Severe mental illness, untreated; tragic consequences

A mother and a son brutally murdered. This time in rural Minnesota ("Man taken in by rural Minnesota family is charged with killing a mother and son," April 20).

Regrettably, this tragic tale is not new: A young man suffers from schizophrenia. His illness causes him to stop taking his medication. He succumbs to symptoms and allegedly commits an unspeakable act.

We struggle to understand how and why this happened, but the answer is equally unsettling: This is a predictable outcome of the system we have created.

Instead of ensuring that a young man with a serious mental illness and a history of violence received comprehensive and compassionate psychiatric care, our so-called mental health care system released him to the street to fend for himself.

Untreated, he posed an elevated risk to himself and others. Perversely, his condition made it more likely that he would refuse medication that may have stabilized him.

None of that mattered. Now two are dead. A community is in shock. Families devastated. And a court will likely decide William Hillman's fate.

As my organization, the Treatment Advocacy Center, reports, most individuals with serious mental illness are not dangerous. In fact, most acts of violence are committed by individuals who are not mentally ill.

Data show us that one main predictor for future violence is past violence. This principle was highlighted again and again in our recent report Treat or Repeat, an analysis of what each state does to ensure that the individuals with severe mental illness who have committed major crimes succeed once they return to the community.

We showed that, if provided with needed community supports, the likelihood that someone with mental illness who has been violent in the past will be violent again can be drastically reduced — from 40-60 percent recidivism to 10 percent or less in the states that adopt best practices.

Minnesota has many of the elements for a good program to help people like William Hillman maintain treatment after release. In fact, we consider its "mentally ill and dangerous" statute a model for other states.

Unfortunately, the tools that are available are often left unused.

A caring society should recognize Hillman was also a victim when his illness allegedly compelled the tragic actions. The system failed this young man, and the McFadzens became casualties of its neglect.

There are common sense measures that can prevent these foreseeable tragedies. One is painfully obvious: Provide the support and supervision needed after discharge. A sustained regimen of medical attention can mitigate the symptoms of diseases such as schizophrenia and bipolar disorder and has been found to reduce the risk of suicide and violence, along with many other negative consequences.

Where can one turn for such treatment?

Minnesota touts its systematic movement away from inpatient treatment and now provides fewer than 25 beds per 100,000 people (a minimum of 50 beds per 100,000 people is typically considered necessary). Even when using a more generous definition that includes both 24-hour inpatient and residential treatment settings, Minnesota still falls below the national average.

Increasing the availability of such treatment beds would be a good start.

Some may note that despite the bed shortage, Hillman had landed in one. After threatening his mother, he was reportedly committed to the Minnesota Security Hospital at St. Peter. Then, in November 2017, he was released, and his treatment stopped. Why didn't Minnesota use the tools it has available to ensure that he stayed on his medication and had the support he needed to succeed?

We can and must do better.