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IT'S NOT TOO LATE: JOIN VOR IN WASHINGTON, D.C. IN JUNE:
VOR 2007 Annual Meeting and Washington Initiative. See -
http://www.vor.net/VORAnnualMeeting2007.htm for complete details, including
a registration form.
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VOR is the only national organization advocating for a full range of
residential and support options for people with mental retardation,
including Medicaid-certified Intermediate Care Facilities for the Mentally
Retarded (ICFs/MR) and home and community-based care. VOR supports choice.
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VOR Weekly E-Mail Update
May 4, 2007
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1. About This Issue
2. Mental-Health Lawyers Caution Colleges Against Disciplining Students
for Emotional Difficulties
3. Statement by the Bazelon Center on Student Mental Health Issues
4. Bedlam Revisited: Why the Virginia Tech Shooter Was Not Committed
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1. About This Issue
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First and foremost, VOR expresses our deepest sympathies to the families,
friends and peers of those students and staff that perished at Virginia
Tech during the recent tragedy.
Although VOR has not issued an official position in response to this
situation, many VOR members have noted obvious parallels regarding our own
advocacy relating to access to necessary services for people with mental
retardation and developmental disabilities, and the "what if"question that
continues to swirl around Seung-Hui Cho and the treatment he needed, but
did not receive, and why.
This update will present three articles which speak to different facets of
the resulting debate. The first two statements, issued by the Chronicle of
Higher Education and the Bazelon Center, offer worthy cautionary
statements, warning against "knee-jerk" discrimination against students and
other citizens with mental illness -- discrimination which, unless we guard
against it, seems almost certain in the wake of this unprecedented tragedy.
As noted by the Chronicle of Higher Education, "Violent behavior is rare
among people with mental illness. . . Students should feel comfortable
seeking counseling without worrying that their colleges will discipline
them." Likewise, the Bazelon Center states, "[S]chools should take actions
to de-stigmatize mental illness, encourage students to seek help early,
remove barriers to seeking treatment, and ensure that students will not be
penalized when they ask for help."
The final article in this Update is an editorial written by psychologist,
Dr. Jonathan Kellerman who recounts the history of the
deinstitutionalization of the mentally ill. Dr. Kellerman suggests that in
our well-meaning pursuit of protecting personal liberties in response to
the unconscionable wrongs of our history relating to involuntary
commitments - a time when society "locked someone up" just because they
were a bit eccentric - that we ended up going too far ("this was
baby-and-bathwater time"). The outcome of pursuing personal liberty at all
costs, argues Dr. Kellerman, is homelessness, victimization of severely
mentally ill persons, and in very rare cases, violence against others.
Whether speaking specifically to the facts of the Virginia Tech tragedy or
the broader advocacy issues that this situation raises, the answer is not
black and white but lies somewhere in the middle. The system should not
institutionalize every person - or even most people - with mental illness
or mental retardation. The system should be responsive to need and offer
treatment and services in the setting most appropriate to those needs. For
most, whether in the context of mental illness or mental retardation, the
care needed is "out patient," community integrated supports. For others,
however, intensive, 24 hours, 7 days a week support is required to maintain
an individual's health and overall well-being. Treatment based on
individual need - a common sense notion and what VOR has been saying all
along.
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2. Mental-Health Lawyers Caution Colleges Against Disciplining Students
for Emotional Difficulties
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For more information: http://chronicle.com
By Sara Lipka
Chronicle of Higher Education
April 27, 2007
College administrators should be careful not to discriminate against
troubled students in response to Seung-Hui Cho's shooting rampage at
Virginia Tech, psychologists and lawyers said at a news briefing on
Thursday.
Violent behavior is rare among people with mental illness, said Robert
Bernstein, a psychologist and executive director of the Judge David L.
Bazelon Center for Mental Health Law, which sponsored the briefing.
Students should feel comfortable seeking counseling without worrying that
their colleges will discipline them, said Karen A. Bower, a senior staff
lawyer for the center.
The Bazelon Center represented students in two recent high-profile lawsuits
against colleges that had suspended the students' privileges based on
mental-health concerns. Last summer Hunter College of the City University
of New York settled a lawsuit with an anonymous female student who had been
barred from campus housing after an overdose of Tylenol landed her in the
hospital (The Chronicle, August 24, 2006). In October, George Washington
University settled a lawsuit with Jordan Nott, a student it had suspended
after he sought treatment for depression (The Chronicle, November 1, 2006).
