The story of Mark Daniel Sallee would be sad enough were it a rare
instance of one dangerously psychotic person slipping through the cracks.
But Sallee's case is just about business-as-usual in Kentucky and the
rest of the United States in 1994. a recent story that grabbed national
headlines broke on June 6, 1991, when a homeless man named Kevin McKiever
fatally stabbed a 30-year-old former Rockette, Alexis Fichs, Welsh, with
in 11-inch butcher knife near New York City's Central Park as she walked
her two cocker spaniels. Fifteen months earlier, he had spent just 30
days in jail after stabbing another woman who lived in Welsh's apartment
building. His mother told reporters that McKiever had been diagnosed as
suffering from "schizophrenia and manic depression" as long ago as the
mid-1970s, but that he had never gotten adequate treatment. "They system
has absolutely failed him," she said.
In 1963, President John E. Kennedy announced a "bold new approach"
to serious mental illness. With the development of anti-psychotic
medications in the 1950s that were found to be at least partly effective
in relieving symptoms for 90 percent of schizophrenics, Kennedy
envisioned the opening of hundreds of community mental health centers,
where people with schizophrenia could get day to day help in managing
their lives. "When carried out," he declared, "reliance on the cold mercy
of custodial isolation will be supplanted by the open warmth of community
concern and capability."
Hand in hand with the new federal policy, civil rights laws in all
but a handful of states threw out all permissible reasons to
institutionalize a person against his or her will, no matter how sick,
save one: imminent danger. Unless a person was found to be in imminent
danger of seriously harming himself or others--imminent as in the next
few minutes or, in the case of malnutrition, days--that person would be
free to go on living in the community.
The deinstitutionalization movement did succeed in bringing down
the number of state mental hospital patients from a high of 552,150 in
1955 to 68,000 today. But despite $40 to $100 million in federal tax
dollars given to community mental health centers beginning in 1965,
according to a recent study by the National Alliance for the Mentally Ill
(NAMI) and the Public Citizen Health Research Group, "It is clear that
whatever was supposed to happen did not happen and that
de-institutionalization was a disaster."
Many schizophrenics remained out of sight and out of mind until the
flop-houses and single-room-occupancy hotels where they had found a last
refuge began to disappear in the mid-1980s. Today, according to the
NAMI-Public Citizen report, there are more than twice as many people with
schizophrenia and manic-depressive psychosis living in public shelters
and on streets than there are in public mental hospitals. In all, about
30 percent of the country's homeless--an estimated 150,000--are seriously
mentally ill.
As a result, "It is clear that episodes of violence by individuals
with untreated serious mental illnesses are on the increase," the report
states. Although mentally ill people, when receiving treatment, are
believed to be no more violent than average, when they are not treated
"some of them will occasionally commit acts of violence," according to
the report.
What spurs them on is the disease itself: paranoia may make them
think they're being attacked, delusional thinking may make them believe
their mother is really the devil, and auditory hallucinations may order
them to kill. Since 1965, eight studies have found that violent acts by
untreated psychiatric patients are on the rise.
Some of the most chilling rampages across the country in recent
years were caused by people long known to the mental health system as
dangerous schizophrenics, but who never qualified as being "imminent"
dangers. In Berkeley, California, in the summer of 1990, Mehrdad Dashti
stormed a bar, killed one man, wounded seven, and took 33 hostages before
police shot him dead. Documents found in his apartment showed that he had
recently been diagnosed as paranoid schizophrenic. Earlier that year,
Calvin Brady shot and killed a man and wounded four others in an Atlanta
shopping mall the day after he was released from a mental hospital. In
his pocket was found a document describing him as having "homicidal and
suicidal tendencies." In October, 1985, Sylvia Seegrist opened fire in a
Philadelphia shopping mall, killing three and wounding 10. She had been
committed 12 times to mental hospitals, had stabbed a hospital worker,
and had repeatedly made violent, bizarre threats in the mall.
Just what does a person have to do to be considered in imminent
danger of harming himself or others?
"As soon as the bullet comes out of the gun, then we can arrest
him;' says Herbert Pardes, M.D., former director of the National
Institute of Mental Health and now chairman of the Department of
Psychiatry at Columbia University in New York. "In an attempt to protect
the rights of the patients, we have compromised the rights of
society."
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