SalemNews.com, Salem, MA

January 22, 2013

Watson: Focus on mental health needed

Brian T. Watson
The Salem News

---- — There are many factors involved behind a shooting like the one in Newtown, Conn., on Dec. 14.

There are gun and ammunition availability issues, social and cultural norms and pressures, family histories, Internet and media dynamics, and the mental condition of the shooter.

Since the Newtown massacre, I have written twice about some of the factors that relate to firearms. As some state governors are proposing, I have recommended that we impose stricter limitations on sales of all semi-automatic pistols and rifles, and that we ban outright the private ownership of gun magazines larger than 10 rounds.

But the most important step we can take relating to gun ownership is to require that every gun buyer undergo a background check. Currently, because purchases made at gun shows and between two private individuals do not require a background check, roughly 40 percent of firearms are procured without any review of the purchaser’s personal record or general fitness to own a weapon.

Although no set of gun regulations, however carefully crafted, will prevent all future murders, we can endeavor to reduce their frequency.

This column will focus on some of the mental health aspects of the gun violence problem.

It has become clear that many — but not all — of the perpetrators of the worst mass shootings in recent decades have had some degree of long-standing, diagnosable mental illness. While it is important to note that the mentally ill population may not commit violence at a rate higher than the general population, it is certainly true that the shooters in Aurora, Colo. (the movie theater); Tucson, Ariz. (Congresswoman Giffords); Virginia Tech (campus shootings); and Newtown, Conn., struggled mightily either to cope with their minds or conventional norms.

After these shootings, advocates for the mentally ill have called our attention to the dismal state of health care for people with mental problems.

In any given year, nearly 60 million Americans experience some type of mental health problem. The ailments can be as diverse as schizophrenia, anorexia, hyperactivity, extreme anxiety or various degrees of depression. Some of those illnesses are temporary, and some may be permanent. But finding, receiving and affording the treatment for any of them can be extremely difficult.

The mental health care system is fragmented, inadequate in scope and capacity, and just plain unaffordable for many people in need. Many patients with really serious problems can wait months for in-patient care. Since 2009, the states have had to cut about 12 percent of their mental health treatment budgets; 3,000 psychiatric hospital beds have been lost.

Most families, even with insurance, cannot afford to pay for residential psychiatric care; they have to rely on publicly funded programs. Medicaid, for example, provides about half of all state mental health budgets. Other programs, mostly for the non-poor mentally ill, are funded through general state budgets (not Medicaid).

Consequently, one-third of all severely mentally ill people never receive any treatment at all. Two-thirds of those with moderate illness receive no treatment.

In some respects, our jails and prisons have become repositories for the mentally ill. Unable to function competently or get psychiatric help, they eventually commit petty crimes (or worse) and end up incarcerated. Almost one-fifth of U.S. inmates are mentally sick.

And then there are shooters — mainly alienated youths — whose grievances may not amount to a psychiatric disorder, but who are nonetheless at risk for destructive behavior. Their rage, humiliation, paranoia, narcissism, isolation, disconnectedness or sense of unworthiness may lead them to plot and commit a horrible crime. The approaches to reaching kids like that may differ markedly from the care of other mentally afflicted people.

Mental health experts are suggesting that we carefully consider a number of reforms. We should discuss the ways that caregivers can increase their reporting of potentially dangerous individuals to the federal background-check database. Developing the definitions, protocols, procedures and safeguards to do this will be difficult, but necessary.

We should increase the system’s capacity generally to see and help the mentally ill. Experts say that community-based and school-based programs should be multiplied.

Perhaps we should consider building more residential care and treatment facilities for psychiatric patients. Decades ago, when we deinstitutionalized mental patients, we left a hole in the system. New facilities, without the abuses of the past, could be part of new reforms.

There are many more improvements we can make to both the care system and to mental health itself. Some despondency, alienation, anger and violence can be a product partly of our coarse and careless culture. Our mental health, sanity and levels of experienced trauma are not unrelated to the conditions and features of our society.

So, to the extent that we can have fewer wars, destroy less natural habitat and environment, be less materialistic and more connected to each other, and be generally more responsible and ethical, we will reap benefits — slowly, over generations — in the quality of our society and thus the quality of our emotional lives.

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Brian T. Watson is a regular Salem News columnist. Contact him at watson@nii.net.