In the best of times and most favorable of
circumstances, it's tricky business to identify
whether a person who is mentally ill might
become violent, so that those in his path can be
protected from potential harm and he can get the
treatment he needs.
But with community mental health services
stretched taut by budget cuts and growing need,
these are not the best of times, say many experts
at the intersection of mental health and public
safety. Nor were circumstances ideal to single out
Jared Lee Loughner — the suspect in Saturday's
Tucson shooting rampage — as a clear-cut case
of someone about to become violent.
Loughner's increasingly bizarre and mistrustful
pronouncements, combined with his age — 22 —
suggest to many mental health professionals a
flowering of mental illness marked by delusional
thinking. People diagnosed with schizophrenia,
for instance, most often begin showing signs of
the illness in their late teens or early 20s, when
they suffer episodes of hallucinations and become
preoccupied with delusions — for instance, of
persecution or conspiracy.
Loughner's apparent embrace of notions such as
mind control, a new currency and "conscience
dreaming" — all mentioned in a YouTube posting
he reportedly made — speak to a troubled mind
but reveal little actual propensity for violence, said
Dr. Mark A. Kalish, a forensic psychiatrist who
teaches at UC San Diego.
The mentally ill, Kalish noted, are no more likely
to engage in violent behavior than members of
the general population.
Nonetheless, the shooting has already stirred
debate about how to protect the public from
violence perpetrated by some among the
mentally ill.
Some activists, citing Loughner's apparent early
signs of instability, suggest that state laws need to
be broadened to allow involuntary commitment
of the potentially violent mentally ill. Most states
require that a mental health professional find an
individual not only to be severely disabled by
mental illness but also to be an imminent danger
to himself or others before allowing involuntary
commitment to a psychiatric facility.
Others, including many mental health
professionals, just as forcefully note that no laws
will ensure safety from the violent mentally ill
unless state and community mental health
services are in place to find them and treat them.
"It isn't that we don't know how to get people to
help. We're just not doing it," said Robert
Bernstein, executive director of the Bazelon Center
for Mental Health Law in Washington.
"Community-based programs are so
underfunded they don't have the resources to
respond appropriately" to evidence that a person
may be teetering on the edge of violence, he
added. "Every day, people with mental illness are
failing to receive services, and every day, people
experience preventable crises — are taken to the
emergency room or arrested and jailed."
In many ways, Arizona provides the perfect
venue for a new round of debate on violence and
mental illness.
In recent years, the state has relaxed the
standards that must be satisfied for the
involuntary commitment and treatment of the
mentally ill. Its laws are now looser than
California's, for example.
Officials in Arizona would have had the latitude to
commit Loughner to involuntary psychiatric
treatment only by showing that he was
"persistently and acutely disabled" by mental
illness, said Brian Stettin of the Treatment
Advocacy Center in Arlington, Va. The center has
strongly lobbied for laws that would make it
easier to commit people to psychiatric care
against their wishes.
In California, by contrast, officials would have to
show "grave" disability and also make a
persuasive case that the person posed a danger
to himself or others.
In Loughner's case, the process could have been
set in motion if someone — perhaps
administrators from Pima Community College —
had called a county hotline and prompted the
dispatch of a mobile crisis outreach team. Such a
team could have urged Loughner to accept care,
or evaluated whether care needed to be imposed
upon him against his wishes, Stettin said.
But at the same time, Arizona's budget crisis —
among the worst in the nation — has prompted
deep cuts in community mental health services.
According to Tim Schmaltz, chief executive of
Protecting Arizona's Family Coalition, some
14,000 residents who earn too much to receive
Medicaid have lost access to all mental health
services, except medications, in the budget cuts.
"You don't want to be seriously mentally ill in
Arizona, unless you're very poor or very sick,"
Schmaltz said.
Money and law aside, gauging someone's
likelihood of acting aggressively requires skill,
patience and a bit of timing, experts said.
"When it comes to long-term predictions of risk
for violence, all bets are off," said Dr. Steven E.
Pitt, a forensic psychiatrist who consults with the
Phoenix Police Department and teaches
psychiatry at the University of Arizona School of
Medicine.
A skilled mental health professional may have
better luck at predicting a person's likelihood of
acting violently in the near term, Pitt said. But "the
assessment is only as good as the information
that is being shared with you and that is at your
disposal, coupled with your clinical judgment," he
added.
And for Jared Lee Loughner, who appeared to
have been growing increasingly mistrustful, that
information may have been both scant and
ambiguous.
Among the red flags a forensic psychiatrist might
look for to predict violence are extensive
substance abuse, gun ownership, whether a
person has a specific target in mind and whether
he or she has thought through details of an
attack, Kalish said.
But, said Pitt, although these are useful signposts
to psychiatrists who are trained in such
evaluations, a checklist of the risk factors for
violent behaviors will draw in too many people
unnecessarily.
"There are thousands who satisfy those
conditions, but the majority will never engage in
a violent act," he said.