Lawyers for the Bazelon Center worry that the Virginia Tech incident will
prompt similar actions against troubled students. The university has drawn
sharp criticism for how it handled Mr. Cho despite evidence of his
mental-health problems.
"We do have a concern that colleges will continue this trend of what we see
as overreacting and placing students on involuntary leave," Ms. Bower said.
Many students prefer to be treated for mental illnesses while at college
rather than being removed from the campus, she said.
Two main misimpressions prevent colleges from doing the right thing when it
comes to dealing with troubled students, said Ira Burnim, the center's
legal director. For one, he said, administrators think that the more they
try to support such students, the greater their institutional liability
will be. Administrators also think they can use rules that prohibit
students from engaging in "endangering" behavior, for example, to remove
those who have mental illnesses. Both views reflect incomplete
understanding of the law, he said.
Colleges' various policies on students' mental health show that the
institutions are just beginning to navigate that terrain, Mr. Burnim said.
The Bazelon Center plans to release soon a model policy that would
encourage students to seek treatment and ensure that any disciplinary
action is based on dangerousness and not discrimination, said Ms. Bower.
In response to the persistent question being raised of how Mr. Cho's attack
might have been prevented, Mr. Bernstein, the executive director, did not
criticize the counseling center at Virginia Tech but instead cited a
mental-health-service industry that is in "shambles."
"The public system is supposed to be the safety net," he said. "But unless
and until a crisis occurs, the system won't respond."
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3. Statement by the Bazelon Center on Student Mental Health Issues
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About the Bazelon Center: See http://www.bazelon.org
Washington DC, April 24, 2007 -- The Bazelon Center wishes to express its
deepest sympathies to the families, friends and peers of the Virginia Tech
shooting victims. In the wake of this tragedy, many students may suffer
emotional distress. It is critically important that counseling and other
mental health services be available to them and that they feel safe asking
for help. Seeking help is often difficult.
The goal of campus policies should be to maximize the likelihood that
students who require mental health treatment receive it and to ensure that
their problems not reach crisis proportions before services become
available. To that end, schools should take actions to de-stigmatize mental
illness, encourage students to seek help early, remove barriers to seeking
treatment, and ensure that students will not be penalized when they ask for
help. Unfortunately, some schools have created a paradox for students in
need: while encouraging students who struggle with mental health problems
to seek assistance, the school administration then applies disciplinary
measures when students take this difficult step, in an effort to remove
mental health problems from the campus. Last year, the Bazelon Center
represented a George Washington University student who voluntarily sought
hospital treatment for depression and then faced disciplinary action by the
university administration and was suspended from school. In another suit,
we represented a Hunter College student who voluntarily admitted herself to
the hospital for treatment of depression and as a consequence was locked
out of her dorm room by the college administration.
By responding in such a way, schools create an appalling dilemma for
students in crisis: either jeopardize their education by asking for help or
forego needed mental health treatment. Such approaches may actually
increase the risk of harm by discouraging students from getting help for
themselves or their friends. The Bazelon Center's successful representation
of students who have been punished for getting mental health care is aimed
at breaking down this shameful obstacle. In the wake of the Virginia Tech
tragedy, the Bazelon Center urges that educational institutions do all they
can to identify and to remove barriers to youths' getting help. We feel
strongly that meaningful remedies rest not in abruptly diluting legal
protections for people with mental health needs, but in addressing the
enormous gaps in service availability.
All students should know whom to call when they or their fellow students
are in trouble and should have ready access to counseling and other
support. Moreover, mental health programs need to work
in partnership with schools to make mental health service readily
available, including getting out of their clinics and reaching out to
students who are at obvious risk.
One can only hope that this tragedy will focus constructive attention on
how difficult it is for youth to connect with the help they need.
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4. Bedlam Revisited: Why the Virginia Tech Shooter Was Not Committed
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About the author: Dr. Kellerman is clinical professor of pediatrics and
psychology at USC's Keck School of Medicine and the author of 27 crime
novels and three books on psychology, including "Savage Spawn: Reflections
on Violent Children" (Ballantine, 1999). His current novel is "Obsession"
(Ballantine, 2007).
By Jonathan Kellerman
Wall Street Journal OP ED
April 23, 2007
I was in graduate school, studying clinical psychology when they began
shutting down the asylums. The place was California, the time was the early
1970s, and "they" were an unprecedented confederation of progressives,
libertarians, and fiscal conservatives.
From the left marched battalions of self-styled mental health "liberation
activists" steeped in the writings of Scottish psychiatrist R.D. Laing.
