American Psychosis by M. D. Torrey Executive Director E Fuller Read Free Book Online

example, Henry Lee Brown, with untreated schizophrenia, drifted between Mississippi, Georgia, South Carolina, Ohio, Texas, and California, “living in homeless shelters and serving jail time in mental hospitals for bizarre crimes that were increasingly violent” for 20 years before he was killed by police. 41
The problem, of course, is confidentiality laws that prohibit the disclosure of psychiatric information. Such laws have become increasingly stringent during the same years in which untreated mentally ill individuals have increasingly flooded the community. The privacy laws have been used by mental health agencies to protect themselves when things go wrong, as they increasingly do. As one observer noted: “One of the problems inthis entire realm is that of state/private agencies constantly taking the Fifth Amendment against self-incrimination by hauling out ‘patient confidentiality’ to say nothing at all.” It is not the patient who is usually being protected but, rather, the agency. 42
There are indications that our obsession with psychiatric privacy and confidentiality may be ameliorating somewhat, as we weigh the needs of individuals against those of society at large. In May 2011, the governor of Kansas signed a bill “that allows police to get more information on a suspect’s mental health. . . . The new law is intended to give police the information they need to take mentally ill offenders someplace where they can be treated rather than to jail.” That same month in Albuquerque, the chief of police announced that “the department is working towards building a database to catalogue where mentally ill people live . . . based on information voluntarily provided by family members.” This announcement followed yet another fatal encounter between a mentally ill man and a policeman. States have supported sex offender registries, available to the public, for many years and are now in the process of introducing public registries for first-degree murderers and drunken drivers. Given this trend toward making more information about potentially dangerous individuals more publicly available, the Kansas law is likely to be replicated in other states. 43
9. In selected cases, psychiatric information on mentally ill individuals who have a history of dangerousness should be made available to law enforcement personnel, because they are now the frontline mental health workers.
The final lesson that has been learned from the past half-century of amorphous and anarchic public psychiatric services is the most important—somebody must be held ultimately accountable. Until the passage of the 1963 legislation creating the federally funded community mental health centers, states had for over a century been ultimately responsible for mental health services. Responsibility was clearly assigned, and if things went wrong, people knew in which direction to point.
All that changed after 1963, when federal officials began funding local mental health agencies directly, without going through the states. The clear message was that states were no longer responsible, which was fine with them. The states proceeded to empty their state hospitals and shift the fiscal burden to the new Medicaid and other federal programs. The states thus rapidly proved the veracity of John Talbott’s warning in his 1978 book The Death of the Asylum : “Society will shuck off responsibility both for the state hospital system and the chronically mentally ill if given half a chance.” 44
The withdrawal of state responsibility for mental health services created a vacuum in accountability that continues to exist today. NIMH officials were happy to give awayfederal funds but had little ability and even less interest in monitoring how the funds were spent. Realistically, there was little capacity at the federal level to oversee the expenditure of federal funds in centers that were geographically spread from southern Florida to northern Alaska, which is why so many of