Monday January 28, 2013

Undertreatment of severe illness plays a role in mass shootings

In July, James Holmes entered a theater in Aurora, Colo., shot 12 people to death, and wounded 58 others.

In December, Adam Lanza shot his mother, then went to an elementary school in Newtown, Conn., and shot to death 20 children and six teachers.

It's understandable that many people immediately focused on controlling firearms.

Emotionally satisfying as that might be, it would allow public officials to ignore the other common element in mass shootings -- the shameful undertreatment of severe mental illness.

That must be addressed.

Consider:

* The move in recent decades to deal with mentally ill people in the least restrictive environment has reduced the number of public psychiatric beds in the United States from 559,000 to only 43,000. That's about the level that prevailed in 1850.

* Civil commitment laws vary from state to state. Under Connecticut law, for example, it's very difficult to have someone confined involuntarily. Connecticut is also one of six states that don't empower courts to order "assisted outpatient treatment."

* As a result, severely mentally ill people often wind up temporarily warehoused in hospital emergency rooms awaiting bed space, or locked in jails or prisons for minor offenses.

As E. Fuller Torrey and Doris A. Fuller of the Treatment Advocacy Center have noted, mentally ill people make up about a third of the homeless population and a fifth of jail and prison populations.

States have underfunded mental health treatment. Olga Khazan of The Washington Post reported this week that between fiscal 2009 and 2012, 28 states and the District of Columbia cut mental health funding by a total of $1.6 billion.

The American people should not allow facile posturing about firearms to obscure the obvious need to review mental health policy.

Gov. John Hickenlooper of Colorado, a Democrat, has spent five months coming up with a more comprehensive approach. He favors universal background checks for all gun sales, but he also proposes the state modernize civil commitment laws and expand community-based mental health treatment.

Hickenlooper's administration suggests simplifying commitment law into one clear statute and changing Colorado's legal threshold for involuntary commitment from "imminent danger" to "substantial probability" of harm to self or others.

He would also spend money to provide more psychiatric beds and more specialists, and add five 24-hour psychiatric crisis centers.

Such discussions should be taking place in all 50 states.

Both severely mentally ill people and the general public deserve policies that actually work. ~Charleston Daily Mail

Charleston, W. Va.