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Effort To Force Treatment On Severely Mentally Ill Meets Resistance

Rep. Tim Murphy, R-Pa., speaks during a December 2013 news conference in Washington to discuss the introduction of a legislative package of major mental health reforms.
Pablo Martinez Monsivais
Rep. Tim Murphy, R-Pa., speaks during a December 2013 news conference in Washington to discuss the introduction of a legislative package of major mental health reforms.

Ed Kelley and his wife have three children. They live in a comfortable suburb of Baltimore. And for a long time their life seemed perfect.

"We were churchgoing; we were involved in the community. We had a very close-knit family all around us."

And he adored his 14-year-old son.

"He was funny, he was getting good grades, he loved playing sports; he was so humorous. Actually for the longest time he was sort of the center of the family."

And then one day, that happy 14-year-old boy disappeared. And in his place emerged a paranoid, delusional child who heard voices, believed he was a U.S. marshal and boarded up the windows of the house. Psychiatrists diagnosed him with paranoid schizophrenia.

In the 15 years since, the Kelleys' lives have fallen apart as they have focused all their attention on trying to get their son help and found themselves battling against state and federal laws that often prohibit them from doing just that.

"I know good people [whose] child has killed somebody or more than one person; I know somebody whose brother killed somebody; I know families who their house got burned down."

The vast majority of people with mental illness are no more likely to be violent than anyone else. Statistically they're actually more likely to be victims of violence. But a small subset of that population, individuals who can no longer tell the difference between what's real and what's not, can be prone to violent acts.

And an uneasy fact has emerged from the two dozen mass shootings in this country over the past decade: The majority of the people pulling the trigger have been severely mentally ill and not receiving treatment.

After the tragedy at Sandy Hook Elementary School a year and a half ago, Rep. Tim Murphy, a Republican from Pennsylvania, sought to change the way those with serious mental illness are handled.

Murphy drafted a bill last year to lower the standard by which seriously mentally ill people may be forced into treatment. He's been met with fierce opposition. Some mental health groups fear people's civil liberties will be violated. Others say it will be a return to state-run insane asylums.

Murphy, a practicing psychologist, is frustrated.

"I've got the pictures on my table over there of kids who died at Sandy Hook and I promised those parents I was going to do something. Because the Adam Lanzas of the world and the other people who have nowhere to go, who have not gotten treatment, who have not gotten a diagnosis, are out there dying with their rights on. Are you kidding me?"

The nuts and bolts of this: Severely mentally ill people, in the vast majority of states, can only be confined to treatment — usually about five days — if they are an imminent danger to themselves or others. But some states also have a lower standard — something called a "need for treatment."

That means a person can be court-ordered to get counseling and stay on medication.

Murphy's bill provides financial incentives for all states to adopt this lower standard. And it eliminates a quirky Medicaid rule that, if passed, could create more inpatient bed space.

And that has mental health advocates worried.

"I certainly know people who have said, 'If it wasn't for forced treatment, I wouldn't be alive today.' I also have listened to thousands of people who have been harmed by their forced treatment," says Gina Nikkel, president of the Foundation for Excellence in Mental Health Care, which supports alternatives to inpatient care and medication when possible. "They wake up 10 years later with medication and they have really lost 10 years of their lives."

But that's not how Kelley sees it when his son loses his grip on reality and he has to try to get him to voluntarily take his meds.

"I hope that the people who are shouting and keeping the families from having their loved ones treated properly never have the experience my family and other families have had, because it would change their perspective," he says.

Murphy is hoping to get his bill out of committee and to the House floor next month.

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Laura Sullivan is an NPR News investigative correspondent whose work has cast a light on some of the country's most significant issues.