Every time America suffers another mass killing by gunfire, as happened in Newtown, Conn. on Dec. 14, the suggestions for change to prevent the next incident — or perhaps reduce the chances of one occurring — start flying fast and furious.
Although the dividing line is ragged, two such suggestions fall roughly along ideological lines. From the left, there are calls for more firearms regulation. From the right we hear about the need for better mental-health screening and the scourge of cultural rot, such as violent video games.
I tend to leave arguments over the First and Second Amendments to others, though I have my opinions. But each time, I feel compelled to address the widespread, glib instructions from the uneducated about mental illness.
As Newtown fades in the national memory, the various proposals on guns are legion. So, too, are laws whose sponsors claim will help identify potential killers and either lock them up or get them help, often both.
But let’s start by doing away with some myths about mental illness.
First, doing something deranged is not evidence of mental illness, ipso facto. Some who kill, such as the Norwegian murderer Anders Behring Breivik, are terrifyingly sane. Mental illness is a discrete diagnosis with identifiable symptoms and typically treatment. These mass killers may be “crazy,” but they are not necessarily mentally ill.
On the flip side, the vast majority of those with diagnosed mental-health conditions — some 45 million Americans, according to federal statistics; 11 million of those have a “serious” mental illness such as schizophrenia or bipolar illness with psychosis — are no more violent than you or I.
According to a study in the September 2010 issue of Archives of General Psychiatry, some 3.4 percent of the population has been convicted of a violent crime, compared to 4.9 percent of those with bipolar disorder (1973-2009). A study published in the Journal of the American Medical Association in 2009 found that 5.1 percent of Americans were convicted of a violent crime between 1973-2006, compared to 8.5 percent with schizophrenia.
But both studies found significantly higher rates for those with bipolar people who also had a substance-abuse disorder — 21.3 percent — and those with schizophrenia with such a “dual diagnosis,” at 27.6 percent. Drug and alcohol problems are the magnifier.
All that said, most of the calls to reform how we deal with mental health in the wake of Newtown offer positive solutions.
President Obama, for example, ordered his Department of Health and Human Services to act quickly on rules requiring insurers to cover more mental health services.
And in Colorado, Gov. John Hickenlooper has proposed a $18.7 million increase in mental-health services.
But the governor’s proposal has problems, according to Phoebe Norton, the former long-time director of the Boulder County Mental Health Center, now called Mental Health Partners. (She also serves on the board of the Colorado chapter of the National Alliance on Mental Illness, but the views here are hers alone.)
First, the governor plans to spend $10 million of the new money to create five regional mental health crisis centers. But we don’t need that. Local agencies and governments have that well covered already. And really, $2 million per center wouldn’t go very far, anyway.
“We already have mental health centers all over the state with relationships with local law enforcement,” Norton says. “Why would you want to lay a new system on top of that?”
Meanwhile, one proposed new law would broaden the criteria necessary for involuntarily placing someone on a 72-hour mental-health hold. The bill would change “imminent danger” of violence to “substantial probability.”
That’s subtle, but it would almost certainly increase the number of people being taken in. And the bill also allows such people to be kept in jail when there are no hospital resources available. And in many areas, especially rural parts of the state, there aren’t.
“This may be a good thing and may protect people, protect their families and others,” she says. “But where are you going to put them to keep them safe?”
The silver lining there is that such a law would push things to a head, and there likely would be a class-action suit to remedy the problem of drastically reduced funding for mental-health services, Norton says.
One other sticking point in the bill is that it would report all persons held for mental-health reasons to a perpetual national registry. In other words, one strike and you’re out — permanently — and who knows what the consequences might be? That’s a severe overreaction that, again, won’t necessarily reduce violence. Neither Lanza nor Aurora shooter John Holmes nor Tucson killer Jared Loughner (diagnosed with paranoid schizophrenia, yet still deemed “competent” in our bizarre system) were ever involuntarily committed.
Still, it’s progress that mental-health issues are in the public eye — for now. The bad news is that misinformation about mental illness continues to be perpetuated and mental-health services, despite all the attention, are still woefully underfunded.
“None of this makes much difference so long as we don’t have the beds available or treatment services to back it up,” Norton says.