Robert Whitcomb; Time for some reinstitutionalization

A version of this first ran in GoLocalProv.com, in Robert Whitcomb’s weekly Digital Diary column.

Read the June 23 Boston Globe article “The Desperate and the Dead: Families in Fear,’’ about how tough it is to treat (and keep off the streets) dangerous mentally ill people. To me, it’s part of a wider problem caused by the closing of most state mental hospitals and the decline of institutionalization. And the story shows how hard it is for many families of mentally ill adults to obtain clinical information about their sick relatives and be allowed to work closely with healthcare providers.

We obviously need to reopen many mental hospitals (whose closing was a false economy), to make it easier to institutionalize more of the most severely ill people and to enact “The Helping Families in Mental Health Crisis Act,’’ long sponsored by Pennsylvania Congressman Tim Murphy, a clinical psychologist. The bill would amend the Health Insurance Portability and Accountability Act (HIPAA) to ease clinical-information sharing between providers and the families of adult mentally ill people. It can be a matter of life and death.

As Mr. Murphy notes: “More than 11 million Americans have severe schizophrenia, bipolar disorder and major depression yet millions are going without treatment as families struggle to find care for loved ones….Sadly, patients end up in the criminal justice system or on the streets because services are not available.’’

Of course, many state mental hospitals were snake pits in the old days. New ones must be run much better. Meanwhile, people of a certain age may remember a remarkably stupid argument for closing mental hospitals: That new drugs then, such as thorazine, for schizophrenics, or lithium, for bi-polar disorder, would make almost all mental hospitals unnecessary.  But why would mentally ill people take their psychotropic drugs with the regularity, say, of someone with heart disease taking his statins? They are, after all, mentally ill.

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When does police officers’ zeal for chasing people whom they suspect of nefarious acts become irresponsible, adrenaline-fueled showing off of  their well-armed power? I thought of that the other week while driving in Providence. 

All of a sudden, in heavy, rush-hour traffic, an unmarked police car (we figured out) started moving very fast and erratically across four lanes of traffic, confusing and scaring the drivers of the other vehicles, who had no idea how to get out of the way of the seemingly crazed driver of the cop car, who wasn’t using his siren.

Then I read  a story in the June 28 Providence Journal headlined “Coventry couple accuse Providence police of excessive force following chase with unmarked vehicles’’ in 2013. Robert Gadoury and Alisa Chamberlain allege in a lawsuit that the police stopped them in their car without probable cause, made them the victims of excessive force and battery and  forced Ms. Chamberlain to undergo an inappropriately invasive search.

The couple say that plainclothes  narcotics unit officers in two unmarked Providence Police Department cars chased and cornered them, initially without flashing lights or sirens.  Mr. Gadoury said he had feared that the drivers of what he learned later were police vehicles were trying to carjack the couple, which is why he fled.

Apparently the officers (erroneously) suspected that the couple had something to do with a young man on a bicycle in the neighborhood suspected of selling drugs. And The Journal reported, Mr. Gadoury  had “faced some drug charges,’’ which may have popped out when the police checked the couple’s license plate. Eventually, the police turned on strobe lights as they moved in on the scared couple.

The lawsuit alleges that after officers pulled Mr. Gadoury from the car,  one of them, Matthew Jennette,  kicked in his teeth after Mr. Gadoury told the officers that he thought that the couple was being carjacked. Under the circumstances,  probably a rational fear.

At the very least, the case raises questions about how well the Providence police are trained to control their adrenaline rushes and power drives when they are exercising their potentially lethal authority. Law enforcement can be difficult and dangerous but that doesn’t obviate the need for self-discipline and an awareness of public safety at all times.

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Crazed Army veteran Micah Johnson might have been able to murder five Dallas police officers if American law and a powerful gun culture hadn’t  made it so astonishingly easy for him to obtain military-style weapons meant to kill as many people as fast as possible…

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The Obama administration’s decision not to more forcefully help the moderate foes of Syrian dictator/mass murderer Bashar Assad has let a catastrophic situation to develop that has fueled the perverts known as the Islamic State, given  Russian dictator/ Assad ally Vladimir Putin an opportunity to make his nation a major military power in the Mideast and strengthened the Shiite dictatorship of Iran, also allied with Assad.

All this has helped cause the immigration crisis in the European Union, the vote in the United Kingdom to quit the E.U. and the rise of right-wing populist movements in Europe. (The more refugees that Putin’s bombing in Syria helps send to  the West, the happier he is.)

What to do? First, the U.S. must lead much more strongly than it has a campaign to destroy ISIS at its heart. That means seizing ISIS’s “capital,’’ Raqqa, Syria, as soon as possible.  That ISIS has the structure and ambitions of a government encourages its members to carry out their outrages. Sen. John McCain was quite right when he said last weekend: “What we need to do is to go to Raqqa and kill them.’’

But there can be no peace in Syria as long as Bashar Assad remains in power.

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New England students should know aboutthe New England Regional Student Program, which lets New Englanders enroll at out-of-state public colleges and universities in the region at a discount from the usual out-of-state tuitions. The New England Board of Higher Education elaborates: “Students are eligible for the RSP Tuition Break when they enroll in an approved major that is not offered by the public colleges and universities in their home-state.’’
More such collaborations among the states in our compact region, please!

