The Eagle ran on Monday’s front page an Associated Press article about an Oklahoma man suspected of killing a 9-year-old neighbor girl; while the article noted his interest in cannibalism and other sensational details, it also suggested a possible reason for the tragedy: The man suffered from mental illness and might have stopped taking Lexapro, an anti-depressant.
That also seemed to be the story in the recent QuikTrip shooting in Wichita: A mentally ill patient not on his meds runs amok.
Which raises the question: How can families and state agencies do a better job of keeping patients on meds and out of trouble?
Posted by Randy Scholfield
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44 Comments
Very difficult question. If the eprson has not been convicted of a crime can we incarcerate him? Force-feed him drugs? Or can some sort of civil committment be done?
Very difficult indeed …
Something else to consider is that many if not most of the drugs used to treat psychosis have extremely unpleasant side effects, such as uncontrolable movements of the arms and legs that continue even after the drug is stopped. Many patients find the drugs worse than the disease, which is why they stop taking them.
In the 70s, were were aghast at what we perceived as warehousing people in hospitals (Such as Winfield), so we gave them some meds knowing in or heart of hearts that these people unable to cope with life would faithfully take their meds, patted them on the back and closed the hospitals. Now we wonder were all the homeless people pushing grocery carts and, sometimes committing crimes, are coming from.Sometimes we’re not very smart.
This is just too sad to believe. Our Liberal and Enlightened sector of society have determined one cannot commit a nutball to a mental facility without their permission. They must therefore be left to go forth and multiply, until such time they commit a serious crime. Only then can a state agency act to correct the situation.I could not even begin to count the number of mental cases I have met over the years that commited serious crimes for the sole purpose of getting themselves into the system, because it was the only way they could get help. The one’s that do it intentionally are most often the border line cases and the tip of the iceburg. Your politicians did this with full knowledge and intent. Don’t expect a change. They like the kickbacks from all the little programs it creates, without the need to maintain proper facilities.
A post I made on a different thread about this topic:
Kansan came up with half of why the de-instituionalization movement came about. True, Liberals thought “let’s have them in the community, it will be a better quality of life”; Conservatives said: “Look at all the money we can save, if we do this” – thus was created a uniquely bipartisan effort that at its base had two different reasons for the mission.
I am going to estimate that the total number of people in the U.S. at any one time with a severe and persistent mential illness is about 5% of the population. Given a population of 300 million, that makes for 15 million people. These folks have expensive treatment needs and are there enough of them (and their families) that they can be adequately advocated for?
Insurance companies right now are fighting a fierce fight, with what I suspect is a sympathetic government, to limit their costs on paying for chronic medical conditions – not just mentally ill people, but also people with diabetes, etc.
These are complex problems, folks. There are no simple solutions that can be easily pulled out of one’s hat.
What is at the foundation of this problem and any solution, is the moral/ethical question of what kind of country do we want to be? No one, certainly in the current administration, appears willing to start this dialogue.
I disagree with this poor father that it is: State Hospitals or jail. There are many other alternatives. Many of them work and are much more cost effective AND humane than the false dichotomy offered.
It is time for this discussion to occur. I thank Melissa for bringing it up.
Posted by: Darwin’sDisciple | April 16, 2006 at 09:21 AM
The newer generation antipsychotic medications are less likely to produce the EPS problems that Jed describes. But, there are no medication treatments that are risk-free.
Lexapro is a medication for mood disorders and not psychosis. So, from this fact alone, we are unable to reliably infer if this person was depressed (like many people – much more than the 5% figure I provide above) or similar to the man who killed the clerk in the Quick Trip tragedy. The latter was paranoid schizophrenic and evidenced a history of violence before he committed murder.
I am in favor of tipping the balance away from a patient’s individual rights and opt more for the interests of the family members. (Which would mean making it easier for family’s to pursue involuntary commitment). If a person with severe and persistent mental illness is going to be violent (which by no means are they ALL at risk to become violent) the most frequent target of this violence is family members, most often mothers.
