Casualties of a System That Worked
Kathryn Faughey died for de-institutionalization. As did Daniel Parmeter and Catalina Garcia. And Ryanne Mace and Julianna Gehant. And Gale Dubowski.
In less than 48 hours six innocent people lost their lives and six families were thrust into unbearable agony.
In the evening of February 12th David Tarloff walked into Dr. Kathryn Faughey’s office in New York and butchered her with a meat cleaver and a knife. The struggle was fierce and by all accounts she fought hard to live. But she died, and her last moments must have been terrifying and excruciatingly painful. She was slashed fifteen times, her blood was all over the office, and the meat cleaver was bent from the force of the blows.
On the afternoon of February 14th Steven Kazmierczak walked onto a classroom stage at Northern Illinois University carrying several weapons. Without saying a word he started shooting, killing five people in less than five minutes before killing himself.
Two days and a thousand miles apart, these murders have one thing in common. They are the result of society’s failure to effectively, even adequately, treat the mentally ill. The real cause of death is a failed policy of de-institutionalization with discharge to the streets and the criminal justice system.
Both killers have histories of mental illness and revolving door hospitalization. Both have histories of refusing medication and treatment. And in both cases the system worked exactly as it is designed to work. During acute episodes they presented to the criminal justice/mental health system, voluntarily or otherwise. They were evaluated and in most instances quickly released to the streets. They were considered not to present an imminent danger to themselves or others so they were sent on their way. No treatment except perhaps medication which they were free to take or not. No followup. No attempt to actually ensure that these individuals got the help they needed.
David Tarloff’s illness tells him he is not ill. He sees no need for treatment or medication. And Kathy Faughey is butchered. Steven Kazmierczak’s illness tells him it is not him but the world that is wrong. And five people sitting in a classroom are slaughtered.
All this pain, all this senseless, meaningless loss occurred because the system worked the way it is supposed to work.
I have heard people angry with doctors for not keeping David Tarloff in the hospital when they had him there. The reality is that the doctors who evaluated Tarloff could not keep him. The criteria for involuntary hospitalization are very strict and usually require that the person present a clear and present threat to their own or other’s safety. Being delusional or psychotic is not enough. Patient privacy laws, well-intentioned but in some cases Kafkaesque, prevent doctors and health care providers from obtaining information that might enable them to make better decisions. I also suspect the last time Tarloff was evaluated, the hospital’s small psychiatric unit was filled with people who were even more acutely ill at the time than he was. So the doctors made the only decision they could within the system they have.
Even when hospitalization does occur, the goal is not resolution or even significant improvement in the patient’s underlying illness. The goal is stabilization and release, as quickly and cheaply as possible. Insurance companies demand it. The government demands it. Patient rights advocates demand it.
Treatment of mental illness most often consists of managing whatever symptoms are most troubling while ignoring the underlying illness in all its complexity. Treatment is largely and by design limited to medications. There have been major advances in medication for mental illnesses but they are not enough. The medications for severe illnesses like paranoid schizophrenia at best manage some of the more troubling symptoms. In many cases they simply do not work very well or have unacceptable side effects or are too expensive. Or patients simply refuse to take them, as did Tarloff and Kazmierczak.
The reality is that there is no comprehensive, integrated system of care to provide the mentally ill with the kind of treatment they need beyond medication: safe places to live, real support for meaningful integration into the community, psychotherapy to give hope and teach the skills needed to effectively manage illness and lead a successful life.
The overriding goal of most mental health treatment is economic rather than psychological. The government and insurance companies, including Medicaid and Medicare, are in the business of limiting — not providing — treatment. Managed care restrictions pressure doctors to release patients prematurely. Reimbursement rates for psychotherapy are lower than they were 25 years ago. There is no other profession where practitioners make less than they did 25 years ago.
In the last 40 years there has been a great movement to de-institutionalize the mentally ill. The cause was just and the motive noble. Many of those housed for years in state psychiatric centers did not belong there. Sometimes, but not always, the conditions were terrible. Sometimes, but not always, the treatment was little more than warehousing. Sometimes, but not always, there was awful abuse. So in New York State, 90 percent of the individuals who lived in the state psychiatric centers were discharged in a relatively brief period of time. While many of these discharges were successful, for many others the horror just shifted locations.
The closing of the psychiatric facilities was supposed to be accompanied by resources to provide the services needed in the community to prevent re-institutionalization. That’s not what happened. Adequate resources were not provided. However, since the institutions no longer existed, patients could not be re-institutionalized. Its advocates considered the lack of re-institutionalization a resounding success. What happened to the thousands of people released in the purge of the state hospitals? They were not suddenly and miraculously cured of their illnesses. They were not receiving services that didn’t exist in the community. Often, they slipped through the cracks and were lost to the mental health system, such as it is. (This too was a success because it meant fewer people receiving services.) Often, they joined the legions of homeless. Very often, they simply shifted from one system to another, from mental health to criminal justice. Living in poverty, often in squalid conditions, developing substance abuse problems that exacerbated their mental illnesses, they committed crimes, usually petty, sometimes serious. So, they were back in institutions but this time it was the county jail or the state prison. In New York State, one of eight prisoners is mentally ill. So much for the economic benefit of de-institutionalization to the taxpayer.
The mentally ill present to emergency rooms or police departments and enter the revolving door of hospitals and jails where they are managed but not really helped. And they suffer for it. And society suffers when their illness leads to horrific acts.
What passes in this country for a mental health care system efficiently meets its goals with David Tarloff and Steven Kazmierczak. And six people die.
David Tarloff and Steven Kazmierczak are not unique. Based on what is known about them, they are like thousands of others throughout the country, struggling with terrible illnesses within a system that fails them. They are not the first whose inner torment led them to destroy other lives. And they will not be the last.
None of this is meant as a criticism of those who work within the mental health system. Most are dedicated and competent professionals working extremely hard with a very difficult population and doing so with very limited resources. They are overburdened, have too many cases, and are limited by laws and bureaucracies in their ability to help those who suffer. They deserve support rather than criticism.
I have a personal as well as professional connection to these events. Kathy Faughey and I were in grad school together in the 1970’s and were good friends for a time. Although I had not seen her in many years, news of her death came as a profound personal shock. She was a wonderful, bright, funny, passionate, and caring woman who was so very full of life. She helped many, many people over the course of her life and career. She did not deserve to have her life ended in this brutal way. She did not deserve to die a casualty of our failed mental health system.
Ray Bepko, Ph.D. is a licensed psychologist. He lives and works in Utica, NY.
Bepko, R. (2018). Casualties of a System That Worked. Psych Central. Retrieved on September 28, 2020, from https://psychcentral.com/blog/casualties-of-a-system-that-worked/