Both NRA types and gun-control advocates have called for greater emphasis on screening for, and treatment of, potential mass murderers by the mental health system. There is no question that the public mental health system in this country has been shredded by decades of ever-intensifying fiscal starvation, as I well know from having worked in that system for 20 years. Likewise, there is no question that a MUCH more robust and effective public mental health system might prevent some small portion of the seemingly ever-more-frequent mass murders by gun in this country. But the idea that the mental health professions, even if lavishly supported, could stem this epidemic of extreme violence in the absence of effective gun control measures, is not just an obvious attempt at distraction and diversion by the NRA but even a fallacious assumption by the best intentioned advocates of mental health services. In brief, you don't treat stop epidemics with targeted medical treatment of individuals but rather with public health measures, ESPECIALLY when it's so difficult to identify the individuals who are actually at high risk of manifesting the "disease.". To see what I mean, follow me below the stylized orange Kama Sutra illustration.
There are many reasons that even an effective public mental health system can only incidentally affect the epidemic of mass murders by gun, but most of them can be subsumed under two general facts.
1. It is close to impossible to identify individuals who are actually likely to commit mass violence because it is such a LOW BASE-RATE behavior -- I.e., it is so rare. It may seem horribly common; but in a population of 330 million or so, the chances of any single person committing such an act are vanishingly small. Even if you restrict your population to people with a diagnosis of schizophrenia, bipolar disorder, or one of the personality disorders with a high incidence of violence, you're still talking about a population of at least 10 million people. Even if you then further restrict your population to those in your 10 million diagnosed people who have characteristics that we know are associated with violent acting-out (e.g., paranoid ideation and violent fantasies), you restrict your "at-risk" population to, at best, 500,000 to 1,000,000. So if even 500 of these people commit murders in a year, your odds against identifying an actual murderer in any year, much less the much rarer MASS murderer ala Aurora or Newton, are 1,000-2,000 to 1.
There's also the problem that a good portion of murderers and even mass murderers don't have an easily diagnosed or obvious psychiatric disorder that would have led them to be labelled "at risk" -- e.g., some portion of those people who "go postal" when fired.
Any therapist who deals with people with severe psychopathology is familiar with this problem. I was director of a community mental health center for five years, staff psychologist on the psychiatric unit of a community hospital for 10 years, and for 20 years had a private practice with an unusually high proportion of patients with severe pathology. I can't make even a ball-park estimate of the times that I dealt directly or as a supervisor with threats of violence by patients, much less heard about patients' violent fantasies. And there certainly were instances in which I was genuinely concerned that certain patients were going to act out those threats or fantasies. Yet there were only two instances in which such acting-out occurred to the point of murder, and in neither instance was the patient presently considered at "high risk" because in neither case had the patient informed his therapist about a definite high-risk indicator -- namely, that the patient had stopped taking his anti-psychotic medication.
These cases illustrate the second reason that the mental health system cannot serve as a public health measure for the prevention of mass murders.
2. Its effectiveness is dependent on the voluntary involvement, truthfulness, and cooperation of its clients.
Take Adam Lanza. There have been reports that Nanzy Lanza had told friends that she had gotten psychiatric help for Adam. But she reportedly had also told friends that Adam was burning himself repeatedly with a lighter. Now if Adam really had seen a psychiatrist AND if either he or Nancy had been truthful and open about Adam's self-injurious behavior and also about the guns in the house, there is no way that any competent mental health professional would have continued to see Adam unless the guns had been removed from the house. So either Adam actually had not been seeing anyone or the person he was seeing was not being given the complete picture relevant to Adam's potential for violence.
Finally, what if a fully informed professional had given Nancy and Adam an ultimatum about the guns -- get them out of the house or I don't see Adam -- and they had refused. What can the professional -- or for that matter society -- do at that point? Assuming that Adam had not in the recent past done any significant violent acting-out toward others, we're back to the LOW BASE-RATE problem again: Adam may be at a much greater risk than the average person of doing something very violent in the near future but the odds are still some thousands to one against it.
Then, of course, there's always the possibility that people in the place of Adam and Nancy agree to get the weapons out of the house but never do so and the therapist is never the wiser -- just as patients often discontinue their medication without telling their therapists. (Most people with mental health problems see a non-medical professional for therapy and a psychiatrist for medication checks only very occasionally.)
Oh, and lastly, whatever the failures of society to deal with Adam Lanza's mental health problems, it obviously had very little if anything to do directly with the financial starvation of the public mental health system over the last 30 years. Nancy Lanza's yearly income was north of $250,000. Assuming that Adam was covered by excellent private insurance, his mother and father could have afforded the finest mental health care available. Perhaps the still powerful stigma attached to psychiatric disorders played a role in Adam's never receiving treatment that prevented his eventually perpetrating the Newtown atrocity, but certainly lack of resources never did.
So, while I'm the last person who would discourage more resources being devoted to the country's mental health system, I'd strongly advise against any claims that such an influx of resources will have any appreciable effect on the national mass murder rate or any claim that the mental health professions have some special ability to identify ahead of time those who are very likely to perpetrate such atrocities -- especially not when it's easier to buy a semi-automatic assault rifle with huge clips than it is to get a driver's license.
Not to mention the contribution of the aggression and violence endemic to our national culture, with its foundation on genocide, slavery, and imperialism. But Michael Moore already covered that today, even if most comments in response to him seemed to avoid assiduously that part of his diary.