Guest Post: Community care for the dangerously mentally ill is not working
September 10th, 2012 at 10:00 am by David FarrarA guest post by David Garrett:
I recently learned that the son of a former colleague had been murdered. It was shocking news, but when I found that Dean Clark was yet another victim of a mentally ill person released to “community care”, and supposedly being monitored in the community rather than in a secure psychiatric facility, it made me both despairing and furious.
The circumstances of Dean’s death were almost identical to those of Colin Moyle, who was bludgeoned to death with a spade, and his body set on fire in 2007. The killer was a mental patient also under “community care” at the time. Mr Moyle took him in and gave him a home because he had been sleeping rough.
At the time of Moyle’s death there were the usual enquiries, and assurances that “systems” would change so that such a tragedy would not happen again. Here we are five years down the track, and clearly absolutely nothing has changed.
The man charged with Dean Clark’s murder is a 38 year old mental health patient who Dean had known for years. Dean took him in because the man had been sleeping rough and on friends’ couches,and had needed somewhere to live. Dean had a spare room and needed a flatmate. Five days later Dean was dead, stabbed to death in his bed.
A recently retired mental health worker told the media there are “gaping holes” in the mental health system that needed to be fixed. Dean’s mother received a visit from some person from the mental health system, which she found “utterly useless”. The mother asked her visitor the questions you would expect: when was the man last seen by the authorities? What steps were being taken to ensure he was adequately monitored?
As usual, for “legal reasons”, a mother’s anguished questions could not be answered. This is indeed a very difficult legal area. By definition, the criminally insane – as they were once called – confined in an institution like the Mason Clinic, are patients and not prisoners. The doctors treating them are in a doctor-patient relationship, and are not their jailers. Such patients have rights of privacy even greater than those of ordinary prisoners.
But the community has rights too. Dean Clark and Colin Moyle had the right to live their lives without unmonitored dangerous psychiatric patients roaming around their neighbourhoods listening to voices in their heads, voices often urging them to kill someone. Each time such a tragedy happens there is the usual hand wringing, offers of sincere condolences – and ducking for cover. But nothing changes.
The “three strikes” law which I helped to put in place, and other changes to sentencing and parole laws, came about in large part because enough people got sick enough of violent thugs being continually released from prison to make sufficient noise for politicians to take notice. Poll driven politicians on both sides of the left-wing divide listened, and the laws gradually changed. Five years on from Colin Moyle’s horrific death clearly nothing has changed regarding the criminally insane, and Dean Clark paid the penalty for that political torpor.
There is an added tragedy in every such case. Two months on, in a secure forensic environment where he is compulsorily medicated, Dean’s killer is probably as “sane” as he will ever be, and now has to live with the horror of what he has done. Living with that will be a burden he must bear for the rest of his life, regardless of what the courts eventually do with him. That alone may make him go off medication in the future – so he can return to a more comfortable world of the voices and delusions – unless he is properly monitored when he is again released.
It is time the same level of public pressure that eventually resulted in “three strikes” was brought to bear on the mental health system. It is simply not acceptable for learned pointy heads to nod wisely and say “this is all a very difficult balancing exercise”, or utter similar platitudes every time such a tragedy happens. The mental health system has a long history of covering its backside, stretching back at least to whistle blower Neil Pugmire, who warned the public in the 1990’s about the imminent release of a dangerous sex offender, and paid a heavy price for doing so. Eventually though, as a result of public pressure, the Protected Disclosures Act was passed to protect the Neil Pugmires of the future.
Whether changes to the way we deal with dangerous psychiatric patients happen now is, in the first instance, up to the public. The National government changed its plans to mine Schedule 4 of the Conservation Estate because enough people objected to the plan, and the polls reflected that level of objection. People need to wake up to the danger of inadequately monitored, dangerously ill mental patients in their midst under non existent “community care”, and make just as much noise. Otherwise you or your son’s next flatmate may be a mental patient in the incompetent hands of those supposed to be monitoring them. And listening to the voices.
