In 1999, this column reviews the benefits of mandatory treatment for people who have dangerous mental illness.
When Julio Perez, a mentally ill convicted felon, shoved Edgar Rivera in front of a subway train in late April, severing the Bronx man's legs, New Yorkers felt a sickening sense of déja vu. Several months
earlier—even more horribly—Andrew Goldstein, suffering from untreated schizophrenia, had hurled receptionist Kendra Webdale to her death under a city subway train. Perez and Goldstein were the latest versions of a familiar story: seriously mentally ill New Yorkers who kill or maim while not receiving proper psychiatric treatment for their illnesses.
Thirty years ago, if someone as sick as Perez or Goldstein left a New York psychiatric hospital, he did so conditionally. To stay outside, he had to continue treatment, taking whatever medication he needed. But that was before deinstitutionalization, inspired by liberationist psychiatrists R. D. Laing and Thomas Szasz, emptied New York's psychiatric hospitals; before civil libertarian lawyers made mandatory treatment next to impossible; before fiscal conservatives, to save money, began shutting down the now-vacant mental hospitals. Today, after three decades of bad policy, many other unmedicated Julio Perezes and Andrew Goldsteins roam New York's streets and subways. They pose a threat to themselves: the suicide rate for untreated schizophrenia is as high as 15 percent, and many mentally ill people meet pitiable ends living on the street. And they pose a threat to the public: the psychiatrically disabled, less than 1 percent of the U.S. population, commit 1,000 homicides a year—4 to 5 percent of the nation's total. Convicted of a host of other misdemeanors and crimes, from disorderly conduct to rape, they crowd our jails and prisons.
How many more crimes from people who have no idea what they are doing are we going to see committed before we decide to take action?