Last week, DC police forcefully entered a man’s home and fatally shot him, twice. Jean Louis, a mentally ill 55-year-old, had resided in the same apartment for over thirty years. His neighbors knew him to be alternately friendly and erratic, but on the day of his death, he had neither hurt anyone nor committed a crime. In fact, he had been attempting to ward off mental health authorities, resisting residential treatment. When police arrived on the scene, he allegedly used a self-sharpened screwdriver to keep them at bay, locking himself in his home and lunging forward when they broke through the door. After killing Mr. Louis, police claimed that they feared he was armed, despite the fact that they crossed his threshold thinking he was unconscious. They found no weapons in the apartment.
The scene raises a number of deeply troubling issues. Why was Mr. Louis’s patent disease left unmanaged for years? Why was he killed, instead of treated for his illness, as he would have been if afflicted with cancer, diabetes, or heart failure? Moreover, why is there no outrage?
Perhaps because the tragedy is, astoundingly, not astounding. Mr. Louis’s death generated a measly two news clippings; his story is just one in a million. In fact, most of the mentally ill are left without care. Federal law prohibits hospitals from turning away patients in dire need, regardless of ability to pay. Yet mentally ill patients who seek urgent care, but cannot afford admission into a private hospital, are often discharged after just a few days, even if they are a clear danger to themselves or others. Emergency room doctors report that finding an open bed in a mental health unit is often impossible, leaving desperately ill patients to fend for themselves. Prisons are home to three times as many mentally ill individuals as treatment facilities; many of these inmates cycle from jail cells to the streets and back again, without obtaining care. Even our veterans suffering from crippling post-traumatic stress disorder are placed on waiting lists that do not turn over for months, and sometimes years. In fact, the 9th Circuit recently concluded that the Dept. of Veterans Affairs’ “unchecked incompetence” is so severe as to violate the statutory and constitutional rights of these often suicidal patients.
Our numbness to Mr. Louis’s predicament reflects widespread indifference to the facts of mental illness. Our callousness toward those afflicted, and the stigma they endure, reflect a failure to acknowledge that these diseases are no more exceptional, blameworthy, or unmanageable than HIV/AIDS, cancer, cardiovascular disease, or influenza. We’ve taken great strides to improve access to treatment for these and other conditions, and soon, the Affordable Care Act (ACA) will expand coverage to millions of uninsured Americans. Yet recessionary cuts have affected mental health budgets far more drastically than other health care spending: states have cut mental health expenditures by several billion dollars in the last few years alone. While the ACA will incorporate parity provisions (providing enrollees with comparable physical and mental health benefits), few patients are able to readily access providers, particularly those who accept third party reimbursement.
Mr. Louis serves as a glaring reminder that it is time to put the same resources behind mental illness as we have health care. In implementing the ACA, Congress must appropriate adequate funding to support community mental health centers, incentivize nursing and medical students to train in mental health treatment, encourage college graduates to pursue degrees in clinical psychology, and require states to adequately train police and social workers to anticipate and respond appropriately to mentally ill individuals. Congress should also increase funding for research and development of pharmaceutical interventions for schizophrenia and bipolar and major depressive disorders, among other illnesses.
Such steps would be small, as compared to what is required under international law (the United States has not ratified the Convention on the Rights of Persons with Disabilities). Yet they would not be insignificant. Mental illness, like any disease, is one that affects us all, be it as individuals, family members, or loved ones. Pretending it isn’t so will not undo that truth.
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.