On NPR yesterday, I heard a father of an SPMI man tell his story about trying to get his son treatment and having the extra burden of fighting the legal system to get his son help. Tragically, he said something to the effect that when you have a son who is SPMI there are no happy endings and he waits for the next crisis – and they inevitably come. You can probably find a recording of the story at http://www.npr.org
This is a significant problem and I appreciate the WE folks for discussing it.
sorry – there are as many of the “Liberal and Enlightened” who want to find a way to either commit or otherwise deal with the mentally ill as there are of the “Conservative and Unenlightened”. What is your proposal? Commit anyone who disagrees with druggie Rush? Now THERE is a nutball who needs to be committed!
DD – I heard that NPR story as well. I would note that it was the LIBERAL station that aired it and the need to do something.
Sorry to bust your bubble Ben, but I saw it happen first hand, and there was nothing bi-partisan about the closings of the state hospitals. It was an exclusive liberal affair to pass laws a generation ago closing mental institutions and protecting someones right to be mentally ill. Liberal Politicians, Liberal Media and Liberal Academics.Nice try spreading the blame but it simply will not fly considering it was a pet project for the Kennedy administration.Good to see though, that Liberals at least acknowledge the problem. Probably with no knowledge they created it in the first place.
I also saw it happen first-hand. The idea was to transfer maintainence of those who could safely be released to community-based treatment centers. The GOP then made sure those never existed. Parts of the overall idea were good; part were bad. Some can and should be released. Some should not. The thing went wrong when Conservative Politicians, Conservative Media, and Conservative Academics saw to it that the support was not provided and that people were released that should not have been.
Again, it isn’t a liberal issue or a conservative issue. There is plenty of blame to go around. Nothing will ever get done to ease these people’s sufferings if all we do is point fingers and call names.I personally don’t think there was anything wrong with the hospitals. At least they got care. Maybe inadequate care, but a lot more than they get on the streets or in prison.
P-Lease: Ben, Sooory;
Why are we bickering over whether liberal or conservatives are responsible for this mess?
I don’t agree with DD much, but I think he’s pretty much spot-on here. I’ve found myself in the legal part of this mess, with a family who wants to help, and myself having to tell the family that there is little I can do; that I cannot involuntarily commit their loved one when we both know that is exactly what needs to happen, at least for a time. It is incredibly sad.
Many of these folks need not only medication, but regular (some daily) monitoring to be sure that the medications are working, working right, and continue to work. Many take the medications, feel better, stop taking the meds because they don’t like the side-effects, and start the cycle over again.
BTW – we still have asylums. For some of our mentally ill, we just call them jails. That’s even sadder.
Ben,I lost a long response to your question. But, I contend that both Liberal and Conservatives supported community treatment, but for different reasons that I summarize above. The rare across the aisle cooperation meant that deinstitutionalization occured quickly without sufficient deliberation.
My proposal on changing commitment laws is simple. When a patient is not competent to decline treatment, do NOT allow them to decline the treatment. If a person is competent to decline treatment, they can – even if it is a bad decision.
The research shows that there is no treatment outcome difference for a person with SPMI regardless of whether they are treated voluntarily or involuntarily. Families of SPMI often have the erroneous idea that their family member will need to “want” treatment for it to be effective. It was like the father on the NPR program said, he had never known an SPMI patient complain later that they were returned to competence, but instead they were grateful.
Competency to consent to treatment in Kansas is defined along the lines of: 1) understanding that one has treatment options; 2) being able to weigh the risk and benefits of the treatment alternatives. I am not a lawyer, but this is pretty close. There are some states that are letting SPMI folks put together advanced treatment desires legal document should they ever become incompetent through psychosis – for whatever reason. This approach makes it much easier for the patient and treating staff.
May post more later. Ben, thanks for caring about this subject.
GMC – I agree. However, I had to respond to sooory’s “Our Liberal and Enlightened sector of society” BS. I agree much with DD and also with you on this issue.
We went through much of this on another thread. I think what is needed is commitment sometimes then perhaps followed by “release with conditions”. This is where the drop-in centers come in. Whereever possible peer counseling by others who have “been there done that” as a part of the picture.
