Over 9 million US adults experience serious mental illness in a broken health system
LONG before the July 23 shooting at a movie theater in Lafayette, La., which killed two young women and the mentally-ill shooter, psychological health remains an important and relevant topic in the US.
One psychiatry professor calls it “the conversation we’re stuck with,” a teachable moment that grew out of horror.
When mental illness is cited as a possible factor in a high-profile mass killing, there’s a collective sigh among mental health professionals, the Associated Press reported. Even as they see an opportunity for serious national discussions of ongoing problems and possible remedies, they also worry about setbacks to their efforts to destigmatize mental illness.
“Most people who suffer from mental illness are not violent, and most violent acts are committed by people who are not mentally ill,” said Dr. Renee Binder, president of the American Psychiatric Association.
“If, hypothetically, everyone with mental illness were locked up, you might think you were safe, but you are not,” Binder said.
According to the National Institute of Mental Health’s latest estimate from 2012, there were an estimated 9.6 million adults in the US—4.1 percent of the total adult population—experiencing serious mental illness over the previous year.
“If you look at that large pool of people, only a tiny proportion of them will eventually commit violence,” Binder said. “How are you going to identify them? It’s like a needle in a haystack.”
Still, public perceptions can be hard to shake. Of the high-profile mass shootings in the past 10 years that are most “ingrained in America’s psyche,” officials say the mental health problems of the perpetrator became a central part of the narrative in several cases: most notably the rampages at Virginia Tech in 2007, at Sandy Hook Elementary School in Newtown, Connecticut, at an Aurora, Colorado, movie theater in 2012, and near the University of California, Santa Barbara, in 2014.
Earlier in July, a grand jury convicted James Holmes of the 12 murders in Colorado, after he shot up a movie theater in 2013 and the months-long, emotional trial that followed, delving deeply into his mental problems.
In two recent rampages, the perpetrators also have been described as mentally troubled. After the killing of four Marines and a Navy sailor in Chattanooga, the family of slain assailant Muhammad Abdulazeez said he had been in and out of treatment for depression, starting as an adolescent.
John Russell Houser, 59, who was responsible for the shooting deaths and injuries at the Lafayette, Louisiana movie theater on July 23, also had a history of mental health illness and domestic violence. Houser had been involuntarily hospitalized to receive psychiatric care, and was denied a concealed weapons permit in 2006 because of a previous arrest connected to an arson plot.
“If [Houser] is adjudicated as a danger to himself or others, or not able to handle his affairs due to his mental capacity, he is also barred from having a firearm,” said Him Cavanaugh, a security analyst and former Bureau of Alcohol, Tobacco, Firearms and Explosives agent.
“He should have never been able to buy that gun,” said Louisiana Governor Bobby Jindal on July 26. “That should have never been able to happen.”
“While these incidents seize public attention, there’s far less focus on the serious, systemic problems besetting America’s mental health system,” says Jeffrey Swanson, a professor of psychiatry at Duke University School of Medicine.
“Forty percent of people with serious mental illness are going without treatment—our systems are fragmented and overburdened,” Swanson said. “When do we pay attention to this? We pay attention when there’s a horrifying mass casualty shooting, and then people say: Let’s fix the system.’”
That puts mental health professionals in a bind, Swanson added.
“We’re trying to debunk the stigma that people in the mental health system are dangerous, and yet refocus attention to how do we improve the system,” he continued. “That’s the conversation we’re stuck with and we need to use it to educate the public that the vast majority of people with mental illness are not violent.”
Swanson and many of his colleagues, while committed to combatting stigma, acknowledge that some people with serious mental illness are more likely to commit violence than people who are not mentally ill.
“There’s a long way to go in developing treatment that works for more people,” he said. “It’s not just about getting better medications—it’s about providing the supportive services, jobs, access to housing.”
Swanson has been working with other researchers and mental health professionals on steps that could be taken to reduce access to firearms by people who pose a high risk of violence, whether or not those people have a mental illness of any degree. By broadening firearms bans to include people who have been convicted of violent misdemeanors or domestic violence, Swanson believes public safety could be enhanced while avoiding further stigmatization of mental illness.
Another topic of concern pertains to information sharing. After some of the recent mass killings, there were accounts of mental health professionals becoming aware that the eventual perpetrator might pose a threat, and questions about whether such information could be shared more effectively.
Dr. Renee Binder said some universities—such as the massacre at Virginia Tech in 2007—have since formed threat management teams to “evaluate possible risks posed by students and employees, and, if necessary, take appropriate steps to prevent violence.”
“Teams generally include lawyers, law enforcement officials and mental health professionals, and their options include putting a potentially violent individual under close observation and arranging protection for potential targets,” she said.
As for individual psychiatrists, the accepted protocol obliges them to take action if they believe patients pose an imminent threat of harm to themselves or others. If the level of threat is difficult to evaluate, a psychiatrist should consult with a colleague in a way that does not violate patient privacy, Dr. Binder said.
Early intervention can be crucial in enabling a person to get proper mental health treatment before problems get out of control, she added. To combat this, the American Psychiatric Association introduced a program called “Typical or Troubled” in more than 2,000 schools nationwide. The program aims to train teachers to notice early warning signs and, if necessary, make referrals.
Paul Gionfriddo, CEO of the advocacy group Mental Health America, says school officials and other adults should think carefully about how to respond when young people do exhibit behavioral problems.
“They are frequently suspended or expelled from school, and the isolation that begins then contributes to further isolation as an adult,” he said. “What these kids need is even greater socialization at this time in their lives.”
In some states where mental illness was clearly a factor in high-profile violence, crucial steps have been taken to improve mental health programs, but not always as aggressively as advocates and victims’ families had hoped.
For instance, in Virginia, emergency mental health services have been re-strengthened, but Republican legislators have blocked the state from expanding Medicaid, which would enable more low-income people to obtain mental health care.
“We know there are tens of thousands of people who are walking time bombs, probably more dangerous to themselves than anyone,” said Virginia State Sen. Creigh Deeds—who was stabbed in 2013 by his own psychologically-troubled son, Gus (who committed suicide hours after he was released from emergency custody)—and is now leading the state’s efforts to expand mental health treatment.
Sen. Deeds added, “I want to make sure that anyone who needs care receives it.” (With reports from The Associated Press, NBC News, USA Today)
