Our elected officials have no meaningful incentive to prevent another murder committed by someone with severe mental illness. It’s not that they want these crimes to continue, but politicians are compelled to do things that will keep them in office. Unfortunately, the behaviors that maintain their power are sometimes very different from the behaviors that would solve problems.
Revamping our mental health system would be the single most effective thing our representatives could do to prevent another Aurora or Newtown. Since our society began deinstitutionalizing the seriously mentally ill in the 1960s (partly under the horribly misguided notion that a new class of medication would cheaply solve the problem) prisons have become the de facto mental health institution for the treatment of violent mental illness.
These patients are only forced into treatment after their lives have fallen apart and they have harmed innocent people. Having worked in that environment, I can assure you that successful long-term treatment is low on the list of a prison administration’s priorities. Who can fault them? That is not the purpose of prisons.
Somewhere out there, right now, the next mentally ill murderer is stewing over his violent video game, possibly having the occasional, unproductive brush with the community mental health system, while his teachers or coworkers watch helplessly as he descends.
What are our representatives doing to help that person? Some, like Colorado’s Governor Hickenlooper, are advocating for comprehensive mental healthcare reform. But the majority are arguing over the Second Amendment like fools rearranging deck chairs on the Titanic.
Of course, they are not fools. They engage in this diversion to gain the attention of their constituents. Whether pro or con, they know where their votes come from, and they align themselves accordingly. They have no reason to shine light on a difficult topic like mental healthcare reform. It is expensive, unglamorous, and unpredictably controversial.
A successful politician will always ask the pragmatic question: how might my constituency respond if I take a position on this a topic? Better to keep the debate focused on something safe and predictable, like guns. Political pragmatism is their instinct, and it hurts the very people who elect them.
That instinct hurt us profoundly when the Aurora shooter pulled his trigger. By all reports, his psychiatrist did all she could for him. It was the system that failed us. She should have had the ability to say to her patient, “You need help, and I’m sorry, but you need to surrender your freedom until you are well enough to function without threatening yourself or others.”
That option was once available, but we threw it away because it seemed unkind and expensive. It’s not that clinicians cannot intervene when a patient is failing to care for themselves or becoming destructive. They can intervene, but in a very limited fashion. It rarely goes beyond 72 hours of intensive paper shuffling. Options beyond that rarely exist for those who don’t consent to treatment, even if they are a palpable threat to themselves or others.
Another major impediment is that successful treatment of severe mental illness can burden the patient or their family with profound financial costs. Although the Bush administration brought mental healthcare parity to life in theory, the federal government poorly enforces it. As a result, patients or their families to pay out of pocket, or to wait in line for overburdened services.
President Obama’s Affordable Healthcare Act also promises parity, but we shall see if it is enforced. Compared to corporate welfare, mental healthcare does not appear to be a priority to this administration. The National Association of State Mental Health Program Directors reported that federal mental healthcare funding dropped by $4.35 billion between 2009 and 2012, and is scheduled to drop further by as much as $196 million in 2013.
Intensive, high-quality mental healthcare therefore remains available mostly to those who have means or are willing to accrue spectacular debt. I have met families who have spent hundreds of thousands of dollars for the care of their loved one. I have met many more mentally ill individuals who lacked even that grim option.
The level of mental healthcare that existed prior to the 1960s (though obviously with current methods) should have been available for the Aurora shooter, the Newtown shooter, and the young man who shot a classmate last week in California. All of them were visibly troubled. Clinicians need more discretion to involuntarily commit individuals who pose a threat to themselves or others. Hospitals need to rebuild facilities for treating those patients rather than letting them languish as they pass in and out of emergency rooms. And we must enforce mental healthcare parity.
We need serious mental healthcare reform, but why on earth would our elected officials open that can of worms? There’s nothing in it for them. It is all downside. It would involve research, and budgetary discussions, and – worst of all – unpredictable voter responses.
So instead, our representatives continue shouting about banana clips and background checks because that’s where they are most comfortable. It does not benefit us, but it serves them quite well.
Shawn Smith is a clinical psychologist in Denver and blogs at IronShrink.com.
