Mass killings and mental health

Moderated by Tom Sabulis

By Frank E. Shelp

Horrible killings across the country dominate the news and the agendas of President Barack Obama, Congress and many state legislatures.

The discussion involves guns, mental illness and violence in video games and movies. But if guns and a culture of violence fed by games and movies were the issues they appear to be, then a city such as Chicago should be the impetus for concern rather than small cities and towns. Chicago had 10 times the death and mayhem last year than Tucson, Ariz., Aurora, Colo., and Newtown, Conn. combined.

The debate over gun accountability and our society’s gluttony for violence in games and movies will continue. Mental health is the area most likely to be explored superficially, couched in cries for money and involuntary confinement of people with mental illness. Yet it is likely none of the recent shooters would have been hospitalized even if they had been evaluated the day before their terrible acts. Snapshot evaluations and acute hospitalizations are not solutions for the progressive effects of untreated mental illness. Maintaining engagement in active treatment is the single most effective and direct element in avoiding tragedies like these.

Our mental health system is described as fragmented, inadequate and dysfunctional. Our safety net of community mental health centers and service boards is largely a training platform for inexperienced, newly licensed or not-yet-licensed counselors and clinicians. Accountability for productivity is highly variable and, for effectiveness, largely nonexistent.

Family, school officials and others knew the shooters in recent tragedies to be troubled at a minimum. Severe mental illness is alienating. It begins with alienation from school and employment, then friends and family. Those with severe mental illness need to be engaged and maintained in their own treatment and recovery, not further alienated by quick-fix policies.

President John F. Kennedy signed the Community Mental Health Act in 1963. It was intended to provide consistent, continuous active treatment in the community while still providing hospitalization when needed. Many states saw this as an opportunity to divest of costly institutions while redirecting money intended for community mental health care to other priorities. De-institutionalization without appropriate community care led to homelessness, poverty and violence toward the mentally ill, far more than by them.

Medication is helpful, but if it were only a matter of taking medicine, the solution would be easy. As in all medicine, diet, exercise, better choices and active engagement of the individual in their recovery is needed.

There are no simple fixes. Laws on the books do not translate into effectiveness in the field. What is needed is an examination of our community mental health safety net.

The most relevant questions we can ask are: Is the skill and expertise in place? Is there measurable value for what is spent? Is our safety net focused on the most needy? Does it serve and support those most severely ill? Are mental health counselors and therapists experienced, motivated and supported in maintaining engagement with those most in need?

Dr. Frank E. Shelp M.D. is former commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities.

26 comments Add your comment

Psuedodipsomaniac

February 3rd, 2013
8:24 pm

Reading the comments, it’s not difficult to ascertain that certain commentors have an axe to grind politically with Frank Shelp. However he is spot on with his analysis of the gun violence. It’s not the guns that kill, it’s the gun-NER. IF the cowardly and liberal judges in this country would hang guilty killers and let the buzzards eat the sorry flesh off their bones, we would see LESS gun violence rather quickly. The doctor who brutally killed his wife with the crow-bar was eligible for parole after five years in the slammer. Hanging him might have served as a better deterrent than the 5 years he served in prison (which was probably the “country club type” for the white collar boys). The laws we have ON THE BOOKS NOW need to be enforced rather than the courts appointing an attorney for the defendant and allowing him to plea some type of “insanity” for lesser sentences. What a system! The killer has more rights than the victim. Imagine what could have happened at Sandy Hook if the killer walked in with two BBQ-grill propane tanks and a fuse…….would anyone have thought ill of him walking with those murder weapons? Again Guns don’t kill people, murderers do.

woody

February 3rd, 2013
5:01 pm

In my mind this issue keeps bumping up against the practice or principle of involuntary committal to a mental institution. I think at one time, this was a kind of safety valve for our society. Unfortunately, the system was largely run by people who were unethical or even unskilled, and the current barriers to being involuntarily committed came about. This led to the most visible symptom of a societal failing, the presence of many homeless on our streets, but also to the less apparent but far more threatening symptom, whacked out people who go off the deep end and kill their family, a public figure, or many people at once in a massacre. These people are to a large extent identifiable by family or others, but the identifiers have no actionable place to go with their concerns.

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Good riddance

February 3rd, 2013
3:09 pm

The CMHC’S safety-net organizations were largely successful in ridding Georgia of the destructive, tyrannical, and unstable Frank Shelp. Sonny Perdue, what were you thinking? Nathan Deal, way to go!

n

February 3rd, 2013
2:24 pm

The issue is very simple. There are too many people living in too small an area. When Sigmund Frued visited NYC in the 1920s and he saw all the people he said,” I’d go nuts if I had to live here,too many people living together”. People need room, Tuscon, Newtown, Aurora, Colorado and Chicago are high density areas. How often do you hear of mayhem and madness in the wide open areas of Arizona, New Mexico and Utah? Never.
Trying to make a complex situation about mass murders is not needed. Listen and learn.

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