A humane society's obligations to the mentally ill

If you link here, you can hear a really sad story. It's the taped reminiscence of Kim Emerson, whose sister, Kendra Webdale, was killed seven years ago when a mentally ill man pushed her in front of an oncoming NY subway train. The story concludes by telling us that "[t]he Webdale case led to the creation of a new law in New York State -- called Kendra's Law -- meant to ensure that mentally ill people take the medication they need." This story triggered something I haven't thought about in a long time, since I no longer live in the City, but which was in the forefront of my mind during the many years I worked downtown: the horrible thing the ACLU did to the mentally ill. One of the big ACLU and liberal lawyer triumphs of the 1960s (and one they're still working on at irregular intervals today) was to deinstitutionalize the mentally ill. (You can get a taste of this through this old City Journal link.) The ACLU's point was that it was a denial of civil liberties to force the mentally ill into institutions when many of them (most notably the paranoid schizophrenics) so obviously didn't want to be there. I remember vividly when Reagan, while still Governor of California, signed off on Legislation deinstitutionalizing the mentally ill. (I don't know if he did it out of conviction, political expediency, or because he was forced to do so. I just remember it happening.) The immediate and obvious result of Reagan's "freeing" of the mentally ill was a huge influx of people on the streets living in filth and talking to themselves. Indeed, nowadays, when I see a well-dressed young man talking to himself and gesticulating, my first thought isn't "Oh, lucky him, he has a wireless headset." Instead, it's "Oh, boy, a crazy man. I'd better cross to the other side of the street to avoid him." These new homeless, who often coupled substance abuse problems with their mental illness, were appalling. They ate out of garbage cans; lived in their own filth; had all their wordly goods piled in stolen shopping carts; had terrible lesions on their bodies; were tubercular; harbored contagious vermin (such as lice); lunged at people walking by; and, as happened to Kendra, occasionally killed people. I said "were appalling." They actually still are. While I don't live in the City anymore, I only have to head to a major urban downtown (New York, S.F., Phillie, wherever) to see them again. In California, they can be "5150'd". That is, the police can bring them in for observation for three days. If they are not deemed an imminent danger to themselves or to others, though, and if they decline treatment (which paranoid schizophrenics usually do -- that being the nature of their illness), they're back on the streets again. I'm not sure how you measure imminent danger for someone who is mentally ill, drug-ridden, tubercular, riddled with skin lesions, eating out of garbage cans, and sleeping in gutters, but, heck, what do I know? All I can say is that, if you measure a society's humanity by how it treats these helpless people, our current laws allowing them to descend into the Seventh Circle of Hell on our own streets is a striking example of inhumanity. The fact that some who are profoundly mentally ill can still function at a minimal, animal level, doesn't mean that we're doing them a favor by allowing them to avoid healthcare, mental health treatment, decent food, and some level of physical safety. I'm absolutely sure that the old mental institutions weren't nice places, and I doubt that the current mental institutions are anything to write home about, but I can't avoid the thought that they're better than life on the streets. Nor can I believe that letting a deeply mentally ill person make the decision about whether to say no to treatment and care is as cruel as letting a two year old decide to walk into a lion's cage without intervention. I therefore believe that the ACLU has much to answer for in this regard, both for the deaths of these homeless (hypothermia, malnutrition, alcohol poisoning, being "rolled", etc), and for the deaths of others at the hands of these same people.