What about the mentally ill?

After tragedies such as that which took place in Arizona on Saturday, what if people were as quick to ask about mental health services as they are to place events in a political equation?

Over the weekend, I asked such a question on Twitter and one reply was that Arizona Republicans pushed a health care package that cut mental health services. We have a hard time not framing things in the context of political philosophy.

Lots of radio talk shows — including ours — are asking about political rhetoric today. That’s a valid topic, to be sure. But ignoring the aspect of the mentally ill seems invalid.

Time’s Joe Klein phrases it this way:

Have we abdicated our responsibility, as a society, to protect ourselves from potentially harmful people like Loughner? We no longer lock up the mentally ill, which reflects two benign tendencies in society: we have become more humane and we have developed drugs that mitigate most forms of mental illness. My old mentor, Daniel Patrick Moynihan, used to lament the explosion of homeless people in New York–the vast majority of them either mentally ill or drug addicts–and he wondered whether, in the name of humanity, we had become inhumane in the treatment of those who couldn’t take care of themselves, even when medicated. A corollary worry was this: Had we exposed ourselves to more violent crimes by assuming the innocence of those, like Jared Loughner, who seemed capable of violence?

Merely “locking up the mentally ill” seems illogical, but how we get to them and provide help to them seem like a reasonable question, especially after Mr. Loughner’s now well-documented community college behavior. Consider this e-mail from a student, obtained by the Washington Post:

“We have a mentally unstable person in the class that scares the living crap out of me. He is one of those whose picture you see on the news, after he has come into class with an automatic weapon. Everyone interviewed would say, Yeah, he was in my math class and he was really weird. I sit by the door with my purse handy. If you see it on the news one night, know that I got out fast…”

Seung-Hui Cho also showed signs of an untreated — or not adequately treated — mental illness just before he shot up Virginia Tech in 2005. A review panel assessed the availability and quality of treatment:

“Virginia’s mental health laws are flawed and services for mental health users are inadequate. Lack of sufficient resources results in gaps in the mental health system including short term crisis stabilization and comprehensive outpatient services. The involuntary commitment process is challenged by unrealistic time constraints, lack of critical psychiatric data and collateral information, and barriers (perceived or real) to open communications among key professionals.”

Dr. Keith Ablow, a FoxNews blogger, says the fact the suspected shooter in Arizona was mentally ill may have more to do with Saturday’s events, than political rhetoric:

As a forensic psychiatrist who also has run community mental health centers, hospitals and clinics, I can tell you for sure, without any question, that the mental health care delivery system in this country is shoddy and shattered and without any hope at present of dealing effectively with sick individuals like Jared Loughner. There are slim resources and no strategy, whatsoever

Last year, Minnesota moved to cut the already patchwork services to the mentally ill. It was a budgetary issue, it was an issue over whether the role of government includes health care. It was never considered a public safety issue.

Is it?

Update 12:45 p.m. – MPR’s Public Insight Network has been soliciting information about availability of mental health care in Minnesota. If you have information you’d like to share, please use this form.

  • phil

    In a timely bit of synchronicity, MinnPost’s Susan Perry just posted an article reminding us that the mentally ill are by and large not violent. In fact, you’re three times more likely to be killed by lightning than be murdered by someone with schizophrenia:

    As the article Perry links to points out, “severe mental illness, on its own, is not an explanation for violence.”

  • Dave Detlie

    The answer to the late Senator Moynihan’s lament.

    We find a way to provide humane care at a reasonable cost. A lawyer decides that these folks are ‘entitled’ to the same care as everyone else, regardless of ability to pay. An unemployed professional discovers they can bill $150 an hour. An advocate decides humane care isn’t enough, we have to do whatever it takes (costs) to make them the same as everyone else. Since the workers who spend the most time with these clients are low wage part timers, they aren’t always the most dedicated employees, so something bad happens. News coverage, investigations, new tougher, costlier regulations. Next thing you know they are all back on the street.

  • Jim Shapiro

    Phil – thanks for the fascinating statistics regarding the risk of murder by a schizophrenic vs death by lighting strike. As we have learned that it’s wise to not go up on the roof during a lightening storm, perhaps Second Amendment extremists can learn to not issue firearms to the mentally ill.

  • Bob Collins

    I’ve seen Perry”s point and it’s largely irrelevant and flawed for a number of reasons, not the least of which is it tries to separate mental illness from all other factors of violence.

    It’s also mixes “mental illness” and schizophrenia. Schizophrenia is, of course, a mental illness. But mental illness is not schizophrenia.

    Secondly, her statistics include only those who have been DIAGNOSED as having schizophrenia and many mental health experts will point out that the basic flaw in the system is people don’t have access to care and that at its basic level, eliminates the chance of diagnosis.

