The Corner

The Tucson Tragedy: Is the Mental Health System at Fault?

From a psychiatric standpoint, there is not yet enough information available to answer the key question surrounding Jared Lee Loughner: At what point, if any, in the last few years did the mental-health surveillance and treatment systems break down? Were there periods along the way where Loughner could have justifiably been coerced into treatment? We simply don’t know yet.

Typically, people who end up at the center of tragic stories such as these — the 2006 Virginia Tech shooter; Andrea Yates, who drowned her children in 2001; Andrew Goldstein, who pushed Kendra Webdale under a New York City subway train in 1999 — have already come into contact with the mental-health system.

And, just as typically, that system broke down in some way: a clinic or emergency room turned them away, released them prematurely, or failed to follow up after discharge. At other times, a state treatment law was inadequate or inadequately enforced.

But it appears, so far, that Loughner never had any interaction with the mental-health system.

We need more information before we can draw conclusions about what went wrong.

We need to know, for example, whether Loughner’s parents or others ever tried to get him help. Did they ever call the police because they were afraid of him?

Pima Community College was clearly worried about him, but should they have done more? Will it become clear that the school has more information on Loughner’s potential riskiness that might have justified their contact with campus police or mental-health authorities?

In retrospect the answer seems obvious, but we must remember that, according to mental-health law, we cannot restrict another’s freedom without first knowing whether he is poised to harm others or himself due to mental illness. Acting weird or lapsing into psychosis, while frightening for everyone and tragic for the ill person, is not, in itself, a crime. Nor does being psychotic necessarily mean one can be treated involuntarily.

Needless to say, I have not examined Loughner, but the details presented thus far suggest that he was wrestling with serious mental illness.

I will update as more facts emerge.

Sally Satel is a practicing psychiatrist and a resident fellow at the American Enterprise Institute, from whose Enterprise Blog this post is reprinted with permission.

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