Though he denied being opposed to his own profession, Laing's notion that
madness could be a reasonable reaction to an unjust society, or even a
vehicle for spiritual transformation, helped fuel the anti-psychiatry
movement of the post Love-In era. The most radical of Laingians carried
revisionism one step further: Not only wasn't psychosis a bad thing, it was
evidence of a superior level of consciousness.
The libertarians were fueled by Thomas Szasz, an iconoclastic psychiatrist
who was, and remains, an outspoken foe of virtually every aspect of his
chosen specialty. Hungarian-born in 1920, and witness to vicious state
exploitation of medical practice by the Nazis and the communists, Dr. Szasz
pushed an absolutist dogma of individual choice, finding ready converts
among members of the Do-
Your-Own-Thing generation. Though his early essays offered much-needed
critiques of the Orwellian nightmares that can result when autocracy
corrupts health care, Dr. Szasz devolved into something of a psychiatric
Flat-Earther, insisting in the face of mounting contrary evidence that
mental illness simply does not exist.
Currently, he serves on a commission cofounded with the Church of
Scientology, that purports to investigate human rights violations
perpetrated by mental health professionals.
Accepting the arguments of the liberationists and the libertarians at face
value led to the assertion that no matter how bizarre, disabling or
life-threatening a person's hallucinations and delusions, involuntary
treatment was never called for. And to the assertion that violation of that
premise created yet another class of political prisoners.
While moderate members of the anti-asylum movement were willing to concede
that psychosis might pose difficulties for a few individuals, they insisted
that society had no more right to force psychoactive drugs upon mental
patients than it did to hold down diabetics for insulin injections. If
treatment was to be offered, it needed to be consensually contracted
between caregivers and care-recipients on an outpatient basis. That fit
perfectly with the sensibilities of conservative scrooges searching for
ways to cut the state budget, and all too happy to dismantle a massive
state hospital system denigrated as inefficient at best and inhumane at
worst. The replacement chosen was an untested, less costly treatment model:
the community mental center.
How nice that everyone agreed.
Everyone, that was, except for many families of hospitalized,
hopelessly-decompensated, often self-destructive and occasionally violent
psychotics. They'd lived with the reality of severe mental illness and
wondered what "freedom" would bring. But there weren't enough of these
families to matter.
Were the state hospitals wretched nightmare-palaces straight out of "One
Flew Over the Cuckoo's Nest"?
A few were. But many were well-run institutions for patients in wretched
circumstances, providing optimal care within the limitations of what
constituted psychiatric treatment at that time: a handful of poorly
understood psychotropic drugs and supportive talk-therapy. Perhaps more
important, they offered clean beds and three squares a day, which led to
them being belittled as warehouses. But the protective environment of the
best state hospitals has yet to be improved upon, or even matched.
No matter, this was baby-and-bathwater time.
When I entered graduate school in 1972, so pervasive was the push to
deinstitutionalize that a newly minted course was added to the mandatory
curriculum: Community Psychology, a cobbled-together
travesty that stood apart from all my other coursework due to its emphasis
on polemics and aversion to science.
The basic premise of Community Psych--that severely mentally ill people
could be depended on to show up for treatment voluntarily--never made sense
to me. The core of the most common and debilitating psychosis,
schizophrenia, is degradation of thought and reason. So the idea that
people with fractured minds could and would make rational, often complex
decisions about self-care seemed preposterous.
One day, I voiced that opinion in class, questioning if any mechanisms were
being set in place to prevent a flood of schizophrenics from ending up on
the streets, homeless, helpless, victims of crime and, in some cases,
victimizers. The Community Psych professor--one of the
liberationists--responded with a patronizing smile and a folksy account of
the success of a program in rural Belgium or some such place, where humble
working folk created a therapeutic milieu by volunteering to house
psychotics in their humble homes and everything ended up peachy.
I didn't challenge what amounted to flimsy anecdotal data, but I did
question its relevance to the plight of thousands of severely mentally
disabled individuals set loose in vast urban centers. The professor's smile
tightened and he changed the subject; and I resolved to get through this
joke of a prerequisite and concentrate on becoming the best psychologist
possible.
By the time I received my doctorate in 1974, the doors to many of the
locked wards had been flung open and the much vaunted community mental
health centers were being built--predominately in low-rent neighborhoods. A
few years later, government funding for these allegedly humane treatment
outposts had been cut, as yet more fiscal belt-tightening was inspired by
findings that they didn't work.
Because crazy people rarely showed up for treatment voluntarily, and when
they did, the treatment milieu consisted of queuing up interminably at
Thorazine Kiosks.
