American Psychosis (21 page)

The problems of mentally ill individuals in nursing homes and board-and-care homes rarely elicited media attention in the 1980s. By contrast, the problem of homeless persons, including the mentally ill homeless, became a major story. In Washington, Mitch Snyder and the National Coalition for the Homeless burst onto the national scene by staging hunger strikes and sleep-ins on sidewalk grates. Their message was that homeless persons are just like you and me and all they need is a house and a job. Snyder challenged President Reagan, accusing him of being the main cause of homelessness, and the media extensively covered the controversy. By the time Snyder committed suicide in 1990, homelessness had become a major topic of national discussion.

Despite the claims of homeless advocates, media attention directed to homeless persons made it increasingly clear that many of them were, in fact, seriously mentally ill. In 1981,
Life
magazine ran a story titled “Emptying the Madhouse: The Mentally Ill Have Become Our Cities’ Lost Souls.” In 1982, Rebecca Smith froze to death in a cardboard box on the streets of New York; the media focused on her death because it was said that she had been valedictorian of her college class before becoming mentally ill. In 1983, the media covered the story of Lionel Aldridge, the former all-pro linebacker for the Green Bay Packers; after developing schizophrenia, he had been homeless for several years on the streets of Milwaukee. In 1984, a study from Boston reported that 38% of homeless persons in Boston were seriously mentally ill. The report was titled “Is Homelessness a Mental Health Problem?” and confirmed what people were increasingly beginning to suspect—that many homeless persons had previously been patients in the state mental hospitals.
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By the mid-1980s, a consensus had emerged that the total number of homeless persons was increasing. The possible reasons for this increase became a political football, but the failure of the mental health system was one option widely discussed. A 1985 report from Los Angeles estimated that 30% to 50% of homeless persons were seriously mentally ill and were being seen in “ever increasing numbers.” The study concluded that this was “in part the product of the deinstitutionalization movement. . . . The ‘Streets’ have become ‘The Asylums’ of the 80s.”
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The appearance of Joyce Brown on the streets of New York in 1986 added a new dimension to the national dialogue. Prior to taking up residence on a steam grate at the corner of East 65th Street and Second Avenue, Brown had worked for 10 years as a secretary. She had then become mentally ill, was hospitalized, and discharged. While living on the street, Brown was observed urinating on the sidewalk, defecating in the gutter, tearing up money given to her by passersby, and running into traffic. New York mayor Ed Koch ordered her to be involuntarily hospitalized, well aware that the Civil Liberties Union’s lawyers would contest the case. Koch’s statement reflected the sentiments of many: “If the crazies want to sue me, they have every right to sue, and by crazies I’m . . . talking about those who say, ‘No, you have no right to intervene to help.’ “The civil liberty lawyers prevailed, and the civil right to be both psychotic and homeless thus added another legal wrinkle to the ongoing homeless debate.
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By the end of the 1980s, the origins of the increasing number of mentally ill homeless persons had become abundantly clear. A study of 187 patients discharged from Metropolitan State Hospital in Massachusetts reported that 27% had become homeless. A study of 132 patients discharged from Columbus State Hospital in Ohio reported that 36% had become homeless. In 1989, when a San Francisco television station wished to advertise its series on homelessness, it put up posters around the city saying, “You are now walking though America’s newest mental institution.” Psychiatrist Richard Lamb
added: “Probably nothing more graphically illustrates the problems of deinstitutionalization than the shameful and incredible phenomenon of the homeless mentally ill.”
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At the same time that mentally ill homeless persons were becoming an object of national concern during the 1980s, the number of mentally ill persons in jails and prisons was also increasing. A 1989 review of available studies concluded that “the prevalence rates for major psychiatric disorders . . . [in jails and prisons] have increased slowly and gradually in the last 20 years and will probably continue to increase.” Various studies reported rates ranging from 6% (Virginia) and 8% (New York) to 10% (Oklahoma and California) and 11% (Michigan and Pennsylvania). By 1990, a national survey concluded:

Given all the data, it seems reasonable to conclude that approximately 10 percent of inmates in prisons and jails, or approximately 100,000 individuals, suffer from schizophrenia or manic-depressive psychosis [bipolar disorder].

This 10% estimate contrasted with the 5% prevalence rate that had been widely cited a decade earlier.
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Amid the various studies, disturbing trends were evident. Among 132 patients discharged from Columbus State Hospital in Ohio, 17% were arrested within 6 months. In California, seriously mentally ill individuals with a history of past violence, including armed robbery and murder, were being discharged from mental hospitals without any planned aftercare. In Colorado in 1984, George Wooton, diagnosed with schizophrenia, was booked into the Denver County Jail for the hundredth time; he would be the first prominent member of a group that would become widely known as “frequent flyers.” In several states the bizarre behavior of mentally ill inmates was also becoming problematic for jail personnel; in Montana a man “tried to drown himself in the jail toilet,” and in California inmates tried to escape “by smearing themselves with their own feces and flushing themselves down the toilet.” To make matters worse, civil liberties lawyers frequently defended the rights of mentally ill prisoners to refuse medication and remain psychotic. At a 1985 commitment hearing in Wisconsin, for example, a public defender argued that his jailed mentally ill client, who had been observed eating his feces, “was in no imminent danger of physical injury or dying” and should therefore be released; the judge agreed.
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As more and more mentally ill individuals entered the criminal justice system in the 1980s, local police and sheriffs’ departments were increasingly affected. In New York City, calls associated with “emotionally disturbed persons,” referred to as “EDPs,” increased from 20,843 in 1980 to 46,845 in 1988, and “experts say similar
increases have occurred in other large cities.” Many such calls required major deployments of police resources. The rescue of a mentally ill man from the top of a tower on Staten Island, for example, “required at least 20 police officers and supervisors, half a dozen emergency vehicles, several highway units and a helicopter.” In an attempt to deal with these psychiatric emergencies, the police department in Memphis, Tennessee, in 1988 created the first specially trained police Crisis Intervention Team, or CIT, as it would become known as it was replicated in other cities.
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Finally, the 1980s witnessed increasing episodes of violence, including homicides, committed by mentally ill individuals who were not receiving treatment. The decade began ominously with three high-profile shootings between March 1980 and March 1981. Former congressman Allard Lowenstein was killed by Dennis Sweeney, John Lennon was killed by Mark David Chapman, and President Ronald Reagan was shot by John Hinckley. All three perpetrators had untreated schizophrenia. Sweeney, for example, believed that Lowenstein, his former mentor, had implanted a transmitter in his teeth through which he was sending harassing voices.

