Can Better Mental Healthcare Prevent Violence?

August 9, 2012

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CENTENNIAL, CO - JULY 23:  James Holmes (L) ma...

James Holmes

Water tossed into hot oil. Sodium tossed into water. Mentos tossed into a 2 liter bottle of soda. Some of the least restrictive gun laws in the world combined with a mental health care system that’s decades behind. Yup, I’m talking about things that don’t go well together.

First, let me get this out of the way: I’m not advocating taking away anyone’s rights to own a firearm. If I had more income to toss away I’d consider owning a handgun myself for the purpose of target shooting at a range – the Glock 19 just looks darn cool. That being said, there are a lot of improvements we can make to ensure mentally unstable people get the help they need. In absence of a gun, a desperate and mentally ill person will use other methods – in 2008 a Japanese man in Akihabara drove a truck into a crowd and then jumped out and started stabbing people. Guns don’t kill people, but they certainly make it orders of magnitude easier to kill people.

We’re all well aware of some of the more hyped mass shootings, but to see the list laid out is shocking. This list I’ve compiled, just from 1999 onward, is depressingly lengthy:

  • April 1999, Columbine.
  • July 1999, An Atlanta daytrader kills his family and then went to a trading firm and killed 9 more and wounded 13.
  • September 1999, A man opens fire in a Baptist church in Fort Worth, Texas, killing 7.
  • October 2002, A man and a minor carry out a series of 11 sniper-style shootings around the DC Beltway and in Northern Virginia.
  • August 2003, A Chicago man returns to where he was fired from 6 months prior and kills 6.
  • November 2004, In a hunting dispute in northern Wisconsin, six are killed and 2 are wounded.
  • March 2005, A man opens fire in a church killing 7, including the pastor and the pastor’s son.
  • October 2006, A milk truck driver enters an Amish school and in execution style kills 5 and severely wounds 6.
  • April 2007, Virginia Tech shootings.
  • August 2007, Three Delaware State students are shot execution style.
  • December 2007, A 20 year old man kills 9 and wounds 5 in a shopping center in Nebraska.
  • December 2007, A woman and her boyfriend shoot and kill 6 members of her family in their Washington State home, including 2 children.
  • February 2008, At a clothing store in Chicago in what authorities think is a robbery-gone-wrong, a man kills 5 and wounds another. The unidentified man is still at large.
  • February 2008, At Northern Illinois University a man kills 5 and wounds 21 before killing himself.
  • September 2008, A mentally ill man released from prison a month earlier shoots 8, killing 6 in Alger Washington.
  • December 2008, A man in a Santa Claus suit opens fire at a family Christmas party, then sets fire to the house and later kills himself. Nine were found dead in the house.
  • March 2009, A recently laid off man kills 11 in multiple locations, including 2 children.
  • March 2009, A heavily armed man kills 8 and wounds 2 at a Carthage, NC nursing home.
  • March 2009, Six people are shot dead in an upscale apartment building in Santa Clara, CA.
  • April 2009, A man enters a civic center in Binghamton, NY, and kills 13 before turning the gun on himself.
  • July 2009, Eight are shot in a drive by shooting on the campus of Texas Southern University, police conclude that it was gang-related.
  • November 2009, A US Army psychologist at Fort Hood, TX, kills 13 and wounds 29 others.
  • January 2010, A man near Appomattox, VA, kills 8 before being apprehended by over 100 police officers.
  • February 2010, A faculty member at The University of Alabama kills 3 and wounds 3 at a biology department meeting.
  • January 2011, Tuscon, AZ mass shooting. 18 people are shot including sitting US Representative Gabrielle Giffords, 9 die.
  • July 2012, Aurora, CO movie theater shootings
  • August 2012, A suspected White Supremacist enters a Sikh temple in Wisconsin and kills six and wounds 4 before being shot by police and then dying from a self-inflicted gunshot wound.

Please note, this is not even a complete list.

In the vast majority of these cases the people pulling the triggers had a severe mental health problem. I could write a whole other article or three on mental health parity in the United States, but to sum it up, mental health is decades behind “the rest” of health care. Anecdotally, I can say that I’ve actually met more than one doctor who says depression is “all in your head” – while technically true, I suppose, they seem to feel it’s not unlike attitude and you can just change how you feel. In addition, mental health issues are often misdiagnosed or go years without diagnosis. For example, as recently as 2000 a study showed that up to 69% of people with bipolar disorder were misdiagnosed and the average length of time that passes without a correct diagnosis can be as much as 10 years. Even when correctly diagnosed, at times law enforcement professionals are either untrained in proper procedure or unwilling to take a claim seriously. Recent evidence shows that James Holmes’ psychiatrist warned police that he was a danger weeks before the Aurora, CO shootings.