I too, care, having known–and, in some instances, loved–several persons with mental illness. I don’t favor institutionalization as a means of “getting them off the streets,” but sometimes it’s just not possible for the ordinary person to handle such situations.
When it’s possible for someone to function in the community with medication, I favor taking steps to make this happen–at no cost to anyone (believe me, it’s worth it to the community!). I support private efforts like the Breakthrough Club, but I nonetheless object to the all-too-common Kansas presumption that the private sector should do everything.
I am also wary of overdoing the patronizing aspect (I knew a guy who claimed he was locked up for being “anti-Nixon”); however, I suspect that happens rarely if at all.
And as no expert of any kind in this area, I am the first to humbly admit to not knowing the answers, though I am all too acquainted with the questions!
I agree that there is a small subset of SPMI folk for whom community living is not likely to be an alternative. Some folks do not want to live in the community, though most do.
Some poster linked to the following Malcolm Gladwell article on a thread about homelessness. I think it has relevance to this discussion also.
http://www.gladwell.com/2006/2006_02_13_a_murray.html
There are state hospitals still open. Topeka State Hospital is closed, but Larned & Osawatomie (sp?) are still open. Rainbows unit in KC, KS is still open – it is for children. It takes a good deal of bureaucratic angst to get someone into one of these st. hospitals, however.
(Winfield [now closed] was a state hospital for mentally retarded people – a subject for a different discussion).
But, GMC is right, a disproportionate number of mentally ill people are in prison.(BTW, GMC, like a broken clock, I am right two times a day even if it is unintenional)
To clarify, I believe in individual freedoms/rights. But, also I think a person has to have a psychological presence to appreciate and responsibly exercise those rights. When a person is psychotic and especially when they are dangerous to themselves or others, they need to involuntarily treated.
I would even lower the dangerous criteria to potentially dangerous in the current statutes. I am not into controlling people, but have seen cases where it became necessary to allow someone to hurt themselves, someone else, or destroy property to get what they needed in terms of help. The fact that the violence or destruction was going to happen was entirely predictable.
Agree, Rage, I am sure I don’t have all the answers, but would like to see some changes.
I hope Damoon will again post about the program she is familiar with. It sounds like a wonderful community program that does many of the things that GMC suggests in terms of monitoring.
One last thing, the reimbursement rate that exists for different services is completely bassackwards.
A visit from a community nurse to monitor meds in the home is paid out at virtually nothing.
A day in a private psychaitric hospital will cost you $1K (the low end places).
If I were ruler of the world, I would reverse these rates. It would then be interesting to see how many more people we could get invested in seeing MI folks staying in the community.
Not to mention how much more cost effective my reversal would be. We would pay a higher rate to services that prevent hospitalization, rather than giving so much to hospitals.
The old saying that “You can scatter dollar bills along a trail, but doctors won’t necessary follow” – is B.S. IMHO
I saw 11 clients this morning, 5 clients who are severely physically disabled and 6 who have severe and persistant mental illness. In the 5 years that I have been seeing these clients along with my coworkers, not one has been hospitalized for a psychotic break. All of these clients live in the community. The service we provide is invaluble in maintaining their independence. Home health services provide qualified nursing staff to do daily assessments, med management, and interventions that help people with SPMI maintain stability. It’s also more cost effective than housing someone in a long term treatment facility. Our clients have much happier and fulfilling lives because they have the support they need to function and have a life. I wish that the state was more supportive of these services, they’ve cut us back twice in the past 5 yrs. It’s a win/win situation, because the client gets the opportunity to fucntion in a more independent environment and it saves the taxpayers money.
Back to the thread, sounds like the guy was a psychopath, medication probably wouldn’t make that much difference. I don’t think it would have helped Dennis Rader.
Medication would not have helped Dennis Rader, other than tying up some of his extra cash so he couldn’t buy his play-things.
Lexipro is being handed out, via samples, like candy. I don’t know much about the perp which started the thread. I guess I will read the Eagle article.
Read the article on this Underwood. Still not sure I can tell what is up with him. But, I don’t think he is the type of person we were talking about on this thread. Certainly he is not like the fellow who killed the QT clerk when off his meds.
