Deinstitutionalization and Murder
Ann Althouse links to a fascinating essay by Clayton Cramer who seems to be a polymath of some sort and has done interesting work on the history of gun ownership in the U.S. as well as mental illness which he was spurred to research after his brother’s battle with schizophrenia.
Besides curtailing the free advertising that the media gives to mass murderers, blame for the shooting in Newtown, like the others, has been largely allocated to either guns or the mental illness of the shooters. If we want to decrease incidents of mass murder, someone’s freedoms will have to be curtailed, and we will either have to limit gun ownership in some way or identify lunatics and pull them off the street or force them, rather than give them the option, of taking their medications.
Since gun control is always the first thing mentioned and since the mass media will do plenty of work pushing that agenda, it’s worth reading up on some of the arguments critical of the deinstitutionalization of the mentally insane.
Though I’ve been a fan of work by people like Thomas Szasz who railed against the psychiatry racket and the therapeutic state which diminishes absolute human liberty, I have to admit that Cramer’s argument makes sense:
Do judges not want to lock up people in mental hospitals? I am beginning to fear that this is the problem. In the 1960s, psychiatrists like R. D. Laing and Thomas Szasz challenged the traditional view of mental illness, especially schizophrenia, one of the psychoses that causes so many of the problems we’re seeing. Dr. Laing argued that schizophrenics were, if anything, more sane than the rest of us. Dr. Szasz saw the mentally ill as victims as a plot by the government to oppress people — rather like the way the Soviet Union regularly declared political dissidents to be mentally ill. 
If these ideas had stayed in dusty journal articles, I don’t think we would be facing the problem we have today. This notion that mentally ill people aren’t really so different from the rest of us — perhaps even a bit more sane — showed up repeatedly in movies of the late 1960s and 1970s. One Flew Over the Cuckoo’s Nest, They Might Be Giants, and King of Hearts are just a few of the movies that were popular as I was reaching adulthood, and I fear have profoundly shaped the thinking of a great many judges.
In an essay titled “Madness, Deinstitutionalization & Murder” Cramer wrote:
In the 1960s, the United States embarked on an innovative approach to caring for its mentally ill: deinstitutionalization. The intentions were quite humane: move patients from long-term commitment in state mental hospitals into community-based mental health treatment. Contrary to popular perception, California Governor Ronald Reagan’s signing of the Lanterman-Petris-Short Act of 196712 was only one small part of a broad-based movement, starting in the late 1950s.13 The Kennedy Administration optimistically described how the days of long-term treatment were now past; newly-developed drugs such as chlorpromazine meant that two-thirds of the mentally ill “could be treated and released within 6 months.”14
At about the same time, two different ideas came to the forefront of American progressive thinking: that there was a right to mental health treatment, and a right to a more substantive form of due process for those who were to be committed to a mental hospital. If there was a right to mental health treatment, then judges could use the threat of releasing patients as a way to force reluctant legislatures to increase funding for treatment.15
The notion of due process for the mentally ill was not radical. American courts have been wrestling with this question from the 1840s onward.16 While perhaps not up to the exacting standards of the American Civil Liberties Union, by the end of the nineteenth century, there was something recognizably like due process before the mentally ill were committed.17 What changed in the 1960s was the result of ACLU attorneys such as Bruce J. Ennis, who claimed that less than 5 percent of mental hospital patients “are dangerous to themselves or to others” and that the rest were improperly locked up “because they are useless, unproductive, ‘odd,’ or ‘different.’”18
Putting some numbers to the decrease in the number of psychiatric beds – a good proxy for deinstitionalization – is research by Glenn Currier, M.D.:
F1 shows the total number of inpatient psychiatric beds per 1,000 population in the seven countries over the past three decades. In the U.S. beds dropped by two-thirds, from four per 1,000 population in 1960 to 1.3 per 1,000 population in 1994. In Australia the reduction was more remarkable, with a tenfold decrease from 3.1 per 1,000 in 1960 to .3 per 1,000 in 1995. In Japan beds increased from one per 1,000 population in 1960 to 2.9 per 1,000 in 1995.
Currier points out that the mortality rate for mentally ill patients moved in the predictable direction – with Japan’s being the only mortality rate to decline.