Is the Lesson of the Aurora Shooting That We Need Better (Or More Compulsory) Mental Health Services in the U.S.?

Maybe the problem isn't Hollywood, a lack of Christian ethics, guns, Occupy Wall Street, nerds, or the Tea Party. Maybe the problem is crazy people sometimes shoot other people. And maybe what is most surprising is how little people have been pushing the familiar narrative that a better, perhaps more coercive mental health system could have prevented tragedies like the July 20 shooting that killed 12 people who just wanted to see The Dark Knight Rises. But here comes that narrative, and maybe when the blame the Tea Party! I mean Occupy Wall Street! screams have died down, more people will go back to worrying that the mentally ill are all one moment from massacring us all, especially if they're obsessed with Batman.

Though mental illness is certainly less scientifically solid than some experts would like you to believe (check out Jacob Sullum on some of the problems with the holy psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders IV) it also exists in some fashion. In spite of the terror over Sarah Palin and angry rhetoric post-Tuscon shooting, it turns out Jared Loughner was just pretty God damn loony. Norway's monstrous Anders Brevik, on the other hand, had a long-winded manifesto detailing why he had to blow up and then shoot 70-odd countrymen. Still, you could argue that he was loony as well. Aren't people who slaughter other people crazy? What else do you call hunting down children in order to keep your country free from immigrants? The debate about James Holmes, the suspect behind the Aurora, Colorado massacre is now beginning; is he crazy or a cold, calculating terrorist? What's the difference? Can he be both, much like Columbine killer Eric Harris turns out to have been a probable psychopath who also had ambitions to change the world with violence?

Over at Pajamas Media, Clayton E. Cramer has posited a variation on this familiar, anti-libertarian theme. Cramer writes that the origins of some America's recent, nastiest shootings stem from that period of deinstitutionalization of the mentally ill that happened in the 1960s-1980s. Back in the day, it seems, you didn't tend to see homeless, mentally ill folks on every other street corner, because they were locked up. Cramer doesn't exactly go out and say that the standards for committing folks should be lowered, but he strongly implies just that. He points to the supposed dangers of Addington vs. Texas (1979) which established that long-term involuntary commitment was kind of a serious thing. So that decision "raised the burden of proof required to commit persons from the usual civil burden of proof of 'preponderance of the evidence' to 'clear and convincing' evidence." However,  "there was no reduction in the rates of commitment as a result of the decision."

Basically, the old standby "beyond a reasonable doubt" was an unfair burden on the state, due to the tricky nature of mental illness. So they decided that the standard for commitment was somewhere in the middle of standards of higher standard of proof for criminal cases versus less for civil ones. 

Cramer is clearly not keen on this, and he points to several studies that point to the high number of prison inmates who seem to be suffering from mental illness. He links to to a 2005 Department of Justice study which reports that 65 percent of local inmates, 56 percent of state inmates, and 45 percent of federal inmates have some kind of mental health issues. But of course, huge percentages of the 2 million people in prison are there for drug-related crimes, not exactly obvious signs that they are would-be Loughners, Mansons, or Dahmers. 

In two pages, Cramer is rather squirrelly as he avoids saying exactly what he wishes the standards of commitment might be, only that they are not what they should be (and that they are not what they once were). He concludes: 

When you watch a relative spiral down into severe mental illness, you know that there is something terribly wrong, but our legal system has made it nearly impossible to provide help to those who are insane. 

[…]

The mainstream media, of course, are using this tragedy in Aurora as an argument for restrictive gun control. But the core problem — the deinstitutionalization of the mentally ill — is simply being ignored.

Over at Fox News, psychiatrist Keith Ablow is also sure that there is a similar lesson to be gleaned from Aurora:

Because, in the end, it will become clear that more than one person—and probably several, including family, friends, neighbors, classmates, health care personnel or educators—knew or should have known that James Holmes was confused, losing sight of reality, experiencing severe mood swings, withdrawing from the world around him, experiencing violent fantasies or all of the above.

