Friday, May 27, 2011

Jared Loughner Is Insane (And We Just Noticed)

cross-posted from Dagblog

So, Jared Loughner, who tried to murder Gabby Giffords, has been found unfit to stand trial because he is too mentally ill to assist his defense. Loughner, among other things, is apparently loudly insisting that Giffords is actually dead, because he succeeded in murdering her. That's pretty much the definition of "unable to assist in your defense" right there.

I don't think anyone's surprised that Loughner is very ill, or that two independent psychiatrists would suggest a diagnosis of schizophrenia. But it's also clear that Loughner has been schizophrenic (and symptomatic) for a good long while, and he's just being given an initial diagnosis now. The American health system has left that important work, in this case, to the criminal justice system. Loughner had to shoot people before anyone noticed how much help he needed. That doesn't excuse him, but it sure as hell indicts the rest of us.

Because we have no real public health system for people in their late teens and early twenties (the ages during which schizophrenia tends to emerge), we don't have anyone to diagnose, let alone treat, these ailments. And in the last thirty years we've cut back our commitment to mental health, "deinstitutionalizing" very, very ill people so they can wander the streets and suffer their symptoms.

Jared Loughner was thrown into the care of institutions, like Pima County Community College, which have no resources or expertise in treating such profound and terrible illnesses. They knew something was wrong with him. They tried talking to him about it. And when the standard college counseling got no results, they expelled him for the safety of the other students. Every part of that process makes perfect sense, from their point of view, and I don't think they deserve even a shred of blame. College math teachers are not equipped to treat the seriously mentally ill. Nor should they be trained to do so. And Pima County Community College doesn't quite have the budget to do their normal job now; they can't afford to take responsibility for severe mental health problems.

The issue is that America as a whole does not take responsibility for the mentally ill. We turn mental health into a game of hot potato, seeing who will step up and pay for the expensive care and treatment patients need and take responsibility for the patient actually complying with treatment. Will the college do it? Are you still on your parents' insurance, which may or may not have coverage for this kind of thing? In this case, the hot potato landed with the court system, now that the damage is done. The criminal justice system gets to care for the mentally ill because it's the one system that the mentally ill can't simply fail their way out of because of their symptoms. This country is full of very sick people who could actually be helped if anyone would actually help them, but those people are left either to the prisons or the streets.

Do you know what's really not effective for dealing with major mental health issues? An employer-based insurance system. The mentally ill often have trouble holding onto jobs, and often have trouble accepting treatment until they've faced serious consequences. There are people who have been prescribed meds and don't take them, because they claim to be doing fine, and then they lose their jobs. But once they face an event that might persuade them to take their medication, there is no medication, because when the patient lost the job the patient lost the insurance. And preaching about individual responsibility to stay healthy, when we're talking about major mental illness, is laughably cruel. The nature of the illness is that the ill person is not fully responsible. Someone else needs to step up and make sure they get help. In our patchwork health system, the mentally ill are always someone else's problem; only when they commit a felony are they understood as everybody's problem.

Jared Loughner walked around with full-blown schizophrenia for years. There are plenty of other people walking around with his symptoms right now, untreated, drifting between convenience stores and parking lots and subway cars, nobody's problem but their own. And unless they hurt someone, they'll stay out there in the agonies of their own madness until they die. In our current system, that is considered the happy ending.

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