Jared Loughner And The Sorry State Of Mental Health Care
There's a lesson to be drawn from the tragedy in Arizona, but it isn't the one the media is talking about.
While the talking heads on cable and in Congress are likely to spend the next week or more bemoaning the uncivil state of our political culture in the wake of the shootings in Tucson, Tamara Holder at The Daily Caller points to a real problem that the case of Jared Lee Loughner lays bare:
Jared Lee Loughner’s shooting massacre could have been prevented if the people around him had paid attention to the warning signs.
This was not a random act. This was not a political act. The simple-minded want to blame politics, because that’s the easy thing to do, instead of really looking at why this 22-year-old, with no known affiliation to any political party or group, launched a terrorist attack on innocent Americans.
The previous major terrorist attack on American soil was on the Ft. Hood Army base. Neither that shooting nor the shooting in Tucson was planned by jihadist sleeper cells; both were committed single-handedly by an American man. Yet we have turned into tunnel-visionists; we are so consumed with issues of religious profiling and TSA pat-downs, we have become blind to the behavior of the people we know best: our kids, friends, classmates and co-workers.
Jared Loughner is another classic case of a person who showed all of the behaviors of a potentially violent person.
Just 48 hours after Loughner opened fire, the evidence of a man with a troubled past, and a troubling personality, is all over the place. There are his incredibly odd YouTube videos and his now deleted MySpace page, emails from fellow students at a Community College that paint a portrait of a man who everyone seemed to think had the potential to engage in mass killing, an odd obsession with Congresswoman Giffords, and changes in his behavior over the past year. Just a few months ago, Loughner was expelled from Community College and told he could not return without a psychiatrist certifying in writing that he was not a danger to himself or others. In hindsight, it would seem that all the signs were there that Loughner was a deeply troubled man who likely could have benefited from psychiatric treatment of some kind, and yet nobody did or said anything until it was literally too late.
Holder draws parallels in her column between Loughner and Major Nidal Hassan, who murdered 13 people at Fort Hood in 2009 and who also had left plenty of warning signs regarding his own mental problems and obsession with jihadist propaganda. A similar parallel can be found in the case of Seung-Hui Cho, the 23 year-old college student who murdered 30 people at Virginia Tech in April 2007. Like Hassan and Loughner, Cho had left plenty of evidence behind of his own mental health problems. As Holder points out, what all these cases show is that the problem isn’t one of politics, but our own inability or unwillingness to focus on a topic that makes many people uncomfortable:
Here’s the brutal truth: Innocent people will continue to die until we recognize that mental illness is a disease that must be treated. Federal law enforcement knew about the Ft. Hood shooter for months, as did his employer. Tucson police knew about Loughner for months, as did his school.
Schools cannot suspend a potentially violent student without first making an attempt to provide mental treatment to the student. It is a school’s duty to protect its students. Summarily suspending one could potentially harm all.
Now is the time to open our eyes. It is time to stop blaming the Tea Party, former leaders who dropped out of leading, the far left, right-wing politics and any other politician or political group. It is time to find mental treatment for the potentially violent so they do not continue to unload on the innocent.
I think part of the reason that we seem to continue to ignore the problem of the violently mentally ill is that mental illness itself is a topic that most people are uncomfortable talking about. Unless you’ve dealt with it yourself, or had a family member who has, understanding what it really means to say that someone is clinically depressed or schizophrenic is difficult for most people. Add to this the fact that our nation has an unfortunate history of mistreating the mentally ill who were confined to hospitals prior to the 1970s, and we’ve essentially got paralysis. By some estimates, for example, as many as 40-45% of the homeless population in the United States are, in fact, people suffering from various forms of mental illness, some treatable with medication and some of it so severe that basic humanity would seem to require institutionalization of some kind. These people obviously don’t pose the same dangers as the Jared Loughner’s of the world, but basic humanity would seem to require that they not be left on their own when they are suffering from diseases that make it impossible for them to live a functional life.Why we’ve allowed this to continue for so long is inconceivable.
I’m not sure I know what the answer to this problem is. Large scale institutionalization isn’t the answer, both because we don’t have the resources and because we need to be mindful of the history of abuses that led to the de-institutionalization movement of the 1960s and 70s. However, if we’re going to have a productive discussion in the wake of the tragedy in Tuscon, it strikes me that this would be a far better, albeit not nearly as “sexy,” subject for the so-called experts in the media to spend their time on.
