A Plea for Mental Health Reform
“Vitriolic statements made night and day on radio and TV about [Rep. Gifford’s] support of health care…” are the sparks that inflamed Jared Loughner into committing mass murder. Pima County Sheriff Clarence Dupnik admits he has no evidence for a belief he is nevertheless proselytizing far and wide. Elsewhere on cable news today one finds rote calls for stricter gun control laws, as if sentient and malignant firearms were collectively to blame for our latest national tragedy. But what about the perpetrator himself: What do we know about Jared Loughner's behavior and his community's response?
Loughner gave every sign of suffering from a serious mental illness that evolved over a great many months. Unfortunately, as with Virginia Tech shooter Sheng-Hui Cho, clear behavioral warnings were ignored or ineffectually managed--casualties of political correctness and absurdly hermetic federal privacy regulations.
For example, the Washington Post presents a series of emails sent last summer by a Loughner classmate at Pima Community College
From June 14: "We have a mentally unstable person in the class that scares the living crap out of me. He is one of those whose picture you see on the news, after he has come into class with an automatic weapon. Everyone interviewed would say, Yeah, he was in my math class and he was really weird. I sit by the door with my purse handy. If you see it on the news one night, know that I got out fast..."
Loughner’s behavior was so bizarre that college instructor Ben McGahee insisted on his removal from class. On Fox News this evening McGahee reported that Loughner spent most lectures red-faced and visibly shaking, and answered one math quiz with a disturbing reference to “mayhemfest.” Despite McGahee’s concerns, political correctness kept Loughner in his seat disrupting class for a full month. Eventually, Pima College administrators suspended Loughner and conditioned return to college on a psychiatric clearance demonstrating that he was not a threat to himself or others. Despite this extraordinary level of concern, nothing further was done to help Loughner or protect the public. As far as we know, Jared Loughner never received any psychiatric attention.
Loughner clearly is suffering from a profound and progressive psychosis. One manifestation of this sort of mental illness is a loss of self-awareness necessitating compulsory diagnosis and treatment. Drug therapy can be surprisingly effective, but somebody first has to step up to do the compelling, and our usually compassionate society has lost its way by failing to implement an appropriate mental health care system.
Consider: Many responsible people worried enough about Jared Loughner's potentially dangerous behavior to suspend him from college and urge a mental health evaluation. Yet no other action was taken--perhaps none could be taken-- and months later Loughner embarked on a lethal rampage that left my beloved aunt and many others dead and a congresswoman and others maimed.
Jared Loughner should have been compelled to undergo a mental health evaluation followed by appropriate treatment. Had this been required by law yesterday’s tragedy would have been avoided. Let's prevent the next mass shooting, not by demonizing political speech we disagree with or further regulating inanimate objects, but by helping those mentally ill people, like Jared Loughner, who cannot help themselves. We need mental health reform and we need it now.
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Oct '10
Re: A Plea for Mental Health Reform
The type of reform you are referring to is not mental health reform it is legal reform. The mentally ill have their civil rights protected to such an extent that it is very difficult to force the mentally ill into therapy against their will, and nearly impossible to force them to continue therapy once it is instituted. In the Emergency Room, I see the scenario of mentally ill people in the revolving door of the mental health system on a nearly daily basis. It is disheartening to see the mentally ill suffering while their loved ones and others who want to help them must stand by helplessly while they reject the help they need, and the legal system perpetuates this viscious cycle.
I am very grieved that you and your family have been victimized by this person and this system. You have my condolences. The system needs to be reformed.
Re: A Plea for Mental Health Reform
Sorry for your loss George.
Jun '10
Re: A Plea for Mental Health Reform
Amen.
Jun '10
Re: A Plea for Mental Health Reform
When a person gets physically sick, we call 911 and the person is taken to an emergency room. Why should a person who is mentally ill be treated differently? Every emergency room I've been in has a padded room for such people. Would repeated calls to 911 not eventually draw a mental health professional who could make an evaluation? Or is it simply policy to allow mentally ill people to suffer as long as no one else gets hurt? The difference between how physical and mental illness is addressed by emergency personnel seems to me both illogical and inhumane. Perhaps a starting point for reform.
I offer my condolences, George, for your loss. Your aunt will be in my prayers.
Re: A Plea for Mental Health Reform
I agree, George. I, too, wonder how it would work. Do you have any thoughts?
My one thought would be that the signs often (not always) show up shortly before adolescence. I hate to say it, but it may fall on the education system. I have, in my years teaching, come across a handful of students with clear instability issues. The changes in body chemicals during puberty make it worse. But while people are still minors, it is up to (and within the power of) parents, teachers and school administrators to work together to arrange appointments and medication if necessary. Probably one strategy would be to educate school districts, teachers, etc. for signs in children/middle schoolers. It's only a step and, of course, the education system is already dysfunctional, so who knows how effective it would be.
Does anyone else have any ideas? I agree that once a person is over 18, he or she can either be on an obvious path toward 1) self destruction (drugs, alcohol) or 2) violent homicidal acts and observers have little power.
George, do you see another way?
