Public discussion and debate about the Aurora, Colo., horror has missed the point. With numbing predictability, liberal opinion leaders in the press have focused on gun laws as the potential solution for such atrocities, while conservatives have responded that maniacs will find ways to kill people and therefore, nothing can be done about rampage shootings. Others have speculated that our excessively violent entertainments are tipping borderline types into spasms of real violence.
I’m no fan of degraded entertainment, yet I suspect that saturation media coverage of these events is probably more culpable. But surely a more fruitful avenue of inquiry concerns our utterly dysfunctional mental health system. We don’t know much about the killer in Colorado yet, but in many cases of rampage shootings, family members, colleagues or teachers saw signs of trouble before the eruption of violence. Family reports of disturbing behavior are often not enough because too many state laws require that a person be “imminently dangerous” before he can be involuntarily committed — even for a short time. Thus, we have failed utterly to protect those in dire need of treatment and also placed society at increased risk from the minority of mentally ill people who are dangerous.
For years, mental health authorities assured us that the mentally ill were no more dangerous than the average person. That’s true of most, but not all. As Dr. E. Fuller Torrey documents in his essential book, “The Insanity Offense,” rates of violence among the untreated mentally ill are significantly higher than among the general population and are also much higher than among those receiving medication. Between 5 and 10 percent of the untreated seriously mentally ill will commit violent crimes in any given year, accounting for at least 5 percent of homicides in the United States (a huge percentage in a nation of more than 300 million). For rampage crimes, such as the Aurora attack, the percentage of mentally ill perpetrators is much greater, as high as 50 percent.
Since the 1960s, when deinstitutionalization became intellectually fashionable and fiscally alluring to states looking to save money, the mentally ill have been dumped onto the streets. Today 95 percent of the in-patient beds that were available for psychiatric patients in 1955 are gone. The Treatment Advocacy Center explains that, “The consequences of the severe shortage of public psychiatric beds include increased homelessness; the incarceration of mentally ill individuals in jails and prisons; emergency rooms being overrun with patients waiting for a psychiatric bed; and an increase in violent behavior, including homicides, in communities across the nation.” Imagine if we treated the mentally retarded this way.
In many cases of mental illness, a belief that one is not in need of treatment is part of the sickness. Yet most studies show that the majority of those who are medicated against their wishes retroactively approve and believe it should be done again if necessary. In New York, 62 percent reported that being ordered by a court into treatment was a good thing for them.
Additionally, a number of avenues are available to ensure that the mentally ill continue to take their medicines once discharged. Supplemental Security Income, Medicaid and other public benefits can be tied to compliance. As in the case of tuberculosis, patients can be required, on pain of jail or loss of benefits, to take their medicines in the presence of a health professional.
According to the Treatment Advocacy Center, 42 states have adopted Assisted Outpatient Treatment, or AOT, programs, but only a minority uses them. AOTs require that patients comply with their treatment regimens or risk losing their housing and the right to live in the community. In New York, only 34 percent of patients regularly took their medicine before the AOT was implemented. Afterwards, 69 percent did so, resulting in a marked decline in hospital admissions. Other states have found that AOTs also reduced homelessness and the risk of being victimized among the mentally ill. In North Carolina, the use of AOTs also resulted in a decline in arrests from 45 percent to 12 percent in one year.
For the most dangerous mentally ill, estimated to number about 40,000 nationwide, a red-flag alert system could be adopted that would give mental health professionals, police and firearms dealers warning. With the proper safeguards, such a system would permit families of the mentally ill to get help for their relatives, as well as provide warnings to society.
There are partial solutions to atrocities like that in Colorado, but they require abandoning the extreme civil libertarian approach that has marked the treatment — or mistreatment — of the mentally ill for the past half-century.