Schizophrenia Daily News Blog

US Supreme Court Weakens Insanity Defence, Affirms Importance of Early Treatment for people with Schizophrenia

The following comes from the Treatment Advocacy Center (TAC).

The U.S. Supreme Court's released two decisions on the very last day of their session - on detainees being held at the U.S. military prison at Guantanamo Bay, and on the insanity defense. The widespread focus on the former precluded much attention being paid to the latter.

That was unfortunate, as TAC executive director Mary Zdanowicz explains, because the Supreme Court’s decision makes it clear that "we as a nation need to finally stop counting on the insanity defense to keep mentally ill people out of prison and start counting on treatment to keep people from committing crimes in the first place.".

Unfortunately, in the US there is no nationwide early diagnosis and treatment programs as there are in many other countries (including Canada, the UK and Australia), and given the low level of insurance coverage for mental illness in the US, its difficult to see how such a program might be enabled or funded. If advocates want to change the current situation they need to start working closely with NAMI and other advocacy groups, as well as letting their elected officials know about their displeasure by writing and on voting days.

US Supreme Court Weakens Insanity Defense, Affirms Importance of Early Treatment for Mentally Ill: Our systems are strong on Retribution and Weak on Prevention and Treatment.

The U.S. Supreme Court ruling in Clark v. Arizona shattered the hopes of long-term psychiatric treatment for Eric Clark, the young man with schizophrenia who killed a police officer while delusional, and instead upheld his sentence of 25 years to life in prison. The Court backed Arizona’s minimally protective insanity defense, saying the Constitution guarantees no more than that for people with severe mental illnesses who commit a crime.

For Clark, who was only 17 when his delusions led him to commit the brutal crime, that means a life behind bars with inconsistent, if any, treatment for a brain disease not of his choosing. For the rest of America, it means more people with mental illnesses landing in our already crowded prisons, fewer chances for treatment once a crime has been committed, and more urgency for policies promoting early and sustained treatment for citizens with severe mental illnesses.

The ruling should act as a thunderous wakeup call to the nation’s mental health system to step up and ensure people get early and sustained treatment for severe mental illnesses. People who are mentally ill deserve to get real help from the civil treatment system before situations occur that lead them to be punished by the criminal one.

What waits for someone like Eric Clark who commits a crime in the grip of a debilitating brain disease? The Court’s ruling makes it clear relying on the insanity defense as a last-ditch effort to get someone help is not just a terrible substitute for early treatment, but one very likely to fail.

Yet there is ever-growing evidence of the mental health system’s readiness to abandon people they are unwilling or unable to help and assume the criminal justice system will pick up the slack.

Too many people with untreated schizophrenia and bipolar disorder slip through the loopholes in our civil commitment system. Untreated symptoms such as delusions and hallucinations significantly increase the risk of violence. Yet it can be virtually impossible to get early and sustained treatment for the mentally ill who refuse help until they are dangerous – which is often too late.

Eric Clark had untreated schizophrenia. He was delusional. And his family tried and tried to get him treatment. But he refused, and ended up brutally killing a police officer because his deluded mind thought the officer was an alien.

The failure of the system to avert such tragedies is directly caused by badly written laws and poorly used policies that turn their back on those too ill to make rational treatment decisions.

In places with more humane laws and policies that actually get implemented, the results are different for people like Eric Clark. Of participants in New York’s assisted outpatient treatment program, for instance, 83% fewer experienced arrest and 87% fewer experienced incarceration. Violent episodes were reduced. Medication compliance improved. Quality of life was restored.

The Court’s ruling dealt a tremendous personal blow to Eric and his family, who were hoping not for exoneration, but transfer to a secure forensic treatment facility. The Clark family has never stopped fighting to get treatment for their son – first in the community, now in prison. Eric Clark’s family did everything they could – it is the mental health community that failed to help Eric when it might have actually made a difference. The system failed everyone involved in this tragedy. We need to do better.

Our current systems are strong in retribution, weak in prevention. They block needed treatment for the severely mentally ill unless they are dangerous, but deliver punishment with ease when the untreated mentally ill commit a crime.

We as a nation need to finally stop counting on the insanity defense to keep mentally ill people out of prison and start counting on treatment to keep people from committing crimes in the first place.

FOR MORE INFORMATION: See the Treatment Advocacy Center's Full Press Kit on the Supreme Court Arizona Insanity Defense Case

(a full legal analysis of the decision is here)

More information on the problem of jailing the mentally ill in the US

Prisons - The New Asylums (News Report)