Better Mental Health Care Won't End Murder, But It Will Save Lives

Illustration for article titled Better Mental Health Care Wont End Murder, But It Will Save Lives

Shooter Jared Loughner's unhinged YouTube rants and strange behavior has many people asking if we're doing enough to protect Americans from mentally ill people. But that's the wrong question.

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In the long, sad session of "how the hell did this happen" that's followed the shooting of Rep. Gabrielle Giffords and over a dozen others Saturday, mental illness has come up nearly as often as lax gun control and violent rhetoric as an explanation for the tragedy. Some arguments verge on the hysterical — one blogger references the "many disturbed individuals who are roaming the streets of every street in America" and the supposed need to "protect the public from mental patients who are tormented by the voices some hear in their heads." Others, however, have more soberly pointed out that despite the fact that Loughner was ordered to get mental health treatment and that one teacher was concerned enough to wonder, "Is he going to bring a weapon to class?," he was able to purchase a semiautomatic weapon and use it to murder multiple people.

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It's important to remember that, as Slate's Vaughn Bell points out, "Severe mental illness, on its own, is not an explanation for violence." While substance abuse does increase a person's risk of becoming violent, mental illness does so only slightly or not at all, and "your chance of being murdered by a stranger with schizophrenia is so vanishingly small that a recent study of four Western countries put the figure at one in 14.3 million. " Of course, just because Loughner's rampage wasn't typical doesn't mean it wasn't deadly, and Janet Novack of Forbes makes a good case for better cooperation between state mental health services and the federal agency that performs background checks for prospective gun owners (this system notably broke down in the case of the Virginia Tech shooter). But ultimately, better mental health treatment might not benefit average bystanders (who aren't at great risk from mentally ill people, despite the weekend's tragedy) nearly as much as it might help those who are mentally ill.

In the smartest take on the subject so far, Amanda Marcotte writes,

[A]t this point in time, [Loughner] seems to be another example of someone who slipped through the cracks. It appears that many people noticed that Loughner was suffering from some kind of mental health problems, and yet so far there's no indication that he got a diagnosis or even saw a mental health professional. If he had, there's a chance that this tragedy could have been averted.

It's hard to say what, if anything, would have helped Loughner, and Marcotte doesn't pretend to have all the answers. But she does point out that although his school demanded he seek therapy, he didn't do so — possibly because finding and paying for therapy in America is still extremely hard. Writes Marcotte, "If a community college student with poor access to health care needs contraception, she knows who to call: Planned Parenthood. We need something like that for people who find themselves in need of mental health services." A Planned Parenthood of mental health care would help the many, many people in this country who are suffering from mental illness and don't know where to turn. Most of these people are not and will never become violent, and getting them the therapy they need wouldn't reduce the national murder rate very much. But it would reduce the number of sick people who can't find help — and that, in itself, is a worthy goal.

'Mental Illness' Not An Explanation For Violence [Slate, via MSNBC]
A Portrait Of A Disturbed Assailant [The New Republic]
Giffords' Shooter's Mental Illness Downplayed By Tucson Politicians [Examiner]
Giffords Shooting Raises Questions About Mental Health Care [RH Reality Check]

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DISCUSSION

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Snacktastic Part III: the Return of the Spatula

I'd like to put this out there as someone who did forensic mental health evaluations for a good part of a decade, including risk assessments. It is very hard to predict the potential of someone to do a homicide. Most of the markers, including the ideation, the paranoia and the isolation, in other people indicates very little potential to do harm to others. I think it's easy in retrospect to look at the people in his lives and wonder why they didn't know and the reality is that for every person that actually acts on this, there are thousands of other people who never do.

I've had clients where horrible stuff has happened to them—I once came off a week vacation and three of my clients died unexpectedly (suicide, gun related violence). But that's an occupational hazard and the reality is that we can't always predict when something horrible will happen.

I think living in a community, understanding people around you, being helpful, offering support and getting people mental healthcare is great—and maybe something that can be promoted positively out of this tragedy. But what I do worry about is that people with schizophrenia and other psychotic disorders, like my brothers, like other posters and posters' families and friends, I imagine, will be further stigmatized and seen as dangerous unnecessarily and by people who think they can predict violence even though they can't. What's harder to manage in life is that we can't control everything that will happen, including the actions of one troubled and violent guy.