[NYAPRS Enews] Bazelon Center: Condemns Trump Call for More Institutions, Analysis: No Correlation Between Psych Beds and Murders

[Harvey Rosenthal]

NYAPRS Note: The President has recently suggested that we rebuild or expand psychiatric hospitals to curb violence and mass murders (see article below).
NYAPRS joins the Bazelon Center for Mental Health Law in strongly condemning the false claim that (forced) institutionalization of people with mental health conditions will promote community safety: "Labeling people with mental health disabilities as "dangerous" and calling for forced institutionalization on the basis of mental illness alone is irresponsible, unconstitutional, and unacceptable, and it must stop."
A 2013 analysis conducted by the Bazelon Center that found no meaningful correlation between the number of psychiatric hospital beds and murders, concluding that "there is a substantial body of evidence suggesting that meaningful remedies may instead be found in appropriately resourcing the nation's community mental health systems enabling them to move from their current crisis focus and to provide early, effective services and supports to people with serious mental illness."

Statement On Recent Proposals To Institutionalize People With Mental Health Disabilities
Bazelon Center for Mental Health Law  February 26, 2018

The Judge David L. Bazelon Center for Mental Health Law condemns President Trump's recent claim that the forced institutionalization of people with mental health disabilities will promote community safety. This statement must be recognized for what it is: an uninformed and discriminatory policy proposal that ignores the uncontroverted evidence that addressing mental illness has virtually no impact on gun violence. It also flies in the face of decades of progress made by state mental health service systems, away from warehousing hundreds of thousands of individuals on the back wards of state psychiatric hospitals to more effective community-based mental health services.

President Trump has called for a return to a time when the civil rights of millions of Americans could be stripped away with little to no due process, and when a person could be involuntarily institutionalized for years and subjected to, at best, inadequate mental health treatment and, in many cases, abuse, neglect, and unnecessary medical procedures, including sterilization. We have moved away from this horrific past, but proposals like President Trump's threaten the lives and liberties of people with mental health disabilities and must be rejected, again and again, in the strongest of terms.

The Bazelon Center was founded in 1972 to advocate for people with mental health disabilities and fight against these abuses. Our work has successfully helped to ensure that people with mental health disabilities have the right, and the services they need, to live, work, and raise families in their own communities. Rhetoric like President Trump's not only encourages discrimination against and stigmatizes people with mental health disabilities, it also drags us back into the past.

People with mental health disabilities are not the cause of gun violence in America, and they must not be the scapegoats in this discussion. Labeling people with mental health disabilities as "dangerous" and calling for forced institutionalization on the basis of mental illness alone is irresponsible, unconstitutional, and unacceptable, and it must stop.
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Bazelon Center 2013 Analysis: No Correlation Between the Availability Of Psychiatric Hospital Beds and either Murders Involving Firearms or Incarceration Rates.

The Relationship between the Availability of Psychiatric Hospital Beds,  Murders Involving Firearms, and Incarceration Rates
Issued January 15, 2013
Judge David L. Bazelon Center for Mental Health Law
http://www.bazelon.org/wp-content/uploads/2017/04/1.16.13-Analysis.pdf

"Some groups have argued that the disability rights movement, deinstitutionalization, and the closure of state hospital beds have significantly contributed to the tragic gun-related homicides across the country.  Such arguments tend to overlook the impact of the nation's failure to fund the comprehensive community mental health systems that were intended to replace archaic state institutions.  Nevertheless, arguments to expand the stock of psychiatric hospital beds have ready appeal, particularly in the wake of tragic mass homicides; increasing the number of psychiatric hospital beds appears to be a straightforward, palpable response.

However, the findings of this study indicate that this would not be an effective response.  If it is true that a shortage of psychiatric hospital beds significantly contributes to the nation's firearm-related homicides (and should significantly guide public policies intended to reduce the murder rate relating to the use of firearms), one would expect a clear relationship between the availability of psychiatric hospital beds within states and their murder rates.  This analysis shows that this is not the case.

The Bazelon Center examined FBI data relating to rates of murder by firearms and compared these statistics with each state's per capita number of psychiatric hospital beds.3  Some of the latter data were obtained from advocates for expansions in psychiatric hospitals.4  The analysis included data from 2006, reflecting the availability of psychiatric beds in facilities traditionally associated with inpatient care of people with serious mental illnesses, public hospitals operated by states and localities.  These facilities provide acute hospital care, and often long term inpatient services as well. Nationwide, the number of public psychiatric beds per capita has declined dramatically over the past decades, and likely has declined since 2006.  However, the most significant reductions in state facilities had occurred long before that year, so it is reasonable to hypothesize that the potential impact of decreases in the availability of public psychiatric beds and the firearm homicide rate would by then be apparent if a significant relationship exists....

Conclusions
The Bazelon Center examined the relationships between states' murder rates by firearms and the availability of psychiatric hospital beds, and states' murder rates by firearms and incarceration rates.

This analysis is not being presented as a comprehensive empirical study of these interrelationships, but rather, as a broad look at whether public policy arguments to increase the number of psychiatric beds have merit as a means of addressing these adverse outcomes.

These arguments are often made in the wake of firearms tragedies, when there is a push to implement some quick and palpable reforms.

If expanding the number of psychiatric beds is a meaningful remedy to firearm related murders in this country, one would expect a clear inverse relationship, showing that states with low per capita numbers of psychiatric hospital beds have higher rates of firearm-related homicides or higher rates of incarceration.

Correlations among these factors were found to be strikingly low and not statistically significant.  These data suggest that, to the extent that unaddressed needs of people with serious mental illness contribute to the nation's homicide rate, the public policy answer is not in increasing the number of psychiatric hospital beds, but is elsewhere.

There is a substantial body of evidence suggesting that meaningful remedies may instead be found in appropriately resourcing the nation's community mental health systems enabling them to move from their current crisis focus and to provide early, effective services and supports to people with serious mental illness.

See the full analysis at http://www.bazelon.org/wp-content/uploads/2017/04/1.16.13-Analysis.pdf
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Trump Calls For Reviving Mental Institutions
By Rebecca Morin Politico February 26, 2018

President Donald Trump on Monday advocated for more institutions to deal with mental health, adding that there is "no halfway" between jail and those who need help on the streets.

"We have to confront the issue and we have to discuss mental health and we have to do something about it," the president said. "You know, in the old days, we had mental institutions. We had a lot of them. And you could nab somebody like this, because they ... knew something was off. You had to know that. People were calling all over the place."

Trump's comments came during a White House meeting with 39 of the nation's governors on gun safety, which was prompted by the Feb. 14 school shooting at Marjory Stoneman Douglas High School in Parkland, Fla., in which 17 were killed.

Following the Parkland shooting, the president noted that the suspect, Nikolas Cruz, was "mentally disturbed," and he urged Americans to report such individuals. During his remarks on Monday, Trump noted that there were "39 red flags" with Cruz but that law enforcement didn't do anything.
Trump said people used to be able to be taken to mental institutions to get help.

"He's off the streets. You can't arrest him, I guess, because he hasn't done anything, but you know he's like a boiler ready to explode, right?" the president said. "You can't put him in jail, I guess, because he hasn't done anything. But in the old days, you would put him into a mental institution."
Trump also said that governments began closing institutions because of costs, and that such decisions were made by some of the governors in that room.

"We're going to have to start talking about mental institutions, because a lot of folks in this room closed their mental institutions also," he said. "We have no halfway. We have nothing between a prison and leaving him at his house, which we can't do anymore. So I think you folks have to start thinking about that."

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