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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Bettering care for mentally ill

Jamie TobiasNeely

Gazing at the oddly familiar face of Jared Loughner, eyes wild as any other zealot’s, smile as loopy as that of a neighbor obsessed by a pyramid scheme, I began to realize how disconnected from reality so many of us are.

It’s appearing likely that Loughner demonstrated the symptoms of a psychotic disorder such as schizophrenia, which usually begins to show up in early adulthood. It can be marked by a profound and frightening break with normal human thinking.

Loughner described a phenomenon of “conscious dreaming.” As I read and learn more about him and that terrible shooting spree in Tucson, Ariz., I find myself disappearing into a delusion of my own. …

In it we live in Spokane, of course, a well-ordered community, where people with serious mental illness are invariably assessed and treated. Profes- sionals are quick to make accurate diagnoses, and laws are designed to balance the civil rights of the person with community protection. Spokane residents understand that patients with mental illness rarely pose a danger to anyone else, but they don’t deny that the risk exists.

Diagnostic tests for mental illness these days are exacting instruments, highly accurate and predictive. And the mental health system, generously funded by a grateful citizenry, has developed a wide array of both inpatient and outpatient commitment programs for the most seriously ill. Those with a high likelihood for violent behavior are kept safely away from the rest of the community, in treatment programs that are models of excellence and compassion. After all, no one elects to develop paranoid schizophrenia any more than they do lymphoma.

Years ago, during the “One Flew Over The Cuckoo’s Nest” era, Americans realized too many of the mentally ill were warehoused in inhumane facilities. They were released from the care of the various Nurse Ratcheds and allowed to gravitate to “least restrictive” alternatives. The vision then was that community-based treatment would do a far better job while giving people with mental illness more freedom and dignity.

Thirty years later, the pendulum had swung to the other extreme. Spokane residents cringed as they realized that significant numbers of the mentally ill spent their nights sleeping under bridges and freeways, in homeless shelters and in jails. Anti-government sentiment became so strong that many of the mentally ill wound up living in abject poverty.

People had to be gravely disabled or an obvious danger to themselves or others before they could be forced into treatment. That was hard to prove unless a person walked down a snowy street stark naked or actually showed up somewhere carrying a gun. People were rarely held much longer than 72 hours, and psychiatric facilities were strained and overcrowded.

Around the country, and even in Spokane, highly publicized cases involving the mentally ill occurred with increasing frequency. Fairchild, Columbine, Virginia Tech, Tucson. Each time one of these big events occurred, the whole country went into shock. But there were so many smaller incidents and near misses that most Americans had begun to shrug them off.

Finally, one day, not long after President Barack Obama urged us, in memory of 9-year-old Christina Taylor Green, to forge an America “forever worthy of her gentle, happy spirit,” a transformation occurred.

The country found a way to bring the pendulum back to the center. Finally the mentally ill were seen as people as deserving of care as those with kidney disease.

A balance was carefully struck between protecting the civil rights of the mentally ill and the safety of the community. Innovative psychiatric research yielded more effective tests and treatments.

In Spokane, as well as around the country, everything from officer-assisted suicides to homelessness to random gun violence dropped dramatically.

Community colleges and other institutions are now deftly linked to the city’s mental health system. No longer do colleges simply expel students for showing possible signs of serious mental illness. Now they quickly refer students to Spokane’s crackerjack system, and everyone gets the optimal treatment, whether medication or long-term psychotherapy, tailored to his or her diagnosis.

In a related development, gun sales have plummeted and political civility has soared.

Nobody would have believed this new reality and the amazing cultural shifts, the brilliant legislation, and the fair but necessary taxation behind it ever would have been possible. But it was, and we in Spokane are all the safer and the healthier for it …

Now that’s one sweet conscious dream.

Jamie Tobias Neely, a former associate editor at The Spokesman-Review, is an assistant professor of journalism at Eastern Washington University. Her e-mail address is jamietobiasneely@comcast.net.