunately, except when some massive outrage occasionally (and very temporarily) grabs hold of the public consciousness, the shirking of moral obligations to our fellow citizens has become the default policy at both state and national levels.

http://www.nytimes.com/2013/09/22/us/once-suicidal-and-shipped-off-now-battling-nevada-over-care.html

Zee said...

@Jay and @Fred--

I initially got off on the tangent of civil libertarians and mental health care specifically with regard to our dear, suddenly-psychotic friend, for whom neither we nor even her son had the authority to get her the help she needed, because she has “rights.” She was—and probably still is—in danger of losing her life's savings and her home—if she hasn't lost them both, already—because, IMHO, of the past actions of well-intentioned civil libertarians..

Yes, the past “system” was broken (and, yes, abused, too), and was damaged for many different reasons and thanks to many different parties. But I maintain that civil liberties organizations have, perhaps, stood too strongly athwart attempts to construct laws that balance the civil rights of the mentally ill with getting them the help they need before they destroy themselves or someone else.

A case in point may be New York State's “Kendra's Law,” which seems to have strong safeguards for the mentally ill, but which the New York Civil Liberties Union apparently vigorously opposes:

http://en.wikipedia.org/wiki/Kendra's_Law#Opposition

There's even a New Mexico connection to “Kendra's Law,” via the New York Association of Psychiatric Recovery Services, Inc.,

http://www.nyaprs.org/e-news-bulletins/index.cfm?do=headlines&mn=8&yr=2008&article=
BD3895DE9E1E2C82CBA4DEC72C370093

which may offer some explanation as to why it was impossible to for us—or even her son—to obtain help for our friend.

Her son might have been suspected of having some “pecuniary” or “personal” interest in having his mother committed for psychiatric evaluation; but what interest—as friends of 15 years, along with a churchload-full of other friends—could we have had in testifying before TPTB that our friend had lost her mind and was in need of commitment and care?

“Sorry, but that's just not possible,” according to the Albuquerque Police Department and the University of New Mexico Hospital. Our friend has “rights.” So yes, I'm resentful that we couldn't be trusted to get our friend the help she needed, and yes, I blame—at least in part—overly-zealous protectors of “our” civil liberties.

Personally, if I lost my marbles and was pissing away my wealth and health, I would hope that Mrs. Zee—or someone else—would have the authority to get me help. But I'm not sure even my wife of 39 years would have that authority under New Mexico law.

Now, perhaps I went too far in holding civil libertarians accountable for “breaking” the mental health system, and, therefore, having to “own” all of the wreckage. It was not my intention to sound so extreme.

Clearly, thanks to the links provided by Jay, I now know that Federal and State governments also “owned” a huge share of the deinstitutionalization disaster.

You will get no disagreement from me that this needs to be fixed—and not in a half-assed, spit-and-bailing-wire, seat-of-the-pants, ObummerCare way. It breaks my heart not to be able to get help for our friend.