We’ve all seen what happens when Ed, CF, FrmGrl and others post on this blog when they’re off their meds. It’s not a pretty sight.
DD,I agree that the new drugs have fewer and less severe side effects, but they are also much more costly. As a result, older, cheaper drugs such as Haldol, which has horrific side effects, are being handed out in quantity not only to psychotic patients, but in nursing homes and hospitals for the purpose of keeping patients quiet. In other words, for the convenience of the staff!
Jed:
All true points.
I am especially troubled by patients beign sedated for the convenience of staff. It used to be that the federal government had inspectors who served to reduce this sort of problem. I will bet that is happening less these days.
Even though hospitals get a lot of money, it does not seem to be enough for them to maintain their margins. Hence, they look to cut staff to the barest minimum and the quality of care suffers significantly. I suspect our resident expert on this, Damoon, knows more than I do on this subject.
“sedated for the convenience of staff”
Is that like giving kids Ritalin for the convenience of teachers?
Yes.
Kansas is one of a few states where if you commit your self then unless a Doctor can point to a real problem. You can check your self out with only the staff asking you to please come back to have your meds checked.
That is what happened in the Robert Garcia case. The staff knew that he was dangeious but could not hold him as he was self commited. Once on his own he quit taking the meds he had and went to his ex-girlfriend’s. Counted the people in the house then the number of shotgun shells. The only surivior was a teenage girl that was holding a two years old.The blast that killed the baby also took off part of the teen’s hand. Then the teen had the sense to play dead.
Real bastard wasn’t he? But when on his meds he was the nicest guy I have ever met.
Dog,
Haven’t heard of the Garcia case.Will look it up.
Commenting this a.m. to note that in the paper version of the Eagle several posts from (I think) the earlier thread on mental illness was in the paper today.
Guess who got the most ink? Damoon, of course.
Ben, JR and Ruby’s comments were in there, too. I am going to show it to my wife to see if she can guess which statement was mine.
Cheers.
A link to the Blog comments in the paper today:
http://www.kansas.com/mld/kansas/news/editorial/14380768.htm
Yes Horst, it is my birthday today, danke!
V.L.R.B!!
I wouldn’t call Philippe Pinel, physician, founder of psychiatry, the greatest man who ever lived. I don’t know if he had a cost effective solution for mental illness.
Happy birthday Ian!
Happy birthday Ian
Ummmmm
I think Horst is referring to Adolf Hitler. This would be his birthday.
4-20 -Also the anniversary of Columbine and the Waco (not sure on this one?) tragedies. And, didn’t the OK City bombing happen at about this same time.
I am convinced this is not a good time of the year.
Heheh. I agree DD. My 50th birthday is this week. Not a good time of year….
The foiled incident in southeast ks was also timed for the same day.
I think the SE Kansas plot; like Columbine and OK City were by WHITE Euro-Americans.
april 20th was Hilter’s B-day so many nutjobs uses that day for their twisted agendas. April 19th was the day waco thing happened So Mcviegh bombed OC the same day.
Thanks all for the birthday greetings, I had a great day with my friends and family.
As for Columbine, one of the shooters was Kliebold who was a jew and not White at all. Also, one of the girls who helped them obtain their weapons was a mestiza and the daught of illegals.
Tim McVeigh had a negro girlfriend and Nichols was married to a Phillipina and has mixed race children. Don’t try to paint those incidents as being the work of “evil White Nationalists”!
Viva La Revolucion Blanco!!
I read that a lot of murderers start by torturing animals, so maybe if the law considers that more those people can be stopped before they get to people?
(in case anyone cares, my personal belief is that hurting an animal is equal to hurting a child, because to me the reasons hurting a child is so much more wrong – such as the innate innocence – also apply to animals.)
True, SL. Their gratification comes from hurting someone or something that’s helpless and can’t fight back. Really, really, sick.
ksfarmgrrl
I’ll trade you. You don’t want to know.
Today was a loss. I just don’t have anything to say. Not that it matters.