Untreated mental illness an imminent danger?
The following script is from "Imminent Danger" which aired on Sept. 29, 2013, and was rebroadcast on June 8, 2014. The correspondent is Steve Kroft. Producers Graham Messick and Coleman Cowan.
The past several weeks have seen another deadly outbreak of mass shootings by lone gunmen in their 20's on or near college campuses, part of an epidemic of senseless violence that's now occurring on a regular basis.
It's become harder and harder to ignore the fact that the majority of the people pulling the triggers have turned out to be severely mentally ill, not in control of their faculties, and not receiving treatment. In the words of one of the country's top psychiatrists, these were preventable tragedies, symptoms of a failed mental health system that's prohibited from intervening until a judge determines that someone presents an "imminent danger to themself or others."
And as we first reported last fall, the consequence is a society that's neglected millions of seriously ill people hidden in plain sight on the streets of our cities, or locked away in prisons or jails.
There is something eerily similar about the shooters, as if they were variations of the same person. All young males, often with the same glazed expression, loners who exhibited bizarre behavior, and withdrew into their own troubled world. They're often portrayed as villains. But Dr. E. Fuller Torrey says their deeds have much more to do with sickness and health than good and evil.
Dr. Torrey: Every person I've taken care of, and I've taken care of several hundred of these people, had a very good reason for doing what looked to be crazy behavior. But in their mind, it wasn't crazy behavior. It was in response to something that was very logical, that their voices were telling them, or that their delusions were telling them.
Dr. Torrey is one of the most famous psychiatrists in the country, an expert on severe mental illness, and a staunch critic of the way the country deals with it.
Steve Kroft: How much of these terrible incidents that we've had, these mass shootings, is traceable to deficiencies in the mental health care system?
Dr. Torrey: Well, they're directly related. About half of these mass killings are being done by people with severe mental illness, mostly schizophrenia. And if they were being treated, they would've been preventable.
For example, before killing 12 people at the Washington Navy Yard last September, the gunman, Aaron Alexis, told police that he was hearing voices and being bombarded by strangers with a microwave machine. If he had been transported to a psych ward, the shootings might never have happened.
"About half of these mass killings are being done by people with severe mental illness, mostly schizophrenia. And if they were being treated, they would've been preventable."
In 2007, Virginia Tech student Seung-Hui Cho was behaving so irrationally that a court ordered him to seek mental health care. The order was never carried out. Cho killed himself and 32 others.
And before James Holmes dressed up as the Joker and shot 70 people in a movie theater, campus police at the University of Colorado had been warned that he was potentially violent. Holmes had been a brilliant graduate student there studying the inner workings of the brain, until something suddenly went wrong with his. Dr. Jeffrey Lieberman, who is president of the American Psychiatric Association, says it's not that unusual.
Dr. Lieberman: You can be the most popular student, you can be the valedictorian of your class. And if you develop schizophrenia it will change the functioning of your brain and change the nature of your behavior.
Steve Kroft: You could be completely normal at age 20, perhaps a good student or a gifted student and a solid citizen, and at 21 or 22 be psychotic?
Dr. Lieberman: Absolutely.
Dr. Lieberman, who runs the psychiatry department at Columbia University's medical school, says that schizophrenia has a genetic component and tends to run in families, affecting the way the circuits in the brain develop. You can see the structural abnormalities in a brain scan.
Dr. Lieberman: And you see people, a young adult, with a normal brain, same age with, who has schizophrenia, and you see that degenerative process has already begun.
Steve Kroft: This is really a disease of the brain. Not a disease of the mind?
Dr. Lieberman: Absolutely.
"You can be the most popular student, you can be the valedictorian of your class. And if you develop schizophrenia it will change the functioning of your brain and change the nature of your behavior."
It lies dormant during childhood and usually emerges in late adolescence and early adulthood, affecting perception and judgment. People see things that aren't there and hear voices that aren't real.
Steve Kroft: What's the nature of these voices and what do they say?
Dr. Lieberman: Usually it's multiple voices, talking about them in the third person, as if they're not there. They may be saying, "You're a horrible person. Everybody hates you. The only way that you can justify yourself is to lash out at them."
Steve Kroft: How strong are the voices?
