The shooting in Tucson, AZ of Congresswoman Gabrielle Giffords and 19 others, six fatally, has provoked much discussion on the current climate of aggressive and negative rhetoric in the media and by politicians.
I’ve heard very little about what I think is the real lesson from the shootings – we have a mental health system that is broken. Reports of Jared Loughner’s bizarre behavior are coming out from former teachers and classmates. His behavior was so frightening, he was told to leave Pima Community College and not to return until he had a mental health evaluation. In this post, I’ll be referring to mental health issues such as chronic schizophrenia and schizoaffective disorders, which affect an individual’s ability to function in society. I’m not talking about the many people who struggle with other disorders, such as depression and anxiety, but are still in touch with reality. I also want to be clear that people with mental illnesses are no more likely to be violent than anyone else. That’s important.
Jared was an adult, 22 years old at the time of the shootings. As an adult, he has the right to refuse treatment for mental illness. What do we do when a symptom of the illness is that the afflicted doesn’t think they have an illness? To the patient, it makes complete sense to refuse treatment and it’s easy to see those who insist that the patient take mysterious pills or get shots as persecutors. To the friends and family of the patient, it’s another hurdle in a long line of hurdles facing them and their loved ones.
We don’t know what kind of help his parents tried to get him, and confidentiality laws prevent any local professionals from revealing whether or not he was treated, but I’m guessing he wasn’t very cooperative and didn’t agree with the college’s suggestion that he seek treatment.
People who have long-term chronic mental illness are not always easy to deal with. They burn bridges, get evicted, don’t follow the rules of housing alternatives. They go off their medication. They usually can’t work and live off long-term disability. Many of them develop substance abuse issues as well, complicating the treatment picture.
I used to have a job where I evaluated people for involuntary hospitalization. I was threatened with all manner of lawsuits and called many names by the people I was trying to help. They saw me as taking away their basic rights and they were right – I was taking away their right to refuse treatment. If I determined they needed to go to the psychiatric hospital, and they fought that decision, they would be handcuffed and restrained. One particularly searing image that stays with me was a terrified, very psychotic woman in her 80’s, screaming as she was wheeled out on a stretcher “I’m being kidnapped! Kidnapped! Someone save me!” The terrified look on her face haunted me. She really believed she was being kidnapped.
Parents looked at me in horror when I explained that yes, they’d need to stop paying their psychotic daughter’s rent and let her become homeless before we could force her to go the hospital, because her behavior, while bizarre, wasn’t dangerous enough yet.
Mental health budgets continue to be cut all over the country. It’s expensive to take care of these members of our society. The care we do give them is substandard. Ever been to a SRO? Unless it was brand new, I don’t think I’ve ever been to one that didn’t reek of urine and wasn’t dirty and worn. The staff who work with the chronically mentally ill have a very difficult job and are not paid well.
We have no safety net for these people. We offer them very basic care, try to keep them housed and safe and stable. We can’t do much more for them. Trying to offer some kind of quality of life is out of the question, because there is no money for it. We as a society don’t want to deal with the mentally ill.
I’m certainly not saying that what Loughner did wasn’t heinous. What I am saying is that it’s not as easy as, “Hey, this guy creeps me out. Let’s put him in the hospital.” Maybe he did go to the hospital and while being evaluated, told the staff, “I’m fine. Really – I live with my parents, I eat and shower daily, and I don’t need medicine.” That would probably be enough to get him discharged into his parent’s care.
What’s the answer? I wish I had one. Taking away a person’s rights is serious and needs to be considered carefully. But by focusing our efforts on protecting those rights, are we abandoning a large segment of our population?
(edited 1/14/11 to correct the shooter’s name)