Many were horrified at events that took place in Tucson, Arizona, when an apparently deeply disturbed individual opened fire on a member of the U.S. congress and several others. In the aftermath of the tragedy, many are asking some serious questions about how such a thing could have happened, notwithstanding the fact that such events have become all too familiar. Are guns and their availability the sole problem? Has our political debate become too intense and vitriolic, unduly influencing the emotionally unstable and predisposing them to violence? How can a person several folks attest they regarded as troubled and “frightening” slip so disturbingly under the radar of the health and community protection systems?
Aside from the horror of the incredible pain and loss suffered by families and loved ones of the victims, the deeper tragedy is the longstanding inadequacy of our system of care for the mentally disturbed. True, we’ve come a long way since the days when the chronically mentally ill were confined interminably in hospitals rightfully depicted in books and movies as “snake pits.” But with the advance of effective anti-psychotic medications, which made it possible for the seriously mentally ill to function outside of confinement, and due to the energetic advocacy of civil liberties lawyers, who championed the rights of individuals to retain their freedoms and not be confined against their will, a true disaster occurred: persons who are seriously disturbed, capable of impulsive and violent acts, but can’t be clearly proven to pose an imminent threat to themselves or others, can easily fall through the proverbial cracks of the mental health system. They often can’t be involuntarily confined or treated, and they are also – often as a consequence of their illness – resistant to accepting the very interventions they need.
It would take more than this brief article to enumerate the many ills of the mental health care system. In the U.S. mental health care does not enjoy parity with other medical treatments. Perhaps that’s at least in part because insurance companies are leery of over-utilization of mental health services by persons with problems that probably shouldn’t be regarded as true mental illnesses in the first place, and because efficacy of some treatment and intervention is sometimes debatable. But there are also many not so easy to justify reasons for the prevailing attitudes toward mental heath issues, and as a result, genuine brain dysfunctions – despite their devastating impact on patients, families, employers, and friends – aren’t regarded in the same manner as diseases of the liver, pancreas or lungs.
What happened in Tucson is no doubt a genuine tragedy. But if we don’t learn what we need to learn from it, it will be an even bigger calamity. Of course, we must be careful not to rush into legislation simply to ease our fears and acquire a sense of having done something. Legislation based on extreme or rare events, motivated primarily by sentiment, and not founded on a solid analysis of causal factors is almost always bad legislation. We also have to avoid rushing into judgment about the likely causes of the tragedy. The interplay between the use of drugs and predispositions toward mental illness is still quite poorly understood. Also, as I’ve written about many times before, the connection between character issues and mental health problems is as poorly understood as it is dealt with by prevailing intervention and treatment methods. However, there is little doubt that something has to be done to attend to critical aspects of our systems of mental health care and community protection systems so that when right-minded people come into contact with someone whom they recognize has serious problems, appears unstable, or may even pose a threat, there is a way to intervene before disaster strikes.
