(Sept. 3, 2015) When Vester Lee Flanagan II fatally shot a television reporter and a cameraman in the midst of a live interview in Moneta, Va., it was a scene that has become all too familiar to us.
In all these scenarios, we learn after the fact that the perpetrator has had a troubled past in which he exhibited bizarre and disruptive behavior, and frequently a history of diagnosed but untreated mental illness. The media and public erupt in outrage, but after the chest thumping and soul searching, nothing is ever done.
As a psychiatrist, I've treated thousands of patients with serious mental illness over my 30-year career and consulted on too many such criminal cases. I find it lamentable that we still cannot connect the dots and take effective action, as a vast majority of these tragedies are preventable.
A 2007 case that I was asked to review illustrates the problem. It involved an 18-year-old man, an athlete and a good student, who began with high hopes.
However, at the start of sophomore year, he quit the football team, left school and went home. At home he was withdrawn, disheveled, talked to himself and was suspicious of his friends and family. His parents knew something was wrong and sought treatment. When a mobile crisis team was called to the house he refused to engage with them. Although he clearly was ill, he was not aggressive, so they told his parents to continue monitoring their son’s behavior and to call if he became a threat to himself or others. The next day he stabbed his twin half-brothers with a kitchen knife, killing one of them and severely injuring the other.
Incidents like this are part of the glaring array of social pathologies that emanate from our country’s failed mental health care system.
In many instances mentally disturbed people lack awareness of their illness, and are unwilling to accept treatment. Almost every mentally ill perpetrator of mass violence had been symptomatic and untreated for lengthy periods of time before their crime; because they (or their families) did not seek treatment or they refused it.
Statutory mechanisms like assisted outpatient treatment have been enacted in 45 states. They enable doctors to obtain a court order that requires severely mentally ill patients who meet certain legal criteria — if they are unable to care for themselves or are unwilling to take medication — to adhere to treatment. However, these legal mechanisms are controversial and infrequently used despite their effectiveness in reducing violent incidents and hospital readmissions.
But we must start using this law to treat patients in need, over their objections if necessary. This strategy would apply to a small number of people who have psychotic disorders, and known risk factors for violence, such as drug abuse and a history of violence.
The good news is that these strategies have proved highly effective and really work. They simply have not been widely applied.
JEFFREY A. LIEBERMAN
CHAIRMAN OF PSYCHIATRY, COLUMBIA UNIVERSITY
(Photo:Peter Kaminski/Flickr)
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