Thanks to David for the guest post.
September 10th, 2012 at 10:10 am
David
Vote:As far as I remember reading over the past two decades, releasing into community care has always been a failure and the opponents have stated so at it’s inception.
I think the The Nordic countries did it better but they recognised that it would cost more in staff and allocated accordingly as far as I recall, but that still doesn’t keep the risk away from the public as does a secure residential scheme.
We of course have the absurd notion with the privacy bullshit that you can’t know “full disclosure” when you rent property to someone or hire for a job.
September 10th, 2012 at 10:13 am
Maybe we should increase sentences for identity thieves at the same time too?
Vote:September 10th, 2012 at 10:21 am
Ah…it didn’t take long for the ad homs…anonymous as always. And with the added bonus of being utterly irrelevant to the subject of the post.
Just to pre-empt some of the others: 1) I have myself had problems with depression for 30 years, well managed by medication until the events of September 2010. I have read widely on “mental illness” generally in order to better understand my own. I have never heard voices or suffered from delusions; 2) the reference in yesterdays “Herald on Sunday” to my “third” drink driving correction is untrue, and supposedly the result of an innocent mistake. I was convicted of my FIRST drink driving offence in February, and have now served my disqualification. A correction will be published in next Sunday’s edition. Depending on the form and placement of that correction, further action may or may not follow.
Vote:September 10th, 2012 at 10:28 am
Struggling to connect the 3 strikes law with the mentally unwell. Apart from that I can’t see the argument David is promoting or in fact where he distinguishes the differences that constitute the fact that psychiatric illness is ‘not a one cap fits all’ illness. I hope we are not of the cusp of removing rights from the depressed or manic and instead imprisoning them for fear of what they ‘might’ do.
Vote:September 10th, 2012 at 10:28 am
If we want to know whether release into community care is working, we need a bit more information than is provided here.
For example: how many people are in community care who have presented few (or none) of the serious issues here and who would otherwise have been locked up?
Vote:September 10th, 2012 at 10:31 am
I was wondering how long it would take some fuckwit to bring up Davids past. 2 posts. Nice addressing of the topic, knob-end. Your smarmy little dig is more important than the deaths of carers of the mentally ill.
Vote:September 10th, 2012 at 10:34 am
I think it is public-agency-wide problem.
My partner’s nephew was recently honey-trapped by a woman who it turns out had already lost full custody of a child to that child’s father.
She got pregnant to the nephew within a couple of weeks of meeting him. The child has been born, and this woman has apparently already made three threats to harm this (2 month old) child.
The nephew’s mother rang CYFS several times a day for five days straight. Got a message service each time. At the end of the week she finally received a call-back which was a mumbled load of uselessness.
Is it any wonder tragedies occur?
Vote:September 10th, 2012 at 10:43 am
Graeme: You raise excellent points…and the fact that we don’t know the answers is a huge part of the problem.
Shortly before my political demise I visited the Mason Clinic and spoke to its Director, Dr Jeremy Skipworth. He was cagey to the point of refusing to confirm that this or that patient was even a resident of his institution, even though such information was in the public domain.
Whether dangerous mental patients should have the same rights of doctor patient privilege as the rest of us is a vexed question. I can barely imagine the various arguments pro and con. But this is part of a “conversation” (that seems to be the latest buzzword for what was once a “discussion”) we need to have about this whole area. Otherwise next year or the year after that, we will be reading about another Colin Moyle or Dean Clark.
Surely someone needs to be talking to the retired mental health worker quoted in the NZ Herald story on 1 July about the “gaping holes in the system” that led to Dean Clark’s death?
Vote:September 10th, 2012 at 10:44 am
Different argument there rouppe.
