Better Care For Mentally Ill Won’t Be Enough, Experts Say
Mental health care alone won’t prevent mass killings
By Jerry Zremski Buffalo News Washington Bureau Chief December 16,
WASHINGTON – For a nation of millions of broken hearts grasping for
something, anything, to prevent yet another schoolhouse slaughter, the
solution sounds simple:
If we could just get the mentally ill the proper care, then the nation
would be spared the agony of one more Newtown.
The trouble is, that’s too simple a solution, and one that’s unlikely to
work on its own, psychiatrists say.
Yes, they say, access to mental health services is not as easy as it
should be. There’s a shortage of psychiatrists in Buffalo, for example,
and insurance problems in many places that often mean psychiatric
patients don’t get the care they need.
Yet other confounding facts prove that better mental health services
alone are not the preventative medicine for mass shootings like the one
that claimed the lives of 20 school children and eight adults, including
the killer, in Connecticut on Friday.
For one thing, while we don’t know if the Connecticut killer,
20-year-old Adam Lanza, was under psychiatric care, we know that some
previous mass murderers were – and that it did nothing to stem the
What’s more, psychiatrists say it’s nearly impossible to identify who
among the mentally ill is truly dangerous, and that any effort to do so
will only further stigmatize a category of illness where many people
already shun treatment out of embarrassment and fear.
And there’s one last important fact: The vast majority of mentally ill
people are not prone to violence.
Add it all up, and psychiatrists say that improving access to mental
health services is likely to be only one of the measures the nation must
take if it really wants to get serious about preventing bloodbaths like
the one that happened at Sandy Hook Elementary School.
“My fear is always that people will write this off as just about another
mentally ill person,” said Dr. Charles P. Ewing, a forensic psychologist
and attorney at the University at Buffalo who specializes in the
psychology of crime. “It’s about way more than mental illness.”
In fact, at this point we can’t even be sure that Lanza was officially
diagnosed as mentally ill. In a story that’s been marked by
misinformation from the start, all we know is that former classmates
have said they believe that Lanza had Asperger syndrome, a form of
autism marked by social awkwardness and odd use of language.
While we don’t know many details of Lanza’s mental state, we do know
that many people inside and outside the medical profession are calling
for better access to mental health services in the wake of the
That’s especially true in Buffalo, where a shortage of psychiatrists
worries many medical professionals.
Dr. Steven L. Dubovsky, professor and chairman of psychiatry at the
University at Buffalo Medical School, said that the shortage stems in
part from the fact that some local insurers reimburse those
psychiatrists in a comparatively paltry way.
For example, some insurers reimburse psychiatrists only $5 more for a
45-minute patient visit than for a one- to 20-minute patient visit.
The result: Local psychiatric patients often don’t get the treatment
they need from the right specialist – and often end up in the emergency
room with problems that otherwise might have been kept under control,
“It doesn’t work well for people with serious problems,” he said.
Then again, access to the best psychiatric care is not a problem limited
Dr. Claudia M. Gold, a pediatrician, writer and director of the Early
Childhood Social Emotional Health program at Newton-Wellesley Hospital
near Boston, said research strongly suggests that early treatment is
very important for young children with behavioral problems that could
mushroom into violence later.
Yet she runs into a problem when she tries to refer young patients and
their parents to top mental health professionals.
“The best therapists often don’t take insurance,” she said.
Once troubled youngsters become adults, the mental health system can
leave people untreated for another reason.
“One complicating factor is that in order to get treatment, people have
to want to get treatment – unless they are seen as an immediate danger
to themselves or others,” said Amanda Nickerson, a psychologist and
associate professor at UB’s Graduate School of Education. “And even that
is difficult to determine.”
What’s more, there’s no guarantee that psychiatric treatment will stop
any one mad mind from lashing out. After all, James Holmes was seeing a
University of Colorado psychiatrist before he shot 12 people at a
showing of the Batman movie “The Dark Knight Rises” in Colorado in July.
And Seung-Hui Cho, who killed 32 people and then himself at Virginia
Tech University in 2007, was under court-ordered psychiatric treatment
that did nothing to prevent his rampage.
“Most of these people are getting some sort of treatment,” Dubovsky
Obviously, in the Colorado and Virginia Tech episodes, that treatment
was by no means adequate.
If you think you should institutionalize any mental patient prone to any
level of violence, the numbers are indeed daunting. Dr. Alec Buchanan,
an associate professor of psychiatry at Yale University, has calculated
that you would have to lock up between five and 10 troubled people to
have a decent chance of preventing a single one from acting violently.
