By Sydney H. Schanberg
New York Newsday, July 15, 1986
The outrage and the finger-pointing were predictable. On Monday of last week, according to police and witnesses, a man who had been released from a private hospital’s psychiatric unit two days earlier ran amok on a Staten Island ferryboat and killed two passengers with a ceremonial sword.
The outcry went up: Why had the hospital let him loose on the streets? “Freed To Kill” shouted one tabloid’s banner headline. “Doc Sprung S.I. Slasher” screamed another.
The postmortems are still going on. Two state agencies are investigating the hospital’s conduct. A New York City investigation has already concluded that the institution, Presbyterian Hospital, was wrong to release the mental patient.
The implication meant to be drawn by the public from this flurry of reaction is that if only a particular psychiatrist or team of psychiatrists has acted differently, we would all be safe from the ferry killer and from other potentially violent, disturbed people like him.
Unfortunately, this is true neither of the accused killer, Juan J. Gonzalez, nor of the others in our midst who could explode in the same way.
Specifically, even if Juan Gonzalez had been held at Presbyterian instead of being released on July 5, present law and procedure would probably have resulted in his discharge in no more than 75 days. That is because, in that 2 1/2-month period, it is possible and even likely that treatment and medication would result in a psychiatric conclusion that he no longer seemed dangerous. In lay terms, he would have been calmed down.
Gonzalez was picked up by the police on July 3 in front of the Fort Washington armory, a large shelter for homeless men. He had been heard saying: “Jesus wants me to kill.”
The police took him a block away to Presbyterian’s psychiatric emergency room where, after two days of medication and evaluation, he was released for outpatient care elsewhere.
The doctor or doctors responsible for that decision obviously made a mistake — but we know that mostly by hindsight. This is not to make light of the deaths of the two ferry victims, for every death by violence is an offense to us all and to our presumption of being a civilized society. But punishing the doctors — and then imagining that by this punishment the matter is solved — is an act of self-delusion.
Committing Gonzalez for 75 days would have meant that the particular people he is accused of killing would still be alive. But had he left the institution after 75 days and perhaps let his medication slide — as Gonzalez apparently did — he could easily have begun hearing his “command hallucinations” again and turned violent against someone else. This is, of course, conjecture, but it is a scenario based upon precedent.
The larger issue, of course, is that there are many Juan Gonzalez among us. The mental health system for the poor is a sieve. If you are middle-class or rich, with a solid medical insurance plan, and you begin to hear the kind of voices Gonzalez heard, you will be cared for in a fine psychiatric unit at a fine private hospital. You will not be evaluated in an emergency room. You will not end up at a public hospital with enormous case loads, bed shortages and treatment gaps. It should not surprise us that most of the mentally deranged crimes are committed by mentally deranged people who are poor.
Though it is only in utopian dreams that the poor receive the same medical care as do those better off, never has the stratification been so dramatic.
The deinstitutionalization policy that began in the 1950s and came into full flower in the 1960s emptied the nation’s public mental hospitals of three-quarters of the patients. This put several hundred thousand poor people into the community, where many ended up literally living on the sidewalks.
The theory was a promising one. It held that large institutions were less effective than outpatient community centers for the care and rehabilitation of the mentally ill. The problem was that the promised public funds have never been provided to create and service such community facilities.
The deinstitutionalization idea also grew out of the discovery of anti-psychotic drugs, which eased severe symptoms such as hallucinations and made patients manageable. Manageable enough, it would seem these days, to let them wander around without proper follow-up care.
Nationally, in 1955, large public mental hospitals held 560,000 patients; now there are about 130,000. In New York State, there used to be 90,000 institutionalized patients; today, the number is only 20,000.
Since neither adequate housing nor community mental health facilities exist for the displaced patients, it does not take much of a search in New York City to discover where many of them have gone. They live on park and plaza benches, in doorways, in public shelters. A 15-minute walk almost anywhere in Manhattan will turn up four or five of them talking and gesturing to the air.
The only thing astonishing about the Gonzalez case is that it doesn’t happen more often.