From NY Mag: Freddie deBoer On Forcibly Treating the Mentally Ill

For New York Magazine’s Intelligencer, Freddie deBoer lays out “The Case for Forcing the Mentally Ill Into Treatment.”

New York Magazine:

This is a deeply uncool thing to care about, but the victims of mentally ill assailants have rights too, and the current rhetorical conditions seem bent on forbidding difficult conversations about how to prevent these incidents. And we have real-world examples of societies that have developed mental-illness policies so lenient that they are a risk to the public. In Toronto, in 2015, a woman named Rohinie Bisesar randomly stabbed 28-year-old Rosemarie Junor to death. She was found not responsible by reason of mental illness was allowed unsupervised excursions into the community by an Ontario review board within a few years, then was released into unsupervised living in 2022. From stabbing someone to death to walking free in less than seven years is, I’m willing say, not an ideal outcome. Call me a fascist for it if you wish.

But the biggest reason I’m opposed to the rampant, reflexive dismissal of violent actions inspired by mental illness is for the good of the mentally ill themselves.

It’s now been more than 60 years since John F. Kennedy signed the Community Mental Health Act of 1963, which spurred the closure of dozens of state psychiatric facilities. In 1955, there were an estimated 559,000 residents in state psychiatric facilities; by 2016, the number of beds in such facilities stood at 35,000. That amounts to, if you’re curious, one bed for more than every 9,000 Americans, meaning that our state psychiatric infrastructure could never possibly accommodate our population of people with mental illness. Of course, there are and have always been those who think that number should be zero because state facilities are “carceral” or similar nonsense. And yet after all these decades of tearing down government-run psychiatric facilities, virtually no one looks at the current scenario of inadequate facilities, overworked doctors, and countless untreated patients and likes what they see.

What’s unclear is why so many people continue to insist that we need even less government intervention and even more hurdles to involuntary treatment. This is a good example of broad ignorance about mental-health policy in this country in the past half-century, even among educated people; I will frequently hear it suggested that we’re taking a more heavy-handed approach to the mentally ill than we used to, when the opposite is true, thanks to policy. Deinstitutionalization shuttered asylums, Medicaid created direct incentives for states to push patients into barely regulated private hospitals, a Supreme Court ruling made the threat of violence a legal standard for involuntary treatment, and the Americans With Disabilities Act dramatically expanded the ability of patients to challenge doctors and hospitals, contributing to a tentative and risk-averse approach to dealing with mental illness.

The current approach to mental-health management, on the societal level, has failed according to just about everyone’s criteria. And yet the broad public conversation continues to be hamstrung by a refusal to contemplate the most essential reform: lowering the bar that the state and medical professionals must clear to treat someone without their consent. The pendulum swung too far.