Officers help evacuate airport passengers during mass shooting at Fort Lauderdale airport that killed five. (Photo courtesy of Daily News) 

(1-8-17) Not everyone agreed with my grim Monday blog about mass murders and my blaming of the dangerous criteria that often is used in deciding who can buy and possess a firearm or be involuntarily admitted into a hospital. Among those with a different point of view was Dr. Annette Hanson, co-author of the book, COMMITTED, The Battle Over Involuntary Psychiatric Care.  Dr. Hanson is an assistant professor of psychiatry at the University of Maryland School of Medicine and Johns Hopkins University School of Medicine. She also is a coauthor of Shrink Rap: Three Psychiatrist Discuss Their Work, and she contributes to a blog by that same name.)

Mass Shootings, Mental Illness, and Public Safety

By Dr. Annette Hanson

Would changing the legal definition of dangerousness for involuntary treatment prevent mass shootings?

In a word, no.

A mass shooting, which is commonly defined as the killing of four victims in a public place, is a relatively rare event.

In 2012, the year with the highest number of mass shootings, there were only seven incidents. Our ability to predict such rare events is tenuous at best. Prediction could be improved if the pool of all potential shooters could be narrowed down a bit, but to date no useful “profile” or typical characteristics of a mass shooter have ever been identified. While some mass shooters have had contact with mental health care prior to their crimes, as many as thirty percent have had no mental health history whatsoever. The strongest consistent characteristic of a mass shooter is male gender, but public gun policy based on gender is obviously impractical.

Even for perpetrators with a history of mental health treatment, changing the legal definition of dangerousness for civil commitment does not help clinicians decide who should or should not be admitted against their will.

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(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.

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(1-13-16) FROM MY FILES FRIDAY – Next week, I will be posting a blog about the recent shooting inside the Fort Lauderdale airport, but today I am reposting an Op Ed of mine published by The Washington Post on September 27, 2013 after a similar rampage at the Washington Navy Yard here in D.C. These shootings continue to spark frustration and anger but little preventive action. This editorial garnered about 100 comments, many agreeing but others strongly challenging my views.)

Getting the mentally ill the help they need

By Pete Earley, published in The Washington Post

When should society intervene if a person shows signs of mental illness?

As with the shooters at Virginia Tech, in Tucson and in Aurora, Colo., there were ample warnings that Aaron Alexis was experiencing mental distress before he killed 12 people at Washington’s Navy Yard.

Police in Newport, R.I., did nothing to help Alexis when he complained about hearing voices and being zapped by skin-vibrating microwaves.

In 1975, the Supreme Court ruled in O’Connor v. Donaldson that the state “cannot constitutionally confine. . . 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.”

That decision established our legal threshold of posing a danger to one’s self or others.

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(1-10-17) Who will president-elect Donald Trump nominate as the new Assistant Secretary for Mental Health and Substance Abuse?

Hearings begin today for the controversial big name cabinet posts so it will be a while before the Senate gets around to the White House’s choice for this new job in the Department of Health and Human Services, but four names already are being circulated on Capitol Hill.

Even before the $6.3 billion 21st Century Cures Act  was signed into law last month (that’s the omnibus bill that contained mental health reforms), I began lobbying for Miami-Dade County Judge Steve Leifman.

The others being mentioned are Dr. John Wernert, who runs Indiana’s mental health system; Dr. Robert Heinssen, a program director at the National Institute of Mental Health; and Dr. Ellie McCance-Katz, the chief medical director in Rhode Island.  Of course, other candidates might surface in the coming days and it’s also possible that Trump could pull a name out of hat that surprises everyone.

But I hope not.

It will take a strong, knowledgeable and accomplished leader to implement the hard-fought reforms that became law primarily because of Rep. Tim Murphy (R-Pa.) and Sens. John Cornyn (R-Tx.), Chris Murphy (D-Conn.) and Bill Cassidy (R-La.)

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judgment

(1-6-17) FROM MY FILES FRIDAY: Four years ago, I wrote about how quickly people often are at judging others, especially those who face tough decisions because they love someone with a mental illness or a brain disorder.  This blog was published January 16, 2012, after the Washington Post published an article about a woman who fell in love with someone else after her husband became mentally incapacitated and about the anger aimed at the parents of Jared Loughner, the Tucson shooter, after I defended them in a USA TODAY story. It is a reminder of how easy it is to judge when you are on the outside looking in.)

