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Norman Ornstein: ‘The mental health system in this country is broken and needs to be fixed’

“We now know that there are many ways of providing wraparound services for people in an outpatient setting that can help get their lives back on track,” Ornstein said. “It is not perfect, but it works. We need to be putting more investment into these kinds of services.”

Norman Ornstein: "In Florida and in most states you can have someone involuntarily committed for up to 72 hours. The standard for this goes back to medieval times."
MinnPost file photo by Jana Freiband

When they had their mentally ill son Matthew involuntarily committed, Norman Ornstein and his wife, Judy Harris, felt they were doing what needed to be done to save his life. But what ended up happening after police in Sarasota, Florida, burst into Matthew’s condo, put him in handcuffs, and placed him on a 72-hour hold in a psychiatric facility seriously set back his recovery and created a rift in the family that lasted until Matthew’s accidental death at age 34.

Inspired by the mass shootings in Parkland, Florida, and troubled by the limitations of the Baker Act, the Florida law that allowed him to commit his son, Ornstein, a Minnesota-born political scientist, author and resident scholar at the American Enterprise Institute, wrote about his experience in a recent issue of the New York Times. 

When I contacted him last week to ask if he would be willing to discuss the piece and why he chose to write it, Ornstein was more than happy to talk.

“The fact is the mental health system in this country is broken and needs to be fixed,” he told me from his Washington, D.C., home. “I’m not going to tell you there are easy answers, but something needs to be done.”

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MinnPost: What inspired you to write this opinion piece?

Norman Ornstein: I was encouraged to write this piece by my other son. In the aftermath of the Parkland tragedy it felt like there was so much talk about. So many people were saying how if we only toughened up the laws that pertain to people with mental illness this wouldn’t have happened.

Some of that was a diversion, not just by the NRA but also by others who like to confuse the legislation of guns with the issue of people with serious mental illness. My son said, “You’ve had your experience with the Baker Act. It may be important for you to write about it,” so I did. 

MP: Why did you want to focus on the limitations of the Baker Act?

NO: The Baker Act was well intentioned, but it has some real problems. There are people who are engaged in its reform and are working on things that can make it better. My motivation was to introduce a conversation about the Baker Act and its flaws and broaden it to the larger problems with the mental health system. 

MP: How does the Baker Act work?

NO: In Florida and in most states you can have someone involuntarily committed for up to 72 hours. The standard for this goes back to medieval times. It is that the person must be an imminent danger to themselves or others.

Because of the Baker Act, it was relatively easy to have our son involuntarily committed. And for a variety of reasons that commitment only made our son’s condition worse.

MP: Why was that? Because your son needed treatment and he didn’t get it during his commitment?

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NO: Yes. In most cases, those 72-hour commitments are basically just holds, not treatments. For a whole set of reasons, most of the psychiatric facilities that you can get into and find a bed at such short notice and are covered under most insurance plans don’t have an incentive to do anything more than just hold an individual for 72 hours. So nothing changes and people just cycle in and out of the hospital.

MP: Can you explain why your decision to invoke the Baker Act negatively impacted your son’s mental illness?

NO: Our son had a condition known as anosognosia, where part of his brain disease was that he didn’t believe he was mentally ill and he aggressively challenged that notion and refused to take medication or get any kind of treatment. Since he was over 18, we were pretty much powerless to do anything to influence his treatment, so he was just released from the hospital without getting the help he needed.

MP: How did you know your son was having problems? You weren’t living near him.

NO: The manager of the place in Florida where he was living was someone we had known for over 30 years. He had known our son since he was tiny. When he called and told us that he felt like Matthew was in danger of harming himself, we had every reason to believe him. But the truth was he wanted Matthew out because he thought his presence might cost him other rentals in the complex. We flew down there and went to a courthouse.  It was amazingly easy to invoke the Baker Act.

MP: What happened then?

NO: Before we even got to his condo, our son went through this terrible humiliation. He had just emerged from the shower. He was getting ready to go to Friday religious services. He stepped into his bedroom to see police officers and a couple of others. They didn’t tell him why they were there. They just cuffed him and took him away.