Dr. Lieberman: When they're at their worst the person can't distinguish the voices from their illness and they think the voices are part of them, and if they tell them what to do, they'll follow it.
Jacob Bowman: I hear a voice. It's a man's voice and it's really, really deep. It's a really deep and scary man's voice...
Schizophrenia is more common than you might think. Several million Americans have it. 17-year-old Jacob Bowman has been struggling with it for a couple of years.
Jacob Bowman: This is basically me on a bad day, I guess. Because I can't think straight. My thoughts are racing really, really fast.
He's dropped out of high school, lives at home under the watchful eyes of his parents, and rarely goes out because he thinks people are trying to kill him. He spends much of his time on social media -- we found him on YouTube -- where he shares his world with other young people who have the same symptoms. He wants them to know that they're not alone, and that the voices and hallucinations are not real.
Jacob Bowman: Basically all my voices I have are just thought-- just voices telling me to harm myself or harm other people or kill people. And, that's why I think I need to get on medication because I don't want to hurt anyone. And because I know schizophrenics aren't violent.
And he's mostly right. The vast majority of people with schizophrenia never show any signs of violence. Mike Robertson was 19 years old and away at college when he was diagnosed three years ago.
Mike Robertson: I felt like there was people around me, like, bad people or nice people.
Steve Kroft: Even when there was nobody there.
Mike Robertson: Yeah. And that's what really, that's what really got to me.
Linda Doran: He told me over the phone, "I feel like I'm going insane. I swear there is a bug in my head and I just want to tear at my eyes and my skin and my scalp to get to it and get it out of there so I don't have to hear it anymore." Very scary.
Michael's mother, Linda Doran, brought him back to California and got him into treatment, which consists of regular therapy sessions and daily doses of heavy duty anti-psychotic drugs that stabilize him and help control the symptoms.
Mike Robertson: Clozapine. It's an anti-psychotic. Haloperidol. Cogentin or Benztropine. Fluvoxatine or Prozac, Lorazepam for anxiety.
They often leave him listless or groggy, which is one of the reasons people with severe mental illness often stop taking them.
Steve Kroft: A lot of people with your illness say the drugs make them feel worse. They just hate it.
Mike Robertson: Yeah. I can see that with the side effects. But it's better than having schizophrenic symptoms.
Steve Kroft: What worries you the most?
Linda Doran: The future and the future without myself being here. Because I am Mike's caregiver. I am his advocate. And so, if I am not here who will be?
It is a serious concern and a sobering thought, because it's estimated that half the 7 million people in the country with schizophrenia and other forms of severe mental illness are not being treated at all.
Duanne Luckow: This is Day 10 now of my fast. So I'm feeling really, really good.
Duanne Luckow is one of them. He has spent the past three years on and off the street and in and out of jails and mental institutions, but he doesn't acknowledge that there is anything wrong with him and has refused treatment. He's been recording the events in his life to prove that he is sane and that the rest of the world is out to get him.
[Police Officer: Do you have a gun at home?
Duanne Luckow: Do I have a gun at my home? Yes, I have a gun at my home.
Police Officer: OK. So it's a true statement.]
There's a confrontation with police at his parents' home and this full blown psychotic episode on the top of Multnomah Falls in Oregon in which he threatens to go over the side.
[Duanne Luckow: I come from the planet of Pluto! I'm here to protect this planet! I'm here to bring justice about! There is no justice. This planet is entirely corrupt! The FBI wanted to screw around with me! They didn't want to give me my ATM cards!
Sandra Luckow: It really feels as though he's on the edge. It's pretty scary.
Duanne gave the footage to his sister, Sandra Luckow, a documentary filmmaker who teaches in New York.
[Duanne Luckow: May the truth be known!]
She spent years trying to help him.
Sandra Luckow: On a certain level, this would make him crazy to think that the very thing that he thinks is going to exonerate him shows how crazy he is.
Steve Kroft: Did you have trouble getting him treatment?
Sandra Luckow: Yes. Yes. A tremendous amount of trouble getting him treatment.
She is no longer sure her brother can be helped, and has kept her distance ever since he sent her a threatening email.
Sandra Luckow: He said that someone was going to come to my apartment with an AR-15 and hollow point bullets and spatter my brains all over my apartment.
Steve Kroft: Has he ever been violent?