Source: Http://www.latimes.com/health/la-he-mental-health-20110111,0,2679941.story
circumstances, it's tricky business to identify
whether a person who is mentally ill might
become violent, so that those in his path can be
protected from potential harm and he can get the
treatment he needs.
But with community mental health services
stretched taut by budget cuts and growing need,
these are not the best of times, say many experts
at the intersection of mental health and public
safety. Nor were circumstances ideal to single out
Jared Lee Loughner — the suspect in Saturday's
Tucson shooting rampage — as a clear-cut case
of someone about to become violent.
Loughner's increasingly bizarre and mistrustful
pronouncements, combined with his age — 22 —
suggest to many mental health professionals a
flowering of mental illness marked by delusional
thinking. People diagnosed with schizophrenia,
for instance, most often begin showing signs of
the illness in their late teens or early 20s, when
they suffer episodes of hallucinations and become
preoccupied with delusions — for instance, of
persecution or conspiracy.
Loughner's apparent embrace of notions such as
mind control, a new currency and "conscience
dreaming" — all mentioned in a YouTube posting
he reportedly made — speak to a troubled mind
but reveal little actual propensity for violence, said
Dr. Mark A. Kalish, a forensic psychiatrist who
teaches at UC San Diego.
The mentally ill, Kalish noted, are no more likely
to engage in violent behavior than members of
the general population.
Nonetheless, the shooting has already stirred
debate about how to protect the public from
violence perpetrated by some among the
mentally ill.
Some activists, citing Loughner's apparent early
signs of instability, suggest that state laws need to
be broadened to allow involuntary commitment
of the potentially violent mentally ill. Most states
require that a mental health professional find an
individual not only to be severely disabled by
mental illness but also to be an imminent danger
to himself or others before allowing involuntary
commitment to a psychiatric facility.
Others, including many mental health
professionals, just as forcefully note that no laws
will ensure safety from the violent mentally ill
unless state and community mental health
services are in place to find them and treat them.
"It isn't that we don't know how to get people to
help. We're just not doing it," said Robert
Bernstein, executive director of the Bazelon Center
for Mental Health Law in Washington.
"Community-based programs are so
underfunded they don't have the resources to
respond appropriately" to evidence that a person
may be teetering on the edge of violence, he
added. "Every day, people with mental illness are
failing to receive services, and every day, people
experience preventable crises — are taken to the
emergency room or arrested and jailed."
In many ways, Arizona provides the perfect
venue for a new round of debate on violence and
mental illness.
In recent years, the state has relaxed the
standards that must be satisfied for the
involuntary commitment and treatment of the
mentally ill. Its laws are now looser than
California's, for example.
Officials in Arizona would have had the latitude to
commit Loughner to involuntary psychiatric
treatment only by showing that he was
"persistently and acutely disabled" by mental
illness, said Brian Stettin of the Treatment
Advocacy Center in Arlington, Va. The center has
strongly lobbied for laws that would make it
easier to commit people to psychiatric care
against their wishes.
In California, by contrast, officials would have to
show "grave" disability and also make a
persuasive case that the person posed a danger
to himself or others.
In Loughner's case, the process could have been
set in motion if someone — perhaps
administrators from Pima Community College —
had called a county hotline and prompted the
dispatch of a mobile crisis outreach team. Such a
team could have urged Loughner to accept care,
or evaluated whether care needed to be imposed
upon him against his wishes, Stettin said.
But at the same time, Arizona's budget crisis —
among the worst in the nation — has prompted
deep cuts in community mental health services.
According to Tim Schmaltz, chief executive of
Protecting Arizona's Family Coalition, some
14,000 residents who earn too much to receive
Medicaid have lost access to all mental health
services, except medications, in the budget cuts.
"You don't want to be seriously mentally ill in
Arizona, unless you're very poor or very sick,"
Schmaltz said.
Money and law aside, gauging someone's
likelihood of acting aggressively requires skill,
patience and a bit of timing, experts said.
"When it comes to long-term predictions of risk
for violence, all bets are off," said Dr. Steven E.
Pitt, a forensic psychiatrist who consults with the
Phoenix Police Department and teaches
psychiatry at the University of Arizona School of
Medicine.
A skilled mental health professional may have
better luck at predicting a person's likelihood of
acting violently in the near term, Pitt said. But "the
assessment is only as good as the information
that is being shared with you and that is at your
disposal, coupled with your clinical judgment," he
added.
And for Jared Lee Loughner, who appeared to
have been growing increasingly mistrustful, that
information may have been both scant and
ambiguous.
Among the red flags a forensic psychiatrist might
look for to predict violence are extensive
substance abuse, gun ownership, whether a
person has a specific target in mind and whether
he or she has thought through details of an
attack, Kalish said.
But, said Pitt, although these are useful signposts
to psychiatrists who are trained in such
evaluations, a checklist of the risk factors for
violent behaviors will draw in too many people
unnecessarily.
"There are thousands who satisfy those
conditions, but the majority will never engage in
a violent act," he said.
Source: Http://www.latimes.com/health/la-he-mental-health-20110111,0,2679941.story
0 comments:
Post a Comment