28 June 2006

The Cost Of Ignoring Mentally Ill Felons

When you ignore predicable problems, you pay a price. Sometimes, the price comes like clockwork every month, like the interest on the national debt or on the balance you are carrying on your credit card. Sometimes, the problem resurfaces suddenly, like deferred maintenance on your car or a bridge that collapses because warnings that it was crumbling were ignored. When you ignore a mentally ill person with a history of violence, often the price paid is that an innocent person ends up dead. This is what happened at the Englewood, Colorado K-Mart store on Sunday.

Anthony Law, 39, is in an Arapahoe County jail right now, charged with shooting Kathy DeBell, 43 and Claudia Nunez, 30, outside the Kmart at 200 W. Belleview Ave. He hasn't been convicted at this point in time, but I'm not too worried that the police have the wrong man. K-mart has surveilance videotape. Witnesses observed the direction the killer walked away immediately after the early evening shooting. He was a regular at that K-mart store, where he bought lottery tickets, so K-mart employees who saw him can be expected to be reliable witnesses. I suspect that physical evidence will surface before the case is over. The press has not stated whether a gun was recovered. When his case goes to trial, it will be an insanity defense case with a decent chance of success because the mental illness was well documented long before the murder took place. Even if Law is convicted of the first degree murder with which he has been charged, a death penalty is probably unlikely, given mitigating evidence of his mental illness, although statistically, his fate is made perilous because he is a black man who killed a white woman.

Law didn't know either of the victims and there does not appear to have been a heated argument that led up to the shooting. It could have been entirely random, or it could have been a case where Law felt that DeBell got a job that he applied for and should have received. Whatever the motive, DeBell is dead now. Nunez is in critical condition at Swedish Medical Center. If this Level One Trauma Center weren't so close to the scene of the crime, she'd probably be dead now as well. Many researchers believe that one of the main causes of the declining murder rate in the United States is improved trauma treatment at hospitals.

The Denver Post revealed today that Law has a long history of schizophrenia including being "paranoid with hallucinations." He was hospitalized for it at age 18 in about 1985. He had a run in with the law in 1991. He attacked a co-worker and arresting officer in 1995, in an incident that left him with a felony record, and was on medication through 2000 when his correctional supervision ended. Is it really a surprise that six years later, apparently without any supervision from anyone, that he slips up and acts violent under the influence of his mental illness again?

We don't know, but the fact that he had recently applied for a job at K-mart suggests that Law was unemployed. The fact that his rap sheet isn't longer and that he completed correctional supervision while taking psychiatric medicine without reoffending suggests that he was not a threat when he was on meds, even though he was when he was off them. He may have skipped appointments with psychiatrists or failed to buy mediciations he needed to control his schizophrenia because he didn't have the money to pay for them. Incidents like this one are a common result of a disruption in taking psychiatric medication.

While there is no cure for schizophrenia, it is a highly treatable and manageable illness. However, people may stop treatment because of medication side effects, disorganized thinking, or because they feel the medication is no longer working. People with schizophrenia who stop taking prescribed medication are at a high risk of relapse into an acute psychotic episode.
In America, prescription drugs that necessary to provide life or sanity are just one more luxury, available only to those who have the money to pay for them. Never mind that drugs to treat schizophrenia not only heal the person who is mentally ill, but also protect the rest of us from random violence. The fact that he lived in an apartment in a working class neighborhood and shopped at bargain basement K-mart on a regular basis is also suggestive of the notion that he may not have been able to afford the medicines he needed. Medicaid is hard to qualify for if you are single man with no dependents Even if Law qualified, he may have lacked the bureaucratic acumen to apply and prove that he was an eligible disabled person by virtue of his mental illness and income. Colorado enrollment in the relevant program is also capped at 2,040 people at a time, and there are often waiting lists, even for men like Law, who, we learned, was a ticking time bomb that the system was informed of, but ignored. Certainly, nothing in existing law gave anyone the right to be told that he had slipped out of treatment, or the authority and duty to urge him to get back on his meds, at state expensive, if necessary.

