The Washington Navy Yard and Our Porous Mental Health System

So it's happened again.

Someone seemingly with severe mental illness has gone on a shooting spree. This time it was Aaron Alexis, in the Washington Navy Yard. Six weeks ago, Alexis told people someone had threatened him at an airport in Virginia. A few days later, in Rhode Island, he heard voices. He thought people were speaking to him through the walls, floor and ceiling of the Navy base there, where he was working. In his hotel room, the voices used "some sort of microwave machine" to send vibrations through the ceiling and into his body, a police report shows him saying.

Twelve innocent people are now dead. And once again the president orders flags to be flown at half-mast. Football games and other sporting events are again delayed. There is a televised ceremony honoring and mourning the deceased. And the debate about gun control will again be engaged, a debate we need to have, but unfortunately will likely lead nowhere.

Nothing will change.

And I sit here mystified, wondering why so little attention is focused on the one common aspect to this and so many recent slaughters: mental illness, and why it goes untreated in this country.

Let's look back (and we don't have to look back very far.) Fourteen months ago James Holmes shot 20 people to death in a movie theatre in Aurora, CO. CBS News reported that Holmes met with at least three mental health professionals at the University of Colorado prior to the massacre. One of Holmes psychiatrists suspected prior to the shooting that he suffered from mental illness and could be dangerous. A month before the shooting, a Dr. Lynne Fenton reported to the campus police that Holmes had made homicidal statements which indicated he was a threat to the public. Sixteen months before the Aurora shooting, Jared Lee Loughner, aiming at Rep. Gabrielle Giffords, killed six people. While a student at Pima Community College, Loughner had five contacts with college police for classroom and library disruptions. Some of his teachers complained to the administration about his disruptions and bizarre behavior, as they thought it a sign of mental illness and feared what he might do. In 2007 Seung-hui Cho, a 23-year-old Virginia Tech senior, opened fire on campus, killing 32 people. Two years before the massacre, Cho was found "mentally ill and in need of hospitalization" by the New River Valley Community Services Board. Based on this mental health examination, he was detained temporarily at a Behavioral Health Center in Radford, Virginia. Virginia Special Justice Paul Barnett certified in an order that Cho "presented an imminent danger to himself as a result of mental illness," but instead recommended treatment for Cho as an outpatient.

These are just a few examples, and there are many more. And since I work in the field of human services, including mental health, I can tell you that there are several layers to what has become a national tragedy and disgrace. One has been our decades-long move to de-institutionalization. In her book, God's Hotel, Dr. Victoria Sweet does a masterful job describing this poorly-thought-out and grossly-underfunded shift in public policy, as does Mac McClellan's article in Mother Jones, "Schizophrenic. Killer. My Cousin." The other trend, which goes hand in hand with that one, is the insistence that no one be forced to receive mental health treatment unless the person is "an imminent danger to self or others." So apparently Aaron Alexis, hearing voices and believing microwave vibrations were in his body, did not constitute a danger to himself or others. Until he was. Same with James Holmes, Jared Lee Loughner, and Seung-hui Cho. None were deemed enough of a danger to self or others for the police or a doctor or a clinician to actually take action, and thus were able to roam freely throughout society, until they took out weapons and killed innocent people.

I know that it is not a simple or easy task to make these decisions about who we provide treatment for, and in what setting, especially since it involves the civil rights of individuals. But I cannot help but conclude the pendulum has swung too far in one direction. In my home state of Vermont, Governor Peter Shumlin recently called for legislation making it easier for mental health professionals to administer medications to patients who are refusing mental health treatment. I support him in this, in fact I hope he advocates for some version of New York State's "Kendra's Law," which was enacted after a mentally ill man pushed Kendra Webdale onto subway tracks in 1999. This law orders patients to receive treatment, and a recent study has shown it has resulted in fewer patients ending up in psychiatric hospitals and in prison, with the additional benefit of mental health costs and Medicaid costs dropping by half or more.

I know there are people in my own field who vehemently disagree with me on these things. Some of them equate the forced treatment of the mentally ill with rape. I don't see it that way. I see it as the humane and compassionate treatment of individuals who suffer from a cruel and insidious illness. I also see it as what we need to do in order for people to feel it is safe to go to their workplace in the morning, or to a political rally in the afternoon, or to a movie theatre at night.

This is a very difficult, emotional debate. But we must have it -- in Vermont and nationally. If we shrink from the debate, we will continue to see these tragedies.