In the 1960s, the severely mentally ill began to be turned out of public hospitals—too often with tragic consequences. In The Insanity Offense, E. Fuller Torrey explores the issues.
What sparked you to write this book?
The immediate impetus for the book was the daily printout of what we call “preventable tragedies,” which we collect from newspaper clippings at the Treatment Advocacy Center [in Arlington, Va., which Torrey heads]. The long-term impetus was the 1989 Tate case, with which I open and close the book. It seems to exemplify everything that is wrong with the system.
Why are so many mentally ill homeless and imprisoned?
Many end up homeless because they are paranoid or delusional, and afraid to stay in shelters, or because they are too psychotic to be able to apply for public assistance or housing. Many end up in jail because of psychosis-related behavior, such as exposing themselves in public or assaulting a stranger.
How much of a threat do severely mentally ill Americans on our streets pose to themselves and the community?
The magnitude of the threat is directly proportional to whether or not they are being treated. At any given time, at least half of those who are dangerous are not being treated. They pose a major threat to themselves through suicide and accidents, and to others through violence and homicide.
Wasn’t outpatient care supposed to replace institutionalization?
Outpatient care has failed because most community mental health centers and other clinics failed to give priority to the sickest patients. Resources went to providing psychotherapy for the “worried well” instead.
What would you say to those who resist changing the law to allow involuntary commitment?
They do not understand what it is like to be psychotic. I tell them to spend a few hours on the streets or in a public shelter with severely mentally ill individuals.
There are very few funds earmarked for treatment and research of this crisis. What can we do?
Money is, of course, an issue, but it is not the most important answer. Surveys we carried out found very little relationship between how much any given state was spending on mental health services and the quality of services available. In some states, there is enough money in the present mental health budget to deliver good services if it were being spent wisely and prioritizing the most seriously mentally ill individuals.
Why don’t elected officials tackle this crisis?
This is not a sexy issue. The patients and their families are not an important political constituency. Perhaps most important is that most officials, like most members of the public, do not understand the problem and are not aware that it is fixable.