He goes on to worry that many people don't know they can get help if a loved one is acting strangely:

They don't know that they can call 911 or that they can call their local police. They don't know that they can petition a district court to commit a loved one to a psychiatric facility. Many have no idea that their communities are covered by mental health centers with crisis teams that are duty bound to respond to such matters by at least considering the possible risks or evaluating the individual in question.

Perhaps so, but Reason readers might recall the dangers of calling police when someone is in emotional distress, chronic or acute. Even in the last two years, Kelly Thomas, Kyle Miller, and Nick Christie — all mentally ill in some fashion — died at the hands of police. Brian Aitken, who nearly went to jail for seven years thanks to New Jersey's convoluted gun laws, found himself in police hands after his mother called them, concerned about her son's mental state.

The state's ease of commitment was also chipped away at in the 1975 case O'Connor vs. Donaldson which held that "A State cannot constitutionally confine a non-dangerous individual who is capable of surviving safely in freedom by themselves or with the help of willing and responsible family members or friends" in response to a man who had been held for 15 years in a mental institution without treatment and without any proof that he was a danger to others, besides a few expressions of paranoia delusions pre-commitment. Fifteen years is a very long time to violate a man's rights just because he displayed some seemingly baseless paranoia.

As Jacob Sullum wrote in April 2011 in Reason's special issue on the Tuscon shooting, when this more commitment idea was being bandied about as a could-have-stopped it thesis:

On The New Republic's website, University of Maryland political scientist William Galston warned that "the rights-based hyper-individualism of our laws governing mental illness is endangering the security of our community and the functioning of our democracy."

These and many other critics argue that innocent people could be saved if it were easier to imprison dangerous lunatics like Jared Lee Loughner before they commit crimes. But the champions of involuntary psychiatric treatment rarely consider the innocent people who would be stripped of their freedom and forced to take antipsychotic drugs if the government were allowed to lock up potential Loughners based on little more than their wacky beliefs and off-putting behavior.

Reason contributor and editor in chief of The Freeman Sheldon Richman also wrote in a 2004 essay in Freedom Daily that even libertarians are guilty of forgetting about the inherent civil liberties violations that involuntary commitment entails:

A person diagnosed as mentally ill and judged to be a danger to himself or others has practically none of the rights enjoyed by the rest of us. Notice the failure to distinguish between harm to oneself and to others — a basic distinction in libertarianism. Such a person can be committed to a hospital and forcibly administered drugs and other brutal psychiatric interventions. Or he can be subjected to "outpatient commitment," according to which he will be compelled to take drugs. If he refuses, he can be hospitalized, that is, locked up. It is estimated that some two million people are committed against their will in the United States each year.

It's true. Even if you are unconvinced of Thomas Szasz's thesis of The Myth of Mental Illness, it is undeniable that to lock someone up for mental illness can be worse than a jail sentence in that it can be done for literally nothing except strange behavior. And it can be indefinite.

It's been a handful of decades since the U.S. forcibly sterilized scores of thousands of the "feeble-minded" and disabled. Around that time they also spent years violating all medical ethics by neglecting to tell 400 black males that their syphilis was not being treated. Doctors, even those of mental health, know a lot, but they don't know everything. Hopefully in a few years people will look at involuntary commitment of individuals with as much shame as we now look at eugenics, the Tuskegee Experiment, or even the Japanese internment.

Meanwhile, shootings will still happen every once in a while, because that's just what happens. As someone who had every right to be irrationally angry, screaming for blood, or laws or anything to fix what happened, once said, "in a free society, we're going to be subject to people like this. I prefer this to the alternative." That was the father of Jared Loughner's youngest victim, nine-year-old Christina Green, just one day after she died.

Reason has reported on mental illness questions in the past, most notably Jacob Sullum's fascinating 2000 interview with Thomas Szasz. Also check out, "Mad Enough to Lead," my May look at two different books exploring the link between mental illness and power.