Nikolas Cruz, the 19-year-old whose alleged shooting rampage claimed 17 lives at Marjory Stoneman Douglas High School in Parkland, Fla., last month, was sick. His family knew it. His neighbors knew it. Local law enforcement and mental-health professionals knew it.
Yet, like so many tragedies involving the seriously mentally ill, no one was able to prevent the rampage. Why?
Too often, mental-health advocates hide behind the platitude that the mentally ill are no more violent than others.
As the family member of someone with serious mental illness, and as someone who has spent 30 years helping other families with seriously ill members, the answer is clear: The system often prevents relatives from getting help for loved ones who have serious mental illness until after they have become a danger to themselves or others. Too often this means after someone — often a family member — is injured or killed.
According to an investigative report by NPR, Cruz was “the subject of dozens of 911 calls and at least two separate tips to the FBI.” Most of the calls were for threats or acts of violence against his family, including apparently holding a gun to his mother’s and brother’s heads. Cruz’s father died in 2004, and his mother died last November of complications from influenza, leaving him with little family support.
Family members are often caretakers for the seriously mentally ill and, as a result, too often victims of violence. In a 2016 report by the nonprofit Treatment Advocacy Center, my co-authors and I found that serious mental illness — typically untreated — is associated with an estimated 29 percent of family homicides and 7 percent of all homicides. In 2013, these fatalities outstripped the number of deaths related to meningitis, kidney infection or Hodgkin’s disease.
Yet too often, mental-health advocates hide behind the platitude that the mentally ill are no more violent than others. That may be true for those being properly treated for their illness, but it is not true for the untreated, including those suffering from schizophrenia or bipolar disorder.
We families with seriously ill members know that. And we hope that, after the Parkland massacre, lawmakers will listen to us rather than to the mental-health industry.
A major problem is that the federal government doles out around $150 billion in mental-health funding, but doesn’t require programs receiving the funds to serve the seriously mentally ill. Instead, the funds are often spent to improve “wellness” in the general population through yoga classes or “mindfulness” training.
We can help stop future Parklands by focusing our spending on those who need help the most and are most likely to become dangerous without that help.
Here are six suggestions that would save lives and help families get their mentally ill loved ones the treatment they need:
First, increase the number of available psychiatric beds by eliminating a Medicaid rule that forbids states from using Medicaid funds for seriously mentally ill adults who need long-term hospitalization.
Second, end the practice of requiring someone to become dangerous before their families can intervene to help them. We could do that by supplementing the standard by which we commit mentally ill people to health facilities — presently “danger to self or others” — to also include “need for treatment,” “grave disability” and “lack of capacity.”
Third, pass strong assisted-outpatient treatment laws so judges can order the most seriously mentally ill people to stay in treatment while continuing to live in the community. A 2017 Manhattan Institute reportfound that assisted-outpatient treatment in New York state reduced rates of arrests and incarceration by 83 percent and 87 percent, respectively. It also led to a 77-percent decrease in hospitalization and a 74-percent decline in homelessness. In 2016, Congress appropriated $20 million for this treatment, but much more is needed.
Fourth, free parents of mentally ill children from the handcuffs of health-privacy laws so they can learn what is wrong with their kids, as well as help refill prescriptions and facilitate treatment compliance.
Fifth, allow people to take out restraining orders — known as red-flag orders — that would remove guns from mentally ill people who threaten themselves or others, and prevent them from making future firearms-related purchases. Also, prevent mentally ill Social Security recipients who have representative payees from purchasing and owning guns.
Finally, rein in the Protection and Advocacy for Individuals with Mental Illness program and the Civil Rights of Institutionalized Persons Act division of the Justice Department. PAIMI defends the right of the psychotic to refuse treatment, while CRIPA has brought lawsuits against state hospitals, resulting in people with serious mental illness moving out of these institutions and into community settings. Eliminating those activities would make it easier for families to facilitate appropriate care for our seriously mentally ill loved ones.
Denial of the association between serious mental illness and violence may be politically correct and well-intended. But, too often, it ends in tragedies such as the Parkland shooting — and another scramble for answers we already have.
This piece originally appeared at the Washington Post
DJ Jaffe is Executive Director of Mental Illness Policy Org., and author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.