    Similarly, she seeks to marry “violence” and “murder.” While murder is violence. Violence is not murder. In many cases, at the very least, the mentally ill are dangerous to themselves. That alone should meet the standard of at one point we care.

    Unfortunately Perry is cherrypicking factoids to make a point that is, itself, debatable — that considering the benefits of mental health care further stigmatizes mental illness.

    There is, in fact, a wide gulf between suggesting the mentally ill receive proper treatment and reinforcing the notion that all mentally ill are violent. That’s absurd leap.

    “It’s not my problem,” is quite often the underlying rationale of those who think the flaws of the mental health system can wait for another day. There are many benefits to an improved mental health system and to argue that it’s irrelevant to the overall conversation doesn’t further an intellectual exercise.

    It also requires a consideration that the shooter here is more sick than a healthy evil; that’s hard for many people to accept.

    Pithy headlines like the one at MinnPost are meant to stop a discussion before it begins.

  • William Zajicek

    I think the direction this news cut took is right on track. For me ever since Virgina Tech the common theme of a mentally unballanced individual or individuals having easy access to weapons appears to the underlaying common theme for most of these types of events, whether they happen in a school, a post office, or at an event at a super market. It starts with the “adults” in a sitution not really taking charge either because there are too many legal hurdles or not enough fundings or whatever. In most cases, authorties in these peoples lives have not been able or willing to act to protect the community even though it was fairly clear there was a problem. Then of course they obtain a weapon and finally end up in the news with all sorts of strange analysis going on.

    I lived in Mayalsa for 4 years. They had a term for this sort of thing. They didn’t get into analysis paralisis. They called it “Man run Amok”. They didn’t deal with it in the kindness way but at least they protected the communty.

    It seems we should be able to deal with these sorts of situations with greater care but if not let’s at least protect the community. Innocent people shouldn’t be dying in mass because one man runs Amok.

  • Jeanne

    I’ve seen many people, even some of my Facebook friends, refer to Loughner as a ‘nutjob’ and ‘whacko.’ Granted, his actions in taking the lives of people on Saturday are horrendous, but he is still a human being. Many reports coming forth in the media now show what a troubled, young man he is.

    My mother was hospitalized twice for schizophrenia. I never viewed her as a threat to anyone other than herself. This disease manifests itself differently in different individuals, making it all the more difficult for a non-professional to assess when and if someone needs professional help.

    My mother’s mental illness manifested itself in, amongst other behaviors, talking to herself and outbursts of (inappropriate) laughter. I was always more worried that she would be out in public and someone would see my mother’s vulnerability and steal her purse or assault her.

    My mother was living in a hell created within her own mind. I can only speculate that the shooter, whatever his mental health diagnosis, is living in his own personal hell.

    It took me many years to come to terms with my mother’s mental illness. Part of the difficulty is the way our society still, after all of these years, continues to diminish and demonize people who are struggling with mental illness.

    I do hope that something can be done to get people help who need it and that we can stop the name-calling.

  • Zebulun

    Judging someone to be a coward for committing suicide also seems invalid, but I recall that you made such comments about Mark Madoff. Can you meet the standard of human compassion that you are asking of the rest of us, Bob?

  • Bob Collins

    The cowardly part of his action was not providing for care for his two-year-old before committing suicide.

    Before killing himself, he had the presence of mind, however, to name his father as the co-executor of his estate.

    While suicide CAN be the manifestation of mental illness, this particular case appears less about neurology and more about shame tracing back to a criminal act..

  • Anonymous

    It is very much a public safety issue.

    A former long-time friend of mine is both Schizophrenic and Bi-Polar. For over the past decade he would frequently stop taking his medication and disappear; within a few weeks his parents would get a phone call from a police department, usually on the other side of the country, asking them to come and pick up their son. As troubling as this was, he wasn’t breaking any major laws and was always released without being charged.

    However, that changed a few years ago when after another episode he disappeared and wasn’t so friendly with law enforcement: he led police in a rural Minnesota county on a very slow chase; simply put, he wouldn’t pull over. To my understanding after sometime the police (who were informed by dispatch of his mental illness) finally stopped his car by force and arrested him where he was then eventually convicted of felony evasion.

    Sadly, as part of an agreement he was sent back to his home county for treatment and the felony evasion conviction was dropped. Upon arrival back in his home county, I watched as a judge sentenced him to Anoka’s facility for the mentally ill. I felt a sense of relief… but not for long.

    His original social services case worker had dropped him as she feared for her safety around him. His new case worker for God knows what reason decided he deserved a second chance. She successfully petitioned to keep him out of the Anoka facility and have him placed in a half-way house where he spent less than a year.

    Over the past two years he has lived alone in Section 8 housing and to my knowledge hasn’t been in trouble with the law; however, knowing that (1) his mental illness cannot be cured, only treated, (2) that stress triggers his illness and (3) considering his history I truly belief it’s only a matter of time before he does something illegal again and I pray when that day comes he is stopped before he hurts or kills someone else or himself (he has already had one failed suicide attempt).

