'He Didn't Seem Crazy': Where Violence Meets Health Care

Philadelphia's mental health interventions aim to prevent random acts of violence and misguided jail time. But critics argue that they preemptively punish the mentally ill for crimes they aren't even likely to commit.

The grainy video begins with a unkempt man in a bulky winter coat, bumming a light for his smoke off a young woman sitting on a subway platform bench. The subway is a low-traffic spur line stopping at Philadelphia's Chinatown, so it's not unusual that at 3:30 in the afternoon on a Tuesday there's nobody else waiting for the train.

The man draws on the cigarette and blows a plume of smoke. It looks like maybe some small talk transpires but there's no audio with the image. The man feints towards the subway tracks like he's looking down the platform to see if a train is coming, then ditches the cigarette and turns, with determination, back towards the woman. With a lunge, his hands are locked on her throat. He slams her against the wall and starts landing blows to her head. Then, almost unbelievably, he reaches down to grab her by the ankles and drags her across the platform before launching her into the air like a ragdoll onto the subway tracks below.

Luckily, there was no train arriving at the station. The man runs off, taking only the woman's cell phone. The woman, miraculously, climbs from the subway tracks suffering only minor scrapes and bruises.

On Thursday, 37-year-old William Clark was arrested near another downtown subway station and charged with aggravated assault, among other charges. In 1997 Clark was sentenced to seven and a half to 15 years in prison for a series of gunpoint robberies. In 2009 he was accused of breaking into his wife's home and making death threats against her; the District Attorney's Office didn't pursue the case.

Arresting officers said that at the time of his arrest last week Clark appeared mentally ill; officers who work Philly's downtown have extensive contact with the city's substantial homeless population and are trained on interactions with the mentally ill. The courts have ordered a psychiatric evaluation; the results are pending. Clark is held in the Detention Center, the county jail that houses the system's psychiatric hospital, awaiting a preliminary hearing scheduled early next month.

The chilling episode echoes recent events in New York, where in December a homeless man, Naeem Davis, 30, pushed 58-year-old Ki-Suck Han in front of an oncoming train. Later in the month, Erika Melendez, a mentally ill woman from Queens, similarly pushed 46-year-old Sunando Sen to his death.

Philadelphia is no stranger to high profile subway attacks by mentally ill offenders. In 2008 Thomas Scantling, who at the time was not taking medication to treat his schizophrenia and who compounded his mental health problems by abusing PCP, attacked 20-year-old Dewayne Taylor on the subway as Taylor was nodding off listening to his iPod. The attack was so shocking because Scantling, who was in the company of his 6-year-old son, is vividly captured on video pulling a hammer from his bag and using it to pound Taylor repeatedly in the head. He violently drags Taylor from the train car and onto the subway platform, where he continues the attack.

Scantling, who had an arrest record that included rape and drug charges, was in the midst of a paranoid delusion and thought Taylor was out to get him. He was given 10 years in jail followed by 15 years of probation.

"This was about you wanting to take drugs, along with the mental illness," a judge told Scantling at his sentencing hearing. "You're going to be watched for a long time to make sure this doesn't happen again."

Taylor came away from the attack with non-fatal head wounds, but the emotional trauma of the attack lingered.

Around the same time as Scantling's subway hammer attack, Philadelphia rolled out its criminal mental health court. Designed to steer low level offenders towards outpatient mental health treatment instead of county jail, the program claims to have saved tens of thousands of cumulative days in jail time and millions of dollars in its three years of existence by ensuring lawful behavior through compulsory therapy and medication management. Advocates of mental health courts say they can prevent terrifying high profile violence of the sort described here by catching mentally ill offenders early and providing them with supportive services.

In addition to the spread of criminal mental health courts, in the wake of the Sandy Hook massacre and last summer's Aurora, Colorado movie theatre mass shooting, there's been an intensification in calls for stringent regulations surrounding civil mental health commitments to be eased, allowing doctors, therapists, and family members of mentally ill individuals to assist in preemptively detaining someone who they feel is on the brink of violence. The focus of mental health interventions is increasingly on preventing potential episodes of violence by people with a greater probability of engaging in them. Better someone spend a few days in the hospital against their will, the argument goes, than spend a decade in jail. And better for society, as well.

Critics claim that expanding the reach of the judicial system into the lives of people with severe mental illness will actually backfire, driving people away from therapists and doctors for fear of being reported to the police. Additionally, the compulsion of mental health treatment and use of psychotropic medications that may come with debilitating side effect is widely considered by mental health advocates to create enormous potential for human rights abuses.

Tammy Seltzer, an attorney with Washington, D.C.'s Progressive Policy Solutions, a mental health law consulting firm, has previously written of mental health courts:

Although the goals of these problem-solving courts are laudable, they have flourished because of systemic failures in public mental health and the criminal justice system. In addition to raising various civil rights and public policy concerns, these specialty courts are inherently flawed, unintentionally signaling an acceptance of the rates at which people with serious mental illnesses are entering the criminal justice system.

Advocate voices against the spreading reach of the law into the lives of mentally ill individuals are compelling, their arguments sound. Yet, with each high profile episode of violence by people with mental illness, more frequently captured in lurid detail by surveillance video, they must struggle harder to cut through emotional outpourings of public opinion that support greater state control and observation of people with mental illnesses, regardless of whether they have histories of criminal behavior. Mental health advocates who work every day with people in recovery from mental illnesses point to the numbers: Serious mental health disorders are fairly rare, and those who are driven to violence by their symptoms even fewer, comprising a tiny portion of America's crime problems. But then another video surfaces, another headline hits the front page, and the tide of public opinion turns against their efforts, again.

It is not known whether Clark was receiving mental health treatment at the time of his attack, or if he had been prescribed medication for any diagnosed disorder. He was not being monitored by any parole or probation authority in association with any of his prior violent offenses. The victim's name in Tuesday's subway attack has not been released. When asked about the experience, she told news sources that she was thankful a train wasn't entering the station when she landed on the subway tracks.

Of Clark, she said that when he approached her, "He seemed fine, he didn't seem like he was crazy."