Even then, you would likely miss some dangerous individuals, noted Dr.
Marvin Swartz, who served with Buchanan on an American Psychiatric
Association Work Group on Violence Risk earlier this year that
concluded: While psychiatrists can often identify circumstances
associated with an increased likelihood of violent behavior, they cannot
predict dangerousness with definitive accuracy.”
The problem, Ewing said, is that finding the violent among the mentally
ill is “totally unpredictable.”
What’s more, violence is actually rare among the mentally ill. Research
shows that between 92 and 96 percent of mental patients do not have
violent tendencies, said Dr. Daniel Antonius, an assistant professor of
psychiatry at the University at Buffalo.
“Their relative contribution to violence is so small,” Antonius said.
So if locking up the mentally ill won’t solve the problem, what will
“I think we have to look at how the seriously mentally ill have access
to weapons like this,” said Ewing, who is a SUNY distinguished service
professor and vice dean for academic affairs at the UB Law School.
“Obviously they do. And doing so, they can do great damage.”
Swartz agreed, noting that academic research shows gun control to be a
better deterrent to violence than any attempt to identify dangerous
individuals before they strike.
“The more efficient way to reduce the rates of violence is to make guns
less available,” he said.
Mental Health Apologists Are Enablers
By Jayne Lyn Stahl Huffington Post December 15, 2012
Like many Americans, I’m devastated by the murder of twenty children,
and six adults at an elementary school in Newton, Connecticut yesterday.
Like others, for years now, I have been calling for stricter gun control
legislation. Understood that Connecticut already has tight restrictions
on firearms, but what happened yesterday was just another in a long
series of examples of why states alone can’t be allowed to make
decisions on this issue. There needs to be federal gun control
Yesterday, I posted a comment to a social media site expressing my
profound sorrow, and outrage that an event like the mass murder at a
public school should happen yet again. . A commenter wrote: “This is not
a gun control issue. It is a mental health issue.” Right, guns don’t
kill people; mentally ill people do. This is simply a more sophisticated
gun apologist argument.
Try telling a youngster in East Oakland, Chicago, or Compton who has
just watched his brother get blown away by a handgun by a rival gang
member that guns don’t kill, mentally ill people do…
Try telling that to parents, and youngsters alike in the suburbs, in
Florida, in Detroit, in a coffee shop, in a bar. According to the
Violence Policy Center, more than 30,000 people a year die as a result
of gun violence <http://www.vpc.org/aboutvpc.htm> .
And, according to the Washington Post
, the U.S. has far more gun-related killings than any other country in
the industrialized world.
I’m tired of hearing excuses about why mass murderers commit these
heinous crimes, that they suffer from this mental illness, etc. Over the
past 30 years, we’ve seen several horrific mass murders in Aurora,
Virginia Tech, and elsewhere, but every day in every city of every state
in this country, someone is faced with the prospect of being the victim
of a loaded gun.
While the focus is on these beautiful young kindergarten children from a
white middle class suburb in New England, it is just as devastating when
we lose African-American, and Latino youngsters in working class
neighborhoods all over America. And, sadly, this happens every day.
Shootings are routinely reported on local evening news. Citizens of this
country have become so accustomed to hearing about people getting shot,
and killed every day in some squabble or other that they mentally reach
for the mute button.
And, no, Martha. This is not a mental health issue. This is a gun
control issue, and a social health issue. First, we need to make guns
less readily available, less convenient, and less opportune, and then,
as a nation, we need to have a conversation not just about violence, but
about our collective anger management issue, an anger management issue
that has led to eleven years of non-stop warfare, and a sociopathic
addiction to military assault rifles, drones, and other weapons of mass
This isn’t about personal mental health issues, but societal mental
health. Even if it were possible to wave a wand and make each and every
individual in this country magically sane, we would still have a problem
with gun violence. Violence is deeply embedded in our collective
consciousness, whether it be instant results achieved from a firearm, or
immediate impact of bombs, and remote-controlled killing machines.
So, please, stop trying to personalize this. Stop looking for this or
that psychiatric disorder to explain a problem that belongs in the
public domain. Stop trying to find new and ingenious ways to not blame
firearms. Stop thinking because a state has sane gun control laws,
that’s all we need.
No, we need federal legislation to regulate firearm sales and use. At a
minimum, we need to reinstate the ban on assault weapons. We need to
stop sales of firearms on the Internet and at gun shows, and most of
all, we need to recognize that this is about our national mental health,
and not that of a lone gunman.