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I recently read a lovely novel called Emily, Alone, about an elderly widow in Pittsburgh as she goes day to day, trying to maintain her independence, with sadness, joy, humor, impatience, whimsy and fatalism in the shrinking world of the old. What particularly struck a chord was howshe found that memories of her early life in near-poverty in a small Pennsylvania town sharpened with age. Toward the end of the book, she drives there to look around and ruminate.

“In my end is my beginning,” T. S. Eliot wrote in Four Quartets.

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The other day  in Newport I saw  (in the spectacular Redwood Library) part of a TV documentary being filmed about Oliver Hazard Perry, the Rhode Islander who led the U.S. victory in the Battle of Lake Erie in the War of 1812. He’s the guy who said: “We have met the enemy and they are ours.’’  

The Jane Pickens Theater, in Newport, would be the perfect place for the documentary’s premiere.

Robert Whitcomb is overseer of New England Diary.

More mental hospitals, please

  By ROBERT WHITCOMB

While we know a lot about Elliot Rodger, the young man who murdered six, injured 13 others and then killed himself on a rampage in Isla Vista, Calif., on May 23, we still do not know as much as we should to derive all the painful lessons; there are ambiguities galore. But his case has rightly energized the debate about gun laws and the fragmented American mental-health “system.”

I’d guess that the Second Amendment was far more about state militias than individual possession. Otherwise why did the Founders write in the amendment of the need for a “well-regulated militia” as its justification? (Especially note the phrase “well-regulated.”) Still, the amendment is badly written and it’s impossible to know for sure what the Founders wanted. Meanwhile, the firearms makers and gun-rights absolutists hold sway in Congress, whatever the public-opinion polls, and presumably will continue to do so for the indefinite future. (The one argument that gun-rights absolutists have that I think has a smidgen of sense is that our heavily armed population might make it more difficult for a dictatorship in Washington or outside invader to impose its will. Still, could they defeat military forces?)

Anyway, since the late ’60s and early ’70s, with the new drugs marketed as panaceas for severe mental illness, and the deinstitutionalization movement, which closed many mental hospitals, it’s been increasingly tough to commit people to institutions against their will.

Things got worse with the Health Insurance Portability and Affordability Act (HIPAA) of 1996, a part of which makes it agonizingly arduous for relatives to obtain essential psychiatric and other medical information about adult mentally ill people. We need to make it easier for families to obtain such information and then be able to act on it by obtaining a court order to involuntarily hold people who have shown themselves as potentially dangerous.

Legislation in Congress filed by Rep. Timothy Murphy (R-Penn.), Congress’s only clinical psychologist (Congress needs many more of them!), would help. It would encourage states to commit severely mentally ill people to mental hospitals or mandatory outpatient treatment by, among other things, loosening the privacy rules to give families more actionable clinical facts about troubled relatives.

But unfortunately it fails to speak to the need to build more mental hospitals, both private and state-run. Far too many of the mentally ill will not cooperate in outpatient therapy, be it sessions with therapists and/or taking medication. The fact is that some people need to be committed for long periods, and some for the rest of their lives. And that’s what happens anyway. We use our prisons for this function; at least half of America’s huge jail population is mentally ill in varying degrees, with many out-and-out insane.

At the same time, laws should be changed to more clearly limit the ability of people declared by a judge to be mentally ill to buy guns. Further, there should be more legal mechanisms to let police obtain warrants to take firearms away from people deemed dangerous. (And, yes, I know that Elliot Rodger stabbed to death three of his victims. But it’s far easier and faster to kill people with guns than with any other weapon except of course with what a competent bomb maker could make.)  Look at the mass murders of recent years.) As it is, the police have remarkably little legal power to stop crazy people from perpetrating violent crimes.

Will any major reforms involving the interface of guns and the mentally ill actually be implemented? Yes, though it may take a few more massacres. Meanwhile, who will lead to the way to build more mental hospitals to hold and treat people for whom outpatient treatment may be insufficient? Liberals and some libertarians will complain about the threat to civil liberties, conservatives about the cost. But what about the right of citizens not to be imperiled by crazy people walking around, and what about the huge financial cost of law enforcement and incarceration for so many of these people?

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Thus we begin another summer. (I take June 1 as the real start of the season.) First comes lushness and freshness — “And what is so rare as a day in June?” asked James Russell Lowell, the 19th Century New England poet. He went on, in romantic (corny?) Victorian fashion:

Now is the high-tide of the year,

and whatever of life hath ebbed away

Comes flooding back with a ripply cheer,

Into every bare inlet and creek and bay;

Now the heart is so full that a drop overfill it

Then it gets grittier as we go into July and the lawns turn brown. Then comes a renewed freshness, almost a second spring, but with dimmer light and school-return anxiety (whatever your age) toward the end. Faster and faster comes Labor Day.

Robert Whitcomb (rwhitcomb51@gmail.com) oversees newenglanddiary.com.  He is a former Providence Journal editorial-page editor, former finance editor of the International Herald Tribune and former  managing editor of several newsletters on mental and behavioral health.