Edited on January 10, 2011 at 2:27pmJul '10
Re: A Plea for Mental Health Reform
George, my condolences to your family.
Reform is a knotty problem. How do we identify those in need of treatment and provide care, when, as is common, they will resist our efforts?
As we've seen in Cuba and the Soviet Union, giving the state the power to decide who is mentally ill is a course fraught with peril.
Indeed, in our own not-too-distant history, people were forcibly subjected to draconian therapies such as electroshock and lobotomy. With that in mind, the intervention of the civil-liberties movement into the issue of mental illness was not entirely wrong-headed.
But clearly, some humane response to the problem must be found.
It's a pity that it may have taken this latest incident to force the issue. We've very clearly had many, many previous warnings.
Oct '10
Re: A Plea for Mental Health Reform
It is noticeable that if there is something wrong with your body, in general, it is met with sympathy and best wishes. But if there is something wrong with your brain (as if it wasn't part of your physical system) it is treated with distaste and shame. To treat the body but not the mind is foolish.
We had a very similar shooting here in Ottawa many years ago, and the target was a popular sportscaster on a local channel. The man who shot him was a schizophrenic who I believe had refused treatment. We need desperately to lessen the "rights" of people who exhibit dangerous behaviours - aren't rights meant to stop at my nose, so to speak? That poor girl living in terror in math class, focussed on escaping out the door from a madman, instead of worrying about quadratic equations. How can her rights have been dwarfed by a red-faced, shaking, madman? The cases are piling up that involve considerable warning ignored.
Oct '10
Re: A Plea for Mental Health Reform
Sorry for the "madman" line - poor choice of words perhaps when I am agreeing with the need to recognize and treat mental disorder - but that is clearly how he presented himself.
May '10
Re: A Plea for Mental Health Reform
This is not on you George but the forum as a whole.
If de-institutionalization is to blame, it is surely a pox on both our ideological houses for as much as it was driven by civil liberty considerations on the left, it was also driven by cost considerations on the right. And so the question becomes -- if the mentally ill are to be taken off the streets and placed in institutions where they might receive better care and in extreme cases society might be safer -- then who pays for that care?
May '10
Re: A Plea for Mental Health Reform
George, please accept our prayers and sympathy.
As a site director for a community Mental Health Clinic, I am all too familiar with this type of case. Unless someone makes overt threats to harm self or others, there is little that can be done. People have a legal right to be psychotic. Usually, untreated psychosis results in more harm to the person than to others. People with schizophrenia tend to die 20-25 years sooner than the general population. They have poor health, poor lives and a higher suicide rate than depression.
This is one of those areas where the government needs to step in because the market fails. There is no money to be made treating the chronically mentally ill. Yet, the cost to society is immense. The cost to the individuals, their families and sometime total strangers, is even higher.
We also need better rules to manage those people who are clearly not stable. It is humane to let someone live on the streets because he is too psychotic to work? That is better than a hospital? Really? 1955 there were 340 public psychiatric beds per 100,000 U.S. citizens. By 2005 the # was 17.
Jun '10
Re: A Plea for Mental Health Reform
Trace Urdan: This is not on you George but the forum as a whole.
If de-institutionalization is to blame, it is surely a pox on both our ideological houses for as much as it was driven by civil liberty considerations on the left, it was also driven by cost considerations on the right. And so the question becomes -- if the mentally ill are to be taken off the streets and placed in institutions where they might receive better care and in extreme cases society might be safer -- then who pays for that care? · Jan 10 at 6:16am
We pay for it one way or another, do we not? There's a cost both economically and socially to allowing the crazy and the homeless to wander freely. We either pay the appropriate institutions to house and treat them, or we pay for emergency room services and incarceration. The former is humane, the latter is not.
Re: A Plea for Mental Health Reform
I agree that the main reform needed here is legal and the first place to change the law is in education. Schizophrenia usually manifests during adolescence and the early twenties--exactly the case with Mr. Loughner. Educators should be required to refer students exhibiting dangerously aberrant behavior for psychiatric evaluation; if the patient and family refuse then a judge should review the case and be empowered to compel such evaluation. A similar process should attend to therapy. Today's legal standard of being an imminent risk to self or others based upon overt threats is too strict.
I am sympathetic to Kenneth's point about the risk of overusing mandatory treatment, but I believe we can limit the process to mandating appropriate diagnosis and care for psychotic patients, not labeling political foes or demonizing alternative lifestyles. Schizophrenia is a serious disease, one that is very frightening for the patient and occasionally hazardous to the public. We are doing far too little about it today, with tragic consequences. Instead of shrinking pistol magazines we need to expand the public mental health apparatus and provide the legal framework in which it can operate effectively.
Re: A Plea for Mental Health Reform
One thing that must be changed is the notion, enshrined in federal privacy law, that once a child reaches the age of 18 his medical information is off-limits to parents. This leads to tragic cases, unlike Loughner's, of adolescents deteriorating at college while loved ones are affirmatively blocked from intervening or even knowing there is a problem. If 21 is a good age for drinking alcohol then I think it's a good minimum age for sealing-off medical information from parents.
