Long Beach Press Telegram: Editorial March 10, 1999

Even if Renee Seiler had never been arrested for gunning down a woman threatening "her" dumpster at wind-swept Angels Gate park, she showed plenty of signs of being severely ill.

The San Pedro woman would curl in a ball rather than talk with her attorney; she sat in court only because she was handcuffed. It later took four people to administer the medication that finally enabled her to carry on a coherent conversation. She told her attorney she didn't need any medicine.

Diagnosed as a paranoid schizophrenic, Seiler was committed to Patton State Hospital this week. Under state law, the Renee Seilers of the world sometimes have to kill someone before losing the right to determine whether they need to take their medicine.

An 87-page report assembled with the help of Long Beach resident Carla Jacobs - who heads the local chapter of the National Alliance for the Mentally III -makes a powerful case for reforming a misshapen patients' rights law. That system has become one of the most complex and adversarial in the country, especially when it involves restrictions against medicating patients to keep them out of hospitals.

The 1967 Lanterman-Petris-Short law was enacted at a time when some felt mental illness was a concoction of a repressive society, or the product of poor parenting.

However, new research shows that schizophrenia is a genetically-linked disorder that causes changes in the brain, and that in some cases, mental illness is better treated by medication than even some physical ailments (such as heart disease).

Forcibly medicating someone is a discomfiting last resort but what would you prefer? That someone jumps off a building? Should we wait until someone lashes out violently at a loved one, or kills a complete stranger?

In what other cases are the courts allowed to routinely interfere with medical decisions?

Any system that refuses to treat people who aren't "gravely disabled" or "dangerous to self or others" is a medical monstrosity. It results in ever worsening relapses that can lead to a person losing their job, home and family.

Patients should have the right to refuse medications if it's an informed decision that weighs the benefits versus the side effects (which are much less harmful than in earlier generations of drugs).

Unfortunately, a key symptom of schizophrenia is the belief that nothing is wrong - studies show such lack of insight exists in 50 to 89 percent of schizophrenics.

At Harbor-UCLA mental ward, patients can be released even though they think their food is poisoned. Should they have the "right" to starve themselves into a hospital emergency room?

Studies show that people who go off their medication spend several extra weeks out of the year in hospitals or jails. Is that freedom?

What kind of "free will" is being exercised by a person obeying voices in his head, or a depressive who regards getting out of bed as an arduous task?

Forty years ago, a person "acting out" their illness in a non-dangerous fashion was institutionalized. Today, they get thrown in L.A. County jail (the nation's largest mental ward) after someone calls the police. How is that an improvement'?

Even Frank, Lanterman argued back in 1974 that sometimes patients must take their medications as a condition of being released from the hospital. We agree.

Doctors should be able to overrule the wishes of patients who show a history of homelessness, arrests or institutionalizations as a result of going off their medication.

Assemblywoman Helen Thompson's reform bill will likely be delayed until next year so Thompson can take up more pressing matters, such as equal insurance coverage for mental illness (which Gov. Pete Wilson inexplicably vetoed last year) and improved funding for community mental health programs.

By next year we hope to see a powerful coalition pressing for reform. It could include police officers who confront the thankless task of apprehending and incarcerating the mentally ill; cities that struggle with a mentally ill homeless population; and taxpaver groups that should rightly be alarmed at the tens of millions spent on institutionalizing relapsed patients and $1-billion plus in related criminal justice costs.

Without their support, this debate will be stymied by those who argue that mental illness is a fraud. That's crazy.