Published by: Maria Raven on 1/14/2011 4:07:11 PM
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Because Gabrielle Giffords is a centrist Democrat targeted by Sarah Palin and other conservative Republicans, many people searching for reason for the shooting, are focused on the political vitriol that afflicts our country and speculate about the potential political motives behind the massacre. But there are other important questions, which I believe are more directly relevant to the events at hand.
As seems to be the case in many acts of seemingly unpredictable violence, many perpetrators exhibit “red flag” behavior, a kind of warning, prior to such events. In the case of Gabrielle Giffords, Jared Lee Loughner showed clear evidence of disordered thinking and even delusional behavior for months, and maybe years leading up to the killings. Let’s be clear: the accused gunman posted videos on a social networking site considered so violent and bizarre that his community college suspended him pending a psychiatric evaluation. Red flag. It’s not clear whether he ever received any evaluation, but he was also denied service in the army during a time of critical need for service members. Another red flag.
As an emergency medicine physician and researcher who works quite closely with many patients affected by mental illness, I understand the importance of patient privacy laws as well as the complications of judging whether a person might be a danger to himself or others, thus warranting more in-depth psychological testing and management. While the accused in this case did not have any prior criminal record, there was abundant evidence pointing toward serious mental illness.
However, each episode was kept siloed within the various organizations and the social networking sites where he interacted. And, had his behavior come to the attention of mental health professionals, current commitment laws render it very difficult to involuntarily commit even those who are quite impaired by mental illness and might benefit greatly from the (admittedly uncomfortable) idea of mandated treatment. Just a month after his suspension from Pima Community College, where he and his family were informed he was not to return without a mental health clearance, Mr. Loughner was allowed to walk into his friendly neighborhood Sportsman’s Warehouse and buy a semi-automatic weapon. Red Flag.
At 22, Mr. Loughner was in the age range when those affected by schizophrenia can first begin to exhibit signs of the disease. People with schizophrenia can be afflicted by paranoid delusions, filling them with the belief they are being followed or persecuted by others. As frightening as Mr. Loughner’s behavior may seem to a person unfamiliar with mental illness, it is especially crippling for the person diagnosed. And, despite what one may be led to believe based on the events of yesterday, evidence shows that violence against non-family members perpetrated by the mentally ill is actually much more the exception then the rule. Among those with serious and persistent mental illness, which includes schizophrenia, comparatively high suicide rates and a life expectancy fully 25 years less than a non-mentally ill American (due in large part to suicide) are more serious public health issues.
Where do we go from here? Is there any way Mr. Loughner’s fatal actions might have been prevented? It is not clear that the community college or the army recruiter’s office had a mechanism or justification to force any type of further evaluation or treatment on Mr. Loughner: as long as he steered clear of their organizations, they probably felt they were doing all they could, or were required to do, and perhaps they were. And I’m certainly not suggesting that the government start policing YouTube and MySpace for bizarre content: aside from the civil liberties violations, our law enforcement system would run out of time and money.
Mr. Loughner’s purchase of a weapon is another matter. The shocking ease with which handguns can be purchased in this country is what ultimately allowed this tragedy to occur. The issue is complicated by the fact that mental health professionals are often unable to act upon red flags due to current law. Mr. Loughner had no criminal record, but I doubt anyone from either side of the political aisle would, at the moment, defend his right to bear arms.
What else can we learn here? Mental health services in this country are underfunded and inaccessible to those who need them most. Let’s hope that the health reform law Congresswoman Giffords fought to pass provides a platform for renewed focus on and funding to the orphan issue of mental health parity.
Maria Raven, MD, MPH, MSc
Assistant Professor
Bellevue Hospital Center
New York University School of Medicine
Department of Emergency Medicine
Division of General Internal Medicine