The director of Mental Health Services for Kern County, interviewed awhile back on KGET-TV, reported that the incidence of violence in the cohort of the mentally ill is no more than for the general population. His statement is directly contradicted by the National Institute of Mental Health, the national clearinghouse for research and program development for mental illness.
I would wager that NIMH's research is exhaustive, valid and reliable. A few numbers: In research involving 10,000 interviews, it was found that 2.1 percent of those not meeting the diagnostic criteria for mental illness committed a violent act in the previous year. For those diagnosed with schizophrenia, 12.7 percent; for depression, 11.7 percent; for bipolar disorder, 11 percent; for alcohol abuse/dependence, 24.6 percent; and for drug abuse/dependence, 34.7 percent. Those numbers pertain to violent acts in the previous year only. How much larger might they be if the research window was opened to two or three years, or more?
It seems, at the very least, the mentally ill are violent about five times more than the non-mentally ill (2.1 percent vs. 11 percent for the least violent subject group). We then hear a qualification: Well, those in treatment and remission are no more violent than your neighbor. OK, but those in remission are by definition not manifesting the symptoms of mental illness (at least not while in remission).
And treating the mentally ill is like trying to hit an erratically moving target; symptoms rarely stand still, and psychiatric patients rarely stay on their meds for long because of their many undesirable side effects. Even with psychiatric meds, symptoms of mental illness wax and wane in response to any number of external and internal triggering factors requiring med levels to be constantly adjusted while the moving target is forever chased. Treatment is always one lap behind whatever is happening symptom-wise today.
Ever since the Lanterman-Petris-Short and Short-Doyle enactments in the early 1970s, with all of their good intentions, the public at large has been exposed to increasing levels of disturbing if dangerous misconduct on the part of the untreated seriously mentally ill.
Whereas before such individuals could be housed in public and private mental hospitals and kept in "protective custody" to various degrees, these enactments threw open the hospital doors for the mentally ill through which they all rushed for their liberty (except for the most dangerous, who were declared by the court to be a danger to themselves, a danger to others, or gravely disabled).
Once out, they tossed their meds (because of those bad side effects) and their symptoms slowly (or rapidly) returned. Now, every city in the country has its shelters for these homeless, wandering, mendicant, at times dangerous, untreated seriously mentally ill. Prisons are full of them, and soon, at least in California, so will be our county jails.
Not a pretty picture. And in this day and age of diminishing public resources, the question of "what to do" is virtually unanswerable. We've shuttered mental hospitals. Once having had 10 throughout the state, we're now down to five. Same with closures around the nation. Across the country, prisons have become the default and de facto mental hospital system. Jails will soon follow. Hospitals shuttered and deteriorating for decades, or razed for other land-use purposes, cannot be made to reappear. Our land of countless civil liberties now finds itself immobilized in a "what do we do now" quagmire. We can treat those willing to be treated. But what about those not who know they need treatment but are unwilling to be treated?
The Lanterman-Petris-Short and Short-Doyle enactments require, except for those declared judicially to be a danger to themselves, a danger to others or gravely disabled, that all mentally ill be left alone and left to their own devises. OK, so who answers for all the innocents who suffer at the hands of the untreated mentally ill at large? We pride ourselves as being a kindly nation. How about showing the same kindness toward the victims of the mentally ill as we show the mentally ill themselves? There's got to be a balance.
Brik McDill, Ph.D., of Tehachapi has spent 40 years in private practice in clinical and forensic psychology. Community Voices is an expanded commentary of 650 to 700 words. The Californian reserves the right to edit all submissions for length and clarity.