Mental Health Matters: Have our laws preventing treatment gone too far? | SierraSun.com

Mental Health Matters: Have our laws preventing treatment gone too far?

Andy Whyman, MD
Special to the Bonanza

On February 18, 2012, then-23-year-old Daniel DeWitt murdered 67-year-old Peter Cukor in his own driveway in the hills overlooking Berkeley, Calif.

DeWitt, before bludgeoning Cukor to death with a flower pot, told him that he was searching for his fiancee, "Zoey."

DeWitt was taken into custody and found to be "insane," unable to participate in his own defense. He was sent to a state hospital, restored to legal competency, and then tried in Superior Court.

DeWitt pleaded no contest to first-degree murder as well as assault for breaking the jaw of a sheriff's deputy at a public psychiatric hospital where he been previously committed.

The Court found DeWitt not guilty by reason of insanity, meaning he could not distinguish right from wrong at the time of the murder. He was committed to a state hospital for 33 years to life.

"Zoey," the fiancee Mr. DeWitt was searching for at the time of the murder, never existed; she was, instead, part of the delusional world of the chronically mentally disordered Mr. DeWitt, who, by the time of the killing, had long carried a diagnosis of paranoid schizophrenia.

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Could this murder have been prevented? Possibly. Chronic severe mental illness with paranoid delusions is associated with both increased rates of violence and suicide. Treatment lowers the risks.

Mr. DeWitt was the second child adopted by Cindy and Al. As a youth, he was "shy,but typical," and an all-league football player in high school. During his senior year, as paranoid thoughts began to take hold, he would burn candles to keep spirits away.

He rejected an opportunity to attend college, and held a job for six weeks before quitting, telling his mother, "I can't do this anymore. People are following me."

According to the San Francisco Chronicle, Daniel was involuntarily hospitalized, meaning he was dangerous, suicidal or gravely disabled, nine times beginning in 2007.

His devoted parents pressured the authorities for long term treatment, but he was usually stabilized within days and released.

Daniel, consistent with half of the schizophrenic population, did not recognize that he was ill. Thus, after each discharge he would stop his medications and fail to attend follow-up care.

In 2010, he served 19 days in jail for sending harassing text messages to a former high school classmate. In 2012, he was again involuntarily hospitalized on a three-day hold until a judge ordered his release.

Two months later, he murdered Mr. Cukor.

How do these things happen? A brief historical survey is instructive. Until the late 19th century, the mentally ill in America were locked away in prison or left to wander. Reform came in the way of state mental hospitals, some a source of refuge, most another form of enforced incarceration.

By the 1950s there was one psychiatric bed per 300 Americans; some 500,000 were in psychiatric hospitals. The average length of stay for the schizophrenic population was 11 years!

Exposure of the horrific conditions in many of these institutions coupled with exploding costs and promising new pharmaceutical therapies led to another reform movement.

In 1963, the Community Mental Health Act promised 1,500 community mental health centers across America with rapid and successful treatment close to home. One half of state mental hospitals were to close over time.

In theory, the program was to provide treatment in the least restrictive setting affording both the protection of civil liberties, i.e. no more interminable involuntary lockups in state run mental hospitals, and an improved opportunity to recover.

In fact, hospitals closed, but only half of the mental health centers were built and they were inadequately funded. Additionally, new state laws restricted involuntary hospitalization to days or at most weeks with rare exception.

What happened? Pharmaceuticals helped, but they were no panacea. Ninety percent of state hospital beds closed. Funding for community programs plummeted; during the last recession another 1.8 billion was cut from mental health budgets.

The promise of rapid and successful treatment floundered on the realities of chronic mental illness and inadequate or nonexistent treatment resources.

By 2012, there was one psychiatric bed for every 7,000 Americans, leading to occasions when involuntarily committed patients remain shackled to emergency room beds, sometimes for days, until an inpatient psychiatric bed becomes available.

The savings achieved by closing state mental hospitals and cutting mental health budgets were more than offset by the increased costs of homelessness, emergency medical care, increased general hospital costs, and incarceration, frequently for "nuisance" offenses.

Now many of the most severely disturbed can be found muttering to themselves, wandering and living on the streets, abusing drugs, delusional and potentially dangerous, or incarcerated, ironically echoing the 1800s.

Is it ethical to allow a mentally ill person who can't care for him or herself and doesn't know they are ill to refuse care? Says Doris Fuller of the Treatment Advocacy Center, "We're protecting civil liberties at the expense of health and safety."

After several spectacular murders committed by severely mentally ill people some states have passed laws potentially providing involuntary outpatient treatment. See, for example, Laura's Law in California and Gregory's Law in New Jersey.

So, was the murder of Mr. Cukor preventable? Maybe, if delusional Mr. DeWitt was forced to accept the mental health care he knew he didn't need.

Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. His column focuses on drugs, mental health and substance abuse in an effort to raise better awareness. He can be reached for comment at adwhyman143@gmail.com.