Every time that there is one of these all too frequently recurring incidents of gun violence that results in the death of multiple people who were strangers to the killer we hear efforts to blame the problem on a lack of mental health resources. Some of the people making the claim are advocates for people with mental illness and others are gun advocates attempting to deflect blame from the lack of gun control. However, in many of these incidents we find that the killer was actually receiving mental health treatment.
For example this was true of Jerad Loughner in Tucson, James Holmes in Colorado, Adam Lanza in Connecticut and of Elliot Roger in Santa Barbara. Information is emerging that not only was Roger receiving treatment but that mental health people had contacted law enforcement about his disturbed behavior. He and his problems were known to the mental health and law enforcement systems. This is not a problem of a lack of resources. It is how those resources deal with a person who has symptoms of a major mental illness.
I began my working life as a social worker at the state hospital in Georgia in 1965. At that point there was very little in the way of community based mental health services and facilities. It was standard procedure to ship a broad range of people that local communities didn't know what to do with off to the place that had once been called the Georgia Lunatic Asylum. One of the buildings still had a corner stone with that name on it. At the time I was there it housed 12,000 people in facilities that should have been accommodating about half that number. The vast majority of them were no danger to anybody. However, the commitment laws were such as to make it easy to confine someone against their will just because they were weird.
The 1960s and 1970s saw an expansion of community mental health programs and various types of care facilities. One of my main activities at the state hospital in Georgia and later at a state hospital in California was moving people out to less restrictive community care facilities. With that trend came a legislative movement to change commitment laws. The trend was for establishing due process standards for involuntary commitment. A series of court decisions provided momentum. The standard was that involuntary confinement required a court finding that a person was a danger to him/herself or to others. Such detention could only be for a very short period.
For the vast majority of people with some form of mental illness this was a very welcome change. Very few of them will ever commit acts of violence and can be persuaded to participate voluntarily in appropriate treatment programs. They do not need to be locked up. However when people do exhibit what might be signs of a propensity to violent psychotic behavior, the present system is geared to discourage actions that would deprive them of ordinary civil rights.
Much of the problem here rests with the limitations of medical knowledge and technology when it comes to psychiatric care and treatment. The ability to predict what people will do in the future is generally limited. It is possible to determine if people have seriously disordered cognitive processes and often to make a reasonable determination that they need some amount of assistance. However, the ability to make highly reliable predictions about such things as violence or suicide is decidedly limited. If someone is involuntarily confined and they do no harm to themselves or others, who can say with certainty that the confinement actually prevented something that would have happened without it.
Most states have now adopted some form of outpatient commitment law. These provide for a court order mandating some specific treatment plan such as regular clinic visits and a monitored medication regimen. The California version of this is known as Laura's law.
Laura Wilcox was a 19 year-old college sophomore who had been valedictorian of her high school before going on to study at prestigious Haverford College.[3] While working at Nevada County's public mental health clinic during her winter break from college, On January 10, 2001, she and two other people were shot to death by Scott Harlan Thorpe, a 41-year old American citizen who resisted his family's attempt to force psychiatric treatment.[4][5] Thorpe was found incompetent to stand trial and was sent to Atascadero State Hospital and was later transferred to California's Napa State Hospital. After the incident Laura’s parents chose to advocate for forced treatment of individuals considered to have mental illness. Scott Harlan Thorpe tried on several occasions to get help from Nevada County Mental Health by going in-person and pleading with the staff to get psychiatric treatment. He was denied treatment on all occasions and told there was nothing the County could do, which was a severe contributing factor to the shooting.
At present this provision is not mandated on a statewide basis. It must be voluntarily adopted by specific county mental health programs. The law was originally passed in 2002, but since it was not mandated it had until recently only been implemented in Nevada County where the above tragedy happened. Orange county recently adopted an implementation in response to a local incident. The lack of implementation is influenced in part by budgetary considerations but also by opposition by people concerned with the protection of the civil rights of the mentally ill.
That brings us to Elliot Rodger the latest focus of justifiable public outrage over an outbreak of mass murder. Despite the debates about the racial bias in the characterization of men who commit such act, there is no question in my mind that Roger had all sorts of classic symptoms of a full blown mental illness.
Rodger, who police say fatally shot himself after his killing spree Friday, had been receiving treatment for years from several psychologists and counselors. Last month, the 22-year-old wrote, his mother was so concerned about his well-being after seeing some of his videos on YouTube that she contacted mental-health officials, who dispatched sheriff’s deputies to check on him at his apartment in Isla Vista, an enclave near the University of California at Santa Barbara.
Had the officers sensed something awry during their April 30 visit, they might have searched Rodger’s home. They would have found his three semiautomatic handguns, dozens of rounds of ammunition and a draft of his 137-page memoir-manifesto. They would have read about his plot for a “Day of Retribution” — when, as Rodger wrote, he planned to “kill everyone in Isla Vista, to utterly destroy that wretched town.”
But the deputies did not look. They concluded that Rodger seemed “quiet and timid . . . polite and courteous,” Santa Barbara County Sheriff Bill Brown said Sunday on CBS’s “Face the Nation.”
So they left and never returned.
From my experience in dealing with mental health services and law enforcement in California, this strikes me as a fairly predictable course of events. It is not some significantly incompetent failure on the part of local law enforcement. It is pretty much the way the system is designed to work.
The revelations about the NSA collecting the phone and email data of ordinary law abiding Americans has outraged many people about the violation of constitutional civil rights and personal privacy. I am one of those people. It comes down to the issue of when a person has done something that justifies a violation of such rights. Obviously when there is evidence that they have committed criminal acts or are engaged in an active conspiracy with others to do so we have some established legal systems for dealing with the matter. When it comes to the situation of a lone individual who has not broken the law, but whose behavior is so erratic and irrational as to suggest the possibility that he might, we don't have a political consensus about how to deal with that. The concerns for both public safety and for personal civil rights are real and valid. In a situation like this most recent tragedy they are in direct competition with each other.