Vote:Unfortunately to say all such services are being cut back in the general way effected by economic woes. Perhaps your nephew should be getting himself to Court and heard as quickly as he can, not overlooking of course the first thing is not to take poles apart positions. People do have mental health problems but that doesn’t mean they’re bad or dangerous better to navigate carefully and without assuming malice. Child birth in itself does result for some mothers in depression that can be worked through over time. All so not forgetting that when couples have problems unfortunately most often bombs are exploded, accusations made and so on which don’t help.
September 10th, 2012 at 10:46 am
“Community care” is yet another euphemism.
In this case it is a pretence that there is care when in fact here isn’t any thing real or meaningful going on.
The left like it cos they idealogically hate institutions and it helps their pretence at concern for human rights (not the community’s rights). The right like it as it means less spending on big expensive institutions.
Which ever way you look at it everyone is a loser. Especially the victims of these dangerous nuts who should be locked up and kept secure.
david g…..the ad homs,fuck ‘em,they’re negative wankers with nothing to contribute.
Vote:September 10th, 2012 at 10:51 am
People who are normal cOmmit homicides as well. We must be careful not to stigmatise the mentally unwell every time someone with this illness commits a crime.
Vote:September 10th, 2012 at 10:53 am
kowtow: I agree with you entirely on the “community care” euphemism…I remember a brilliant Tom Scott cartoon at the time when the institutions were being closed down, and almost everyone being released into “the community” …aka a run down boarding house in Kingsland…
A huge male psych nurse was handing a large jar of pills to a guy whose eyes were spirals, like those on the engine of a Boeing….he is saying:
“There you go Nigel…you’ve got your all weather pajamas,…now you’re FREE!”
Funny but not funny, either for the patients or their potential victims…
Vote:September 10th, 2012 at 10:59 am
Plenty of people out there seem to experience life’s joys and life’s sorrows more intensely than a lot of us… Do we need to lock up anyone who gets a bit depressed occasionally, because you never know what they MIGHT do?
I hope those tasked with making the calls on who needs locking up “for the public good” or “for their own good” are more accurate (and more reasonable) than the Kiwiblog audience…
[Edit: My God kowtow you talk a lot of shit. Have yourself another whisky, mix it with fewer pointless generalisations this time. ]
Vote:September 10th, 2012 at 10:59 am
I cannot see why we don’t bring back mental institutions. This is 2012 for fucks sake. They do not have to be built on the model of a Bedlam from two centuries ago. We could make a much better home and life for the mentally ill. Surely the care of people who are dangerous to themselves and/or others should be taken more seriously. This is something I wouldn’t mind my taxes paying for.
Vote:September 10th, 2012 at 11:06 am
RRM: May I politely suggest you read the post a bit more carefully, and my own comment ?
There is a massive difference between those who are ” a bit depressed occasionally” – or even those who suffer debilitating depression or bi-polar disorder – and those who are compulsorily detained because they are a danger to themselves or others.
I learned from my visit to the Mason Clinic that every patient there is remanded there by the Courts; in other words, they are either remanded prior to trial because of questions about their fitness to plead, or whether they are insane, or they are detained there in lieu of prison after a trial, and a finding of “not guilty by reason of insanity”. The latter are what was once, in euphemism free days, called the criminally insane.
The danger is in fact exactly the opposite from that you posit: i.e assuming that those who ARE dangerous, can be “managed in the community” in the same way as those with severe depression, bi-polar disorder, or even many with schizophrenia. And that is the whole point of my post: we need to start managing the truly dangerous differently from those who are merely mentally unwell.
Vote:September 10th, 2012 at 11:24 am
RRM
NATO alphabet;
Foxtrot Oscar.
Vote:September 10th, 2012 at 11:25 am
The major issue here is knowing who is”dangerous” and who is not. Research in Forensic institutions around the world have shown that mental health professionals have only a 50% success rate in predicting who is high risk and who is low risk. In other words tossing a coin would be just as useful. The people who end up in such places are usually held for lengthy periods and would be the most carefully treated of all those who end up in the mental health system. medicated properly (often for the first time ever), physically and psychologically assessed and treated. By the time they leave they will be as well as they have ever been. BUT. just like Stewart Murray Wilson they will need to be released and 24/7 supervision for them all is neither affordable nor ethical. As others have said most murders are not commited by “the insane” but by the drunk or stoned.