Again, what would you have had them do? Have him arrested on the suspicion of having a mental illness?
Michael,
As I said at the end of the post, I’m not approaching this with the idea that I know what the answer is. I realize this is a cardinal sin for a blogger. However, I think it is fairly obvious that we are doing a very crappy job when it comes to mental illness in general, and the violently mentally ill in particular.
Good post. On various websites and on Twitter, I’ve seen a lot of people question why Loughner’s family and friends didn’t do more to help. The answer is likely that it is very difficult to force a mentally ill person to seek psychiatric help. Loughner is 22 years old. All his parents, friends, teachers, and the police could do was encourage him to seek help.
There’s no easy answer on this one, as I believe it should be difficult to have someone committed against his or her will if they haven’t engaged in criminal activity. It’s a hard question.
While I absolutely agree that the return to easy institutionalization of the past isn’t the answer, I do think the pendulum has swung too far. I see people every day on the streets of DC who would be much better off in some sort of care facility rather than wandering around homeless and screaming at people.
I think our mental healthcare system is screwed up.
There is a huge stigma attached to people with mental illness. There is also a stigma attached to using drugs to control the mental illness, and there isn’t a willingness to provide the care needed to keep the mentally ill stable.
I think one ethics issue we have to address is just how much say the government should have with regards to medication compliance. There is a line with regards to medical privacy-and while many mentally ill people can function in society while medicated, some of them become very dangerous when not on medications. I do not want to see a situation where the mentally ill are warehoused in facilities, but I can’t help but wonder if we shouldn’t do more with regards to community support with home health services that can monitor and help mentally ill people manage in the community.
Also, I know in some cases family members will report the downward spiral of a family member, but receive no support or help and then they do the unthinkable.
You’re spot on with this post. Hopefully, the media will shift focus sooner rather than later.
If someone had found a way to convince Jared Loughner to seek a psychiatric evaluation, I believe a diagnosis of mental illness would have resulted. Then, assuming the state of Arizona participates, this diagnosis would have been reported to the FBI, for inclusion in the NICS (National Instant Criminal Background Check System). Then, assuming the NICS is updated on a timely basis, when he went to buy the gun in November, he would have shown up in the NICS and would have been denied access to a gun.
How can we create a public protection law to give us the ability to involuntarily commit someone based on a strong pattern of mentally unstable behavior, at least for long enough to obtain a diagnosis? The public paid the bill all 5 times when law enforcement had to visit Pima Community College due to Jared Loughner’s erratic behavior. At some point, the public should have the right to demand that the situation be escalated to mental health authorities for a diagnosis.
I think the first difficulty with mental health problems is it’s an intangible disorder that requires the victim’s cooperation to identify and treat (except in the worst cases). My wife is a therapist, and someone resistant to therapy can sit there for the entire session refusing to talk. I believe that was the problem with the VATech student.
I think the Community College did something good by conditioning readmittance on a mental health examination. That gave the therapist some leverage, if he wanted help or to return.
It would help if family and friends knew more about mental health illness and could identify the problems early and encourage cooperation. But psychotic disorders tend to break when the young person is leaving home for the first time (or if staying home, independence is being asserted) and all kinds of odd behavior can be considered normal.
“I think it is fairly obvious that we are doing a very crappy job when it comes to mental illness in general”
I disagree.
I think mental illness is one of the few fields where science has been making consistent progress over the past 50 years or so.
If you want to talk about scientific failures, let’s talk about physics, 50 years of wankers wasting billion of dollars looking for an imaginary particle.
and someone resistant to therapy can sit there for the entire session refusing to talk.
We also don’t have a lot of recourse when a person is non compliant with medication or other therapies.
and someone resistant to therapy can sit there for the entire session refusing to talk.
We may know more about it, but treatment is very inadequate and inconsistent and it has the added problem of social stigma attached. Between people being unwilling to admit they have a problem (or recognize when they have a problem) and the general reluctance to pay for therapy-especially in patient-treatment is hit and miss.
Just Me, I hear you. I’ve often suggested third-party enforcement of meds, but I think the number of people on medications makes it too expensive and we are reducing payment on this end. Mental health will take a back seat to physcial health.
I’m sorry but, as a libertarian, you’re okay with this statement?
That’s exactly right. It’s not like the flu where you can test someone for it, it’s a diagnosis based on behavioral observations, and there is plenty of room where equally qualified psychiatrists will disagree.
