Monday, January 10, 2011

Mental Health Care In the Wake of Tucson

As I was listening to Joe Klein on Andrea Mitchell Reports this morning, Klein invoked the history of civil commit laws and how they were used freely decades ago to protect the public from those who were perceived to be a threat to themselves and others. Klein commented that we've gone from one extreme to the other in terms of mental health--an over abundance of incarcerations and psychiatric commitments to the exact opposite. In the wake of the tragedy in Tucson over the weekend, the one thing I feel we should be focusing on as a country is mental health care.

First, let be clear about a few things. I do not agree with what is currently being said on the right. The inability for those on the right to admit that the rhetoric they have employed over the past few years comes at a cost is unfortunate. I believe, as Dave Neiwert at Crooks & Liars said in the title of a superb post on the topic, "Yes, Jared Loughner was 'crazy'. That doesn't exculpate the milieu that unhinged him." I also do not agree that having a firearm, concealed or open carry, would have done anything to prevent Saturday's shooting. I do not agree that the answer to the growing number of incidents of domestic terrorism is for more people to carry guns. I also fully support the Brady Bill and reimplementing legislation that for ten years prevented the legal ownership of extended ammunition clips like the one used in Saturday's shooting. I do not believe that states like the one in which I live as well as Arizona where the shooting took place are going to change any gun laws anytime soon. However, none of these things are at the forefront of my mind. Changing not only the process, but the perception of mental health care in this country is something that should be explored and implemented sooner rather than later.

If you don't believe something like what happened in Arizona could happen here, you are gravely mistaken. Take for instance the young college student who was shot in the parking lot of a busy coffee house in Pocatello last year. The young man did nothing wrong and was simply in the wrong place at the wrong time. His shooting could have been prevented. How? His shooter was a man who had been impacted by the numerous budget cuts by the Idaho Legislature that have placed the burden of a poor economy and a shrinking government disproportionately on the backs of those least capable of lobbying for their own cause--the poor, kids and the disabled (physically, mentally, or otherwise)--and was desperately in need of mental health care. What happened in Arizona, no matter what the motive and catalyst, was certainly made all the more possible by the shooter's unhinged mental state. What happened in Arizona in terms of this young man slipping through the cracks and out of the reach of effective mental health care can happen here and has.

The day after our latest elections here in Idaho, State Senator Nicole LeFavour (D-District 20) wrote an elegiacally stirring post about the "starving" of state government saying that "things break down when you starve state government, when you cut it again and again and again." Senator LeFavour has been a tireless advocate for those who most need an advocate, a position that has not won her the favor of some of her colleagues and many Idahoans. She understands her position as one who represents a liberal constituency and the meager 30% of Idahoans who align politically and ideologically with her, "[t]he 30% that worry how expensive it is to lives and budgets when we cut mental health and substance abuse treatment, driving people and their families into desperation and crisis." Unfortunately, the majority of Idaho legislators would rather spend money on prisons than on mental health care and education (two things that greatly affect the number of incarcerated Idahoans). I know nothing of the mental health care system in Arizona, but if it is anything like the system in Idaho, I truly hope the people of Arizona have a dedicated public servant like Senator LeFavour leading the charge to improve mental health care.

The flaws in mental health care in this country extend far beyond any discussion of the mentally ill acquiring dangerous weapons. Yes, it was far too easy for Jared Loughner to purchase a handgun in Arizona without alerting anyone of the coming tragedy. But the larger problem is the lack of mental health reporting. We saw it with Virginia Tech and we are seeing it now. Someone with the mental health history of a man like Loughner should not be able to purchase a handgun. Period. He should have been flagged, he should have been turned away, and he should have received mental health treatment. That statement alone consists of three places this kid fell through the cracks. In order for his name to be flagged in the FBI's NICS database, authorities would have had to submit a report. Overworked, underfunded agencies are often years behind in such reporting. Once in the store, Loughner should not have so easily obtained a weapon even with a clear background check--it shouldn't be so easy to lie on a simple mental health and drug use questionnaire. Self-reporting isn't going to keep a gun out of the hands of a deranged individual. And anyone with any degree of mental instability should be able to attain affordable, effective treatment. The situation that is being recounted regarding Loughner's time at college should have been reported to authorities or should have resulted in mandatory mental health treatment and evaluation. However, community colleges fall under the same restraints as overburdened government agencies.

Returning to the comments of Joe Klein this morning, another dilemma quite common in mental health care is that of the rights of the individual. In the early 20th century, even so late as the 1950s, it was not uncommon for a husband to seek a court order to have his wife committed to a state hospital, insane asylum or mental institution for any number of so-called mental illnesses (some were, of course, illnesses like schizophrenia, but others were as commonplace as premenstrual syndrome or disobedience). Parents were having their children committed for any number of reasons, most of which were things we would consider today to be simply part of adolescence. Courts became the last resort of those whose loved ones could no longer be treated at home or trusted to not harm themselves or others. Eventually, and not after years of abuses, it became evident that civil commit laws (what is often referred to as involuntary commitment) were threatening the civil liberties of Americans. With deinstitutionalization, decreasing stigma surrounding mental health care, and greater concern for civil liberties came a nearly complete transition from a country that sought to protect the public from the mentally ill no matter the cost to a country ignorant of the needs of the very members of society that were once considered an extreme threat to the public safety.

I certainly don't claim to know what the answer is to the problem of people like Loughner falling through the cracks, but we have to begin a serious dialogue or incidents will continue to occur. We have to understand that rhetoric may sound precisely like rhetoric and hyperbole to you or I, but to someone struggling with their own mental health that rhetoric may sound like an assignment to do real harm. In the current political and cultural climate, we aren't going to change how accessible guns are, but we can make mental health treatment more accessible. We can encourage those among us who are on the brink of mental and emotional collapse to begin and continue treatment and we can ensure that those who do so are not shunned.

Until we get mental health care under control in this country, devoting to it as many resources and research hours as we do physical health care (and yes, even prisons), we are always going to find ourselves repeating the oft used adjectives like 'loner' and 'disturbed' on chaotic Saturday mornings when young, deranged men take guns where they have no reason to be and walk into crowds outside grocery stores and begin shooting.

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