Next, there is the very real issue of mental health issues having a stigma of weakness or instability associated with them. Many people don’t seek help for mental illness thinking that the problem is temporary, or not treatable. Others don’t seek help for fear of being marginalized – the media often associates mental illness with violence and aberrant behavior.  The glorification of the American media has molded an image of the perfect person that is often near-unobtainable. We think that everyone should be content, cheerful, witty, grounded, have a great job, and a body like a supermodel and anything outside these “norms” has something wrong with them. Even when confiding with family and friends people are often told they simply need to sleep more, or cheer up, or pray more – dangerous things to tell someone who is depressed.

Finally, mental health is still seen as a sticky area by insurance companies. It can sometimes take years between first seeing a doctor to when a patient then sees a referred psychiatrist. In 2010 in Arizona only 5% of insurance companies offered equal benefits for mental issues vs. other health issues. As recently as 2006 the National Alliance on Mental Illness gave the US a grade of “D” on mental health treatment and awareness. It’s ironic that some politicians claim the government is trying to get between you and your doctor when health care companies already do when your doctor refers you to a psychologist – all in the interest of their profit.

What can be done? First and foremost both the general public and the insurance companies need to realize that mental health is at least as important as the health of any other specific area. We are people because of our thoughts and deeds and emotions, not because we have good blood sugar levels or need a pill to get an erection. Being able to tell a doctor you’re depressed or anxious shouldn’t be a big deal. Having your health insurance fully cover your visit to a psychiatrist should be a no-brainer. If that doctor then refers you to counseling, that should also be covered. Finally better training for law enforcement on working with mental health professionals needs to be implemented. As seen with Aurora, CO, that could have made all the difference.

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A Crazy Plan, Part 3

December 20, 2009

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“Oh, no. Stan told me that you snoop into his stuff, and that he often fabricates his notes in an effort to get a rise out of you. That must be what he meant. He and I are old childhood friends.”

“Right, he mentions that delusion as well. You believe that you and he are old friends, but he never set eyes on you before he examined you prior to your commitment.”

Walker slumped in the chair. “You have to believe me. This was all a stunt for my book.”

“These notebooks, filled with the incoherent ramblings of a madman? You are operating in a false reality. You have constructed a grand illusion to shield yourself from the fact that you are mentally ill. Stanley’s notes indicated that he had concerns about your ability to receive adequate treatment at this facility. I concur with his opinion and will make a recommendation that you be committed to the Springfield facility, where you will have more constant observation.

The next day, Sascha arrived at Lennox for her monthly visit, and Joe shared the dreadful news with her.

“Don’t worry, honey,” whispered Sacha. “The director at Springfield is in on the plan. You’ll be set free as soon as you get dropped off”

Joe perked up at hearing this news, and returned to his normal self for his final few days at Lennox. Finally, the day of his transfer arrived. He gathered up his belongings – mostly consisting of the notebooks – and Rogers drove him up to Springfield.

After Rogers scrawled his signature on a few forms to authorize the transfers, he jumped back in the car for the solo trip back to Lennox.

“OK, this has been fun, guys,” Joe said to the director of the Springfield facility. “You can let me go now.”

“Go where?”

“Go home.”

“You are confused, son. This is your new home. It may be difficult at first, but you will soon grow to like it here. Let me give you a tour.”

After the fruitless discussion with Rogers at Lennox, Joe decided that it would be pointless to continue his plea for freedom. Sascha had been certain that the director of this facility had been privy to their secret. Clearly, some wires had gotten crossed at some point.

Joe expected Sascha to visit the Springfield facility to inquire as to his whereabouts. A few days passed, then a few weeks. To kill time, he continued his writings, using his experiences at Springfield to write several more chapters in his character’s life.

On the last day of the month, Sascha finally came to visit. She scarcely had time to sit before Joe started talking.

“You have to talk to the director, and to the judge who committed me. You have to explain that this was all research for a book and that I should be set free” he pleaded.

“But then I would have to admit that I lied during the hearing, Joe. That would be perjury. I certainly wouldn’t want to go to jail.”

Joe gasped as she continued to speak.

“I’ve decided that I rather enjoy life without you, Joe. The power of attorney gives me unlimited access to your funds, and I don’t have to put up with any of your annoying habits. I can take a young lover whenever I want. It’s a pleasant life, Joe.”

Walker was stunned. “You can’t possibly be thinking of leaving me here!”

“I really have no choice,” she said, giving him a kiss. “You’ve heard the doctors, Joe. You need treatment.”

A Crazy Plan, Part 2

December 19, 2009

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He received his first disappointment when Banks told him that he would not be able to use his trusty ink pen. A pen could be a dangerous weapon in the hands of some of the residents. Gone, too, were spiral bound notebooks. Joe was dismayed by their replacements – crayons and composition books. Joe reminded himself that a competent professional could succeed with any tools.

Joe spoke with his good friend, Director Stanley Banks, nearly every day. One day Joe noticed that Banks always carried a red notebook with him.

