Pretty much everyone who knew Robert Card was surprised when doctors let him walk out of a New York psychiatric hospital last August.
The 40-year-old from Bowdoin, Maine, had been acting strangely for months. He told friends and family members that everywhere he went strangers were whispering about him behind his back, accusing him of being a pedophile.
He was getting sick of it. And he was getting angrier.
Finally in July, Army Reserve leaders ordered Card to go to the hospital after he tried to fight a fellow soldier he believed was in on the conspiracy. The medical staff who evaluated him said he appeared to be suffering from psychosis. He admitted to having a growing “hit list.” And when he resisted psychiatric treatment, hospital staff took the first steps toward committing him against his will.
But he promised doctors he would take his meds and attend follow-up care. So on Aug. 3, 19 days after arriving at the hospital, they let him go. Nobody made more than limited attempts to reach him when he almost immediately broke those promises.
Eighty-three days later, Card committed the deadliest mass shooting in Maine’s history, killing 18 people and shooting another 13.
The massacre in Lewiston was the rarest and worst possible outcome of a pattern mental health experts say they see all too often across the country. For generations, they argue, we have failed to adequately treat millions of people with serious mental illness until they reach a point of crisis.
It was once routine to commit unwilling patients to psychiatric hospitals – but that approach was largely abandoned decades ago because of widespread abuse. And, in Maine, one program set up to be a less intrusive alternative has never been widely used.
Like nearly every other state in the nation, Maine has a law that can compel people with serious mental illnesses to comply with outpatient treatment while still living in their own communities. Proponents of this law, called the progressive treatment program (PTP), believe it could have pushed Card to accept help before he became violent.
Yet many law enforcement officials, including the Sagadahoc County deputy who responded to the last and most serious warnings about his behavior, didn’t even know it existed.
Though PTP has been on the books for well over a decade, it remains a little-used tool, especially by law enforcement. The Maine Department of Public Safety and the Department of Health and Human Services both say they are not responsible for training police on how the law works. And while state legislators have consistently indicated support for the statute in theory, they’ve never adequately funded programs that would make it easier to use.
The conversation around PTP and similar laws is part of a long simmering debate around the ethics and efficacy of involuntary treatment – a debate that’s often stoked after high-profile mass shootings.