They were able to put our son in a facility that actually deals with mental illness, which sounds good. But that didn’t help him. He still felt like he was imprisoned against his will for no reason. He went through the required 72 hours and then they put him out on the street without his wallet or his cellphone. He was put in a cab and sent back to the condo. When he realized that we did this to him it felt like an enormous breach of trust.

He never really forgave us. He died years later in an accident.

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MP: Do you think the Baker Act should be replaced with something else?

NO: There is no question that there are instances when people are an imminent threat and they need to be hospitalized, but we haven’t calibrated this appropriately and we haven’t created a set of conditions where we can find a way to balance their civil liberties with the need to provide some treatment.

MP: Do you have any suggestions about what can be done to make the system work better?

NO: A few things are at the top of my list. The first is we clearly need more qualified beds, more facilities, more opportunities, more community health centers to help deal with people in mental health crisis.

MP: Are these the kind of places that President Trump was talking about when he called for more “mental institutions” in the wake of the Parkland, Florida, mass shooting?

NO: What the president was talking about is not more humane treatment facilities. He wants to go back to the hellholes we had the 1950s. The history of this is the Kennedy administration, shaped by the Kennedy family history of the mistreatment of Rosemary Kennedy. She was probably bipolar and was given a lobotomy and left to rot in an institution for the rest of her life. In those days, you could put someone away maybe forever for the simple reason that they were odd. The Kennedy family was responding to that.

MP: Do you have other suggestions for improving the mental health system in America?

NO: We now know that there are many ways of providing wraparound services for people in an outpatient setting that can help get their lives back on track. It is not perfect, but it works. We need to be putting more investment into these kinds of services, programs that help people in a holistic manner with their physical and mental heath, with their housing, not throwing people with mental illness into jail or poorly run hospitals and watching them cycle through the system for the rest of their lives.

MP: Can you tell me about a good example of this kind of wraparound program?

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NO: Judge Steve Leifman is [an associate administrative] judge in Miami-Dade County. He is the person many people with mental illness come into contact with when they become part of the criminal justice system in Miami-Dade. Many of the people he sees in his courtroom are people with serious mental illnesses. They are often in court for misdemeanors like vagrancies or drug charges.

What Leifman’s been able to do in Miami-Dade, which may have the largest concentration of people with serious mental illness in the country, is to offer people who come in with a misdemeanor charge or a nonviolent felony the option of going to trial or going voluntarily into a mental health treatment program. Leifman and his team work directly with police, prosecutors and public defenders to help get these people a place to live. As Al Franken very powerfully once said, “The best solution to homelessness is a home.” They have a team of social workers, mental health professionals and peer counselors who work with people and get them stabilized. In some cases, this involves taking medications or getting therapy or both.

MP: This sounds expensive.

NO: In large numbers of these cases, people who go through this program end up with jobs and with stability. Along the way this program has not only saved a large number of lives, they’ve also been able to close a jail because so many fewer people were being sent there. They’ve saved $12 million a year.

Not helping people is expensive, too. There were something like 99 people in Miami-Dade County who were regularly cycling into jail and back out on the streets and homeless. Those 99 people were costing the county something like $30 million a year. This program saves that money.

MP: Does an approach like Liefman’s change the way other members of the community view and treat people with mental illness?

NO: One important thing that Leifman has done with this program was to put well over 5,000 police officers in the county through a weeklong crisis-intervention training program. At first, he had to drag the police into this program, but now they have embraced it overwhelmingly. It has reduced the number of arrests, lowered violence and reduced the number of wrongful-arrest lawsuits.

The program also reaches out to the rest of the community. Leifman’s been very adept at getting buy-in from public officials, from the city of Miami and the business community. He’s also gotten buy-in from the state legislature. He’s been doing this for 17 years, and everybody’s seen the impact.

Programs like this one require an initial outlay of funds. That’s what so many advocates run up against. But you save money in the long run if you can take people out of homelessness or out of constantly cycling in and out of jail and get them into stable situations.

MP: Is this the kind of life that you wish could’ve been possible for your son?

NO: Yes. But it didn’t happen. After our son died we created a foundation in his memory.  We want to do something good in his honor. We are going to do a documentary on Leifman so we can spread best practices.