My adult son suffered from severe bipolar disorder. During his first manic episode in January 1994, while he lived in northern Virginia, he became psychotic, paranoid, and lost touch with reality. He developed an unhealthy fixation for the president and made many attempts to get into the White House for what he actually thought were scheduled meetings with President Bill Clinton.
But he was in denial that anything was wrong with him. It took the assault of a police officer to get him committed. He spent his 27th birthday in a padded cell in the psychiatric ward at a Virginia hospital. He was diagnosed with bipolar disorder and transferred to a mental hospital where, after six weeks of involuntary commitment and forced meds, he recovered and resumed his life. Six years later, when he stopped taking his meds, he suffered a second psychotic break, this time fixating on President George W. Bush. He claimed he was in possession of very important information for both these presidents and he needed to share it. As seems to be the case with the two alleged White House fence-jumpers this month, Dominic Adesayana and Omar Gonzalez, his sickness propelled him there.
After 9/11, my son told his family he had obtained a top secret security clearance at the White House, that the FBI had issued him a special gun permit, and that he was exercising his constitutional right to purchase a gun. Several days later, he showed up at the White House and told the Secret Service he was there for his scheduled appointment with Bush. I became very concerned for his and everyone else’s safety. What would Secret Service do if they ever encountered him? Were they trained to distinguish between a terrorist and a mentally ill person?
So in January 2002, I called the Secret Service and told them about my son’s mental illness. On the phone with an agent, I described his obsession with Bush, his many attempt to enter the White House, and my concern for his safety. The agent, who was sympathetic, consulted his records and confirmed that my son’s name was not on a danger list, which meant that he always left the premises when instructed to do so. My next question was, “What happens if, next time, he refuses to leave and makes a run for the White House fence?”
How very sad that in this country we allow individuals with serious mental illness to commit crimes before we treat them.
Most people who try to enter the White House without permission, he told me, suffer from mental illness. Nevertheless, it is the job of the Secret Service to protect the president, and his colleagues were sworn to do so at all costs, he said. He told me the agents would first shoot my son with rubber bullets. If that didn’t stop him, they would use a Taser on him. If that didn’t take him down, they would be forced to shoot him in one or both of his legs to immobilize him.
I was flummoxed by how familiar the Secret Service was with this sort of threat. How very sad that in this country we allow individuals with serious mental illness to commit crimes before we treat them. Mr. Gonzales, an Army veteran, who is charged with recently scaling the White House fence with a knife in his possession, suffered from post-traumatic stress, according to his family.
State laws vary, but all states set strict controls on involuntary hospitalization, limiting it to circumstances when a person is an imminent danger to self or others, or likely to become so. These laws give people with severe mental illness the right to decide when, where, how, or even if they will receive treatment. Today’s laws, although well intended, were mostly written decades ago, in response to an era when doctors and hospitals had broad control over patients lives. Mental institutions, as they were called then, became a dumping ground not only for the mentally ill, but for the disabled, the handicapped, and the elderly. Eventually a public outcry led to laws forbidding the state from forcing treatment or medications on mentally ill people. Once you turn 18, you have a civil right to refuse treatment and remain mentally ill.
Yet some serious mental illnesses make it difficult for sick people to assess their own need for treatment. Families watch their loved ones descend, sometimes slowly, into Code Red territory, but current laws do not allow them to push help onto a deteriorating person until he or she reaches crisis stage. Only when a sick person becomes a danger, as determined by a judge at a commitment hearing, can he or she be committed. But by this time, it is sometimes too late. Sometimes the best way to neutralize a threat (and prevent a tragedy) is to preempt it.
On the federal level, the approach “to mental health is a chaotic patchwork of antiquated programs and ineffective policies across numerous agencies,” as Rep. Tim Murphy (R-Pa.) has put it. When patient rights exceed necessary protections, individuals with severe untreated mental illness can die because we’ve protected their civil liberties to remain mentally ill and refuse treatment. Many—like my son, who committed suicide on his third attempt in 2007—do die. Sometimes they harm others along the way. The tragic shooting at the Washington Navy Yard, the movie theater attack in Aurora, Colo., the assassination attempt against Gabby Giffords, and the Virginia Tech massacre all involved mentally ill assailants who badly needed treatment.
Mental illness is not going away. We must find a balance between protecting the rights of mentally ill people and also getting them the treatment they require to recover and not be a threat to society. Murphy has introduced a bill, the “Helping Families in Mental Health Crisis Act,” that does just that. It would require states to have commitment criteria broader than “dangerousness” in order to receive Community Mental Health Services Block Grant funds. It would clarify HIPPA to assure caregivers are able to receive protected health information when necessary to safeguard the well-being of a patient or the safety of another. It would require states to have “assisted outpatient treatment” laws. AOT is for a small segment of the most seriously mentally ill individuals who have accumulated multiple episodes of homelessness, hospitalization, arrest, or violence associated with not taking their medications. AOT allows judges to order them to stay in six months of mandated and monitored treatment while living in the community. My son would have been a perfect candidate.
Families for decades have had to work within the constraints of our broken, dysfunctional mental-health system that fails the sickest – those people who need treatment the most, but are too sick to recognize their illness, and refuse treatment. This bill addresses the obstacles families face when trying to save loved ones from untreated serious mental illness. It would expand access to treatment for individuals who miss out on mental-health services because they are too ill to seek them. It will lead to treatment before tragedy.