Is justice served by putting an individual suffering schizophrenia from in prison for the rest of his life?
DEBRA G. DIHOFF
Editorial News & Record
There are many victims in the events that led to the death of Ruth Terrell, 88, at the hands of a young man with full-blown psychosis in 2005. The National Alliance on Mental Illness North Carolina extends its deepest sympathies to the family of the victim and to the whole community.
But there are other victims here, too. Anthony Zichi is a victim of the failure of the mental health system to provide the right level of treatment to protect both him and others. His story mirrors the decline of the state’s mental health system.
He was diagnosed with schizophrenia in 1999 when he was 20 years old. He then was placed in nine different homes from 2001 to 2005. He had seven short-term hospitalizations in a three-year period and attempted during that time to get long-term help but was turned down.
In March 2005, he was placed in a family care home near Elon, where the attack on Terrell took place two months later.
Schizophrenia is a neurobiological disease that affects reasoning, memory and judgment. Often it causes delusions, in which people or events take on unusual or threatening significance, which was the case with Zichi on the day of the tragedy. Even the most irrational delusion seems absolutely real to the person experiencing it.
At times schizophrenia may cause overly aggressive or violent behavior, and at these times hospitalization is needed to prevent self-injury or harm to others. Zichi and Terrell and their families are all victims of the lack of appropriate treatment - hospitalization - for this illness.
Is justice served by putting Zichi in prison for the rest of his life? These are tragic dilemmas we face. But one has to wonder if the behavior caused by the disease itself and by the lack of appropriate treatment should count for something. Society must be protected, and Zichi must get the right treatment. Treatment in a secure hospital setting, which would result in both of these objectives, would be the right choice.
What else can be done to prevent tragedies like this one from ever happening?
No young person should be placed with elderly people in a care setting where there is no specialized training for recognition of the signs of a worsening condition. Unfortunately, there are not enough of these residential treatment facilities.
There are insufficient crisis response systems as well. North Carolina ranks 43rd per capita in funding for people with severe mental illnesses - so a young 25-year-old man is placed in a home with elderly females because there is no other place.
Alamance County is working to put into place things that work, like the start of a jail diversion program called Crisis Intervention Training. Kudos to everyone involved in this effective program that trains law enforcement to recognize mental illness and to get people to treatment rather than to jail.
Taxpayers spend $125 per day to house prisoners with mental illnesses in jails that for the most part have no appropriate treatment programs for them. This money would be better spent in getting people the treatment they need before they encounter the police. There’s more to be done, such as forming mental health courts to reduce incarceration and improve treatment outcomes. There are no additional costs and better outcomes for communities that adopt this strategy. And, finally, we need to put in place 24-hour crisis responses and supportive housing so that people with mental illness live in a structured setting where they are helped by qualified professionals who recognize changes and progressions in the disease.
North Carolina has experienced a decrease in psychiatric bed availability and in community mental health services. Zichi is a victim of this decrease, as are many others. While 6 percent of the general population has a serious mental illness, these same individuals are overrepresented in our jails and prisons - 21 percent and 24 percent, respectively.
Let’s get the right services in place in the community to prevent this from ever happening again. And let’s remember there is more than one victim in this scenario, and let’s do our best to make it right.
Debra G. Dihoff, MA, is executive director of the National Alliance on Mental Illness North Carolina.
Copyright 2008 News & Record (Greensboro, NC)