So if insurance coverage and early identification are not the problem, what is? The critical issue, quite simply, is getting these mentally ill, potentially dangerous individuals into psychiatric treatment before they carry out mass killings. Accomplishing this involves two things: having sufficient psychiatric beds available so that such individuals can be hospitalized for evaluation, and having adequate commitment laws that allow for such evaluations before the individual has demonstrated dangerousness.
There are major impediments to both measures. As a result of the closing of state mental hospitals, the United States has only 5 percent of the public psychiatric beds that were available 50 years ago. Virginia, Arizona, Colorado, and Connecticut all have major psychiatric-bed shortages. Even if decisions had been made to hospitalize Cho, Loughner, Holmes, or Lanza for an evaluation, it is doubtful that a public psychiatric bed could have been found. Lanza’s case is especially ironic, as one of Connecticut’s three state mental hospitals was located in Newtown a short distance from his home — until it closed in 1996.
Having adequate state commitment laws is even more problematic. In recent decades, under intense lobbying by civil-rights organizations, commitment laws for mental illness in most states have been made increasingly strict. In many states they permit involuntary commitment of mentally ill individuals only after they have demonstrated dangerousness. Involuntary commitment and treatment are necessary because in some cases schizophrenia and bipolar disorder impair the parts of the brains we use to think about ourselves. Individuals thus afflicted lack the capacity to appreciate their own illness or need for treatment. They think that the voices commanding them to kill are really coming from God, or that the CIA is really trying to kill them. This unawareness of one’s own illness is a neurological condition called anosognosia. It clearly affected Cho, Loughner, and Holmes and probably affected Lanza. This means that any evaluation or care they might have received — that is, before they committed mass murder — would have had to have been carried out by means of an involuntary commitment. It was the only effective means by which these tragedies could have been prevented.
The Biden task force did not address either of these problems because they are not on SAMHSA’s agenda. Instead, the task force recommended that the Obama administration ask Congress for an additional $235 million, most of which is to be used to train teachers to identify the signs of mental illness in their students and to provide “mental health first aid,” whatever that is. This recommendation was enthusiastically applauded by school administrators who are always looking for new sources of federal funds, but it will have no effect on the problem of untreated severe mental illness.
The Obama administration then followed up the task force on June 3 with a one-day National Conference on Mental Health, at the White House. This conference brought together the usual leaders of the mental-health community, who appeared to agree on only one thing — that the federal government should do more. There was also much discussion of widespread stigmatization of individuals with severe mental illness by the general public. Since studies have shown that the largest cause of such stigma is high-profile homicides committed by untreated individuals like Cho, Loughner, Holmes, and Lanza, that aspect of the problem was not discussed.
At the same time that the failed Biden task force was holding hearings, another set of hearings, which are more likely to produce significant change, was taking place in Congress. These hearings were convened by Representative Tim Murphy (R., Pa.), a psychologist by training and the chairman of the Subcommittee on Oversight and Investigation of the Committee on Energy and Commerce. The hearings were titled “Examining SAMHSA’s Role in Delivering Services to the Severely Mentally Ill.” In contrast to the Biden task force and White House conference, Murphy said:
One lesson we must immediately draw from the Newtown tragedy is that we need to make it our priority to get those with serious mental illnesses, who are not presently being treated, into sound, evidence-based treatments. . . . [Such treatment] can reduce the risk of violent behavior fifteen-fold in persons with serious mental illness. . . . SAMHSA has not made the treatment of the seriously mentally ill a priority. In fact, I’m afraid serous mental illness such as schizophrenia and bipolar disorder may not be a concern at all to SAMHSA. . . . It’s as if SAMHSA doesn’t believe serious mental illness exists.
During her testimony before the subcommittee, SAMHSA administrator Pam Hyde appeared to do nothing to persuade the members that Representative Murphy was wrong.
What happens next remains to be seen. Members of Congress looking for places to cut the budget should look closely at SAMHSA’s low-hanging fruit. The one thing that is certain is that nothing has changed and that the tragedies of Virginia Tech, Tucson, Aurora, and Newtown will be followed by another, and another, until things do change. It is not a question of if, merely when.
— Fuller Torrey, M.D., is the founder of the Treatment Advocacy Center and author of American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System. D. J. Jaffe is the executive director of MentalIllnessPolicy.org.