Prevention, punishment, mental illness and crime

The US Supreme Court has said executing the mentally retarded is unconstitutional, but the mentally ill are still fair game. Dr. Lucy Puryear, a clinical psychiatrist from the Baylor College of Medicine offers a thoughtful discussion at Women in Crime Ink regarding the astonishing case of Andre Thomas, a schizophrenic death row inmate who plucked out his only good eye and ate it (he'd pulled the first one out while sitting in jail awaiting his capital murder trial), adding a whole new dimension to the biblical adage, "an eye for an eye."

Thomas' crime couldn't have been more horrific. As Dr. Puryear described it:

In 2004 Andre Thomas killed his wife and children, cut their hearts out, put the hearts in his pocket, and walked outside. He then went home, put them in a plastic bag and threw them out. He stabbed himself three times in the chest and then walked into a police station to report his crime.

But while most of the public debate about Thomas revolves around whether he should be executed for his crime, Dr. Puryear offers a more constructive reaction, wondering how his crime might have been prevented in the first place:

To those of you who would suggest that I am soft on crime, consider this novel idea. How about we make mental health treatment available in the community to those who need it. Had Mr. Thomas been adequately treated and monitored he never would have killed his family or plucked out his eye. Three people would be alive today and an enormous amount of money would be saved keeping him out of the prison system. That's not soft on crime, that's preventing crime.

Excellent point! Given that Andre Thomas had twice sought psychiatric help at a local hospital in the weeks before he murdered his family, these observations are particularly salient. In the comments section she added:

I am not suggesting that being mentally ill is a get out of jail free card.

I am saying that the system is broken. That people with severe mental illnesses often do not receive adequate care in the community. It can take three months or longer to get an outpatient appointment in our "free" (paid for by taxpayers)mental health system in Harris County. While waiting for these appointments people go off of their medications, become ill, and SOME commit crimes.

Puryear particularly lauded Harris County's recent creation of a mental health court:

There may be one way to make some sense out of the issue of the mentally ill who commit crimes. Several communities have Mental Health Courts. These courts are in place for those defendants who have histories of mental illness before committing a crime, or committed a crime while mentally ill. The lawyers, judges, and others assigned to these courts have special training in mental illness and are equipped to knowledgeably handle these defendants. Instead of the revolving door from prison to back on the streets where psychiatric care is lacking, then back in prison when another crime is committed, these persons can be put into a system where follow-up is mandatory and resources are available. Another example of not being soft on crime, but preventing crime.

And in the comments, the good doctor mentioned a common sense solution for mentally ill offenders who go off their meds:

When I worked briefly in Ohio we could get outpatient commitments that meant that a patient was mandated to attend outpatient appointments. If they did not show they could be picked up and returned to an inpatient facility.

Dr. Puryear's post reminds us that by the time mentally ill people commit heinous crimes, we're having the discussion too late.

I really admire Lucy's professionalism and her common sense reaction to this sad, heinous case. While most of us, myself included, can do little but gape in awe at such a monstrous crime, her writing demonstrates an ability to perceive the thread of humanity underlying Thomas' illness and recognize that, even though a horribly tragedy occurred, the outcome wasn't inevitable. If society learns the right lessons, maybe more such horrific cases can be prevented in the future.