“The associate director, Rogers, is a real snoop. I like to toy with him by pretending that this is some master record of my observations of all the residents at Lennox. Really, I just make up stuff, just to see if he slips up and mentions any of it in conversation. The stuff I’ve written about you is great,” laughed Banks.

A month after being committed to Lennox, Joe felt that he had become sufficiently institutionalized and had begun to learn about the various disorders that afflicted the other residents. He began to write. His novel would be a pseudo-biographical account detailing the daily struggles of mental illness. He decided that he rather enjoyed the look of the crayon writings – they gave the work a juvenile look. Perhaps Vic, the publisher, could retain that unique look and feel for a few small parts of the book.

Time passed quickly inside the walls of Lennox. Other than the near-daily visits from Banks and the monthly visits from Sascha, Joe was completely focused on his book. He spent nearly all his time either writing or interacting with other residents to gain further insights into mental illness. Over the course of a year, he filled the pages of dozens of composition books with his novel. The novel, he reflected, would likely have to be broken into two or three books, even after Vic edited it.

Near the end of his stay at Lennox, he was visited one day by Associate Director Rogers, rather than by his friend Banks. It wasn’t like Banks to take a day off, and Joe questioned the Rogers about Banks’ absence.

“Dr. Banks was involved in a traffic accident last night and remains in a coma. I have looked over Stanley’s notes on you, Joe. It seems that you will not be in our company much longer.”

Walker smiled. “It will be nice to be free once again – to walk in the park on beautiful spring nights …”

“I’m afraid you misunderstand, Mr. Walker. You will be leaving Lennox, but you will not be re-entering society. You are being transferred to the facility in Springfield.”

“No, no,” replied Walker. “This is a mistake. The story of the transfer was just a ruse to cover the fact that I was going to be released. I completely orchestrated a plan to have myself committed.”

“Oh, yes. Here it is,” Rogers said, leafing through pages in a notebook. “’Patient Walker believes himself to be a famous writer. He is under the delusion that he convinced his wife and myself to have him committed so that he could better research an upcoming book’”


A Crazy Plan

December 18, 2009

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Today, I bring you the first of yet another multi-part story.  I really do intend for the Fiction Friday stories to be 500-700 words, but I’ve been having a few of them get away from me lately.  This is the first of a three part story – the other segments will be published over the weekend.  Without further ado, A Crazy Plan.

“Then, at the end of a year, you get me released, and I vanish from the facility.”

Dr. Stanley Banks finished his steaming coffee with a gulp, and then broke into a broad grin as he looked across the table at his childhood friend.

“I’d probably fake a transfer to another facility. It wouldn’t reflect well on Lennox to simply have you walk out the door.”

“You’re on board with the plan?”

“Count me in. It sounds like splendid fun.”

“Wonderful. I’ve always wanted to write a novel from the perspective of an inmate of an insane asylum. What better way to gain perspective that though immersion?”

“You’ll be a resident, Joe, not an inmate. We don’t much cotton to the term asylum any more, either. I’m sure you’ll learn a lot during your year as our guest,” Banks said with a laugh.

Joe flagged down the waitress, who topped off their cups of coffee. The two men clinked mugs as a toasts toward the success of the endeavor.

The next day, world renowned author Scooter Smith – known to his friends by his real name of Carlton Joseph “Joe” Walker – informed his publisher that Scooter would be taking a step back from the limelight to focus on his next book. Scooter Smith tended to avoid the public eye, and had retreated into seclusion several times in the past, so the publisher was not overly surprised.

“Enjoy the time away from society,” same the voice from the other end of the phone.

“You bet, Vic. I’ll have a best seller on your desk a year from today.”

Vic laughed. “That’s what every publisher wants to hear.”

Shortly thereafter, Sascha Walker began the process of having her husband committed to a mental institution. On the night before the hearing, Joe and Sascha celebrated Joe’s imminent detention with a night of wild sex – fueled by a small amount of cocaine purchased especially for the occasion.

The hearing was decidedly one sided. Sascha’s testimony about Joe’s recent spate hallucinations, delusions, and violent behavior made a strong case for commitment. The renowned psychiatrist Stanley Banks testified that he had examined Walker and felt that an appropriate course of action would be to commit him for a period of one year, with a further course of action to be determined at the end of the year.

The judge agreed took only a few minutes to reach his decision.

“At this moment, I feel that it would be in the best interest of Mr. Walker if he were to be under careful observation. I am committing Mr. Walker to the Lennox Estates Home for the Mentally Ill. His confinement will be at the discrection of Dr. Stanley Banks. Until and unless Mr. Walker is deemed to be mentally competent to handle his own affairs, Sascha Walker shall be granted durable power of attorney.”

Joe could barely contain his excitement when they arrived at Lennox. Joe was duly processed, and Carlton Joseph Walker became the newest resident of the east wing. He embraced Sascha, and she promised to visit at least once a month. After his wife left, Joe got to work, actively blending into the population.