Sandra Luckow: Not that I know.
Steve Kroft: But you think it's possible?
Sandra Luckow: Sure.
Fifty years ago, someone like Duanne Luckow would have ended up in a place like this, involuntarily committed to one of the big state-run hospitals that were used to warehouse the seriously mentally ill.
Documentaries like Frederick Wiseman's "Titicut Follies" helped expose the dehumanizing conditions and led to reforms. One by one, the big asylums were shut down, and over time, a half million inmates were released into communities to fend for themselves. They were supposed to be housed in residential treatment centers, medicated, and supervised by case workers at walk-in clinics. But the programs were never adequately funded.
Dr. Torrey: What we did is we emptied out the hospitals and, on any given day now in the United States, half of the people with schizophrenia and other severe mental illnesses are not being treated.
Steve Kroft: How difficult is it to get somebody admitted who does not want to be admitted?
Dr. Torrey: Almost impossible in most states. The laws will read, "You have to be a danger to yourself or others," in some states, and judges may interpret this very, very strictly. You know, we kiddingly say, "You have to be either trying to kill your psychiatrist, or trying to kill yourself in front of your psychiatrist, to be able to get hospitalized."
Steve Kroft: If these people aren't receiving medical attention, where are they ending up?
Dr. Torrey: Many of them end up homeless. Many of them end up in jails and prisons now. So this is a huge problem. Our jails and prisons are our main place now where you find mentally ill people.
In fact by some measures, the largest mental institution in the United States is the Cook County Jail in Chicago. It houses the largest number of mentally ill people in the country.
Tom Dart: This is a population that people don't care about and so as a result of that there are not the resources out there to care for them.
Cook County Sheriff Tom Dart is in charge of the jail and he is not very happy about the situation.
Tom Dart: I've got probably 2,500, 2,800 people with mental illness in my jail today. And you look at their backgrounds, they've been in here 50, 60, 100, we have some people who've been in here 400 times.
Steve Kroft: What kind of offenses?
Tom Dart: Oh my God, retail theft is a norm. And usually it's 'cause they're stealing something either to feed themselves or, frankly, they're stealing something because they just wanted it that second. Loads of cases of criminal trespass to land. What's that? They're breaking in some place to sleep.
Steve Kroft: You're saying the prisons and the jails are the new asylums?
Tom Dart: Absolutely. There is no person that could argue otherwise that the jails and prisons are the new insane asylums. That's what we are.
[Inmate: What the? Wait! Don't spray me!]
Sheriff Dart has told guards and employees to videotape incidents so that he can show people what actually goes on here.
Tom Dart: And the videos we've shown people are to show them what happens when we take people who are mentally ill and we cram them into the criminal justice system where they're not supposed to be. And the irony's so deep that you have a society that finds it wrong to have people warehoused in a state mental institution, but those very same people were OK if we warehouse 'em in a jail. It's just-- you've got to be kidding me.
[Elli Montgomery: Were you ever diagnosed with depression or bipolar disorder?
Inmate: Yeah, a long time ago.]
Every day Elli Montgomery, one of five social workers here, goes over the list of new inmates with mental illness.
Elli Montgomery: We have 1, 2, 3, 4, 5, 6, 7...15. With a severe mental illness.
Steve Kroft: Just this morning?
Elli Montgomery: Yeah, just this morning. Severely mentally ill. Not like a little bit of depression.
Most of them will be here for several days to several months, then released back on the street with a packet of pills and no plan. Sheriff Dart says it's become a huge public safety issue.
Steve Kroft: There's been an epidemic of mass shootings. A lot of them by people with serious mental health problems. Do you think there's a connection?
Tom Dart: Yes, I do think there are connections here because people-- some are getting treated. Other ones aren't getting treated. People are falling through the cracks all the time. And so to think that that won't then boil up at some point and end up in a tragedy, that's just naive. That's just naive.
Dr. Torrey: We have a grand experiment: what happens when you don't treat people. But then you're going to have to accept 10 percent of homicides being killed by untreated, mentally ill people. You're going to have to accept Tucson and Aurora. You're going to have to accept Cho at Virginia Tech. These are the consequences, when we allow people who need to be treated to go untreated. And, if you are willing to do that, then that's fine. But I'm not willing to do that.