Vote:September 10th, 2012 at 12:02 pm
On behalf of the bloke who had his head cut off by the flatmate I kautoko David Garret.
Vote:September 10th, 2012 at 12:04 pm
There are plenty of mentally ill people who are not dangerous.
Vote:There are plenty of people who are not mentally ill – who are very very dangerous.
I really believe we have a problem in dealing with dangerous people. Or rather, we are not actually dealing with it.
Very dangerous – but not mentally ill people – are being released from prison all the time.
Should dangerousness, not mental illness, not be the target here. David at 11.06 is saying that I think.
David is sensitive about his past conviction(s?) being raised in this debate.
But it underlines the point – challenging as it is to him – that the issue is not ‘those different people over there’ who we can easily blame.
But rather its an issue of all of us.
September 10th, 2012 at 12:09 pm
DG – No, I’m pretty happy with what I said.
The power to detain people because – in ourestimation – they are not right in the head is every bit as grave as the power to detain people because – in our estimation – they are villains. I don’t dispute there are cases where it probably needs to be done, all I’m saying is I hope the power is exercised properly, through the right mechanisms, and I hope the people working within that mechanism who make the decisions get it right.
I actually like what you’re saying but you should choose your words with care… I don’t think getting up and campaigning “Can I have a show of hands for how many people here want to have dangerous lunatics walking around in our midst? No-One? Great! We have our mental health policy then!” is a very intellectually honest thing to do… you can probably see the reason?
Vote:September 10th, 2012 at 12:16 pm
Kowtow –
Papa Mike Sierra Lima to you too.
If the subject was neighbors protesting a planned oil refinery on the outskirts of town, I wonder if you would still be trumpeting “the community’s rights”… I suspect you wouldn’t. It’s amazing how malleable conservative “principles” can be.
No-one’s further left than the extreme right, and either they’re genuinely blind to it, or their hypocrisy is staggering…
Vote:September 10th, 2012 at 12:25 pm
hj: I would be grateful for a translation…I think!
Jinky: Spot on…so if “expert medical opinion” is no better guarantee than tossing a coin, then we need to have the very difficult discussion about whether – having killed once in a psychotic state – such an offender needs to be detained forever because future behaviour cannot be guaranteed. Or do we adopt the “hope for the best now you have done all the courses” approach that the Parole Board essentially adopts for offenders who are not mentally ill?
At the moment, we are doing precisely NOTHING…we are not discussing the issue, we are not even acknowledging it…we just passively accept that every now and again the doctors get it wrong and there is another tragedy. Are we as a society prepared to accept that in the same way we (most of us) accept “better that one guilty man go free rather than one innocent man be found guilty? Who knows? We are not even talking about it.
RRM: Surprisingly often (it’s our benign influence on your leftie brain I think) you make quite sensible points on here…your 12.09 – or at least the last part of it – is not one of them. Where in my post do you detect me suggesting that the italicised section of your comment should be any party’s mental health policy?
Vote:September 10th, 2012 at 12:31 pm
Romeo,romeo ,mike
An oil refinery! Great. Bring it on. Jobs,money ,wealth,yes please.
Vote:September 10th, 2012 at 12:43 pm
DG: You’re saying that at the start of what DPF has quoted as your last paragraph.
Citizen XX’s son is probably more likely to walk in front of a bus than take in a nutter and be murdered by him.
So if you want to also avoid all the entrenched interests and haters-of-the-Act-Party from throwing up every road block imaginable in front of this, don’t give them ammunition by saying things like:
Just my 2c.
