(1-16-17) Twenty four days after President Barack Obama signed into law what was billed as the most major mental health reform bill in decades, a gunman pulled a semi-automatic pistol from his checked luggage in the Fort Lauderdale-Hollywood International Airport and began shooting, murdering five and injuring six others.
It is fair to ask if any of the reforms in the mental health bills that were merged into the 21st Century Cures Act would have stopped Esteban Santiago-Ruiz from committing murder.
Sadly, I believe the answer is no.
Yes, the Helping Families in Mental Health Crisis Act, the Mental Health and Safe Communities Act, and the Mental Health Reform Act, included promising initiatives. The bills call for better law enforcement training, more support for early identification and intervention programs, greater use of Assertive Community Treatment, more peer provided services, additional funds for community mental health programs and for continued funding for Assisted Outpatient Treatment.
Having police officers who have been Crisis Intervention Team trained can intercede and stop violence, having peers available to help persons with mental illnesses who encounter the police can help stop violence, access to better services can stop violence, and outpatient treatment can stop violence.
But none of these programs can make a difference if the person who is sick either doesn’t believe he/she is ill or rejects help. Whether by persuasion or coercion, there is no legal way in America today to stop a mentally distributed individual from buying or owning a gun unless they are or have been ruled a danger to themselves or others, or previously hospitalized.
After the Virginia Tech shootings in 2007, states hurried to restrict the sale of firearms to individuals with mental disorders. It proved trickier than many first thought, in part, because of how loosely we define what is and isn’t a mental illness. (Remember the DSM-5 includes ‘restless leg syndrome’ as a mental disorder.) This led to most states adopting the same criteria in denying gun ownership as they used in deciding if someone needed to be involuntarily hospitalized.
That standard was established by the U.S. Supreme Court in the precedent setting case: O’Connor v. Donaldson when it ruled:
May the State fence in the harmless mentally ill solely to save its citizens from exposure to those whose ways are different? One might as well ask if the State, to avoid public unease, could incarcerate all who are physically unattractive or socially eccentric. Mere public intolerance or animosity cannot constitutionally justify the deprivation of a person’s physical liberty. In short, a State cannot constitutionally confine without more a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends…
Having a mental illness should not be illegal. No one should be held against their will simply because they are hearing voices. No one should be incarcerated simply to “avoid public unease.” All of us understand that. None of us, especially family members of someone with a mental disorder, want that.
But what happened in Florida is a repeat of what has occurred nearly every time one of these mass murders happens, whether it is a shooting in Tucson, in Aurora, in Newtown, or at the Navy Yard. There were clear warnings. Alarm bells sounded. Yet no one acted because the shooter did not meet the dangerous criteria for intervention.
Let’s look at this most recent case. The accused Florida shooter had his personal firearms taken away from him twice before he allegedly became a mass murderer. We don’t know what happened in 2012 when authorities in his native Puerto Rico confiscated his guns for two years before returning them. Those records apparently have been destroyed. But we do know what happened last year.
Three months before the Florida airport shootings, Santiago-Ruiz visited the FBI field office in Anchorage and reported that the U.S. government was controlling his mind, was making him watch videos by the Islamic State of Iraq and the Levant and that the CIA was forcing him to join the group. He stated that he was hearing voices in his head telling him to commit acts of violence, but he also said that he was in control and did not intend to hurt anyone.
Authorities recognized that he was disturbed, enough so that they urged him to seek mental health treatment and they notified the local police who detained him and took him to a medical facility for a mental health evaluation. He was later investigated by the FBI, who discovered no links to terrorism or any violation of laws occurring during the incident. Alaska police took his handgun from him due to the incident, but returned it in December because Santiago-Ruiz had not been convicted of a serious crime, involuntarily committed to a mental institution, or adjudicated mentally defective.
According to the Sun Sentinel newspaper:
Anchorage police took him to a psychiatric hospital, where he agreed to be admitted for evaluation. He was discharged after 72 hours, according to his family.
A doctor had told him he may have schizophrenia, a serious mental illness that can strike in young adulthood. A hallmark is auditory hallucinations.
But since a court had not found him mentally ill, Anchorage police had no legal reason to keep his gun and they gave it back to him.
Clearly there were ample warnings that Santiago-Ruiz was a tinderbox. It is also important to note that Santiago-Ruiz contacted the FBI on his own and went voluntarily for evaluation. He apparently recognized something was wrong with his thinking, was worried and wanted help. This was a critical moment when someone could’ve and should’ve interceded. But he didn’t receive help. Why?
Those of us who have been through this process with our own family members know the answer: he wasn’t deemed sick enough. He wasn’t considered dangerous enough to be held longer than 72 hours. At that point, he either refused to sign himself into a hospital or he wasn’t offered a bed because there were no beds available or no one wanted to admit and treat him for a variety of other reasons, such as no insurance coverage.
So here we are, back to the same issue that is raised after each of these shootings, hearing the same old excuses.
(Ironically, if Santiago-Ruiz had lived in Florida, there’s a high probability that his gun would have been taken away from him. Unlike most states that allow someone with a mental illness to own a weapon until they have been convicted of “a serious crime, involuntarily committed to a mental institution, or adjudicated mentally defective,” Florida allows the state to confiscate guns if someone voluntarily admits themselves into a hospital for evaluation. The Florida statute does not apply to people who voluntarily go to private counseling for help, nor people who seek psychiatric help from a doctor or voluntarily go to a public clinic. It applies only to individuals who have been taken to a mental health facility by the police or others under a commitment order for a Baker Act hearing to determine danger to self or others.
The Florida law was passed, with support from the National Rifle Association, which described its backing in an email this way:
“The problem is that some of these dangerous people with mental illnesses who are known to be a danger to self or others, immediately revoke their voluntary agreement as soon as they reach the treatment facility. They must then be released within 24 hours.”)
The Florida law, HB1355, is an example of a state trying to tweak its laws to prevent a tragedy, without state legislators dealing with the elephant in the room.
No one can accurately predict dangerousness, which is why the Supreme Court’s ruling, while eloquent and inspiring, ultimately creates a fool’s standard.
Initially, Rep. Tim Murphy (R. Pa.) attempted to address the dangerous criteria in his original bill. I testified at his first hearing held after the Sandy Hook Elementary School shootings. But Murphy’s attempt to deal with the folly of the dangerous criteria slipped away because it is each state’s duty to establish criteria for involuntary commitment, not the federal government’s, and because the dangerous criteria is the most sacred of all hard-won civil rights by people with mental illnesses.
I DO NOT want to strip away the civil rights of persons such as my son. I am fully aware of how horribly we have treated persons with mental illnesses in our nation. But it is time for the U.S. Supreme Court and state legislators to understand that waiting for someone to become dangerous simply sets the stage for these mass murders. I’ve written before about how other countries have criteria that focuses on a need for treatment. Would those criterial be accepted in the U.S. given the past abuses that happened in our state run institutions and current abuses too? (See BuzzFeed reports about how the nation’s largest provider of mental health services has been accused of overstating patient symptoms to keep them hospitalized to maximize insurance benefits.)
I doubt that either the Supreme Court justices or any state legislators would be willing to override O’Connor v Donaldson, which appears to leave us with two sad choices.
We can upfront mental health services and push for better, easier accessible care. We can move to make our involuntary commitment system kinder and more dignified while still maintaining the dangerous criteria. But if we do all of that, we still must accept that mass murders are inevitable.
Or we can do our best to establish as many safeguards as we possibly can into a system that is uploaded and more welcoming but loosens the standard to a need for treatment, and accept that we will be favoring the public good over the individual good, making abuses of individuals inevitable.