According to Amenoma Hartocollis of the New York Times, New York City tightened their rules for monitoring discharged patients with tuberculosis because if left untreated, TB is easily transmitted and could put the public at risk.
The regulation requires hospitals and other health care centers to consult with the Department of Health and Mental Hygiene at least 72 hours before discharging tuberculosis patients, and to wait for the department to determine that the patient is not a danger to public health before letting the patient out of the hospital
. This makes sense for patients with TB who might otherwise become dangerous to the public. The policy sees they get the treatment they need to stay well and not create a contagion danger to the public.
But what about people with schizophrenia?
There is a small group of people with the most serious mental illnesses who have a history of violence, history of failing to take medications that could prevent it, and who ultimately do create danger for the public by their violence.
Shouldn't we also report their release from hospitals and jails so they too can have services put in place and monitored? Yes.
Judy Miller and Dr. E. Fuller Torrey, the nation's leading schizophrenia researcher and policy expert originally wrote on this in the November 1999 issue of Psychiatric Services
For the same reason we treat and monitor people with TB, we should be treating and monitoring people with schizophrenia who have previously been violent and are likely-without treatment-to become so again. Their discharge from hospitals (and prisons) should be reported to mental health departments so they can put in place any monitoring and services that are needed to prevent them from becoming violent.
During the last New York State legislative session, Assemblywoman Aileen Gunther, a former nurse who knows her stuff, and State Senator Catherine Young, who has had constituents killed by the lack of such a policy, tried to amend Kendra's Law to require that when involuntarily committed patients are being discharged from hospitals--and inmates with mental illness are being discharged from jail-that the institutions be required to report the discharges to mental health officials so they could ensure adequate treatment is in place to help them stay healthy and peaceful.
But New York State legislators, egged on by (hopefully former) New York State Commissioner of Mental Health Michael Hogan, PhD., rejected this approach. Hogan's department 'treats' over 650,000 people with barely diagnosable politically-correct mental 'health' issues but less than 7,000 individuals with non-compliant schizophrenia. He feared this change would force him to focus his department's efforts on the seriously ill rather than worried well.
According to Carla Jacobs, California's leading mental health advocate, of the California Treatment Advocacy Coalition, the San Francisco's public health director, Dr. Mitch Katz, has also been resistant to focusing his department's efforts on the most seriously ill. He has opposed a law in that county, Laura's Law, that would cut crime and violence and help people with schizophrenia live better lives. His rationale? It would take resources away from his other programs. People with serious mental illness go to the end of the line.
If we want to reduce violence by people with untreated schizophrenia, we have to treat it as the medical illness it is. We have to force mental health departments to refocus their resources towards the most seriously ill. We should require hospitals, prisons, and jails to report the discharge of potentially dangerous patients to mental illness authorities so they can end their 'look the other way and put the public at risk' policies.
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