Vote:September 10th, 2012 at 12:52 pm
RRM: “Haters of the ACT Party” and/or me personally will feel that way regardless…
but you are certainly correct that one is more likely to be killed by a bus than a psyc patient. There are a number of differences though, the most obvious being something (the bus) that is potentially very dangerous, and able to cause harm, as compared to an unmonitored psychotic who has already killed who goes off his meds….the latter is more like a buzz bomb than the bus: almost certain to cause serious harm or death, but with no certainty as to who the victim might be.
I personally have a pretty good idea what I think is the right way of dealing with the problem, but I am more interested in having an informed and honest discussion about it that trumpeting my own views…much as that might surprise “haters of the ACT party”…
Vote:September 10th, 2012 at 1:01 pm
If you post that RRM is slowly migrating towards the right of course you are going to receive a blast at act. Cognitive dissonance has that effect
Vote:The sad thing is act was a movement developed from the ideas of the best brains on the left in its time
September 10th, 2012 at 1:37 pm
Lets acknowledge that ‘community care’ has been phenomenally successful over institutional care. 50 – 60 years ago if there were difficulties there was nothing. You only got assistance if you checked into some bin in the country. And if you were found to be a good worker in the vege gardens you had zero show of getting out again.
Vote:So a mum having post natal problems, could only go to the hospital, so it was better to ignore them. As for the rest of you who had a depression. Well ‘pull yourself together’.
As for services for kids. Zip.
Most of the need was ignored.
It’s still pretty crappy in my view. But a mile ahead of what we had.
As for dangerousness. Let’s treat that as dangerousness and separately.
September 10th, 2012 at 1:55 pm
KH: Well written Sir/Madam but only partially correct. It is not correct that the old “bins” existed simply to keep people confined. My aunt, was diagnosed as a schizophrenic (who knows whether that was correct? That was a widely used label at the time) and was a danger to herself and others. She was confined to Tokanui hospital in the late 40′s where she would have stayed until better drugs were available. In the early 50′s my father was presented with the agonising decision of whether to consent to a lobotomy for my aunt so she could “come home.” He did so, but the decision bothered him for the rest of his life. My aunt lived in the community, in sheltered accomodation for the rest of her life. And this WAS 50 years ago, or almost.
But I agree with the last part of what you say: the major issue is dangerousness. Rather than repeat myself, I would say again what I said at 12.25.
Vote:September 10th, 2012 at 2:46 pm
Reminding what most remember: Janet Frame was scheduled for a lobotomy and was saved by a ms being accepted for publication.
Psychiatry has progressed slowly compared to other professions and no doubt the reason for that is that a psychiatrist cannot see into the mind, or into the future, which is no cause for fear.
Vote:September 10th, 2012 at 4:31 pm
It’s a trade off, as is everything.
The old way there were a lot of people inappropriately locked up, but mostly those who were mad and bad were also locked up. For some of them things were pretty grim, for some of them I gather it was reasonably OK.
The new way there are very few people inappropriately locked up, but there are some who probably should be locked up who aren’t. And here I’m interpreting locked up loosely, I think that some of them might voluntarily move themselves into care, they just don’t have that option.
The question is whether there is some way in between that offers better options for those who shouldn’t be in the community without closing doors for those who can and should be in the community. As many are saying, that implies that:
Vote:1. We can tell which are which with any certainty. That’s a big if, but surely we can do better than we are at the moment
2. We have the funding or the will to create options for people who don’t fit in public life. That is also a big if
September 10th, 2012 at 5:51 pm
Great comments Nostalgia NZ.
Vote:September 10th, 2012 at 7:14 pm
Effective competency training for caregivers might go a long way towards better supervision and monitoring of “dangerous” patients in the community.
Vote:September 10th, 2012 at 7:18 pm
David Garrett
Thanks for posting this. In the rush to deinstitutionalise those formerly committed to psychiatric care much was made of “community care” overseen by trained staff. The doors to the facilities were shut, the land sold or given to the Tangata Whenua but somehow the bit about care slipped through the cracks.
