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The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens

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This author is not kidding...he really tells it as it is, but with a light touch that may miss the mark. State legislators need to be slammed up side the head to get their attention and I fear he is a little too politically correct. As the father of a middle-aged bi-polar daughter, I was blindsided by the impact of her disease. She is one of the lucky ones who found a qualified psychiatrist and medications that are working to keep her off the streets, but barely. Unless you experience the family impact of mental illness most people just walk on by. The civil rights lawyers and courts who curtailed mandatory treatment are the real criminals in this crisis and the author is too easy on them. Mental illness still is a great social taboo in this culture of control and cure. When neither are possible our government seems paralized to respond. Unfortunately, I fear that it will take a lot more homeless people and mentally ill criminal behavior to get the needed attention and reforms. But, hey, never forget that a few highly dedicated people can change things. Meantime, you suffer and hope. Read this book and get involved.

I am a psychiatric social worker and have been in the field for years. I think anyone who works in behavioral health should read this book. It clearly explores the relationship between the "deinstitutionalization" of the 1950s and 1960s and the relationship as those in mental hospitals were set free to fend for themselves in the community. The relationship unfolkds as the author explains how the population decline in state mental hospitals has been off-set by the soaring number of mentally ill men and women who are wandering the streets homeless, or are locked away in jails and prisons with little to no treatment.

By now, 50 or so years on, it's obvious shutting down mental hospitals was not the solution -- rather, improving conditions and quality of life in the hospitals was what was needed. The author cites hundreds of specific cases in which institutionalized men and women are set free -- to become victims, or to victimize. The community mental health clinic concept works for a certain segment of the mentally ill population. But, as I have seen and experienced on an almost daily basis, there are far too many chronically mentally ill people who have no insight into their illness and the need to take medication consistently, and thus suffer in poverty, filth, and psychic ghettos in the inner cities of America.

The once-hospitalized men and women have achieved the "freedom" lawyers and psychiatrists a generation ago sought. Sadly, to quote from "Me and Bobby McGee" -- freedom's just another word for nothing left to lose. Those of you who work with the men and women who live in run-down housing, eat out of trash cans, are a revolving door in emergency rooms and jail cells will know what I talking about. This book paints a grave picture of the state of public behavioral health's state of the union in the early part of the 21st Century. It's not an easy book to read, but perhaps it will inspire a few people to push for some changes, because the system's broken and it needs fixing -- bad!

E. Fuller Torrey has been one of the most astute commentators on the deinstitutionalization charade for decades. This is his best book. He takes the key states (California and Wisconsin) which contributed to the legislative and court changes to the involuntary commitment laws for people with mental disorders and traces them from their original passing (late 1960s and early 1970s) to the present. He uses case vignettes and journal articles to convey the consequences of the new legislation and court decisions respectively. The result is deeply disturbing and powerful. Torrey has been controversial for years but he is right on target. The solutions to this very problematic reality are extremely difficult. But talking about it is the beginning. This book is an excellent place to start.

At least one-third of America's homeless persons are severely mentally ill, while another one-tenth the population of jails and prisons are as well. About 25% of all severely mentally ill individuals living in the community are victims of violent crimes each year; this same group is responsible for at least 5% of all homicides.

Deinstitutionalization was a policy to move psychiatric patients out of public mental hospitals and place them in the community. The trend began after WWII, sparked by a series of exposes of dreadful conditions in state psychiatric hospitals and aided by the discovery of effective anti-psychotic drugs in the early 1950s. Unfortunately, essential after care in most places varied from inadequate to invisible.

Additional impetus came from the legal profession via logic that civil liberties were violated when patients were involuntarily treated in most cases, including refusing to take medications.

An estimated 4 million American adults have the most severe forms of psychiatric disorders - schizophrenia, bipolar disorder, and sever depression. The most severe 1% are the ones most in need of enforced treatment.

Relatively simple solutions that Torrey recommends include direct observation of medication-taking (backed up by required inpatient commitment if not complied with), the use of longer-lasting medications (eg. single injections that provide treatment over 3-4 weeks), and compilation of local statistics that reveal the true cost of untreated mental illnesses.

The Tuscon shootings have spurred serious questions about why the mentally-ill shooter was free. After 40 pages or so of alarming anecdotes, this book becomes a highly repetitive compilation of more alarming anecdotes documenting the horrific unintended consequences of emptying our mental institutions starting in the 1960's and moving forward. If you are looking for ways to change the status quo in the treatment of the seriously mentally ill while protecting families and society from the dangerous, current white papers online from any number of sources will better help you find solutions. This work served well in helping identify the problem, its genesis and current manifestations - but little to direct or crystalize any energy around needed, practical legal changes.

