The case for a Cuckoo's Nest

Mental hospitals and state commitment are generally a thing of the past. Maybe we need to look at bringing them back.

You’ve heard the old saw “if it’s everyone’s job, nobody does it.” Maine spree killer Robert R. Card II gave every possible clue to everyone in his orbit that he was about to “snap,” and do the thing he did—kill 18 people and injure 15 more, before taking his own life. As journalists dig further down than the platitudes and talking points, the story emerging is that Maine’s “yellow flag” law gave the police in Bowdoin the actual authority to take Card’s guns from him and confine him until his mental status could be ascertained.

We used to have places for the police to take people like Card, but no more.

Central State Hospital, Milledgeville, Georgia. Image: farrargirl, CC BY-SA 4.0, via Wikimedia Commons

“Everybody knows” was the headline Kevin D. Williamson chose for his dive into the upside-down and arcane world of legal authority versus execution of our patchwork gun laws.

If anything is clear from the events preceding the bloodbath in Maine—in which everybody from the military to the police to friends and family and mental health authorities had good reason to intervene and the legal means to do so—it is that this is not, as our friends in the gun control movement insist, mainly a question of more robust retail regulation of sporting goods stores. The gun shop clerks in this story did what they were supposed to do: They declined to make a sale to someone they had reason to believe was a prohibited person. The police, on the other hand, basically punted public safety to the lunatic’s brother, asking him to lock up the guns and then more or less crossing their fingers and hoping for the best. 

The police did in fact have more than a clue. The Sagadahoc County Sheriff’s Office issued a File 6 alert — attempt to locate — with a notation “ARMED & DANGEROUS,” and the Bowdoin police officers responded with a welfare check. They knew someone was inside Card’s trailer because they heard noise coming from inside. They knocked, and nobody answered. They ultimately decided not to attempt to enter. The PD was in contact with Card’s brother, who said he had locked up Card’s firearms, so they told the brother to let them know if there were more issues.

But in fact, everyone from Card’s U.S. Army buddies, to his brother, to the gun shop clerks, knew Card was about to snap and go on a shooting spree. They did what the law allowed and trusted the system to keep this from happening. But the system didn’t work. The number of mass shootings in the U.S. gives proof to the fact if it does work at all, it’s got some massive holes.

Without talking to the police officers who responded to Card’s trailer, it’s impossible to know exactly what they were thinking. But I believe, from talking to enough friends in law enforcement, they were trying to balance the near certainty of a standoff with an armed, trained, deranged man with the possibility of him doing what he ended up doing. Card could have killed the officers, and had they tried to enter his trailer (which they had the legal authority to do, according to the law’s author speaking to the Boston Globe). Police frequently have to balance their own safety against the public order, even when making the simplest traffic stop. But here, at Card’s trailer, if they were able to take Card alive, they’d know what to do with the guns he had—they’d have to figure out what to do with him, and that’s a really big problem.

Nobody expects the cops to go in, guns blazing, anytime a report of someone potentially violent and armed, out of their right minds, is called in by the public. When it does happen, frequently the police go in without sufficient articulable reasonable suspicion (ARS), and end up using excessive force, then have to go back and justify it. Sometimes, this results in unnecessary injury to people doing nothing more than standing in their own driveway.

I covered a case in north Georgia of police responding to a man in his driveway behaving erratically. The man was not armed, but there were guns in the home, and also young children. It ended up with a K-9 officer calling out the dog, ordering four officer who were trying to restrain the individual away so the dog could bite the man. The officer is no longer with the department in question (and the city is dealing with a huge lawsuit). But police all over the U.S. are very cognizant of what the public would think in excessive force cases, and what their own department policies dictate.

If Bowdoin cops had gathered enough officers outside Card’s trailer to go in, and ended up killing him, some people might say that they were not justified, because Card’s brother had his guns locked up. At the time, the officer didn’t know, but they knew there was an order to locate Card, which they did.

Here was a situation where the Army, the Sheriff’s Office and the local police had fore knowledge of Card’s mental state. They had the legal authority to act to remove Card’s firearms (Maine’s “yellow flag” law is in fact stronger than many state “red flag” laws in this regard), but what should be done with Card?

Let’s say, for the sake of argument, the Bowdoin officers decided to, and were able to go in and take Card’s weapons, without killing him in the process. Would that have stopped the massacre? As many shootings in the past have shown, probably not. It would have made it slightly more difficult for Card to get weapons, but he would have been able to either legally buy more guns, or retrieve his own from his brother or elsewhere. Someone set on a mass shooting is likely to find what they need.

The key is not in the guns, it’s in the deranged individual. I know, people who are in the “gun control’ camp say that if there were no guns to get, people who want to conduct mass shootings would not have a way to get them. But (a) that’s not really true, since people do have access to guns even in so-called “gun free” societies; and (b) that’s not the reality in America, so it’s useless to talk about it. I don’t want to bloviate about some utopia where nobody has guns. I do want to talk about mental health.

