Mentally Ill In Public: How Sick Is Too Sick?

I have a new neighbor who scares me. He likes to wander the halls, yelling at nobody and at least once threatening criminal activity. I'm scared it could turn violent. I lock my door, keep a knife handy and try to ignore his rants. People have told me to call the police and try to get him admitted to the psych ward. But the staff at my apartment assure me he's sick, not violent, and there's nothing they can do. Which means there's nothing I can do. So how sick is too sick to be in public?

The Mentally Ill Have the Right to Live in the Community

In Olmstead vs. L.C., the Supreme Court ruled that people with mental illness have the right to live in the community instead of institutions. As a result, many people with severe mental illness now live in the community when they previously would have been hospitalized. Some of them are my neighbors.

One thinks he is the world's greatest athlete. He frequently boasts of being the Oilers' quarterback and field goal kicker. He has five Super Bowl rings and once scored 100 points in a game. He's also a professional wrestler specializing in submission holds, which has caused him to get in one fight that I witnessed, and he's a professional race car driver. He brags about how he loves to beat people up in his life, as an athlete. But because he's not a danger to himself or others, he's out in the community.

Another thinks he is a seraphim. He once showed me a picture of him as a child, claiming it proved he had clear hair and blue eyes. He also said "I just farted and the Holy Spirit came out my ***."

He got into one fight that I witnessed and claims he got in trouble with the law over a battery charge. But because he's not a danger to himself or others, he's out in the community.

Another is on house arrest. She has a hot temper and has threatened to cuss out staff for making her wait for her disability check. She'll cuss someone out for saying hello. But because she's not a danger to herself or others, well, you get the idea.

Why the Mentally Ill Are in Public

The Olmstead ruling decreed that:

. . . institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life . . . confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.

On the surface, this is a positive ruling. But in practice, it has resulted in many individuals being in the community when they are not in full control of their illnesses.

Justice Kennedy wrote in his concurring opinion:

It would be unreasonable, it would be a tragic event, then, were the Americans with Disabilities Act of 1990 (ADA) to be interpreted so that states had some incentive, for fear of litigation to drive those in need of medical care and treatment out of appropriate care and into settings with too little assistance and supervision.

And that has occurred. Several years ago, the State of Indiana closed Central State Hospital, transitioning the patients into the community. I mentioned it during an interview with a mental health advocate, and she said, "People are dying because of this. They are dying slowly by losing their incomes, and their housing, and their ability to access health care. They are dying quickly by turning to other drug substances and suicide."

An investigation by a newspaper in Atlanta, where Olmstead originated, found similar unacceptable results.

Is it better to error on the side of caution?

A Need for a New Standard for the Mentally Ill in Public

"Danger to self and/or others" varies, according to the person making the decision. Some mental health professionals include self-injury, while others will require an actual suicide attempt. We need a clear standard. In addition to that, we need a clear standard of "gravely disabled--"some states have more stringent requirements than others.

Olmstead originally was to be carried out on a case-by-case basis. We need to consider what is in the person's best interests. Sometimes that may mean hospitalizing someone who's harmless but would benefit from hospitalization. We owe it to ourselves, as a society, to do the compassionate thing and step in before the situation deteriorates.

We need a long, hard look at new legislation.

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