The criminally insane are still housed by the government but it is in prisons where they go in one door & out the other on a continuous basis without ever being given a chance to get the help they need. When they are on the street they will inevitably backslide.
As has already been stated the aim was both a matter of policy & money…..the results have not been kind to those left to their own devices nor those affected by the subsequent crimes.
Vote:September 10th, 2012 at 8:28 pm
Nasska: Well said…the point has been made by others that we now use prisons to try to solve all our social problems… as expensive as they are, they are undoubtedly less expensive than secure psychiatric facilities for the “mad AND bad”…
But it’s actually worse than that I think…it is a cynical gamble that of all of these guys released into community care, only a few will actually kill someone…someone somewhere did, and continues to do, some macabre cost benefit analysis on how many murders by the criminally insane in the community is acceptable.
I would really like to hear from this recently retired mental health worker quoted in the media…He or she will have a good idea of just what the “glaring holes in the system” are, and he may even have some idea at least of the cost of plugging them. I have always been a great believer in the wisdom of guys at the coal face or on the factory floor. Pointy heads never have all the answers.
Contacting him is the next step for me. Watch this space…
Vote:September 10th, 2012 at 8:57 pm
funnily enough DG…
…guess what I do for a job? then refer to my previous post.
Vote:September 10th, 2012 at 9:05 pm
Those that I know who work in your trade bwav have no formal training competence or other wise. The only thing they have is a predisposition to smoking pot and a reasonably tolerant outlook towards difference
Vote:September 10th, 2012 at 9:14 pm
some of us are quite empathic and feel like we can make a difference in spite of the rules
first rule though is same as Wu tang clan and applies across the board…
protect ya neck:)
Vote:September 10th, 2012 at 9:24 pm
Hypothetically…what would y’all think of spending 350k a year for 2 support workers on 24 .hr watch to help a guy with special needs live In his own flat? Bearing in mind this guy adds no intrinsic value to society?
Vote:September 10th, 2012 at 9:35 pm
BWAV
It’s not much of a bargain but it’s the price we pay to live in a society where it is unusual to restrain or incarcerate citizens indefinitely.
Without this as a ‘no go area’ governments under stress have been known to make people disappear under the pretence of the madness of those who oppose them.
Vote:September 10th, 2012 at 9:37 pm
I would say that
Vote:1 it would take four to give 24×7 care
2 depending on the “special needs” the level of care needed;;not a high skill set required so 40 000 pa each its costing to much
3 any reason for the singular focus why not 1;3 to 1;5 caregiver to patient ratio?
4 Then you start getting into taboo stuff like why keep pets?
September 10th, 2012 at 9:39 pm
WTF are you talking about nasska?
btw…how is Key’s trip to russia going ?
Are we winning ?
Vote:September 10th, 2012 at 9:43 pm
BWV: And there I think you have nailed it…someone somewhere has done the sums..: $350K a year for the kind of care you describe; $90K a year for jail; $??K a year to put dangerous patients (and before I get pulled up for that, I mean “dangerous if not medicated”) into a boarding house in Kingsland, with a visit once a week or once a month from someone like you, and hope for the best.
There has to be a better and more cost effective way somewhere between the first and last options which doesn’t mean a victim is created every couple of years.
At the risk of sounding a bit cheesy, I would like to thank everyone who has contributed to this thread today…Aside from one “What about the dead baby” dickhead, the comments have almost all been well thought out and have really added to the debate. If anyone wants to contact me privately my e-mail is: d.garrett@xtra.co.nz
Vote:September 10th, 2012 at 9:48 pm
griff…
1) 6 on 3 rotations of 8 hrs a day, 4 days on 2 days off.
Vote:2) minimum of 350k a year possibly up to half a mil and yeah…babysitter cum chauffeur come night cleaner…hardly rocket surgeon
3) every cause needs a posterchild but true that most clients do share houses with that ratio.
4) cos we can
September 11th, 2012 at 8:06 am
Thanks for the opportunity to enjoy a sardonic smirk, David.