    The county he lived in (and continues to live in) is well aware of his illness, as is the rural Minnesota county he was arrested in; however, because the felony conviction was dropped to protect his rights against discrimination, every other police agency as well as every gun dealer has no way of knowing of his past actions.

    While I agree his right to privacy should be enforced in employment situations. As a matter of public safety, law enforcement and gun dealers should know of his felony conviction, as he and thousands like him, are fully capable, and at times, ill enough to possibly repeat what was done in Arizona.

  • Bob Collins

    The first mental health treatment that a large number of young Minnesotans get, is the treatment they get in the juvenile justice system.

  • Zebulun

    I don’t know how much “presence of mind” you can arbitrarily place on a suicidal man, but I do know you haven’t all of the facts.


    “I love you,” he wrote in one of the missives to his wife just moments before his death. He added: “Send someone to take care of Nick”.

    Further, he hadn’t changed his will since last adjusting it three years previous to his suicide. His father cannot serve as executor because of prison, obviously. That role went to Mark’s brother.

    Specificity matters.

  • Jeanne

    Grading the States 2009. Source: National Alliance on Mental Illness. NAMI Link

  • John P.

    It seems to me to be very much the same debate we have had over terrorism.

    How do we balance the extraordinary freedoms we have with public safety? We rightfully hesitate to restrict anyone’s freedom. One thinks of the “mentally ill” people locked up in the Soviet Union because they were crazy enough to disagree with the state. At exactly what point does angry disagreement become a sign of danger? How far do we want to go with airport security? How much can we restrict guns without going afoul of what the Supreme Court has determined is a right to keep and bear arms?

    It’s all the same problem in my mind. Weighing personal rights against security concerns. The problem is, there never will be a clear line, but a spectrum. The upshot of this tragedy is likely to be that we may decide to push the meter one direction on the scale. The debate will continue in some context or another forever.

    Solving the problem by taking better care of the mentally ill seems like a long shot. Not because it isn’t the right thing to do, but because we can’t even get agreement on universal coverage for physical illness. Mental illness will be an even harder sell.

  • Jim Shapiro

    Jeanne – regarding solutions, if I had a magic wand, I would fully fund compassionate care for the mentally ill, while at the same time protecting society by restricting gun ownership and isolating (while continuing to treat) those who commit violent crimes and have an incurable mental illness. Nana nana boo boo. 🙂

  • Jeanne

    @JimShapiro – would your solution also take name-calling and “nana nana boo boo” (taunting) off the list?

    From NAMI website’s StigmaBuster’s page:

    Use of Language

    * We do not protest usage of single words like “crazy” “psycho” “wacko” or “loony” unless they refer directly to individuals struggling with mental illnesses or to the illness itself.

  • Kassie

    It isn’t just the availability of mental health treatment, it is also the availability of people to be able to pay for it.

    Basically, in almost every state, a single adult without a job has no way to get publicly funded health care once they turn 21. Which is about the exact same time many mental illness kick in. So even if s young man needs mental health care, there is no way for him or his family to pay for it.

    Obviously, extending the age in which children can be carried on their parents insurance is a great step toward helping them, it only works if the parents have insurance, can afford expanded coverage, and have ties to the child still.

    Medicaid expansion, which only two states are electing to do early, is going to be huge on this front. This brings Medical Assistance to single adults who have in most states (not ours) been with no health insurance options. It covers mental health treatment, including the in patient acute treatment that is often necessary.

  • Jeanne

    Here’s the full Grading the States post on NAMI

  • Jim Shapiro

    Jeanne – Thanks for the useful NAMI information. While I don’t personally use “name-calling” except to describe unacceptable behaviors and the thinking ( or lack there in) that leads to them, I don’t criticize someone who would call the premeditated murderer of innocent people “crazy, whacko, psycho or looney”. And the “nana nana boo boo 🙂 ” stuff was an apparently unsuccessful attempt at humor to diminish your understandable pain. Sorry.

  • Bob Collins

    Fascinating. Arizona gets better marks than Minnesota.

  • Tyler

    I can’t find any info about the shooter’s family life. Was he living at with his parents? Working somewhere? Going to church?

    One interesting factoid – both this (accused) shooter and the Virginia Tech shooter bought their weapons legally.

  • bob collins

    I’m removing all the comments with personal attacks (which should leave relatively few.)

  • Lily

    In this County persons with serious and persistent mental illness often have more access to weapons than they do to treatment.

    We need institutions like Anoka Metro RTC, as well as local long term residential options. We have fewer and fewer resources.

    Loughner has schizophrenia with paranoid delusions. Treatment could have saved the lives of many.