Mr. Weston, for example, had been receiving monthly SSI payments since 1984, but such payments were never linked to his treatment. We prevent individuals with Alzheimer's disease from living on the streets, because we understand that they have a brain disorder. We mandate involuntary treatment for some tuberculosis sufferers who refuse to take medication, because we understand that they are potentially dangerous to other people. We should do the same for individuals with schizophrenia and manic-depressive illness. The care of severely mentally ill and disabled individuals has been a state responsibility for 150 years.
Most states have no internal monitoring to assess the quality of public psychiatric services.
As a condition for receiving federal mental health block grants, states could be required to institute such programs, using audits of mental health centers' clinical activities and unannounced inspections of hospitals and group homes. The state data could then be sent to the Institute of Medicine under the National Academy of Sciences, which would submit an annual report to Congress. These horrors are preventable. Michael Laudor should be teaching at Yale Law School and Russell Weston should be mining Montana's hills. Their victims should still be alive.