Is this about protecting the community from from the mentally ill, or do we now require protection from Mr. Garrett using KB to crow about his (questionable) former glories? Personally I think using the mentally ill to prop up the Three-Strikes’ idea is really scraping the barrel.
Ironically I couldn’t help but feel that this post seems like part of a slowly unfolding strategy to re-introduce the writer himself back into some sort of community – perhaps the political one? The irony being of course, many would argue against his re-introduction regardless of how many times he trumpets his contribution to the flawed ‘three-strikes’ law, based on his isolated ‘dangerous’ outbursts..
So we get an article stigmatising the majority of mentally ill people (which is everyone, at some time) from someone who calls for understanding about his own bouts of mental illness. He’s seriously calling for ‘three strikes’ but feels that ‘three strikes’ plainly should not apply to him. He then claims that certain people to be disbarred from ‘well’ society using a very small sample of examples.
And yet, when people apply the same kinds of reductionistic, simplistic and pointless arguments against the writer, and bring up his own misdemeanours, he gives us hurt feelings about ‘ad homs’ and ‘defends’ himself by pointing out he was ‘mentally ill’ when it happened. I don’t know who would be more envious of such moral gymnastics – Lewis Carroll Jonathon Swift or Olga Korbutt.
I get the point about the dangerous and the failings of the system in some ways. But, David – Where’s the sophistication? Human rights? Reference to the vast majority of successful examples? MIA because it is so much easier to get the pitch-forks and torches out and start a dog-whistle’ pogrom against the ‘mentally ill’ as a way to grease the wheels of your own ‘road to redemption’?.
FFS you couldn’t make it up.
Vote:September 11th, 2012 at 12:09 pm
LeeC: What a nasty twisted leftie! (Anonymous as you all are) I wasn’t going to bother responding, but your comment is so twisted I feel I must. Point form is best – makes it easier for you to follow, and I expend less time on you.
1. I have no intention of re-entering politics, although I have been asked to.
2. I never used “because I was mentally ill” as an excuse for my offending in 1984. In fact I pleaded guilty to the charge.
3. I am not attempting to “stigmatise all people with mental illness”. Perhaps you should do some research on the word “forensic”. As I say in the post, all patients at the Mason Clinic are there because they have been sent there by the courts. They and other FORENSIC psychiatric patients are a small subset of those who are compulsorily detained – most of whom are a danger to themselves rather than others – who are in turn a very small subset of those patients in institutions, most of whom are voluntary. Those three categories – forensic patients, compulsorily detained patients and voluntary patients are in term collectively a tiny subset of the “mentally ill”, most of whom are and always will be managed in the community. That’s all a bit complicated so you might have to read it slowly.
4. My concern is about FORENSIC psych patients who are released into the community with inadequate care, potentially resulting in tragedies for the community, and added suffering for them.
Have you got all that? Unless you are incredibly stupid I’m sure you “got it” from the post, but nasty attacks are much easier. Especially when hiding behind a pseud.
PS I don’t know what “reductionistic” arguments are, and I have no interest in finding out. When attacking me please use plain words, I don’t enjoy having to consult a dictionary before responding.
Vote:September 11th, 2012 at 4:36 pm
I’m glad you responded.
By’reductionistic’ means taking a large issue which has lots of sophisticated and perhaps contradictory or challenging ideas and ‘reducing’ it to a simple ‘one-size-fits-all’ blanket assertion. It’s often levelled at people who can’t hold more than one idea in their heads at the same time.
You kind of prove my accusation by assuming I’m a ‘nasty lefty’ – what – on the basis that I have a different political opinion to yours – do you hold the monopoly on political evaluation? Then compound the impression, by then accusing me of at once being too explicit, and then accusing me of being too obscure.
I mean which one is it? Anyway I was being more explicit with you than I might be because I thought you were used to the ‘cut and thrust’ of plain talking. I wasn’t trying to offend as much point out the inconsistencies in your argument.
