The Mental Health System Can’t Stop Mass Shooters

SACRAMENTO — A few years ago, the police brought a 21-year-old man into the crisis unit where I work as an emergency psychiatrist. His parents had called the police after seeing postings on his Facebook page that praised the Columbine shooters, referred to imminent death and destruction at his community college and promised his own “Day of Retribution.” His brother reported to the police that he had recently purchased a gun.

When I interviewed the patient, he denied all of this. He had no history of mental illness and said he didn’t want or need any treatment. My job was to evaluate whether he met the criteria to be involuntarily admitted to a psychiatric hospital.

Each mass shooting reignites a debate about what causes this type of violence and how it can be prevented. Those who oppose further restrictions on gun ownership often set their sights on the mental health care system. Shouldn’t psychiatrists be able to identify as dangerous someone like Nikolas Cruz, the young man charged in the school shooting last week in Florida, who scared his classmates, hurt animals and left menacing online posts?

Mr. Cruz had suffered from depression and was getting counseling at one point. He was also evaluated by emergency mental health workers in 2016, but they decided not to hospitalize him. Why, some critics are demanding, didn’t he receive proper treatment? And can’t we just stop angry, unstable young men like him from buying firearms?

It’s much harder than it sounds.

The mental health system doesn’t identify most of these people because they don’t come in to get care. And even if they do, laws designed to preserve the civil liberties of people with mental illness place limits on what treatments can be imposed against a person’s will.

Here in California, as in most states, patients must be a danger to themselves or others because of mental illness before they can be involuntarily admitted to a psychiatric hospital. This is a mechanism for getting people into treatment when they are too deep in the throes of their illness to understand that they need it. It allowed me to hospitalize a woman who tried to choke her mother because she was convinced her family had been replaced with impostors, and a man who had sent threatening letters to his boss because he believed she had implanted a microchip in his brain.

But the young man who had written about shooting his classmates was calm, cooperative and polite. The posts, he insisted, were nothing more than online braggadocio. He denied being suicidal or homicidal; he had never heard voices or gotten strange messages from the television. He admitted to having been bullied and was resentful of classmates who seemed to have more thriving social and romantic lives. But he adamantly denied he would be violent toward them.

What options did I have? It was clear to me that he did not have a psychiatric illness that would justify an involuntary hospitalization, but I was reluctant to release this man whose story echoed that of so many mass shooters.

I could fudge it a little, claiming to need more time for observation, and admit him to the hospital anyway. But within the week he would go before a hearing officer to contest being held against his will. The hearing officer would probably come to the same conclusion I had, that he was not dangerous because of a mental illness, and he would be free to go. The only advantage of this version of events would be that the order to release the man who might be the next mass shooter would not be signed with my pen.

Maybe the hearing officer would share my trepidation and commit him out of fear of the alternative. Then the hospital would have 14 more days to treat him.

The psychiatrist responsible for his care would know how to treat delusions, paranoia, mania, suicidal impulses, self-injurious behaviors, auditory hallucinations and catatonia. But there are no reliable cures for insecurity, resentment, entitlement and hatred.

The one concrete benefit of officially committing him would be that he could be prohibited from buying a gun from any federally licensed retailer. Of course, this would do nothing about any guns and ammunition he may already have amassed. Nor would it deter him from getting guns from private-party sales, which are exempt from background checks in many states.

I ended up admitting this patient, and he was released by the hearing officer two days later. He never took any medication, never reached the threshold for a federal firearm prohibition and left the hospital in the same state he arrived in. Like so many of his peers, he will not seek out therapy for the longstanding personality traits that seem to predispose him to violence and rage, and there is no way to impose treatment upon him.

The reason the mental health system fails to prevent mass shootings is that mental illness is rarely the cause of such violence. Even if all potential mass shooters did get psychiatric care, there is no reliable cure for angry young men who harbor violent fantasies. And the laws intended to stop the mentally ill from buying guns are too narrow and easily sidestepped; people like Nikolas Cruz and my patient are unlikely to qualify.

Instead of hoping that imposing mental health treatment on everyone who shows “red flags” will put an end to mass shootings, we should focus on ways to put some distance between these young men and their guns.

Source: The New York Times, Amy Barnhorst, February, 2018. Amy Barnhorst is the vice chairwoman of community psychiatry at the University of California, Davis.

