Why Do People Starve To Death in America?

These articles appeared in the Portland Oregonian in December of 2002 as part of a series about the failure of the Oregon public mental health system. Since I'm writing about the failure of deinstitutionalization, these tragedies are examples of where Oregon's involuntary commitment law failed--and failed in a way that scarcely seems believable:

In at least 28 cases, people died after mental health professionals failed to push involuntary hospitalization, despite clear signs that their clients were dangerous to themselves, others or were unable to survive in the near future. Any of those conditions allow mental health workers to seek commitment of a mentally ill person.

Sometimes the mentally ill were denied hospitalization because of a statewide shortage of psychiatric beds. Other times, county mental health workers didn't know how to use the law. In a few of those cases, county workers tried, but judges refused to involuntarily commit, seriously ill people because of Oregon's high legal standard.

Here's one of the cases where the commitment law was the entire problem:

The painful life and tragic death of Mary Boos, a Portland woman with paranoid schizophrenia, is one such case.

Mental health workers, her parents and two court psychiatrists agreed that Boos, 40, was in grave danger and should be hospitalized. A judge, not Lawrence, refused, saying her case didn't meet Oregon's standard, under which a person must be a danger to herself, others or unable to provide for her basic personal needs. The Oregon Court of Appeals has told judges not to force patients into treatment unless they are unable to "survive in the near future."

Boos lived 10 more months. But without treatment, she sank so deeply into her delusions that she would not leave her apartment. She would not eat the food her parents faithfully and frantically set outside the door no law could make her open. Her decomposing remains were found almost a year later on Oct. 20, 1997. The medical examiner ruled she died of "natural causes probably related to schizophrenia." In other words, she starved to death.