Friday, September 25, 2009

Who are the Manifestly Violent Mentally Ill and Why Should We Care About the Current Law Regarding MVMI?

Research shows the mentally ill are more violent than the general population. Other factors, like substituting cocaine for licit medication, make their violent behavior highly predictable.

Studies find that a schizophrenic off meds and on cocaine will be violent in the first six months. (See the work of J. Reid Meloy, Ph.D. especially, his book Violence Risk and Threat Assessment.)

In every city, there are a set number of mentally ill who monopolize resources and pose serious risk to the public. Their violent behavior causes the public to wrongly consider all mentally ill dangerous and therefore to be avoided. I believe that if we identify and isolate the manifestly violent mentally ill (MVMI), we will free the passively ill from this stigma.

A major myth is that the MVMI just "snap." Studies show they warn family and mental health professionals well before they act. It appears that now in our culture mass shootings by the mentally ill are increasing and they are often accompanied by warnings sent to the media.

Currently, our jails are the largest treatment facilities for the MVMI

My son and two brothers are police officers. Law enforcement is our first line of defense against these offenders and our jails are the largest treatment facilities. The former executive director of the National Sheriffs' Association, Thomas Faust, has written that the three largest mental health facilities in this country are these well-known jails: Rikers Island (NYC); Los Angeles County Jail; and Cook County Jail (Chicago).

I would like every officer to see on his computer when they are approaching the house of a MVMI, that they are former patients who expressed a desire to “die by cop.”

Death threats by the mentally ill should be considered as seriously as a suicide threat.

All death threats to family and members and others by the mentally ill should be taken as seriously as threats to commit suicide. It will save lives. Mental illness is the third highest predictor of violence following previous violent history and drug use.

Currently, there is too much pressure placed upon the treating physicians.

Only patients, who are dangerous to themselves or others, are committed involuntarily. Indeed, without the word “kill” in the affidavit supporting commitment, it is most difficult to access the state hospital. Almost everyone who goes in, goes in and out again and again.

Presently, statistics show judges never overrule a doctor who directs commitment or release!

That means all the responsibility for ensuring public safety rests with doctors. The doctors’ treatment and decision to report or not to report are also protected by medical privacy. Except for notorious crimes, their reports are never seen by the media or public, even if the patient has foretold their behavior with serious violent hallucinations.

I believe new legislation is vitally important to the public safety, that new laws will save lives of police officers, that passing new statutes will reduce the stigma the mentally ill suffer and relieve psychiatrists from the sole responsibility of dealing with the MVMI.

In the future, I will have guest posts by mental health professionals, who will discuss this issue from their professional perspective. Other experts in fields related to this issue will also be providing their input (from the judiciary, law enforcement, etc.)

And, of course, I welcome your comments to this issue.

-- Judge Tom Rickhoff

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