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Those who have read the recent news coverage about Thomas Gilbert, Jr.—the “hedge fund heir” diagnosed with schizophrenia, as well as obsessive-compulsive disorder (OCD) and depression, who was recently convicted in the 2015 murder of his father over a dispute concerning his allowance—now have a clearer understanding of the families who often seek help from mental health attorneys. During the murder trial, Mr. Gilbert’s mother offered devastating testimony that’s all too familiar to professionals like me: she and her now-deceased husband knew the extent of their son’s mental illness and the threat he posed to himself and others but felt they had few options regarding his care. Even forced hospitalization seemed a poor choice as he would be released after only a few weeks, and they’d be back in the same scenario, only with an “extremely angry mentally ill child… rather than just a mentally ill child,” as she said in court.
This is all too true. Outdated reforms to our mental health system have had the unintended consequence of rendering caregiving families nearly helpless when loved ones with diagnoses like schizophrenia become symptomatic (i.e., paranoid, delusional, hallucinating) and subsequently self-resistant to treatment. Because involuntarily commitments are generally limited to very short time periods, hospitalized individuals who might benefit from long-term care quickly return to their family homes again and again even as relationships become increasingly toxic and spiral out of control. While acts of violence are rarely committed by those with mental illness, it’s not unusual for their families to feel endangered as a result of outbursts and unpredictable, volatile behaviors. Regardless, families are almost always fearful that afflicted loved ones will suffer harm, which statistics show to be far more likely.
The benefit of hindsight aside, it’s extremely difficult to hypothesize an alternate legal or clinical approach that would have spared the Gilbert family this tragedy. Though prudence would have dictated that they seek legal orders of protection and security detail in advance of limiting Thomas’ allowance, it’s not unusual for families to minimize the danger of these situations. It’s part of the understandable denial that accompanies love for one’s child, even when warning signs are present and mental health is deteriorating.
The Gilberts’ tragedy embodies a pendulum in favor of patient rights that has simply swung too far. Though an understanding response to the horrific abuses that dominated mental health care for decades, our current system doesn’t account for the fact that mental illness is often accompanied by crippling psychosis and a lacking self-awareness and insight. Those who suffer from severe mental health conditions are frequently incapable of taking long-term responsibility for their own treatment.
The added horror of the situation is that Mrs. Gilbert is enduring the unthinkable reality of surviving a husband murdered by her ill child despite the opportunities afforded by the family’s great wealth. Millions of families face this same severity of diagnosis but without the financial resources required for a lifetime of psychiatric care and supportive housing.
We can only guarantee more options for such families – regardless of means – if we, as a society, commit to funding the kinds of long-term programs that can do real good, and ensure legal statutes offer pathways to them when necessary. For openers, easing federal and state confidentiality laws that currently impede a family’s involvement in their loved ones’ psychiatric care would be a big step and one worth taking.
