Ethical and Legal Issues 737
court-mandated outpatient treatment for a mentally ill person who refuses treatment;
a judge makes the fi nal decision about mandating treatment. The unfortunate irony is
that Goldstein sought further treatment, but the lack of social support and available
treatment allowed his illness to interfere with his taking medication. In his case, the
real culprit may have been the lack of resources to provide the type of support and
services that he and others like him—such as the man described Case 16.4—need.
The problems in obtaining appropriate treatment for people with chronic and se-
vere mental illnesses are described by parents of an individual with schizophrenia:
We are the parents of the throwaway schizophrenics, the disposables, the ones who are
the most diffi cult to treat; who are often, as a result of their disability, unable to ask for
or accept help. They refuse it.
Left without treatment they continue to suffer. Relatives must stand by and watch,
unable to alleviate the suffering which in the main is ignored by the mental health care
system until it is too late. It seems to be the same story the world over. We are the peo-
ple who are told you can’t help those who won’t help themselves, and we reply under
our breath that is seems to us that you won’t help those who can’t help themselves.
We are the people who mop up the blood of our sons and daughters when they have
killed themselves, released from hospital all too soon, or not considered sick enough to
be hospitalised.... When we ask psychiatrists why they do not declare our obviously
ill relatives incompetent, they reply that [mental health law] ties their hands. When we
ask the bureaucrats and the politicians how such a law can be passed, they tell us that
the psychiatrists are interpreting the law too narrowly. When we turn to the lawyers
they tell us that the rights of the individual are paramount.... We are left helpless and
hopeless, alone in our struggle to save the lives of our children.
(Deveson, 1991, p. 244)
Sexual Predator Laws
People who are repeat sexual offenders—often referred to as sexual predators—are
clearly dangerous. How do they fi t into the legal concept of dangerousness? Are
they to be treated as mentally ill? How do the criminal justice and mental health
systems view such individuals?
The answers to these questions have evolved over time. Before the 1930s, a
sexual offense was viewed as a criminal offense: The perpetrator was seen as able
to control the behavior although he or she didn’t do so. In the 1930s, sexual of-
fenses were viewed as related to mental illness (sexual psychopaths), and treatment
programs for those who committed such offenses proliferated. Unfortunately, the
treatments were not effective. By the 1980s, sexual offenses were again seen as
crimes for which prison sentences were appropriate consequences. In the 1990s, af-
ter highly publicized cases of sexual mutilation and murder of children, some states
passed laws to deal with sexually violent predators, who were seen as having no or
poor ability to control their impulses. Rather than emphasizing treatment (which
had not been effective), the new laws called for incarcerating these individuals as a
preventative measure.
CASE 16.4 • FROM THE OUTSIDE: A Failed Mandated Outpatient Treatment
On February 12, 2008, David Tarloff murdered psychologist Kathryn Faughey and injured psy-
chiatrist Kent Shinbach in a delusional plan to steal money to fl y to Hawaii with his elderly
mother. Tarloff, who had been a patient of Shinbach, was hospitalized over a dozen times
since 1991, when he was diagnosed with paranoid schizophrenia. In the year leading up to the
murders, Tarloff received psychiatric care three times after violent or threatening behavior;
he was stabilized on medication and released, despite his family’s request for continued in-
patient treatment. After release each time, he stopped taking his medication. His family even
made use of Kendra’s law, so that Tarloff was supposed to receive mandated outpatient treat-
ment, but he avoided the periodic outpatient visits. He was released from a psychiatric unit 10
days before he murdered Faughey.
(Konigsberg & Farmer, 2008).
Eight months after David Tarloff committed mur-
der, the judge hearing the case declared Tarloff
unfi t to stand trial. Tarloff was sent to a psychiat-
ric facility (Eligon, 2008).
Patrick Andrade/The New York Times/Redux