Mental Health Experts Respond Carefully to Mass Killings
UPDATED: 7:07 AM EDT
NEW YORK (AP) -- One psychiatry professor calls it "the
conversation we're stuck with," a teachable moment growing out of
Each time mental illness is cited as a possible factor in
a high-profile mass killing, there's a collective sigh among mental
health professionals. Even as they see an opportunity for serious
discussions of problems and 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.
to the National Institute of Mental Health's latest estimate, from
2012, there were an estimated 9.6 million adults in the U.S. - 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."
Yet public perceptions can be hard to
shake. Of the mass shootings of the past 10 years that are most
ingrained in America's psyche, the mental health problems of the
perpetrator became a central part of the narrative in several cases -
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.
this month, a jury convicted James Holmes of 12 murders in Aurora,
after a wrenching trial that delved deeply into his mental problems.
two rampages recently, 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, who killed two people and wounded nine
before killing himself at a Louisiana movie theater last week, had a
history of mental health issues, according to his family.
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 said.
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 said. "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 mental illness. By
broadening firearms bans to include people who've been convicted of
violent misdemeanors or domestic violence, Swanson believes public
safety could be enhanced while avoiding further stigmatization of mental
Another topic of concern pertains to sharing of
information. 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.
Renee Binder said
some universities, aware of what happened at Virginia Tech in this
regard, have formed threat management teams to evaluate possible risks
posed by students and employees, and, if necessary, take appropriate
steps to prevent violence. She said the teams generally include lawyers,
law enforcement officials and mental health professionals; their
options include putting a potentially violent individual under close
observation and arranging protection for potential targets.
for individual psychiatrists, 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, Binder said.
Binder says early
intervention can be crucial in enabling a person to get proper mental
health treatment before problems get out of control. To this end, the
American Psychiatric Association has presented a program called "Typical
or Troubled" in more than 2,000 schools nationwide. It aims to train
teachers to notice early warning signs and, if warranted, make
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
"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 states where mental illness was
clearly a factor in high-profile violence, steps have been taken to
improve mental health programs, but not always as aggressively as
advocates and victims' families had hoped.
In Connecticut, after
disturbed gunman Adam Lanza shot 20 children and six educators in
Newtown, some new mental health services for high-risk populations were
implemented, as well as an anti-stigma campaign meant to encourage
people to seek treatment. There was some debate this spring over funding
levels, but Gov. Dannel P. Malloy's administration contends that
Connecticut has one of the best-funded public mental health systems in
Colorado responded to the Aurora rampage with a $20
million expansion of mental health services, including a 24-hour hotline
and a dozen new drop-in crisis centers. According to Rocky Mountain
Crisis Partners, which runs the hotline service for the state, it has
received more than 53,000 calls since Dec. 1, 2014.
debate about mental health has been affected by two high-profile
incidents. Seung-Hui Cho, the gunman who massacred 32 people at Virginia
Tech, had been ordered into outpatient treatment prior to his 2007
rampage. And in 2013, Gus Deeds, the son of state Sen. Creigh Deeds,
stabbed his father and then killed himself hours after he was released
from emergency custody because mental health officials couldn't find an
available psychiatric bed.
Since then, a panel has been formed to
study Virginia's mental health system, and emergency mental health
services have been bolstered. But Deeds and his allies are frustrated
that Republican legislators have blocked the state from expanding
Medicaid, a step which would enable large numbers of 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," Deeds said. "I want to make sure that
anyone who needs care receives it."