M
Miklos
Strong Medicine
A Doctor's Fight: More Forced Care For the Mentally Ill --- Torrey's
Push for State Laws Sparks Growing Debate Over Rights of Patients ---
Mr. Hadd Goes Underground
By Mark Fritz
1 February 2006
Copyright The Wall Street Journal
Every other week, Jeff Demann drives to a clinic in rural Michigan,
drops his pants and gets a shot of an antipsychotic drug that he says
makes him sick.
"If I don't show up, the cops show up at my door and I wind up in a
mental ward," says the unemployed 44-year-old, who lives on disability
in Holland, Mich.
Mr. Demann's routine reflects a national trend toward forcing people
with psychotic tendencies to get treatment -- even if they haven't
committed violent acts. Driving the trend are E. Fuller Torrey, a
68-year-old maverick psychiatrist who believes the laws help prevent
crime, and memorabilia mogul Ted Stanley, who has contributed millions
of dollars to the cause.
Dr. Torrey keeps an online database with hundreds of grisly anecdotes
about mentally ill people who killed the innocent. They include a
jobless drifter who pushed an aspiring screenwriter in front of a
subway train and a farmer who shot a 19-year-old receptionist to
death. Influenced by such stories, Michigan, New York, Florida and
California are among the states that have toughened their
mental-health treatment laws since 1998, when Dr. Torrey formed the
Treatment Advocacy Center to lobby for forced care.
The laws have become the subject of a heated debate among
mental-health specialists, with some seeing a threat to civil rights.
"There should be a high standard before you take someone else's
liberty," says Tammy Seltzer, senior staff attorney for the Bazelon
Center for Mental Health Law, a Florida nonprofit group that has
fought the Treatment Advocacy Center in statehouses nationwide. Others
say the connection between mental illness and violence isn't as
well-established as Dr. Torrey's anecdotes imply.
Mary Zdanowicz, executive director of Dr. Torrey's center, retorts
that such opponents "want to preserve a person's right to be
psychotic."
It has long been common for states to compel people to undergo
psychiatric evaluation after they have committed acts of violence. If
mental illness is confirmed, they are likely to end up in the
psychiatric ward of a prison or hospital.
Dr. Torrey was a key adviser to the National Alliance on Mental
Illness when it began lobbying in the early 1980s for laws that would
permit states to impose treatment on people even if they hadn't done
something violent. The number of states to adopt such laws has jumped
from 25 in 1998 -- when Dr. Torrey and Mr. Stanley created their own,
more aggressive organization -- to 42 currently. Those targeted by the
laws usually are people picked up for behaving strangely in public,
threatening family members, or refusing to take prescribed medication
after being released from a psychiatric ward.
The laws are enforced haphazardly, sometimes because of inadequate
funding or opposition from mental-health activists. Implementation
varies not just from state to state, but from county to county and
judge to judge. Many mental-health departments already are
overburdened with existing patients and have little interest in
pushing police to round up more people to throw into the system.
It isn't clear whether the laws have led to an increase in the number
of people receiving forced care. Roughly 250,000 people in 1997 who
weren't institutionalized or jailed were forcibly evaluated, monitored
and sometimes medicated, according to federal statistics. Federal
health officials have begun a six-month study to update that figure.
California passed a forced-treatment law in 2003 after Dr. Torrey's
group pushed for it but has yet to use it on anyone. Researchers say
only about eight to 10 states frequently use their laws. Still, it is
clear that Dr. Torrey's movement marks a shift in how the U.S. treats
the mentally ill.
Beginning in the 1950s, the emergence of behavior-stabilizing
medications helped spur a 40-year movement to shut down huge asylums
and free their inhabitants. Emptying institutions was supposed to be
accompanied by the creation of community-based mental-health programs,
treatment centers, and housing and job opportunities.
But local programs didn't have the money, political will or expertise
to handle the deluge. The result was a flood of mentally ill people on
the streets and in jails.
In recent years, governments have spent more on community-based
programs and a raft of new antipsychotic drugs have come on the
market. Still, many mentally ill go without care, either because there
isn't a program to treat them or because they don't want help.
Dr. Torrey, whose sister suffers from schizophrenia, was working as a
psychiatrist at St. Elizabeth's Hospital in Washington, D.C., in the
1970s when the district enacted one of the earliest involuntary
outpatient programs. Before the law, patients were discharged dozens
of times with medication, which they quickly threw away, Dr. Torrey
says. With the law, he says, "we would have guys come in for an
injection."
The author of 15 books and hundreds of papers, Dr. Torrey was an
assistant to the director for the National Institute of Mental Health
and worked at a mental-health clinic for the homeless for 15 years. He
is well-known in psychiatry for his iconoclastic views on a range of
subjects. He has theorized that schizophrenia is an infectious disease
triggered by environmental factors.
One of Dr. Torrey's books on schizophrenia caught the eye of a wealthy
businessman, Ted Stanley, whose son, Jonathan, became delusional
during college and later was diagnosed with bipolar disease.
Jonathan Stanley says he accosted people on the street and believed he
was being trailed by Naval Intelligence. He says he was arrested when
he stood naked atop a milk crate in a Manhattan diner, trying to avoid
the lethal radiation he thought was bombarding him from a satellite
dish across the street.