As the decade progressed, such widely publicized homicides became more common:

1985: Sylvia Seegrist, diagnosed with schizophrenia and with 12 past hospitalizations, killed three and wounded seven in a Pennsylvania shopping mall.

Bryan Stanley, diagnosed with schizophrenia and with seven past hospitalizations, killed a priest and two others in a Wisconsin Catholic church.

Lois Lang, diagnosed with schizophrenia and discharged from a mental hospital 3 months earlier, killed the chairman of a foreign exchange firm and his receptionist in New York.

1986: Juan Gonzalez, diagnosed with schizophrenia and psychiatrically evaluated 4 days earlier, killed two and injured nine others with a sword on New York’s Staten Island Ferry.

1987: David Hassan, discharged 2 days earlier from a mental hospital, killed four people by running them over with his car in California.

1988: Laurie Dann, who was known to both the police and FBI because of her threatening and psychotic behavior, killed a boy and injured five of his classmates in an Illinois elementary school.

Dorothy Montalvo, diagnosed with schizophrenia, was accused of murdering at least seven elderly individuals and burying them in her backyard in California.

Aaron Lindh, known to be mentally ill and threatening, killed the Dane County coroner in Madison, Wisconsin. This was one of six incidents in that county during 1988 “involving mentally ill individuals . . . [that] resulted in four homicides, three suicides, seven victims wounded by gunshots, and one victim mauled by a polar bear” when a mentally ill man climbed into its pen at the local zoo.
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1989: Joseph Wesbecker, diagnosed with bipolar disorder, killed 7 and wounded 13 at a printing plant in Kentucky.

Another indication that such episodes of violence were increasing was a study that compared admissions to a New York state psychiatric hospital in 1975 and 1982. It reported that “the percentage of patients who had committed violence toward persons while living in the community in the 1982 cohort was nearly double the percentage in the 1975 cohort.” In addition, “the percentage of patients who had had encounters with the criminal justice system in the 1982 cohort was more than quadruple the percentage in the 1975 cohort.”
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Is there any way to estimate the frequency of these episodes of violence committed by mentally ill person who were not being treated? There was then, and continues to be, no national database that tracks homicides committed by mentally ill persons. However, a small study published in 1988 provided a clue. In Contra Costa County, California, all 71 homicides committed between 1978 and 1980 were examined. Seven of the 71 homicides were found to have been done by individuals with schizophrenia, all of whom had been previously hospitalized at some point before the crime. The 10% rate was also consistent with the findings of another small study in Albany County, New York. Therefore, by the late 1980s, it appeared that violent acts committed by untreated mentally ill persons was one of the consequences of the deinstitutionalization movement, and the problem appeared to be a growing one.
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1990S: FROM BAD TO WORSE

The decade of the 1990s witnessed the advanced stages of deinstitutionalization with the closure of 44 more state hospitals and loss of an additional 40,000 beds. The patients being discharged to live in the community by this stage were the sickest and most difficult to manage. They were the patients who were most in need of well-organized community mental health services that could ensure that patients receive the treatment needed to remain well. With rare exceptions, such services did not exist. The primary concern of most state mental health agencies was to continue emptying their hospitals as quickly as possible, thereby shifting the cost to the federal government and saving state funds. Where the patients went was of lesser concern.
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Nursing homes, once used exclusively for elderly patients, increasingly became dumping grounds for younger mentally ill patients. This was especially true in Illinois, which, by the late 1990s, had 12,000 mentally ill patients in 562 nursing homes. The consequences of such placements were dramatically described in a 1998 series in the
Chicago Tribune
.
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One patient described in the series was Victor Reyes, a 20-year-old, 190-pound young man with fetal alcohol syndrome and an extensive history of violent behavior. At age 17 years, it was recommended that he be placed “in a highly structured environment with a significant amount of supervision.” At age 19 years, he was expelled from a board-and-care home because of violent episodes. He was therefore placed in a nursing home that included many elderly residents. Within 2 days of arriving, Reyes had threatened to kill his roommate and “dumped an elderly man from a wheelchair.” Over the following 4 months, he sexually harassed patients and staff and ran away several times, until May 6, 1997, when he brutally beat to death a 69-year-old woman with dementia who had denied him sex. He then ran away, stole a car, and intentionally drove it head-on into a group of bicyclists, killing one.

As the
Chicago Tribune
series made clear, Reyes was not an isolated aberration. At another nursing home, “state inspectors discovered that a 34-year-old blind, schizophrenic woman had been sitting naked on a toilet for up to 14 hours a day. . . . Her meals were frequently delivered and consumed in the bathroom.” In another home, “a man diagnosed with mental disorders had fondled the private parts or was found naked with at least three female residents, two with Alzheimer’s disease,” and there were 13 such incidents in 1 month. The response of the staff was to tell the man that he could be involved in no more than three incidents monthly; his official treatment plan thus read: “Decrease fondling to 3x monthly by 4/15/98.”