Or we could just get rid of the federal rule entirely and once again allow colleges to set individual policies. Whatever the solution, the one-size-fits-all approach to medical privacy is not working in the area of adolescent mental health.
Edited on January 10, 2011 at 3:54pmJul '10
Re: A Plea for Mental Health Reform
George, I hold you in very high regard.
But I'm hesitant to give primacy in this to "educators" - the same people who expel a little girl from school for having a paring knife in her lunchbox or press charges of sexual harassment against kindergarten boys for kissing a girl.
Once someone is referred into the system of judicial review, he or she could be stigmatized for life, based upon the judgment of an educator who may be inclined to see a monster under every bed.
Jun '10
Re: A Plea for Mental Health Reform
I think it's also worth noting that incidents like this (where over a dozen people can get shot and killed, by one shooter, in a very public place) are rare in Israel. Bombings in public places, yes, shootings, not so much. It's because nearly every adult Israeli male is in the military, or was in the military, and they carry firearms everywhere. If a terrorist starts shooting into a crowd, he won't do it very long.
Sep '10
Re: A Plea for Mental Health Reform
Taken to an extreme, the charge of having a mental illness could be used against those that one either does not like or with whom they disagree. Sure, I know, not likely, but who decides?
We all remember those kids in high school and college that were on the fringe, who wore the trench coats to school, who just didn't fit in and were "weird". After these shootings, some might seek to label these kids as "dangerous" and attempt to - against their will - have them psychologically evaluated.
Is this a stretch? Maybe. But then we might have thought respectable journalists blaming a horrific crime on political opponents a stretch also. Until this weekend.
Unfortunately, mental illness just isn't cut and dry like most physical medical issues. For many, medications taken as they should allow a person to be a normal functioning member of society. For others, they may have some days when they are seem normal, and it can't be predicted when they will crack.
So I'm very leery of reform efforts. But then, I admit, I'm not sure what the right steps are.
Aug '10
Re: A Plea for Mental Health Reform
I agree, George. Students' families are, on average, substantially more able than anyone else to help their children.
Tragically, not always. Sometimes the family is more part of the problem than it is the solution.
However, these exceptions -- where the family itself is too sick to really help a mentally-ill child -- are rare enough that, painful as they are for children stuck in this situation, they cannot serve as a guide to policy or lawmaking.
Parental notification is not a perfect policy -- it, too, will have costs -- but it's the best we can do in this imperfect world.
Edited on January 10, 2011 at 6:07pmRe: A Plea for Mental Health Reform
Kenneth, you make an excellent point. I'm not certain how to enact my prescription into law--perhaps one of Ricochet's legal experts could weigh in?--but I am not speaking of run-of-the-mill eccentricity (why would I, after all, put myself at risk?). Loughner's instructor tells us that he has never before encountered such a dangerous-seeming student. Other students were writing unprompted emails worrying about their safety. Clearly, Loughner's behavior was exceptional and demanded an exceptional response.
If middle school drawings of stick figures shooting guns were grounds for commitment, then I would be have been prescribed serious pharmacotherapy 40 years ago. I hope we can find some way to avoid another zero-tolerance monster-under-the-bed educational fetish while systematically helping the rare desperately ill individual standing in plain sight.
Could any of our legally inclined members weigh in on how to achieve the necessary balance?
May '10
Re: A Plea for Mental Health Reform
Dr. Savage, please accept my deepest condolences for your loss.
Are horrific events like these related in any significant way to the "anti-psychaitry" theories of the '60's, where it was held that diagnoses can only be arbitrary at best, treatment was worse than the disease, and that the disease itself was an attempt to cope with a "sick society?"
The theory seemed tailor-made for those intent on closing down the system of in-patient state hospitals for the mentally ill, and indeed most of the state hospitals (in Calif. at least) were closed. I have a sister who is severely developmentally disabled, blind, too, who was institutionalized as a child. In the early '70's she was approached by the hospital administration and asked if she would like to be released and of course she said yes. She would have said yes if you asked her if she wanted to fly. She was very nearly discharged to be on her own and my poor parents struggled mightily with the courts to continue her care.
If that could happen to my sister, who needs constant custodial care, our garden-variety psychotics and schizophrenics don't stand a chance.
May '10
Re: A Plea for Mental Health Reform
In other words, what was lacking was room for human judgment. We can't computize the world. Subjective decisions will always be necessary, and we're fools if we think finer-tuned laws and rules can protect us from hard trade-offs and the possibility of grievous error.
A cousin of mine is schizophrenic. Medicine does wonders, but occasionally he stops taking it or circumstances unbalance the chemicals in his brain. His best protection, and others best protection from him, is a network of family who love him, watch him closely and intervene when need exists. As Bryan says, the costs are high. But oh well. That's life.
Perhaps some reforms would be good, but I doubt we could ever reach a point at which people were not calling for reform because of various problems. The most important element is demanding that families and neighbors take care of their own. Child or adult, a mentally sick person can be helped by family, even when he or she rejects much of the help offered.