Trump's solution to school shootings: arm teachers with guns

The US president proposes to arm school teachers in an attempt to prevent mass shootings, a move certain to prove fiercely divisive

Donald Trump has said he will consider a proposal to arm school teachers in an attempt to prevent mass shootings, a move certain to prove fiercely divisive.

The US president, holding a listening session at the White House with survivors of last week’s Florida school shooting and others affected by gun violence, claimed that allowing airline pilots to carry and conceal guns had demonstrated the measure could be a success.

“It only works when you have people very adept at using firearms, of which you have many,” Trump said during an emotionally searing session that, extraordinarily, was broadcast live on national television. “It would be teachers and coaches.”

Referring to Aaron Feis, a football coach who used his body as a shield to protect a student during the massacre at Marjory Stoneman Douglas high school in Parkland, the president continued: “If the coach had a firearm in his locker when he ran at this guy – that coach was very brave, saved a lot of lives, I suspect.

“But if he had a firearm, he wouldn’t have had to run, he would have shot him, and that would have been the end of it. This would only obviously be for people who are very adept at handling a gun. It’s called concealed carry, where a teacher would have a concealed gun on them. They’d go for special training and they would be there and you would no longer have a gun free zone.”

Trump added: “Gun free zone to a maniac – because they’re all cowards – a gun free zone is, ‘let’s go in and let’s attack, because bullets aren’t coming back at us’... It’s certainly a point that we’ll discuss.

“An attack has lasted, on average, about three minutes. It takes five to eight minutes for responders, for the police to come in, so the attack is over. If you had a teacher who was adept at firearms, they could very well end the attack very quickly, and the good thing about a suggestion like that ... you’ll have a lot of people like that. You can’t have a hundred security guards in Stoneman Douglas.”

Knowledge of this would act as a deterrent to would-be attacked, Trump claimed. “You know, a lot of people don’t understand that airline pilots now, a lot of them carry guns, and I have to say that things have changed a lot. People aren’t attacking the way they would routinely attack and maybe you would have the same situation in schools.”

The president asked for a show of hands in the room over the proposal: some agreed with it, others disagreed. “We can understand both sides and certainly it’s controversial,” he acknowledged.

Nicole Hockley, whose six-year-old son Dylan died at Sandy Hook Elementary School in Newtown, Connecticut, in 2012, spoke out against the idea of arming teachers. “It’s not personally something that I support. Rather than arming them with a firearm, I would rather arm them with the knowledge of how to prevent these acts from happening in the first place,” she told Trump.

Safety assessments programmes, finding out why a child is on that pathway and intervening is crucial, she added. “There are some fabulous solutions being talked about today which still go to imminent danger. Let’s talk about prevention. There is so much that we can do to help people before it reaches that point, and I urge you please stay focused on that as well. It is the gun, it’s the person behind the gun and it’s about helping people before they ever reach that point.”

Earlier during the session in the state dining room, where some speakers were tearful but composed as they recalled their experiences, Hockley also issued a challenge to the president. ‘This is not difficult,” she told him. “These deaths are preventable. And I implore you: consider your own children. You don’t want to be me. No parent does.”

In May 2016, during the presidential election, Trump tweeted: “Crooked Hillary said that I want guns brought into the school classroom. Wrong!”

The proposal, which also followed Trump’s assertion that he would be “very strong” on background checks for gun buyers, came as he sat in the middle of a semi-circle listening intently as six survivors of last week’s shooting and bereaved parents from Parkland, Columbine and Sandy Hook took turns to address him.

Sam Zeif, 18, a Parkland student whose text messages with his brother during last week’s shooting went viral, fought back tears as he told Trump: “No brothers or sisters, family members or anyone ever have to share those texts again. And that’s why I’m here. I lost a best friend. I’m here to use my voice because I know he can’t and I know he’s with me cheering me on.

“And to feel like this, it doesn’t even feel like a week. Time has stood still. To feel like this ever. I can’t feel comfortable in my country knowing that people have, will ever feel like this.”

Zeif added: “I want to feel safe in my school.I’ve started actually enjoying school and now I don’t know how I’m ever going to set foot in that place ... Me and my friends, we get scared when a car drives by, anywhere ... I don’t understand how I can go into a store and buy a weapon of war. How is it that easy to buy this type of weapon? Let’s never let this happen again please, please.”

Source: The Guardian, David Smith, February 21, 2018

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