Vote:September 11th, 2012 at 4:43 pm
ps the ‘C’ stands for ‘Clark’ 09 815 4321 give me a call sometime.
Vote:September 11th, 2012 at 7:28 pm
OK I’m back. Firstly I’d like to apologise for any offence I caused you or indeed any upset. I want to qualify my motives for expressing myself as I did when I posted originally and clear up a couple of things. BTW, as far as I recall I’ve never made any reference to your ‘crime’ which you did as a kid, I thinkto do so is a low shot, and I did not do so in my original post today. I was concerned by three things.
First, the apparent way you were advocating and promoting your ‘Three Strikes’ law. I think you will find I’ve never supported that, and have never made any secret of it here. I just think it’s based on dodgy assumptions and at worst, dangerous.
Secondly, the use of mental illness as a means to promote said law. My objections to its usage are based around reservations about its legal and Human Rights applications against the ‘sane’ – so using it against the ‘insane’ would, instead of (as you appear to be suggesting) not vindicate it’s usage, but compound any opportunities for misuse /abuses if used so.
Thirdly, I think it is risible to suggest that basing a proposition that what I consider to be a questionable law, if applied to the mentally ill would serve as much more than cannon-fodder for the wing-nuts who think that all criminals get an easy ride – in short I was concerned that this was dog-whistle politics.
I did not infer that you had pleaded mental illness in your case. You indicated your own history with depression on this thread, which is why I referred to that. My sole error was that I referred to your own lack of enthusiasm to go down under your own ‘three strikes’ law, when it transpires you were found ‘not guilty’, and my apologies for that.
What I was trying to get across to you is that sometimes there is a thin line between advocating for treatment of a certain kind for some, and forgetting ones’ own history and needs. I’m not accusing you of being forensically insane, but in my clumsy way was trying to highlight how easy it is, when discussing mental illness, to get people to engage in ill-informed discriminatory actions, simply by pushing the right kinds of buttons. Now if you think your motives for writing this were pure, and the way you wrote it were blameless, then fine and dandy. But you have to accept that if you play with gunpowder, you should not express yourself with such suprised self-righteous terms if occasionally you get your fingers blown off. Surely you knew what you were taking on here?
I think,deep down, you knew that. So apologies for my nastiness, but try to recall that mental illness is many faceted, and should not be reduced to a cassus-belli, indicating to the good people that loonies are everywhere (like in the flat next door). That, my friend, is just mischievous.
Vote:September 13th, 2012 at 6:26 am
(i) Though examples rarely make the paper, people with mental illness are much more likely to be subjected to crime and violence than to commit either. (ii) Public opinion notwithstanding, the overwhelming majority of people who have been diagnosed with mental illness are not dangerous. (iii) It is correct that there is an increase in relative risk of violence for some groups of people with mental illness (males with a history of violence who are manic; people who have a paranoid form of schizophrenia), but the absolute risk of violence from those groups is still extremely low. Nonetheless, when examples do occur, they are highly publicized. (iv) With some exceptions (e.g., serial sex offenders), psychiatrists are no better at predicting future violence than, for example, juries.
That said, do we need a conversation about when to detain people in advance of potential violence? No, because we have had it once already, namely when we introduced preventive detention, and, as the the MoJ guidance makes clear, decided that a person had to pose ‘a substantial risk of grave harm to the public or specific individuals’. The Court of Appeal requires a long history of serious offending and, inter alia, a failure to successfully remediate the tendency to reoffend. It’s clear that reoffending – even serious reoffending – possibly being on the radar screen is not enough to justify intervention.
Since we’ve set the bar here for people with a history of very harmful acts, requiring a high probability of serious future harm we can’t sensibly impose a much lower threshold on people who are mentally ill, simply because some of them may have a relative risk of offending that, though low in absolute terms, is somewhat higher than the general population.
Finally, I agree with David that psychiatric care, and especially pass-the-parcel community care, is often wanting. We disagree on elements of the solution.
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