Two unrelated stories last week caused me to think about how easy it is to blame others without “walking in” their shoes.

The first was an incredible magazine story published by The Washington Post written by Susan Baer. I once worked at the magazine and knew the subject of the cover story, Robert Melton, although certainly not well. Melton suffered a stroke that drastically reduced his cognitive abilities. He was married and his wife, Page, continued to love and take care of him even though he had become a stranger who had little understanding of their marriage or her.  Eventually, Page fell in love with another man. She divorced her husband to marry him.

What makes this story different is that Page and her new husband did not abandon Robert. Rather, they made him a part of their new family and even moved Robert with them to St. Louis when she joined her new husband to begin their lives together.

The story, which was brilliantly told, was a courageous effort to describe one of the most difficult challenges that a person can face in their lives:  what do you do when someone you love suffers a debilitating brain injury. It is an especially poignant question for those of us who love someone with a severe mental disorder or develops dementia.

Many readers saw the article much differently from me. Writing in today’s Washington Post, columnist Robert McCartney revealed in his column that the story sparked a torrent of mean-spirited comments from readers, especially anonymous ones.

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(1-2-17) I was honored last week to be interviewed by Jennifer Bleyer, a senior editor at Psychology Today. 

A New Day for Mental Health

Author and advocate Pete Earley reflects on passage of mental health reform.

In a year when political discourse seemed to reach all new levels of fire-spitting acrimony, one collaborative bright spot was the recent passage of the 21st Century Cures Act, part of which aims to reform the nation’s mental health care system.

The $6.4 billion legislation received broad bipartisan support in the Senate and House and was signed into law by President Obama earlier this month, and includes provisions intended to improve the diagnosis and treatment of mental health and substance use disorders, increase access to effective, evidence-based mental health services, and shift the seriously mentally ill away from the criminal justice system and into appropriate treatment.

I heard author and mental health advocate Pete Earley speak about the pending legislation in September at a National Press Foundation fellowship seminar, Training Journalists in Mental Health, in Washington. Earley is the bestselling author of Crazy: A Father’s Search Through Mental Health Madness, a 2006 book that tells the story of his own experience after his college-aged son developed bipolar disorder and spent years cycling through hospitals and jails; Earley also reported on life inside Miami Dade County Jail, which like much of the U.S. prison system has become a de facto warehouse for the untreated or undertreated mentally ill.

Since the publication of Crazy, Earley has become a vocal advocate for mental health reform in writing and speeches to stakeholders all over the country. He has testified or appeared before Congress five times, including once in the exploratory phase of the legislation that just passed. I reached out to Earley to hear his thoughts on the new law.

What’s your general reaction to the passage of this legislation?

Overall, I’m hopeful that this bill signals a real shift in where mental health is going. It refocuses programs on evidence-based tools that will look at serious mental disorders such as schizophrenia, bipolar disorder, and severe and persistent depression rather than other DSM-5  disorders, such as restless leg syndrome and problems of the so-called “worried well.” It calls for a serious reexamination of HIPAA with an eye toward allowing caregivers, especially parents of the mentally ill, more access to information and participation in the treatment team, which is good. It calls for additional funding forassertive community treatment, which is perhaps the most effective and cost-efficient way of treating people in our communities, especially when combined with housing. I’m especially thrilled with the emphasis on how to stop the inappropriate incarceration of people with mental illness. What we’ve discovered is it’s cheaper to provide treatment and help people than it is to have them going in and out of jail constantly. So I like the funding that Senator John Cornyn of Texas got for crisis intervention team (CIT) training, which teaches law enforcement and communities how to handle the mentally ill, as well as mental health courts and reentry programs.

Overall, I think the biggest achievement is that it elevates the importance of mental health in the federal government through the appointment of an Assistant Secretary for Mental Health and Substance Abuse. I think that will cause a major shift in [the] Substance Abuse and Mental Health Services Administration, which is what Rep. Tim Murphy (a sponsor of the bill) wanted, making it focus more on mental health and less on programs that Murphy strongly felt are anti-psychiatry and feel-good programs with little value. All of the changes in the new law are positive steps forward, but it will all depend on whether someone strong enough to change the culture at SAMHSA is appointed and whether HHS and the feds put money behind necessary services, which they have never done adequately.

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