Picture a small county in Texas, 25,000 population, with only one special confinement cell and no specially trained sheriff's deputies.

Picture a severely bipolar young man, with other mental health diagnoses as well, such as PTSD, on parole from a manslaughter convictioon (he may or may not have committed) assaulting his mother and stepfather.

Picture him now locked away here, literally trying to bash his head against the walls. Add to the fact that the PTSD was prison induced, in part through prison rape, just as Dr. Torrey describes.

Picture a relatively sympathetic DA, and very sympathetic sheriff, hands tied do to lack of resources.

I don't have to "picture" it. I've reported on it.

What Dr. Fuller Torrey says is all so true.

Add in the Texas mental health system, which is one of the worst in the nation, as Torrey notes. A system lacking mental health beds in both the "outside" world and inside the criminal justice system.

We CAN do better, without going back to stereotyped days of the 1950s. We don't need hyper-civil libertarians (I am a card-carrying ACLU member myself), or Scientologists, telling us mental illness doesn't exist, or the severely mentally ill have freedom of choice when they don't even know who they are.

Somehow, some way, we must change our laws.

Dr. Fuller Torrey provides us with another sane plea to help "the insane" - those whom society has abandoned to homelessness and jail rather than to the medical treatment they so deserve. The US is not alone in its treatment of the victims of serious mental illness. What is seen in the US is repeated in most western countries with only a few exceptions.

A policy of deinstitutionalization has emptied our psychiatric hospitals while the actions of civil libertarian lawyers has allowed them to remain in the community even though they are too ill to make a rational decision. They are given the authority to refuse treatment when they do not have the capacity to understand that they are ill. These are the two main reasons for the situation we see today. Torrey points out that in 1955, the US population was 164 million and there were about 560,000 patients in psychiatric facilities. By 2006, the US population grew to 300 million. If the proportion of the population in mental institutions was the same as in 1955, there would be over one million hospitalized. Instead, the number is only 40,000.

The emptying of hospitals was initially done for humanitarian reasons and coincided with the development of better medication. Unfortunately, the medication was not as effective as initially hoped and those discharged were not provided with support or services in the community. Getting someone psychiatric care and into hospital was described by D. J Jaffe as more difficult than getting into Harvard Law School. That was in 1991 and Jaffe was a spokesperson for the New York City Friends and Advocates for the Mentally Ill. That same situation exists today.

Lawyers and civil libertarians quote John Stuart Mill's On Liberty for their reasons for allowing the mentally non competent to make treatment decisions. Mill said that "the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant."

At the time Mill wrote that, there were few effective medical treatments for anything let alone schizophrenia.

However, in the very next paragraph, Mill offers an exception for the above quoted assertion used by so many of the so called friends of the mentally ill. He says that "those who are still in a state to require being taken care of by others must be protected against their own actions as well as against personal injury."

Let us hope that Dr. Torrey's book and his activity to change the laws through the Treatment Advocacy Center will win out in the end.

Marvin Ross Author of Schizophrenia: Medicine's Mystery - Society's Shame

This is more of the same tired, emotional diatribe that has made Fuller Torrey a hit with the many families whose members have been failed by the mental health system. But not for the reasons he cites. An absence of adequate resources that make care easily accessible and managed is the major problem with the mental health system today.Difficult problems that beg for clear solutions are used by Torrey to fashion an attack on those who work to make the system accountable and keep the excesses of certain professionals in check. He also is very loose with his facts. For example, at p 170, conflating federal funding of legal services or protection and advocacy with state funded and constitutionally mandated public defenders is just factually wrong, and legally wrong headed.

I found the book "THe Insanity Offense" very interesting and informative
when it came to the historical facts of why so many of the mentally ill
were turned back into the community without adequate resources to rely on
during the Reagan years. Regarding alternative treatment of the mentally ill other then what conventional medicine has to offer I felt his
perspective was very lacking. His descriptive analysis of what the
concept of " treatment" was needed to be more informative. He did
reveal the fall out of what a happens to so many of the mentally ill
in an indifferent and callous society. He could have offered more
valid solutions to the problem or offered information of successful
projects or programs that have helped get the mentally ill off of
the streets and into alternative treatments.

I knew nothing about Schizophrenia or the disaster well intended liberals and fiscal conservatives created when they released the mentally ill onto America's streets,before reading this most informative book.