On Wednesday, Jared Loughner was dragged out of the court room in Tucson because of an angry outburst.  After the strange interruption by Loughner, a U.S. District judge Larry Burns ruled that Loughner was mentally incompetent to stand trial.

Loughner is accused of killing 6 and injuring 12 including Congresswoman Gabrielle Giffords in Tucson in January. He has pleaded “Not Guilty” to the 49 counts. During the hearing, Loughner stated, “Thank you for the freak show. She died in front of me.” His words were loud but mumbled, and it wasn’t clear who he was talking about.

The decision means that Loughner will be held in a federal facility for four months in order to restore his competency.  When he is considered competent, he will face trial.  If he is not mentally competent at the end of his stay, the length of time will be extended.  This can be done repeatedly with no time limit. If psychiatrists eventually decide that Loughner’s mental competency cannot be restored, it will be up to the judge whether competency can be restored.   If the judge decides there’s no likelihood of restoration, the judge can dismiss the charges against him. In that case, state and federal authorities can petition to have him civilly committed and could seek to extend that commitment repeatedly, said Heather Williams, a federal public defender in Tucson who isn’t involved in the Loughner case.

Loughner has already spent five weeks in March and April at a federal facility in Springfield, Mo., where he was examined by two court-appointed mental health professionals. The two were asked to determine whether Loughner understands the consequences of the case against him.  The competency reports have not been released.

After the outburst, two marshals standing behind Loughner’s chair grabbed him by each arm and led him from the courtroom. A short recess was held and Loughner returned when he calmed down.  Judge Burns gave him the choice of staying for the proceedings or watching in another room on the closed circuit television.

Loughner’s lawyers haven’t said whether they intend to present an insanity defense. But they noted in court filings that his mental condition will likely be a central issue at trial and described him as a “gravely mentally ill man.”

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Even when something goes horribly wrong, as it did that September day in Tucson, the mental health budget of states are the first to be slashed.  The mentally ill usually do not have large lobbying groups or funds to help direct the voting in Washington.  The mentally ill are not known to be a voting bloc that lawmakers have to fear, such as senior citizens.  The severely mentally ill are usually relying on state and federal funding to survive because their mental illness disabled them to the point of not being able to work.

According to a study from the National Association of State Mental Health Program Directors’ Research Institute, states have cut $2.1 billion from their mental health budgets over the last three fiscal years.  And they are likely not done.  More spending cuts are expected in the coming weeks as states finalize their 2012 spending plans.  Another study from the National Alliance on Mental Illness finds that between fiscal years 2009 and 2011, 16 states and the District of Columbia cut their mental health budgets by more than 10 percent.

The reality is even worse than those numbers.  Up to now, federal stimulus money has helped soften the blow by sending in $103 billion to states through Medicaid since early 2009.  The money has helped to keep state-run health insurance program surviving for the past two years, but the money will end this summer.  Meanwhile, because of the economic crisis, the need for mental health services continues to grow.  With more and more unemployed and uninsured, more people are in line for public services—including mental health services.  “The safety net,” says Marylou Sudders, former Massachusetts commissioner for mental health, “is shredded.”

Mental illness is the leading cause of disability in the United States and Canada.  Nearly 6 percent of the U.S. population has a serious mental illness like schizophrenia or bipolar disorder.  People with severe mental illnesses are more likely to have low incomes because their education was interrupted by the disease, says Elaine Alfano, deputy policy director for the Judge David L. Bazelon Center for Mental Health Law in Washington, D.C. It is difficult for people with severe mental illness to get a job, but add the historic unemployment rates and employers are not going to hire someone with a mental illness.  Their unexplained behaviors can alienate friends and family. Their conditions can be expensive to treat, which puts a hefty burden on the government if they qualify for public support.

According to the state directors’ survey, in fiscal 2010 and 2011, roughly half the states reported reducing the number of hospital beds in state run psychiatric hospitals. They’ve limited the amount of money they pass on to out-patient providers and cut staff everywhere. A third of states say they’ve had to reduce the number of people their programs serve.  The numbers become even more distressing when you look at them state by state.

Mental illness has traditionally been unfunded.  Many of the psychiatric hospitals have closed, but money has not been redirected to community mental health centers in order to provide outpatient care.  We closed the hospitals and then closed our eyes and just pretended the mentally ill did not exist.  Community programs have done the best with what they have.  But, in the end, there is not enough staff to handle the outpatient demands.  This just leads to more hospitalizations, which is expensive.  If we put the money into funding mental illness in the first place, we would save money in the long run.  I know… a novel idea in Washington.  Sometimes you have to spend money to save in the long run.

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