A Doctor's Fight: More Forced Care For the Mentally Ill --- Torrey's
Push for State Laws Sparks Growing Debate Over Rights of Patients ---
Mr. Hadd Goes Underground
By Mark Fritz
1 February 2006
Copyright The Wall Street Journal
Every other week, Jeff Demann drives to a clinic in rural Michigan,
drops his pants and gets a shot of an antipsychotic drug that he says
makes him sick.
"If I don't show up, the cops show up at my door and I wind up in a
mental ward," says the unemployed 44-year-old, who lives on disability
in Holland, Mich.
Mr. Demann's routine reflects a national trend toward forcing people
with psychotic tendencies to get treatment -- even if they haven't
committed violent acts. Driving the trend are E. Fuller Torrey, a
68-year-old maverick psychiatrist who believes the laws help prevent
crime, and memorabilia mogul Ted Stanley, who has contributed millions
of dollars to the cause.
Dr. Torrey keeps an online database with hundreds of grisly anecdotes
about mentally ill people who killed the innocent. They include a
jobless drifter who pushed an aspiring screenwriter in front of a
subway train and a farmer who shot a 19-year-old receptionist to
death. Influenced by such stories, Michigan, New York, Florida and
California are among the states that have toughened their
mental-health treatment laws since 1998, when Dr. Torrey formed the
Treatment Advocacy Center to lobby for forced care.
The laws have become the subject of a heated debate among
mental-health specialists, with some seeing a threat to civil rights.
"There should be a high standard before you take someone else's
liberty," says Tammy Seltzer, senior staff attorney for the Bazelon
Center for Mental Health Law, a Florida nonprofit group that has
fought the Treatment Advocacy Center in statehouses nationwide. Others
say the connection between mental illness and violence isn't as
well-established as Dr. Torrey's anecdotes imply.
Mary Zdanowicz, executive director of Dr. Torrey's center, retorts
that such opponents "want to preserve a person's right to be
psychotic."
It has long been common for states to compel people to undergo
psychiatric evaluation after they have committed acts of violence. If
mental illness is confirmed, they are likely to end up in the
psychiatric ward of a prison or hospital.
Dr. Torrey was a key adviser to the National Alliance on Mental
Illness when it began lobbying in the early 1980s for laws that would
permit states to impose treatment on people even if they hadn't done
something violent. The number of states to adopt such laws has jumped
from 25 in 1998 -- when Dr. Torrey and Mr. Stanley created their own,
more aggressive organization -- to 42 currently. Those targeted by the
laws usually are people picked up for behaving strangely in public,
threatening family members, or refusing to take prescribed medication
after being released from a psychiatric ward.
The laws are enforced haphazardly, sometimes because of inadequate
funding or opposition from mental-health activists. Implementation
varies not just from state to state, but from county to county and
judge to judge. Many mental-health departments already are
overburdened with existing patients and have little interest in
pushing police to round up more people to throw into the system.
It isn't clear whether the laws have led to an increase in the number
of people receiving forced care. Roughly 250,000 people in 1997 who
weren't institutionalized or jailed were forcibly evaluated, monitored
and sometimes medicated, according to federal statistics. Federal
health officials have begun a six-month study to update that figure.
California passed a forced-treatment law in 2003 after Dr. Torrey's
group pushed for it but has yet to use it on anyone. Researchers say
only about eight to 10 states frequently use their laws. Still, it is
clear that Dr. Torrey's movement marks a shift in how the U.S. treats
the mentally ill.
Beginning in the 1950s, the emergence of behavior-stabilizing
medications helped spur a 40-year movement to shut down huge asylums
and free their inhabitants. Emptying institutions was supposed to be
accompanied by the creation of community-based mental-health programs,
treatment centers, and housing and job opportunities.
But local programs didn't have the money, political will or expertise
to handle the deluge. The result was a flood of mentally ill people on
the streets and in jails.
In recent years, governments have spent more on community-based
programs and a raft of new antipsychotic drugs have come on the
market. Still, many mentally ill go without care, either because there
isn't a program to treat them or because they don't want help.
Dr. Torrey, whose sister suffers from schizophrenia, was working as a
psychiatrist at St. Elizabeth's Hospital in Washington, D.C., in the
1970s when the district enacted one of the earliest involuntary
outpatient programs. Before the law, patients were discharged dozens
of times with medication, which they quickly threw away, Dr. Torrey
says. With the law, he says, "we would have guys come in for an
injection."
The author of 15 books and hundreds of papers, Dr. Torrey was an
assistant to the director for the National Institute of Mental Health
and worked at a mental-health clinic for the homeless for 15 years. He
is well-known in psychiatry for his iconoclastic views on a range of
subjects. He has theorized that schizophrenia is an infectious disease
triggered by environmental factors.
One of Dr. Torrey's books on schizophrenia caught the eye of a wealthy
businessman, Ted Stanley, whose son, Jonathan, became delusional
during college and later was diagnosed with bipolar disease.
Jonathan Stanley says he accosted people on the street and believed he
was being trailed by Naval Intelligence. He says he was arrested when
he stood naked atop a milk crate in a Manhattan diner, trying to avoid
the lethal radiation he thought was bombarding him from a satellite
dish across the street.
I love it - especially the tattoo! No stigma with taking a daily dose of a medication (notwithstanding any stigmas associated with tattoos!). Would we pharmacists add tattooing as an additional dispensing option or is the "parlor located" in medical offices. Don't limit yourself - how about piercings? - just think about the possibilities! 