There used to be places where authorities, or families, could take mentally ill people. They were called mental hospitals, or sanitariums, and they were prolific in the U.S. until the 1970s. Milledgeville, Georgia is the home of what was the world’s largest mental hospital, Central State Hospital, which kept more than 12,000 patients in the 1960s. The hospital still operates, though most of it has been closed and the building abandoned.

In the northeast, where I grew up, everyone knew about “Danvers.” And by that, I don’t mean the city between Beverly and Peabody, Massachusetts. Its official name was “State Hospital for the Insane.” Opened in 1874 as the State Lunatic Hospital, it was closed in 1992 and demolished in 2006. Massachusetts had eleven state hospitals still operating in 1973—many of them were called the “snake pits” because of their poor treatment of patients. Here’s a portion of an excerpt of a patient abuse report from Danvers State:

Ms. G, a registered nurse and Chief Hospital Supervisor, responding to the "help" call, found Mr. X on his back in a gurney in four-point restraint. "Four or five" MHW's were transferring the gurney to the corridor. Mr. X attempted to sit up, which he was unable to do because of the restraints. At that point, Ms. G observed Mr. A "jump into the air and land with his full body weight, left knee first, on [X's] mid sternum. Following that deliberate force Mr. [A] once again lifted his knee and with harmful intent forced his knee down on [X]'s chest in the mid sternum area. In both instances the force applied was severe enough to push Mr. [X's] back into the mattress." In an interview with DPPC investigators, Ms. G described the incident, "I've never seen anything like it. It was disgusting to see. Terrible." Ms. G did not report this incident to the DPPC.

The history of sanitariums in the U.S. is not good. “One Flew Over the Cuckoo’s Nest” (the 1975 film starring Jack Nicholson) is surely not explicit enough to describe the abuse that took place in many of these places. But these places did serve a purpose, even if badly served. The were a place for courts, law enforcement, or families to take people who were indeed profoundly mentally disturbed. In response to the abuse, America has swung far the other direction.

A report by the Treatment Advocacy Center noted the massive decline in beds available for mental health.

In 1955 there were 558,239 state and county psychiatric beds available, or about 340 beds per 100,000 population. Currently, there are about 35,000 state psychiatric beds available, or about 11 beds per 100,000 population. However, even this figure is misleading because in most states the existing state psychiatric hospital beds are largely occupied by court-ordered long-stay patients and therefore not available for the admission of acutely psychotic patients.

For example, a 2014 study reported that Larned State Hospital in Kansas had 457 beds.6However, 190 of the beds were occupied by court-ordered forensic patients who had criminal charges, and another 177 beds were occupied by court-ordered sexual predators; this left only 90 beds for possible admissions. And in many state hospitals such beds are used only for brief hospitalizations, leaving no alternatives for patients who need longer periods for stabilization.

The fact is that most severely disordered mental patients today are either living at home, homeless on the streets, or are in prison. Sometimes, they are getting care, but more often, they are not. In Card’s case, he needed care, and the Army forced him to get it for two weeks, but then he was released to go home. If the Bowdoin police took Card, they’d have to charge him with something to remand him to jail. Most likely, he’d end up back home within days.

For laws like Maine’s “yellow flag” to have bite, there needs to be somewhere to take mentally disturbed patients who need to be away from firearms, and receive needed treatment. There needs to be some kind of better system to take the mentally ill and drug addicted off the streets. San Francisco has places turned into literal “Zombie Land” due to the prevalence of drugs.

I am not a fan of expanding federal bureaucracy, but I do think if this country wants to have less mass shootings, we need to establish a strong mental health infrastructure, well enough funded and staffed (well-paid staff) to avoid the mistakes and abuse of of the past, and robust enough to receive and treat patients in a variety of situations. It will take billions of dollars, but what is it costing our nation to have hundreds of thousands of mentally ill in our prisons, and living among us?

It’s easy to say the police didn’t do what they needed to do with Robert R. Card II. It’s easy to say there were laws, and everybody knew something had to be done. But as I wrote in the first sentence of this article, if it’s everyone’s job, nobody does it. America needs to look at having a Cuckoo’s Nest again, but not a place to pack away the crazy people, or shock them, or conduct mass lobotomies. A place to treat them, and to segregate them from weapons, and if necessary, society because they are a danger to themselves and to us.

With treatment and followup, a good number of these individuals could return to society (though not able to buy firearms). But without a system at all, we’re left with what happened in Lewiston, Maine. It could happen in your town, or mine. It could happen anywhere, because it’s everyone’s job to stop it. Let’s give the courts and the police real options to deal with mental health, instead of using massive force, dogs, or simply walking way and leaving the problem to families to solve.

Congress should fund a Department of Mental Health. It’s time to reinvent the Cuckoo’s Nest.