And now we had a Homeless Problem.
And everyone was astonished.
Estimates vary but there's no doubt that a significant percentage of people
living on heating vents, pushing their belongings in shopping carts,
squatting in city parks and immersed in the squalor of tent cities suffer
from severe mental disease. And their psychosis is often exacerbated by
drug and alcohol abuse--what is, essentially, a regimen of self-medication
that should make a Szaszian proud.
Many of these unfortunates end up as victims of violent crimes. A few
become victimizers and when they do, watch out. For though it is true that
schizophrenics are responsible for a proportionally lower rate of violent
offenses than the general population (because many forms of the disease
engender passivity and physical inactivity), when crazy people do act out
the results are often horrific: bloody spree killings ignited by paranoid
thinking and the angry urgings of internal voices.
Which brings us to outrages such as the Virginia Tech massacre.
Diagnosis from afar is the purview of talk-shows hosts and other
charlatans, and I will not attempt to detail the psyche of the Virginia
Tech slaughterer. But I will hazard that much of what has been reported
about his pre-massacre behavior--prolonged periods of asocial mutism and
withdrawal, irrational anger and hatred, bizarre writing and speech--is not
at odds with the picture of a fulminating, serious mental disease. And his
age falls squarely within the most common period when psychosis blossoms.
No one who knew him seems surprised by what he did. On the contrary, dorm
chatter characterized him explicitly as a future school-shooter. One of his
professors, the poet Nikki Giovanni, saw him as a disruptive bully and
kicked him out of her class. Other teachers viewed him as disturbed and
referred him for the ubiquitous "counseling"--an outcome that is ambiguous
to the point of meaninglessness and akin to "treatment" for a patient with
metastasized cancer.
But even that minimal care wasn't given. The shooter didn't want it and no
one tried to force him to get it. While it's been reported that he was
involuntarily committed to a "Behavioral Health Center" in December 2005,
those reports also say he was released the very next morning. Even if the
will to segregate an obvious menace had been in place, the legal mechanisms
to provide even temporary "warehousing" were absent. The rest is terrible
history.
That is not to say that anyone who pens violence-laden poetry or lets slip
the occasional hostile remark should be protectively incarcerated. But when
the level of threat rises to college freshmen and faculty prophesying
accurately, perhaps we should err on the side of public safety rather than
protect individual liberty at all costs.
If the Virginia Tech shooter had been locked up for careful observation in
a humane mental hospital, the worst-case scenario would've been a minor
league civil liberties goof: an unpleasant semester break for an odd and
hostile young misanthrope who might've even have learned to be more polite.
Yes, it's possible confinement would've been futile or even stoked his
rage. But a third outcome is also possible: Simply getting a patient
through a crisis point can prevent disaster, as happens with suicidal
people restrained from self-destruction who lose their enthusiasm for
repeat performances.
At the very least, in a better world, time spent on psychiatric watch
could've been used to justify placing the Virginia killer on a no-buy gun
list. I'm not naive enough to believe that illegal firearms aren't within
reach for anyone who really wants them, but just as loud dogs deter
burglars and crime rates drop during harsh weather, sometimes making life
difficult for a would-be criminal is enough.
But all this remains in the realm of fantasy. Penning up and carefully
scrutinizing the killer was never an option. Not in Virginia or California
or any other state in the union. Because in our well-intentioned quest to
maximize personal liberty, we've moved conceptual eons away from taking the
concept of dangerousness seriously.
The best predictor of future violent behavior is past violent behavior, yet
we regularly grant parole to murderers, serial rapists, chronically
assaultive individuals and habitual pedophiles. Even when we do attempt to
segregate low-impulse multiple offenders with effective tools such as with
three-strikes laws, liberationist clamor never ceases.
Talk to anyone who's tried to commit a dangerously violent child or parent
for even a few days: A stranger with a law degree will show up at the
hearing and paint you as a fascist. So it's far too much to expect anything
resembling a decisive approach to those whose level of threat remains at
the verbal level.
Given the excesses of the past--husbands committing troublesome wives,
involuntary sterilization of those judged defective--extreme caution is
warranted. But like drunk drivers, we sway from one side of the legal road
to the other and find the sensible center lane elusive.
Unless we confront the unpleasant fact that the brains of a small
percentage of our citizens incubate dark, disturbed thoughts that can
blossom into vicious behavior, we can look forward to repeats of last
week's outrage.
________________________________________________________________
Tamie Hopp
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