This is despite the fact that clear evidence shows that Medicaid coverage reduces recidivism rates for mentally ill convicted felons. A Washington State program targeting dangerous mentally ill offenders for special follow up after release significantly reduced recidivism according to a 2005 study of the program.

We have a system of lifetime supervision for every convicted rapist (class four felony or more see pdf page 50) in Colorado, since 1998. This is true despite the fact that many studies have shown that violent offenders, including sex offenders, are much less likely to reoffend than felons who commit economic crimes (including drug offenses) for which crime is a profession, not just an acting out of improper impulses that tend to fade with age after long sentences.

While mentally ill felons do not necessarily commit future crimes at lower rates than other felons, it is possible to predict those with the highest risk of doing so to some degree, and knowing that an offender was mentally ill provides a clear and effective approach to preventing recidivism, not necessarily available for other felons. We also know that mental illnesses like schizophrenia are lifetime conditions, which makes lifetime supervision of people with such conditions who have proven to be threats to themselves or others in the past more rational than existing lifetime supervision provisions for sex offenders (although the fact that the vast majority of sex offenders under lifetime supervision in Colorado who are in prison are child molestors is suggestive of the possibility that they too may suffer from their own form of mental illness.)

Law was typical of the small class of mentally ill persons who are a threat to themselves or others, in that he spent more time in prison than receiving mental health treatment in facilities designed for that purpose. Law isn't atypical in this regard. About 42% of inmates in Colorado prisons have mental health problems (pdf page 53) according to the the Department of Corrections. The same source reports that 0.2% of inmates have a severe mental health problem, another 3.7% have a moderately severe mental health problem, and another 16% have a moderate mental health problem (even larger percentages have severe or moderately severe substance abuse problems). Even Republicans in Congress like Senator Mike DeWine from Ohio and Representative Chris Cannon of Utah, recognize that this is bad policy.

Of course, another important question is how he got a gun. Both convicted felons and people have have been committed to a hospital for a mental illness are prohibited from buying guns under Section 922 of Title 18 of the United States Code. In reality, the mental illness part has never been effectively enforced, because mental health information is kept private and few states have effective registries of mental health commitments. This is a problem that needs to be fixed, although it was not a factor in this case. As a convicted felon, and this is probably one reason that the D.A. pushed for the 1995 conviction of this clearly mentally ill man, background checks should have prevented him from buying a gun from any legitimate dealer.

More than a hundred improper gun purchases are prevented every year by the system in Colorado, and hundreds of people who try to purchase guns when they aren't eligible to do so are arrested in Colorado every year. In the wake of the Columbine shooting, Colorado voters in 2000 closed the "gun show loophole" in its background check requirements (a response considerably more meaningful than the establishment of "Respect Life" license plates which have ended up being largely a bumper sticker alternative for anti-abortion advocates that generated nothing to help Columbine victims.)

It is possible, indeed, likely, that the only one criminally punished from this incident will be the person who provided Law with a gun. He probably obtained the gun through a straw man purchase, or a private sale outside a gun show, or by theft. But, this is probably too little too late. Also, in all likelihood, the person who did it has too few assets to make a civil suit for damages for the wrongful death and injuries arising from the shootings made possible by the illegal gun sale meaningful. Straw man purchasers such as those recounted in a 1999 Denver Post article don't tend to be well heeled.

Paranoid delusional people are uniquely not impacted by a fear of criminal laws on the books. Prevention is the only way to stop incidents like the one that took place at K-Mart last Sunday from happening. And, there are warning signs. In this case, there were two decades of warning signs, some of which came through loud and clear. But, our system wasn't designed to listen. Not everyone in our society needs an elaborate and intrusive safety net. But, some of us, based on a history of prior actions and personal conditions are accidents waiting to happen. For them, an intrusive safety net, not the default rule of live and let live applied to the population at large, can prevent tragedies for everyone later on.


Anonymous said...

Thank you for posting about Anthony Law. I work at Kmart and briefly knew Kathy Debell. I will be atteding her memorial service Sat.You post explains things better and I will be looking forward to more.

Anonymous said...

Well said,i applaud your blog, mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.

I now have a victims support page against Eli Lilly for it's Zyprexa product causing my diabetes.--Daniel Haszard www.zyprexa-victims.com