Thursday, January 17, 2013

The Invisible Trigger: Mental Health and Gun Violence

The Invisible Trigger: Mental Health and Gun Violence:

After every mass shooting, the talk of the nation turns to gun control, and the particular horror of the Newtown tragedy has made the conversation louder than ever.
New York lawmakers passed the strictest gun laws in the country on Tuesday, and yesterday President Obama released a set of executive orders that marked the strongest action on guns since President Clinton signed the Brady Act banning assault weapons.
We don’t know for certain if these moves will have a significant effect, but it doesn’t look too promising. Obama’s executive orders merely enforce existing gun laws, and even supporters admit getting serious new legislation through Congress will be tough.
“I think everybody acknowledges that the assault weapons ban is a challenge, but other things — like the size of the magazines, the background checks, straw purchases — are all things that have a good chance of passing,” Rep. Bobby Scott (D-Va.) said to Politico.
The impact of any new gun laws will be small; the horse is already out of the barn. There are too many guns strewn across the country; attempting to confiscate them all would be an exercise in futility even if such legislation could pass (it couldn’t), and the Supreme Court has swung solidly to the view that gun ownership is an individual constitutional right, severely restricting the kinds of legislation that can be passed. And of course there is the inconvenient truth that many violent criminals don’t mind breaking the law. People drank during Prohibition; people snort cocaine now in spite of the law; criminals will find ways to get the guns and the ammo they think they need. For this reason the national hue and cry about gun control strikes us as more an understandable emotional reaction to a terrible disaster than as a sober and pragmatic approach to a serious issue.
Love it or loathe it, legislative gun control is unlikely to have much impact on violence American style. But there is another door to progress: taking care of America’s mentally ill. The good people at Mother Jones recently compiled a study, revealing that of the 62 mass shootings since 1982, 38 were carried out by a person suffering from mental illness (mostly men). Most had displayed signs of paranoia, depression, and other issues with mental health well before reaching for a weapon.
While most of the gun violence in America is committed by the clinically sane, the most horrific massacres are often the work of deranged people whose problems had come to the attention of family, neighbors or work associates.
Strangely, America has regressed in its treatment of the mentally ill. In the 19th century, most of the nation’s disturbed were either on the street or in jail. In an effort to provide humane treatment, state institutions popped up across the country, confining most of the nation’s severely deranged. Yet by the 1960s, controversy erupted as stories of mistreatment and poor conditions (One Flew Over the Cuckoos Nest, anyone?) became rampant. Deinstitutionalization followed, in a movement that received strong bipartisan support. Liberals championed the fall of state psychiatric hospitals on the grounds of compassion and freedom; conservatives saw it as a way to save money and as a blow against the intrusive nanny state.
State institutions closed down in droves; of the one public psychiatric bed for every 300 Americans in 1955, only one for 7,000 remained in 2012. Community treatment centers (nursing homes, care homes, etc.) moved in as substitutes, but they received little funding and resources. A series of federal laws were then passed to make it nearly impossible to confine or treat someone against their will. Individuals had to be shown to pose an imminent threat to themselves or others. In America, you have a right to be mad.
Overall, available treatment not only became scarcer, but far more expensive. The mentally ill were either forced to live with their families, who weren’t prepared to deal with their condition, or were abandoned altogether.
Much of the impetus for change was legitimate, as abuse in institutions was very real and there were shocking cases of people being wrongfully confined. But instead of carefully reforming the old system, we junked it without putting anything in its place.
Today, the picture is eerily reminiscent of the 19th century. According to the National Institute of Mental Illness, approximately half of people living with bipolar disorder or schizophrenia are left untreated in any given year. Large numbers find themselves on the streets or in prison.  The Los Angeles County Jail, Rikers Island Jail in New York City, and the Cook County Jail in Illinois make up the three largest inpatient psychiatric facilities in the country.
Families have born the brunt of the burden, and they have very little help. The criteria for commitment are subjective at best. Few judges or law enforcement agents want to get involved with these cases since the resources for commitment are scarce. The best available options are visits to the emergency room, providing temporary relief, or prison, and many families are understandable hesitant to press charges. The result is that the very people who are in a position to alert our society to possible danger are isolated, ashamed and discouraged from bringing the problems they see to the attention of the authorities. This is really no way to run a railroad, and our ‘discovery’ of the constitutional right of the mentally ill to sicken and suffer without help does little credit to our society.
Time and the courts will tell how successful the current cry for gun control will be. We look at the Republican House and at the Democrats in the Senate whose constituents dislike gun control, and we are skeptical that big legislative changes are on the way. And we wonder what will happen when Justices Thomas, Scalia and their colleagues settle down to review any new laws.
This nation is awash in guns, and there is no sign that that is about to change. The cultural heritage and the social conditions that make violence so prominent a part of American life will also change slowly if at all. Those are facts. And enough Americans believe in the importance of the Second Amendment that it cannot be repealed; the belief that the right to bear arms is the citizen’s last defense against government tyranny (or insurance against the breakdown of civil order) is deeply rooted in American life. Serious thought about gun violence needs to begin with these truths, unpleasant though many of them are. Policy must stand on solid ground rather than on a tissue of hopes and illusions and the reality is that we are not going to solve America’s massacre problem by passing gun control laws. Nothing we do will solve this problem completely; some of the most violent cities in America have the toughest gun control laws and in some of our least homicidal cities and states have very loose laws.
But if as a practical matter we can’t do much to keep dangerous weapons out of the country, we can do something about keeping dangerous people away from them. This is not just a question of background checks; it is also a question of rebuilding our ability to protect society from people whose mental state makes them a threat to society at large. In dealing with the potentially violent mentally ill, we need to balance the potential danger to society more effectively against the loss of individual freedom. Building better facilities for the mentally ill and being more proactive about putting dangerous people in them is a necessary precaution given the abundance of weapons in these United States. In any case, making treatment more readily available and providing better services and more support for the families and friends of the mentally ill is a good thing in and of itself.
President Obama gave a nod to mental health issues in his executive orders yesterday, but if we are serious about reducing the number of future incidents like the horror in Newtown, more needs to be done. (The mental health component of the package doesn’t appear to be particularly focused on the specific issue of violence.) This problem is going to be with us for a long time. There is no clean and quick solution. There won’t be one magic law or one golden policy that frees us from the specter of these tragedies. But making it harder for the deranged to get weapons, and making it easier for society to protect and treat people showing serious signs of dangerous mental disturbance is a step that we can and should take, regardless of what happens on the gun control front.
Image courtesy Shutterstock.