Almost everybody, in some way, form, or fashion, has some kind of mental issue.

While on RDC duty in Great Lakes one of the psychologists told me that you can find and diagnose a mental condition in anyone if you dug enough.
As stated in your article this is a very difficult area. How do you balance the safety of the public and the rights of the individual? No matter what you do, someone will get mistreated.

When I completed undergrad in 1970 and found myself with a BA in psychology, there were no apparent jobs. I scrabbled for a year working several part-time jobs to get by. Finally, I signed on with a partial hospitalisation programme at a Community Mental Health Centre in a very blue-collar county. Our clientele were mostly schizophrenic, mostly diagnosed with the chronic undifferentiated form of the illness. Since this was the early days of the ‘great back ward clearing’ effort to treat the mentally ill in less restrictive environments at much lower cost, most of our patients were folks who’d been discharged from the state mental institutions.

They were typically delusional, disoriented, hallucinated, confused, disorganised and heavily medicated. Some were also violent, suicidal, homicidal and dangerous. Weekly injectable proxlin enanthate was the drug of choice at the time since the patient couldn’t play games with his/her meds. But it was a horrible drug – it caused tardive dyskinesia (shakes and involuntary leg, arm and eye movements), foot drop (aka phenothyazine shuffle), dry mouth, anorgasmia, and lethargy. Most patients were also give Artane, an anticholinergic drug which eased the tardive dykinesia, but which exacerbated the lethargy, drowziness and often made patients very sensitive to sunlight.

To say that these people were ill-equipped to survive in the community is an understatement.

When the ‘great back ward clearing’ took place, many chronically mentally ill, people who’d been institutionalised for 20+ years, were shipped off to group living homes in the communities whence they’d originated, medicated within an inch of their lives and referred to the local CMH. The flaw in the plan was that a sizable number of them correctly saw this as their big chance to escape the control of psychiatrists, psychologists, social workers, therapists, group home operators, family and pretty much everyone else. And like we do with any minority, the rest of society generally kow-towed to their “right” to be free and untreated, lest we offend them. Never mind that communities around the country were experiencing the violence, crime and disruption which accompanied these folks – they had the “right to be crazy”.

Thus the homeless mentally ill were hatched onto the American landscape.

During my dozen years in the business, I had the following patients:

- A man who smeared his feces on himself and passers-by on the streets while screaming incoherent obscenities at them;
- A man who poured five gallons of petrol over his head and lit it on fire (he survived, though he looked like a monster);
- A woman who attempted to cross a three-lane interstate at rush hour (she didn’t);
- A man who strangled no fewer than thirty pets in his neighbourhood;
- A man who broke into his elderly mother’s home and shot her, killing her;
- A man who appeared on my doorstep naked at 3AM with an M-16, two bandoleer-style ammo belts and a 1911-type .45 ACP pistol;
- A man who single-handedly attacked a gang of bikers in the parking lot of the biker bar where they congregated and was killed;
- A man who shot himself in the head with a shotgun (I got to watch);
- A man who jumped from a bridge into the river and drowned (I got to watch);
- A man who took a five-story nose-dive onto a parking lot (I got to watch and he survived);
- A woman who finally succeeded in overdosing after no fewer than ten serious attempts;
- A woman who stalked and terrorised the local Senator and his staff;
- A man who fatally shot the three mentally ill roommates who had taken him in off the streets, before killing himself.

I wrote a nice book about the “characters” I met while doing that work. It sold nicely for a time in the ’80′s. The point of it was simple – many, many of these folks didn’t belong in the community. It was hard on the community and hell for them.

There’s a delicate balance between the rights of the mentally ill and the rights of everyone else, and I don’t think our current approach accommodates everyone’s rights and needs very well.

Another real life scenario: My brother-in-law teaches junior high science, coaches baseball, and drives a school bus. A few years ago he had a kid who came out for the baseball team but kept missing practices so he kicked him off the team. Then the kid wouldn’t quit pestering a girl on the bus, and started shooting him the finger every time he’d tell the kid to knock it off, so my bro-in-law suspended him from riding his bus for a month. Then the kid started acting up in class, back-talking, refusing to take quizzes, stuff like that… so they went down to the office together, and the principal told the kid that if he didn’t get his act together he was going to get suspended from school.

At this point, the kid whips a notebook out of his pocket and starts writing in it. They asked him what he was doing. He said, “I just like to write down the names of people who treat me this way.”

The principal confiscated the notebook, and inside were names of students and teachers, with multiple checkmarks by them. That’s all. Nothing more. The kid never made a verbal threat, never got in fights, never acted violent… just creepy. And they couldn’t do anytihng about him being creepy. After this incident, the kid started making a habit of standing in front of the school bus before it left after school, and makng sure my brother-in-law could see him as he pulled the notebook out of his pocket and made a check mark in it.

Nothing else ever happened. The kid has since graduated high school (whereupon I’m sure every teacher breathed a huge sigh of relief). But that story has always stuck with me as a perfect example of what John is talking about above.

I think there were enough warning signs in this case to warrant denying him the right to purchase a semi-automatic weapon and 31 round clip.

In some cases, yes I agree that some people should be forcibly put into mental institutions. It should be difficult and rare but possible.

This has long been an issue in NYC, considering the population size and number of mentally ill people.

Not even involuntary commitment, but forcing people to take their meds.

Then someone goes off their meds (or is released from the hospital) and stabs or assaults someone or pushes someone on the train tracks.

Imagine if this guy would have been on meds to control his madness, instead of smoking weed and drinking alcohol?

The question is not “Should We Commit Mentally Unstable People?” either because first you need some sort of universal standard to apply.