BN: Improvements in MH Care Won't Help Identify Mass Shooters

NYAPRS Note: The following piece looks at efforts to ramp up state mental health systems and whether these efforts would indeed prevent mass shootings and other forms of violence. It features Columbia’s Paul Appelbaum’s assertions that “improving the mental- health system would ‘have a relatively small impact on overall rates of violent victimization.”

Dr. Appelbaum, ACMHA President Ron Manderscheid and the National Empowerment Center’s Dan Fisher were among the first to respond to the Newtown tragedy and its implications for people with psychiatric diagnoses and mental health service systems. All 3 of them will be joined by NYAPRS President Steve Coe in a featured panel presentation entitled “Rethinking the Mental Health System in Response to the Newtown Legacy” at NYAPRS’ April 25-6 Annual Executive Seminar in Albany. See program and registration details at

Expecting Mental Care to Curb Shootings Overlooks Neglect

ByJames Rowley Bloomberg News February 27, 2013

Counting on improved mental-health care to help avert gun violence such as the shootings in Newtown,Connecticut, and Tucson,Arizona, overlooks years of neglect and funding cuts.

TheNational Rifle Associationand its mostly Republican allies propose bolstering the mental-health system in place of gun-control measures sought by PresidentBarack Obamaand other Democrats. States have reduced mental-health spending by 10 percent since 2009, and with federal spending cuts starting March 1, money for improvements is scarce.

“The infrastructure for the public mental-health system is in the worst shape it’s been in 40 years,” said Robert Glover, executive director of the National Association of State Mental Health Program Directors. “We’re not responding adequately to routine mental-health needs, let alone crisis issues.”

The Senate Judiciary Committee is set to hold a hearing today on Obama’s Jan. 16 proposal to reinstate an assault-weapon ban, which expired in 2004. The NRA opposes that and other limits on gun ownership. A better alternative, it said, is “securing our schools, fixing our broken mental health system and prosecuting violent criminals.”

More spending would be required to improve a deteriorating public mental-health system financed by the states and federal Medicaid. States have cut about $4 billion, or 10 percent, of their mental-health spending since 2009, according to Glover’s organization, based in Alexandria, Virginia.

Jared Loughner

Even if governments spend more money, experts including Paul Appelbaum, a psychiatry professor atColumbia University Medical CenterinNew York, question whether improvements in care would help identify mass shooters like Jared Lee Loughner, who was diagnosed as schizophrenic after his arrest in Tucson.

“As far as we know he was never seen” by mental-health professionals before his arrest and diagnosis by prison psychiatrists, Appelbaum said.

Loughner pleaded guilty in August to fatally shooting six people and trying to kill then-RepresentativeGabrielle Giffordsin 2011.

“It’s very difficult to be able to identify, among the many troubled people who come for mental-health treatment, that very small number who are truly likely to act on their impulses,” Appelbaum said in a telephone interview.

‘Small Impact’

Loughner’s case demonstrates that improving the mental- health system would “have a relatively small impact on overall rates of violent victimization,” Appelbaum said. Most violent acts can’t be attributed to mental illness or occur in an early stage of illness, he said.

Still, after a 2007 mass shooting on a college campus, Virginia lawmakers voted to require information about outpatient psychiatric therapy to be included in the database for screening potential gun purchasers. Seung-Hui Cho, who killed himself and 32 others at Virginia Polytechnic Institute and State University in Blacksburg, had failed to undergo court-ordered outpatient psychiatric care and was able to buy weapons after a judge determined he posed a danger.

The gun-control debate was revived when 20-year-old Adam Lanza stormed Sandy Hook Elementary School in Newtown on Dec. 14, killing 20 students and six adults. The main weapon he used was a semi-automatic rifle with multiple high-capacity magazines, police said. Lanza, who fatally shot his mother before going to the school, committed suicide.

Obama in January proposed banning semi-automatic weapons, limiting the capacity of ammunition magazines and expanding background checks for gun purchases. The administration also is studying improved access to mental-health care.

Strong Opposition

The NRA didn’t respond to repeated requests for comment. An assault-weapon ban faces strong opposition in the Republican- dominated House and lacks the votes to pass the Democratic- controlled Senate. At least six of the 55 senators in the Democratic caucus expressed skepticism or opposition to a ban as of last month.

Rather than restricting the constitutional right of “law- abiding citizens” to own guns, Representative Mac Thornberry, a Texas Republican, said in a Jan. 16 statement, “a more responsible approach is to take significant steps to address mental illness and the root causes of such violence.”

Glover and other mental-health advocates say fixing the system won’t be quick, easy or inexpensive. Starting March 1, $85 billion in across-the-board federal spending cuts are scheduled to take effect.

Sebelius Letter

Health and Human Services SecretaryKathleen Sebeliustold Congress in a Feb. 1 letter that the spending cuts will jeopardize mental-health services for 373,000 “seriously mentally ill adults” and emotionally disturbed children, and outreach services for 8,900 homeless people with mental illness.

Even if governments restore spending, “you won’t be able to rebuild the infrastructure of the public mental system overnight,” Glover said.

Mental-health workers must be recruited and trained to work in a system that has been neglected since the 1970s, when states began closing large mental hospitals and changed the focus to community-based services, advocates say.

Many states “underestimated the amount of support services, housing and treatment” that was needed, said Linda Rosenberg, president of the National Council for Community Behavioral Healthcare.

People released into the community from state hospitals often “would wind up on the streets or wind up in jails,” said Rosenberg, a former New York state mental-health official.

Community Treatment

Community-based treatment is expensive, particularly housing patients in residential centers, said Democratic Representative Jim McDermott ofWashington, a psychiatrist.

Society treats “people who have problems by throwing them into someplace where they don’t bother us,” McDermott said. When a mass shooting occurs, lawmakers and other public officials talk “about how much they care about this and then they vote ‘no, no, no,’” he said.

In Connecticut, which ended 2012 with an 8.6 percent unemployment rate, GovernorDan Malloyis trying to balance the state budget and meet the public demand to improve the state’s mental-health system following the Newtown shootings.

Malloy, a Democrat and advocate of stricter gun laws, restored $7.7 million this month for mental-health services that had been rescinded weeks before the Newtown shootings.

Little is known about Lanza, except that a friend of his mother said he was diagnosed with Asperger’s syndrome, a form of autism, and lived a reclusive life with his mother.

$60 Million

Malloy has proposed another $60 million for mental-health services over the next two years. Still, his two-year budget hasn’t satisfied community mental-health providers.

It would impose “draconian cuts” on services to the uninsured, said Raymond J. Gorman, president of Community Mental Health Affiliates, which serves 8,500 adults and children in central Connecticut. The cuts assume those people would receive treatment under next year’s expansion of Medicaid, he said.

People who “don’t trust anyone” and “may live under a bridge” are less likely to navigate the bureaucracy to qualify for Medicaid, Gorman said.

In Washington, a bipartisan group of senators proposed allowing public mental-health centers to bill Medicaid for more of their expenses. That would cost $1 billion over a decade.

Republican SenatorRoy Bluntof Missouri said his party would be willing to pay for that to help prevent gun violence.

“We all know that what we have been doing in mental health is not working and hasn’t worked for about 50 years, if it’s ever worked,” Blunt said.