Mental Illness has been either a recognized or implied component of many of the recent mass killings, leading to the question: What can be done to avert such tragedies from a mental health point of view?
It is important to first recognize the fact just as the majority of mentally healthy people do not commit mass murder, the majority of mentally ill people do not commit mass murder. Whether the individual is mentally ill or mentally healthy, the act of killing strangers is a rare phenomenon in society and affects a small subgroup of people. In the case of mentally ill individuals acting upon delusions, and out of unhealthy obsessions, what can be done to stop them before they kill?
Were there red flags in the killers behavior, and if so, who saw those signs? What could be done to stop them?
Patrick Kennedy speaks about the need to recognize signs of mental illness and to provide comprehensive and early intervention before disaster strikes. One of the reasons society is slow to recognize the serious need for mental health treatment, is society still hides behind the denial that is an offshoot of the stigma of mental illness. Mental Illness is like the White Elephant in the middle of the room, hiding in plain sight while everyone ignores the problem. In order to provide early diagnoses and treatment, there needs to be a more accessible health plan in place, and the stigma of mental illness needs to be removed. Mental Illness needs to be talked about as openly as cancer awareness, and the relatives and friends of those suffering from mental illness need to be able to recognize signs of mental illness.
In the cases of the small percentage of the mentally ill who are capable of extreme violence, there must be individuals willing to support them when it is needed, and to report them when it is essential to public safety. The key element of civil commitment of the mentally ill is to recognize when they are a " Danger to Self or Others', which is a guideline in all fifty states. Although civil commitment is not always and option for relatives and friends, there should be a legal option to report potentially lethal behavior, such as using social media to advertise violent plots.
Mental health professionals treating potentially deadly clients were not under legal obligation to warn others until the 1976 landmark case of Tarasoff v. Regents of the University of California, in which a patient told his psychotherapist he intended to kill a a woman: two months later the patient stabbed the woman to death and the parents sued. The Supreme Court decision resulted in the nationally adopted 'Duty to Warn' rule that applies to all mental health professionals, which was expanded to include warning third parties when the threat is specific in the case of Family Reported Threats
Someone almost always knows about even a 'loners' strange behavior and there needs to be a reporting method that will result in the individual being assessed and monitored, even in cases in which mandatory treatment is not an option. In cases in which violence has been threatened, there needs to be legislation in place that will allow for weapons screening.
Although many mental health advocates deny there is any connection between mass killing and mental health issues, The Treatment Advocacy Center released data from a study covering 30 killings over a 50 year period, that confirms mental illness as an element in the mass murders.
Out of the 30 perpetrators, the Mental Illness Treatment Advocacy Center stated
“Twelve perpetrators had psychotic symptoms at the time of the killings and another 8 individuals “exhibited behavior suggestive of psychosis;” thus 20 of the 30 perpetrators (67%) had definite or probable psychosis”
One of the worst mass killings of this century was the Sandy Hook Elementary school killing in which twenty year-old Adam Lanza killed his mother, 20 elementary school children, before killing himself. It does not require a mental health assessment to determine Lanza was not only mentally ill, but Violent and Mentally ILL. The facts uncovered a very troubled teen, isolated, anorexic, and in contact with a 'mirco-society of mass murderers' via the internet. Lanza fueled his sick mind with the unhealthy communication from other sick and violent minds. Lanza evolved into an obsessed mass murderer with access to resources, guns and ammunition.
Someone knew about Lanza's mental instability and his potential for violence long before The Sandy Hook Killings happened, even if that someone was only Lanza's mother. Lanza should have been committed for forced treatment and assessed as either 'safe' to release into society or unsafe. There should be better assessment tools, better legal alternatives to civil commitment and better reporting channels, and better support for families dealing with seriously disturbed family members.
Legislation must address the gaps in mental health treatment for the general population and the identification of the small subgroup capable of violence against others. The general population of the mentally ill are not responsible for violent act against society, and should be exempted from the strict controls needed to weed out the Lethally Mentally Ill, such as Adam Lanza.