Doug,
Really enjoyed your post. I wrote on the same topic yesterday check it out: http://comingoutofthetruth.wordpress.com/2011/01/09/jared-lee-loughner-is-in-my-class/
Best,
Candice
And learned quite a bit about the very nature of matter, energy and our universe in the process. Yup, totally wasted.
I agree with James. It was back in the late 70’s (IIRC, and my memory for dates is pathetic) that the de-institutionalization push began.
It was “my side,” the left, that was chiefly responsible. They pushed for an end to institutionalization on the theory that community programs would pick up the slack. Huge surprise: didn’t happen. I thought at the time it didn’t sound right. It sounded naive, and “naive” always makes my flesh creep.
I think some of that was needed reform, but it’s gone too far. We need some mechanism for responding to cases of mental illness.
Look, if I called up my local health department and said, “My neighbor has buboes under his armpits,” I like to think they’d do something. Schizophrenia is an illness as much as plague or cholera or swine flu. It’s not communicable in the usual sense, but it can be “communicable” in those cases where there are violent propensities.
Of course, here’s a thought: maybe we should stop selling guns to anyone with a drivers license. Or at gun shows anyone with a pulse. Maybe we should stop holding the entire population hostage to the ludicrous fantasies of paranoid hillbillies.
But I digress.
In a world where we had adequate public health funding we should be able to set up a process for reporting a possible case of serious mental illness. A report from a civilian, followed by a preliminary look-see from the police, followed by a professional evaluation, followed by recommendations to a court, and ending in treatment — voluntary or compulsory. Compulsory treatment should only be considered in cases where violent behavior is a probably outcome, and where more than one layer of mental health pro has done an evaluation.
We certainly should not force treatment on the odd, the eccentric, the weird, the obnoxious, etc… But the schizophrenic? I’m sorry but by definition they cannot give consent, and at that point the government should become involved.
Have you considered that making it easier to institutionalize people might actually make the problem worse? Institutionalization is, for all practical purposes, a punishment for being diagnosed with a mental illnees. The more likely you make that punishment, the less likely people are to voluntarily seek treatment. As with most chronic health problems, the early treatment is sought the better the prognosis is likely to be, so the unintended consequence of increasing the penalties associated with treatment is to assure more people go undiagnosed until a crisis occurs.
In the Jared Loughner case, his school made the perhaps regretable in hindsight choice to make treatment an all or nothing proposition for him: you can’t come back here until you’re completely healthy. Not suprisingly he chose to just drop out and never saw a professional. Perhaps if it had been a more positive option (you can stay as long as you’re receiving treatment), he’d have been more likely to actually go to someone.
I have personal experience with a family member who is profoundly mentally ill. A few observations.
– Many people who are mentally ill do not realize it, even when presented with family & medical opinions and supporting evidence. Lack of self awareness is part of the illness.
– Many who are mentally ill will refuse treatment, therapy, and medication. If you have some leverage over them they may go through the motions, but they become very good con artists.
– The system is not necessarily helpful. When my relative had a psychotic break in Texas, police were called in twice by friends and family. In spite of the fact that he was delusional and wearing a bulletproof vest, the police said there was nothing they could do. He was arrested for causing a disturbance shortly after arriving in California and taken to the county psych ward, where he at least got into a treatment pipeline.
– The pendulum has swung too far in the direction of patients rights.
– It took my wife and I, two college educated professionals with resources, years of concerted effort to get my relative hospitalized in a long-term care situation. He probably had 10 72 hour psych holds and several serous incidents with police before we were able to get the system to take the necessary action. Our friends in the local mental health community were amazed that he was conserved, they said that between budget cuts and patients rights it is near impossible to do in California now. And this is an individual who is clearly a danger to himself and others.
– Hospitals are letting patients go who are in serious need of constant care and supervision because of budget cuts.
– About 90% of hospitalized patients are abandoned by their families. They are too burned out to continue to be involved. A lot of relatives end up with post traumatic shock from years of dealing with a mentally ill relative. It is tragic, because the system has gaps and makes mistakes, family involvement is critical for successful treatment.
– The stigma associated with mental illness can be crushing. The community does not rally around you when your kid is mentally ill. They are scared and they just want the problem to go away.
– Address the problems in our mental health system and you are also addressing the homeless problem. About half of the homeless are mentally ill.
Thanks for reading my piece!